St. Barnabas Hospital

All Charges

Charge

Type

Price

SKN SUB GRFT T/A/L CHILD ADD

Facility OP

$261.11

Service Code	HCPCS 15274
Hospital Charge Code	42500208
Hospital Revenue Code	361
Min. Negotiated Rate	$40.83
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.83
Rate for Payer: Aetna Government	$40.83
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: Fidelis CHP/HARP/Medicaid	$51.36
Rate for Payer: Group Health Inc Commercial	$130.56
Rate for Payer: Group Health Inc Medicare	$91.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.56
Rate for Payer: Hamaspik Choice Inc Medicare	$130.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$57.07

SKULL BOLT KIT MICRO CODMAN

Facility OP

$2,110.00

Hospital Charge Code	64904948
Hospital Revenue Code	270
Min. Negotiated Rate	$738.50
Max. Negotiated Rate	$1,688.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,160.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,055.00
Rate for Payer: Aetna Government	$1,055.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,688.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,434.80
Rate for Payer: Group Health Inc Commercial	$1,055.00
Rate for Payer: Group Health Inc Medicare	$738.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,055.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,055.00

SKULL &FACIAL BONE SURVEY FILM

Facility OP

$147.42

Service Code	HCPCS D0290
Hospital Charge Code	42300706
Hospital Revenue Code	361
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.71
Rate for Payer: Aetna Government	$73.71
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	$73.71
Rate for Payer: Group Health Inc Medicare	$51.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.71
Rate for Payer: Hamaspik Choice Inc Medicare	$73.71

SKW DEEP SCOTAL RETRACT SYS

Facility OP

$731.12

Service Code	HCPCS C1813
Hospital Charge Code	40003446
Hospital Revenue Code	278
Min. Negotiated Rate	$255.89
Max. Negotiated Rate	$3,775.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$402.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$365.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$420.39
Rate for Payer: Fidelis Medicare Advantage	$767.68
Rate for Payer: Group Health Inc Commercial	$365.56
Rate for Payer: Group Health Inc Medicare	$255.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$365.56
Rate for Payer: Hamaspik Choice Inc Medicare	$365.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$475.23

SKW DEEP SCOTAL RETRACT SYS

Facility IP

$731.12

Service Code	HCPCS C1813
Hospital Charge Code	40003446
Hospital Revenue Code	278
Min. Negotiated Rate	$365.56
Max. Negotiated Rate	$365.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$365.56
Rate for Payer: Hamaspik Choice Inc Medicare	$365.56

SKYLER DRILL BIT 3.2

Facility OP

$963.00

Hospital Charge Code	40203650
Hospital Revenue Code	272
Min. Negotiated Rate	$337.05
Max. Negotiated Rate	$770.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$529.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$481.50
Rate for Payer: Aetna Government	$481.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$770.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$654.84
Rate for Payer: Group Health Inc Commercial	$481.50
Rate for Payer: Group Health Inc Medicare	$337.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$481.50
Rate for Payer: Hamaspik Choice Inc Medicare	$481.50

SLCTV WND DEBRIDEM 20 CM OR <

Facility OP

$529.23

Service Code	HCPCS 97597
Hospital Charge Code	30305048
Hospital Revenue Code	510
Min. Negotiated Rate	$37.15
Max. Negotiated Rate	$291.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Elderplan Medicare Advantage	$231.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37.15
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
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	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41.28
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

SLCTV WND DEBRIDEM ADDL 20 CM/<

Facility OP

$529.23

Service Code	HCPCS 97598
Hospital Charge Code	30300021
Hospital Revenue Code	510
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$291.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.26
Rate for Payer: Aetna Government	$9.26
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: Fidelis CHP/HARP/Medicaid	$26.61
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	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$264.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.57

SLEEP EEG (SHORT DURATION)

