St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ATOMOXETINE 40 MG CAP

Facility

$6.00

Hospital Charge Code	41643896
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

ATOMOXETINE 40 MG CAP

Facility

$6.00

Hospital Charge Code	41653896
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

ATOMOXETINE HCL 40 MG PO CAPS [34447]

Facility

$15.47

Service Code	NDC 00093354556
Hospital Charge Code	00093354556
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$12.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Brighton Health Commercial	$11.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.52
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$5.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.05

ATOMOXETINE HCL 40 MG PO CAPS [34447]

Facility

$15.47

Service Code	NDC 55111052130
Hospital Charge Code	55111052130
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$12.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Brighton Health Commercial	$11.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.52
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$5.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.05

ATOVAQUONE 750 MG/5ML PO SUSP [14953]

Facility

$8.26

Service Code	NDC 68462042169
Hospital Charge Code	68462042169
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$6.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.13
Rate for Payer: Aetna Government	$4.13
Rate for Payer: Brighton Health Commercial	$6.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.62
Rate for Payer: Group Health Inc Commercial	$4.13
Rate for Payer: Group Health Inc Medicare	$2.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13
Rate for Payer: Hamaspik Choice Inc Medicare	$4.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.37

ATOVAQUONE 750 MG/5ML PO SUSP [14953]

Facility

$8.26

Service Code	NDC 50268008611
Hospital Charge Code	50268008611
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$6.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.13
Rate for Payer: Aetna Government	$4.13
Rate for Payer: Brighton Health Commercial	$6.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.62
Rate for Payer: Group Health Inc Commercial	$4.13
Rate for Payer: Group Health Inc Medicare	$2.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.13
Rate for Payer: Hamaspik Choice Inc Medicare	$4.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.37

ATOVAQUONE 750 MG/5ML PO SUSP [14953]

Facility

$6.86

Service Code	NDC 60687053436
Hospital Charge Code	60687053436
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$5.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$5.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.66
Rate for Payer: Group Health Inc Commercial	$3.43
Rate for Payer: Group Health Inc Medicare	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.43
Rate for Payer: Hamaspik Choice Inc Medicare	$3.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.46

ATOVAQUONE 750 MG/5ML PO SUSP [14953]

Facility

$7.96

Service Code	NDC 00173054700
Hospital Charge Code	00173054700
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$6.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.98
Rate for Payer: Aetna Government	$3.98
Rate for Payer: Brighton Health Commercial	$5.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.41
Rate for Payer: Group Health Inc Commercial	$3.98
Rate for Payer: Group Health Inc Medicare	$2.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.98
Rate for Payer: Hamaspik Choice Inc Medicare	$3.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.17

ATOVAQUONE 750 MG/5ML PO SUSP [14953]

Facility

$7.51

Service Code	NDC 31722062921
Hospital Charge Code	31722062921
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$6.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.75
Rate for Payer: Aetna Government	$3.75
Rate for Payer: Brighton Health Commercial	$5.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.11
Rate for Payer: Group Health Inc Commercial	$3.75
Rate for Payer: Group Health Inc Medicare	$2.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.88

ATOVAQUONE 750MG/5ML SUSP UDC

Facility

$47.45

Hospital Charge Code	41643260
Hospital Revenue Code	250
Min. Negotiated Rate	$16.61
Max. Negotiated Rate	$37.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.72
Rate for Payer: Aetna Government	$23.72
Rate for Payer: Brighton Health Commercial	$35.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.27
Rate for Payer: Group Health Inc Commercial	$23.72
Rate for Payer: Group Health Inc Medicare	$16.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.72
Rate for Payer: Hamaspik Choice Inc Medicare	$23.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.84

ATOVAQUONE 750MG/5ML SUSP UDC

Facility

$47.45

Hospital Charge Code	41653260
Hospital Revenue Code	250
Min. Negotiated Rate	$16.61
Max. Negotiated Rate	$37.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.72
Rate for Payer: Aetna Government	$23.72
Rate for Payer: Brighton Health Commercial	$35.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.27
Rate for Payer: Group Health Inc Commercial	$23.72
Rate for Payer: Group Health Inc Medicare	$16.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.72
Rate for Payer: Hamaspik Choice Inc Medicare	$23.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.84

ATOVAQUONE/PROGUANIL 250-100MG

Facility

$1.18

Hospital Charge Code	41656493
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.80
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

ATOVAQUONE/PROGUANIL 250-100MG

Facility

$1.18

Hospital Charge Code	41646493
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.80
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

