St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

POST EXT FIXATION 11MM DIA B

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	64902949
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.75
Rate for Payer: EmblemHealth Commercial	$225.00
Rate for Payer: Fidelis Medicare Advantage	$472.50
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.50

POST EXT FIXATION 11MM DIA C

Facility

$531.00

Service Code	HCPCS C1713
Hospital Charge Code	64903599
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$557.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$292.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$318.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$265.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$305.32
Rate for Payer: EmblemHealth Commercial	$265.50
Rate for Payer: Fidelis Medicare Advantage	$557.55
Rate for Payer: Group Health Inc Commercial	$265.50
Rate for Payer: Group Health Inc Medicare	$185.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.50
Rate for Payer: Hamaspik Choice Inc Medicare	$265.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$345.15

POST EXT FIXATION 11MM DIA C

Facility

$531.00

Service Code	HCPCS C1713
Hospital Charge Code	64903599
Hospital Revenue Code	278
Min. Negotiated Rate	$265.50
Max. Negotiated Rate	$265.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.50
Rate for Payer: Hamaspik Choice Inc Medicare	$265.50

POST EXT FIXATION 30DEG ANG

Facility

$185.25

Service Code	HCPCS C1713
Hospital Charge Code	64901798
Hospital Revenue Code	278
Min. Negotiated Rate	$92.62
Max. Negotiated Rate	$92.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.62
Rate for Payer: Hamaspik Choice Inc Medicare	$92.62

POST EXT FIXATION 30DEG ANG

Facility

$185.25

Service Code	HCPCS C1713
Hospital Charge Code	64901798
Hospital Revenue Code	278
Min. Negotiated Rate	$64.84
Max. Negotiated Rate	$194.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$111.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.52
Rate for Payer: EmblemHealth Commercial	$92.62
Rate for Payer: Fidelis Medicare Advantage	$194.51
Rate for Payer: Group Health Inc Commercial	$92.62
Rate for Payer: Group Health Inc Medicare	$64.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.62
Rate for Payer: Hamaspik Choice Inc Medicare	$92.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.41

POST EXT FIXATION LONG 88M

Facility

$430.00

Service Code	HCPCS C1713
Hospital Charge Code	64904379
Hospital Revenue Code	278
Min. Negotiated Rate	$215.00
Max. Negotiated Rate	$215.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$215.00
Rate for Payer: Hamaspik Choice Inc Medicare	$215.00

POST EXT FIXATION LONG 88M

Facility

$430.00

Service Code	HCPCS C1713
Hospital Charge Code	64904379
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$451.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$236.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$258.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$215.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$247.25
Rate for Payer: EmblemHealth Commercial	$215.00
Rate for Payer: Fidelis Medicare Advantage	$451.50
Rate for Payer: Group Health Inc Commercial	$215.00
Rate for Payer: Group Health Inc Medicare	$150.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$215.00
Rate for Payer: Hamaspik Choice Inc Medicare	$215.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$279.50

POST EXT FIXATION SHORT 44

Facility

$312.50

Service Code	HCPCS C1713
Hospital Charge Code	64904370
Hospital Revenue Code	278
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$328.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$156.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.69
Rate for Payer: EmblemHealth Commercial	$156.25
Rate for Payer: Fidelis Medicare Advantage	$328.12
Rate for Payer: Group Health Inc Commercial	$156.25
Rate for Payer: Group Health Inc Medicare	$109.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$203.12

POST EXT FIXATION SHORT 44

Facility

$312.50

Service Code	HCPCS C1713
Hospital Charge Code	64904370
Hospital Revenue Code	278
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$156.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25

POST EXT FIXATION STRAIGHT

Facility

$185.25

Service Code	HCPCS C1713
Hospital Charge Code	64902068
Hospital Revenue Code	278
Min. Negotiated Rate	$92.62
Max. Negotiated Rate	$92.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.62
Rate for Payer: Hamaspik Choice Inc Medicare	$92.62

POST EXT FIXATION STRAIGHT

Facility

$185.25

Service Code	HCPCS C1713
Hospital Charge Code	64902068
Hospital Revenue Code	278
Min. Negotiated Rate	$64.84
Max. Negotiated Rate	$194.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$111.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.52
Rate for Payer: EmblemHealth Commercial	$92.62
Rate for Payer: Fidelis Medicare Advantage	$194.51
Rate for Payer: Group Health Inc Commercial	$92.62
Rate for Payer: Group Health Inc Medicare	$64.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.62
Rate for Payer: Hamaspik Choice Inc Medicare	$92.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.41

POST EXT FIXATOR LARGE BONE

Facility

$288.75

Service Code	HCPCS C1713
Hospital Charge Code	64901244
Hospital Revenue Code	278
Min. Negotiated Rate	$144.38
Max. Negotiated Rate	$144.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.38
Rate for Payer: Hamaspik Choice Inc Medicare	$144.38