Facility OP

$766.58

Service Code	HCPCS 95822 TC
Hospital Charge Code	41003000
Hospital Revenue Code	740
Min. Negotiated Rate	$268.30
Max. Negotiated Rate	$613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$383.29
Rate for Payer: Aetna Government	$383.29
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$399.44
Rate for Payer: Group Health Inc Commercial	$383.29
Rate for Payer: Group Health Inc Medicare	$268.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$383.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$443.82

SLEEP STUDY

Facility OP

$1,470.80

Service Code	HCPCS 95805 TC
Hospital Charge Code	30305002
Hospital Revenue Code	510
Min. Negotiated Rate	$173.89
Max. Negotiated Rate	$808.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$735.40
Rate for Payer: Aetna Government	$735.40
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$403.62
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	$735.40
Rate for Payer: Hamaspik Choice Inc Medicare	$735.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$448.47

SLEEP STUDY, ATTENDED

Facility OP

$1,470.80

Service Code	HCPCS 95807 TC
Hospital Charge Code	40401602
Hospital Revenue Code	920
Min. Negotiated Rate	$366.33
Max. Negotiated Rate	$1,176.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$735.40
Rate for Payer: Aetna Government	$735.40
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,000.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$366.33
Rate for Payer: Group Health Inc Commercial	$735.40
Rate for Payer: Group Health Inc Medicare	$514.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.40
Rate for Payer: Hamaspik Choice Inc Medicare	$735.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$407.03

SLEEP STUDY, UNATTENDED

Facility OP

$419.03

Service Code	HCPCS 95806 TC
Hospital Charge Code	30305453
Hospital Revenue Code	920
Min. Negotiated Rate	$54.27
Max. Negotiated Rate	$2,342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.52
Rate for Payer: Aetna Government	$209.52
Rate for Payer: Brighton Health Commercial	$2,342.00
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$54.27
Rate for Payer: Group Health Inc Commercial	$209.52
Rate for Payer: Group Health Inc Medicare	$146.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$209.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.30

SLEEP STUDY UNATTENDED - HOME

Facility OP

$419.03

Service Code	HCPCS 95800 TC
Hospital Charge Code	40402500
Hospital Revenue Code	920
Min. Negotiated Rate	$121.17
Max. Negotiated Rate	$2,342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.52
Rate for Payer: Aetna Government	$209.52
Rate for Payer: Brighton Health Commercial	$2,342.00
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$121.17
Rate for Payer: Group Health Inc Commercial	$209.52
Rate for Payer: Group Health Inc Medicare	$146.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$209.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$134.63

SLEEP STUDY, UNATTENDED W/ANAL

Facility OP

$2,752.98

Service Code	HCPCS 95810 TC
Hospital Charge Code	30305445
Hospital Revenue Code	510
Min. Negotiated Rate	$173.89
Max. Negotiated Rate	$1,514.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,514.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,376.49
Rate for Payer: Aetna Government	$1,376.49
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,209.08
Rate for Payer: Cash Price	$1,209.08
Rate for Payer: Cash Price	$1,209.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$547.31
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	$1,376.49
Rate for Payer: Hamaspik Choice Inc Medicare	$1,376.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$608.12

SLEEP STUDY UNATT&RESP EFFT

Facility OP

$419.03

Service Code	HCPCS 95806 TC
Hospital Charge Code	40401601
Hospital Revenue Code	920
Min. Negotiated Rate	$54.27
Max. Negotiated Rate	$2,342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.52
Rate for Payer: Aetna Government	$209.52
Rate for Payer: Brighton Health Commercial	$2,342.00
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$54.27
Rate for Payer: Group Health Inc Commercial	$209.52
Rate for Payer: Group Health Inc Medicare	$146.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$209.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.30