ATOVAQUONE PROGUANIL 62/5-25MG

Facility

$3.34

Hospital Charge Code	41656494
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.67
Rate for Payer: Aetna Government	$1.67
Rate for Payer: Brighton Health Commercial	$2.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.27
Rate for Payer: Group Health Inc Commercial	$1.67
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.67
Rate for Payer: Hamaspik Choice Inc Medicare	$1.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.17

ATOVAQUONE/PROGUANIL 62.5-25MG

Facility

$3.34

Hospital Charge Code	41646494
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.67
Rate for Payer: Aetna Government	$1.67
Rate for Payer: Brighton Health Commercial	$2.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.27
Rate for Payer: Group Health Inc Commercial	$1.67
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.67
Rate for Payer: Hamaspik Choice Inc Medicare	$1.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.17

ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS [23814]

Facility

$8.24

Service Code	NDC 00173067502
Hospital Charge Code	00173067502
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$6.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.12
Rate for Payer: Aetna Government	$4.12
Rate for Payer: Brighton Health Commercial	$6.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.60
Rate for Payer: Group Health Inc Commercial	$4.12
Rate for Payer: Group Health Inc Medicare	$2.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.12
Rate for Payer: Hamaspik Choice Inc Medicare	$4.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.36

ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS [23814]

Facility

$7.41

Service Code	NDC 66993006027
Hospital Charge Code	66993006027
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$5.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.70
Rate for Payer: Aetna Government	$3.70
Rate for Payer: Brighton Health Commercial	$5.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.04
Rate for Payer: Group Health Inc Commercial	$3.70
Rate for Payer: Group Health Inc Medicare	$2.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.70
Rate for Payer: Hamaspik Choice Inc Medicare	$3.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.82

ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS [23814]

Facility

$7.15

Service Code	NDC 68462040401
Hospital Charge Code	68462040401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.57
Rate for Payer: Aetna Government	$3.57
Rate for Payer: Brighton Health Commercial	$5.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.86
Rate for Payer: Group Health Inc Commercial	$3.57
Rate for Payer: Group Health Inc Medicare	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.57
Rate for Payer: Hamaspik Choice Inc Medicare	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.65

ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS [28686]

Facility

$2.99

Service Code	NDC 00173067601
Hospital Charge Code	00173067601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.49
Rate for Payer: Aetna Government	$1.49
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.03
Rate for Payer: Group Health Inc Commercial	$1.49
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.49
Rate for Payer: Hamaspik Choice Inc Medicare	$1.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.94

ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS [28686]

Facility

$2.69

Service Code	NDC 68462040201
Hospital Charge Code	68462040201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$2.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.34
Rate for Payer: Aetna Government	$1.34
Rate for Payer: Brighton Health Commercial	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.83
Rate for Payer: Group Health Inc Commercial	$1.34
Rate for Payer: Group Health Inc Medicare	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.75

ATRACURIUM 100MG/250ML

Facility

$28.60

Hospital Charge Code	41650221
Hospital Revenue Code	636
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$14.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.30
Rate for Payer: Hamaspik Choice Inc Medicare	$14.30

ATRACURIUM 100MG/250ML

Facility

$28.60

Hospital Charge Code	41650221
Hospital Revenue Code	636
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$18.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.30
Rate for Payer: Aetna Government	$14.30
Rate for Payer: Brighton Health Commercial	$17.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.44
Rate for Payer: Group Health Inc Commercial	$14.30
Rate for Payer: Group Health Inc Medicare	$10.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.30
Rate for Payer: Hamaspik Choice Inc Medicare	$14.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.59

ATRACURIUM 100MG/250ML

Facility

$28.60

Hospital Charge Code	41640221
Hospital Revenue Code	636
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$14.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.30
Rate for Payer: Hamaspik Choice Inc Medicare	$14.30

ATRACURIUM 100MG/250ML

Facility

$28.60

Hospital Charge Code	41640221
Hospital Revenue Code	636
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$18.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.30
Rate for Payer: Aetna Government	$14.30
Rate for Payer: Brighton Health Commercial	$17.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.44
Rate for Payer: Group Health Inc Commercial	$14.30
Rate for Payer: Group Health Inc Medicare	$10.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.30
Rate for Payer: Hamaspik Choice Inc Medicare	$14.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.59

ATRIAL LEAD 4592 53 CM

Facility

$1,300.00

Service Code	HCPCS C1713
Hospital Charge Code	40200398
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,365.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$715.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$780.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$747.50
Rate for Payer: EmblemHealth Commercial	$650.00
Rate for Payer: Fidelis Medicare Advantage	$1,365.00
Rate for Payer: Group Health Inc Commercial	$650.00
Rate for Payer: Group Health Inc Medicare	$455.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$650.00
Rate for Payer: Hamaspik Choice Inc Medicare	$650.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$845.00

Know your out-of-pocket cost for care.

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