POST EXT FIXATOR LARGE BONE

Facility

$288.75

Service Code	HCPCS C1713
Hospital Charge Code	64901244
Hospital Revenue Code	278
Min. Negotiated Rate	$101.06
Max. Negotiated Rate	$303.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$158.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$173.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$166.03
Rate for Payer: EmblemHealth Commercial	$144.38
Rate for Payer: Fidelis Medicare Advantage	$303.19
Rate for Payer: Group Health Inc Commercial	$144.38
Rate for Payer: Group Health Inc Medicare	$101.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.38
Rate for Payer: Hamaspik Choice Inc Medicare	$144.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$187.69

POST EXT FIXATOR STRAIGHT

Facility

$344.75

Service Code	HCPCS C1713
Hospital Charge Code	64901817
Hospital Revenue Code	278
Min. Negotiated Rate	$172.38
Max. Negotiated Rate	$172.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.38
Rate for Payer: Hamaspik Choice Inc Medicare	$172.38

POST EXT FIXATOR STRAIGHT

Facility

$344.75

Service Code	HCPCS C1713
Hospital Charge Code	64901817
Hospital Revenue Code	278
Min. Negotiated Rate	$120.66
Max. Negotiated Rate	$361.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$206.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$198.23
Rate for Payer: EmblemHealth Commercial	$172.38
Rate for Payer: Fidelis Medicare Advantage	$361.99
Rate for Payer: Group Health Inc Commercial	$172.38
Rate for Payer: Group Health Inc Medicare	$120.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.38
Rate for Payer: Hamaspik Choice Inc Medicare	$172.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.09

POST FAILED BIO PROFILE

Facility

$177.19

Hospital Charge Code	40250800
Hospital Revenue Code	720
Min. Negotiated Rate	$62.02
Max. Negotiated Rate	$8,223.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$97.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.60
Rate for Payer: Aetna Government	$88.60
Rate for Payer: Brighton Health Commercial	$132.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$141.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.49
Rate for Payer: Group Health Inc Commercial	$88.60
Rate for Payer: Group Health Inc Medicare	$62.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$88.60
Rate for Payer: Hamaspik Choice Inc Medicare	$88.60
Rate for Payer: United Healthcare Commercial	$8,223.00

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$45,198.40

Service Code	MSDRG 862
Min. Negotiated Rate	$15,285.28
Max. Negotiated Rate	$45,198.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27,160.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32,871.56
Rate for Payer: Aetna Government	$32,871.56
Rate for Payer: Brighton Health Commercial	$26,709.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$33,528.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31,809.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$26,250.56
Rate for Payer: Elderplan Medicare Advantage	$31,227.98
Rate for Payer: EmblemHealth Commercial	$15,795.20
Rate for Payer: Fidelis Medicare Advantage	$32,871.56
Rate for Payer: Group Health Inc Commercial	$32,871.56
Rate for Payer: Group Health Inc Medicare	$32,871.56
Rate for Payer: Hamaspik Choice Inc Medicare	$32,871.56
Rate for Payer: Healthfirst Medicare Advantage	$15,285.28
Rate for Payer: Humana Medicare	$45,198.40
Rate for Payer: Senior Whole Health Medicare Advantage	$32,871.56
Rate for Payer: United Healthcare Commercial	$36,631.85
Rate for Payer: United Healthcare Medicare Advantage	$32,871.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32,871.56
Rate for Payer: Wellcare Medicare	$31,227.98

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$29,248.30

Service Code	MSDRG 863
Min. Negotiated Rate	$8,622.16
Max. Negotiated Rate	$29,248.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,826.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21,271.49
Rate for Payer: Aetna Government	$21,271.49
Rate for Payer: Brighton Health Commercial	$14,579.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21,696.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17,363.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,329.50
Rate for Payer: Elderplan Medicare Advantage	$20,207.92
Rate for Payer: EmblemHealth Commercial	$8,622.16
Rate for Payer: Fidelis Medicare Advantage	$21,271.49
Rate for Payer: Group Health Inc Commercial	$21,271.49
Rate for Payer: Group Health Inc Medicare	$21,271.49
Rate for Payer: Hamaspik Choice Inc Medicare	$21,271.49
Rate for Payer: Healthfirst Medicare Advantage	$9,891.24
Rate for Payer: Humana Medicare	$29,248.30
Rate for Payer: Senior Whole Health Medicare Advantage	$21,271.49
Rate for Payer: United Healthcare Commercial	$19,996.38
Rate for Payer: United Healthcare Medicare Advantage	$21,271.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,271.49
Rate for Payer: Wellcare Medicare	$20,207.92

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$50,798.55

Service Code	MSDRG 857
Min. Negotiated Rate	$17,179.15
Max. Negotiated Rate	$50,798.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31,490.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36,944.40
Rate for Payer: Aetna Government	$36,944.40
Rate for Payer: Brighton Health Commercial	$30,967.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$37,683.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36,881.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$30,436.12
Rate for Payer: Elderplan Medicare Advantage	$35,097.18
Rate for Payer: EmblemHealth Commercial	$18,313.60
Rate for Payer: Fidelis Medicare Advantage	$36,944.40
Rate for Payer: Group Health Inc Commercial	$36,944.40
Rate for Payer: Group Health Inc Medicare	$36,944.40
Rate for Payer: Hamaspik Choice Inc Medicare	$36,944.40
Rate for Payer: Healthfirst Medicare Advantage	$17,179.15
Rate for Payer: Humana Medicare	$50,798.55
Rate for Payer: Senior Whole Health Medicare Advantage	$36,944.40
Rate for Payer: United Healthcare Commercial	$42,472.67
Rate for Payer: United Healthcare Medicare Advantage	$36,944.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36,944.40
Rate for Payer: Wellcare Medicare	$35,097.18