SLEEVE 4 CM LGTH STR DIA 3/32

Facility OP

$81.40

Hospital Charge Code	64906643
Hospital Revenue Code	270
Min. Negotiated Rate	$28.49
Max. Negotiated Rate	$65.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.70
Rate for Payer: Aetna Government	$40.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.35
Rate for Payer: Group Health Inc Commercial	$40.70
Rate for Payer: Group Health Inc Medicare	$28.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.70
Rate for Payer: Hamaspik Choice Inc Medicare	$40.70

SLEEVE 4 CURVED 1CM NEEDLE

Facility OP

$102.12

Hospital Charge Code	64906642
Hospital Revenue Code	270
Min. Negotiated Rate	$35.74
Max. Negotiated Rate	$81.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.06
Rate for Payer: Aetna Government	$51.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.44
Rate for Payer: Group Health Inc Commercial	$51.06
Rate for Payer: Group Health Inc Medicare	$35.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.06
Rate for Payer: Hamaspik Choice Inc Medicare	$51.06

SLEEVE ADAPTER

Facility OP

$661.50

Hospital Charge Code	64907295
Hospital Revenue Code	270
Min. Negotiated Rate	$231.52
Max. Negotiated Rate	$529.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$363.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$330.75
Rate for Payer: Aetna Government	$330.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$529.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$449.82
Rate for Payer: Group Health Inc Commercial	$330.75
Rate for Payer: Group Health Inc Medicare	$231.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$330.75
Rate for Payer: Hamaspik Choice Inc Medicare	$330.75

SLEEVE CABLE MED VITALLIUM

Facility OP

$1,280.25

Hospital Charge Code	64904430
Hospital Revenue Code	270
Min. Negotiated Rate	$448.09
Max. Negotiated Rate	$1,024.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$704.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$640.12
Rate for Payer: Aetna Government	$640.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,024.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$870.57
Rate for Payer: Group Health Inc Commercial	$640.12
Rate for Payer: Group Health Inc Medicare	$448.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$640.12
Rate for Payer: Hamaspik Choice Inc Medicare	$640.12

SLEEVE NAIL INSRT ELASTC 1407S

Facility OP

$400.00

Hospital Charge Code	64906516
Hospital Revenue Code	270
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.00
Rate for Payer: Aetna Government	$200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

SLEEVE PORT IRIS

Facility OP

$18.29

Hospital Charge Code	64902472
Hospital Revenue Code	270
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$14.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.14
Rate for Payer: Aetna Government	$9.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.44
Rate for Payer: Group Health Inc Commercial	$9.14
Rate for Payer: Group Health Inc Medicare	$6.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.14
Rate for Payer: Hamaspik Choice Inc Medicare	$9.14

SLEEVES INFUSION 0.9MM

Facility OP

$312.50

Hospital Charge Code	64905016
Hospital Revenue Code	270
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.25
Rate for Payer: Aetna Government	$156.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.50
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

SLEEVE STERILE OR

Facility OP

$1.80

Hospital Charge Code	64904238
Hospital Revenue Code	270
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.90
Rate for Payer: Aetna Government	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90

SLEEVE TISSUE

Facility OP

$559.00

Hospital Charge Code	40202422
Hospital Revenue Code	270
Min. Negotiated Rate	$195.65
Max. Negotiated Rate	$447.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$307.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$279.50
Rate for Payer: Aetna Government	$279.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$447.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$380.12
Rate for Payer: Group Health Inc Commercial	$279.50
Rate for Payer: Group Health Inc Medicare	$195.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.50
Rate for Payer: Hamaspik Choice Inc Medicare	$279.50

SLEEVE UNITRAX V40 )MM STD

Facility OP

$603.00

Service Code	HCPCS C1713
Hospital Charge Code	64901457
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$633.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$331.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$301.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$346.72
Rate for Payer: Fidelis Medicare Advantage	$633.15
Rate for Payer: Group Health Inc Commercial	$301.50
Rate for Payer: Group Health Inc Medicare	$211.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$301.50
Rate for Payer: Hamaspik Choice Inc Medicare	$301.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$391.95

Price Transparency.

All Charges