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$94,514.98

Service Code	MSDRG 856
Min. Negotiated Rate	$31,963.25
Max. Negotiated Rate	$94,514.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65,296.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68,738.17
Rate for Payer: Aetna Government	$68,738.17
Rate for Payer: Brighton Health Commercial	$64,211.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70,112.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76,474.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$63,109.66
Rate for Payer: Elderplan Medicare Advantage	$65,301.26
Rate for Payer: EmblemHealth Commercial	$37,973.50
Rate for Payer: Fidelis Medicare Advantage	$68,738.17
Rate for Payer: Group Health Inc Commercial	$68,738.17
Rate for Payer: Group Health Inc Medicare	$68,738.17
Rate for Payer: Hamaspik Choice Inc Medicare	$68,738.17
Rate for Payer: Healthfirst Medicare Advantage	$31,963.25
Rate for Payer: Humana Medicare	$94,514.98
Rate for Payer: Senior Whole Health Medicare Advantage	$68,738.17
Rate for Payer: United Healthcare Commercial	$88,067.59
Rate for Payer: United Healthcare Medicare Advantage	$68,738.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68,738.17
Rate for Payer: Wellcare Medicare	$65,301.26

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$34,547.20

Service Code	MSDRG 858
Min. Negotiated Rate	$11,005.20
Max. Negotiated Rate	$34,547.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18,923.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25,125.24
Rate for Payer: Aetna Government	$25,125.24
Rate for Payer: Brighton Health Commercial	$18,609.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$25,627.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22,163.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$18,289.89
Rate for Payer: Elderplan Medicare Advantage	$23,868.98
Rate for Payer: EmblemHealth Commercial	$11,005.20
Rate for Payer: Fidelis Medicare Advantage	$25,125.24
Rate for Payer: Group Health Inc Commercial	$25,125.24
Rate for Payer: Group Health Inc Medicare	$25,125.24
Rate for Payer: Hamaspik Choice Inc Medicare	$25,125.24
Rate for Payer: Healthfirst Medicare Advantage	$11,683.24
Rate for Payer: Humana Medicare	$34,547.20
Rate for Payer: Senior Whole Health Medicare Advantage	$25,125.24
Rate for Payer: United Healthcare Commercial	$25,522.98
Rate for Payer: United Healthcare Medicare Advantage	$25,125.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,125.24
Rate for Payer: Wellcare Medicare	$23,868.98

POST-OP FOLLOW-UP VISIT

Facility

$250.00

Service Code	HCPCS 99024
Hospital Charge Code	40089476
Hospital Revenue Code	510
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.02
Rate for Payer: Aetna Government	$9.02
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00
Rate for Payer: United Healthcare Commercial	$222.00

POSTOP FOLLOW-UP VISIT

Facility

$250.00

Service Code	HCPCS 99024
Hospital Charge Code	42500553
Hospital Revenue Code	361
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.02
Rate for Payer: Aetna Government	$9.02
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

POST-OP SHOES

Facility

$34.38

Hospital Charge Code	40207591
Hospital Revenue Code	270
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$27.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.19
Rate for Payer: Aetna Government	$17.19
Rate for Payer: Brighton Health Commercial	$25.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.38
Rate for Payer: Group Health Inc Commercial	$17.19
Rate for Payer: Group Health Inc Medicare	$12.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.19
Rate for Payer: Hamaspik Choice Inc Medicare	$17.19

POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$39,514.34

Service Code	MSDRG 769
Min. Negotiated Rate	$13,238.90
Max. Negotiated Rate	$39,514.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,764.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28,737.70
Rate for Payer: Aetna Government	$28,737.70
Rate for Payer: Brighton Health Commercial	$22,386.55
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29,312.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26,661.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,002.30
Rate for Payer: Elderplan Medicare Advantage	$27,300.82
Rate for Payer: EmblemHealth Commercial	$13,238.90
Rate for Payer: Fidelis Medicare Advantage	$28,737.70
Rate for Payer: Group Health Inc Commercial	$28,737.70
Rate for Payer: Group Health Inc Medicare	$28,737.70
Rate for Payer: Hamaspik Choice Inc Medicare	$28,737.70
Rate for Payer: Healthfirst Medicare Advantage	$13,363.03
Rate for Payer: Humana Medicare	$39,514.34
Rate for Payer: Senior Whole Health Medicare Advantage	$28,737.70
Rate for Payer: United Healthcare Commercial	$30,703.54
Rate for Payer: United Healthcare Medicare Advantage	$28,737.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28,737.70
Rate for Payer: Wellcare Medicare	$27,300.82

Know your out-of-pocket cost for care.

All Charges