St. Barnabas Hospital

All Charges

Charge

Type

Price

TIBULA CMNTD PSN STM 5 DEG SZ E L

Facility OP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204596
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,420.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,530.00
Rate for Payer: Fidelis Medicare Advantage	$4,620.00
Rate for Payer: Group Health Inc Commercial	$2,200.00
Rate for Payer: Group Health Inc Medicare	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,860.00

TIBULA,CMTD PSA STM 5 DEG SZ E L

Facility OP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007515
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,420.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,530.00
Rate for Payer: Fidelis Medicare Advantage	$4,620.00
Rate for Payer: Group Health Inc Commercial	$2,200.00
Rate for Payer: Group Health Inc Medicare	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,860.00

TIBULA,CMTD PSA STM 5 DEG SZ E L

Facility IP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007515
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00

TIBULA,CMTD PSN STM 5 DEG SZ D L

Facility IP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007523
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00

TIBULA,CMTD PSN STM 5 DEG SZ D L

Facility OP

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007523
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,420.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,530.00
Rate for Payer: Fidelis Medicare Advantage	$4,620.00
Rate for Payer: Group Health Inc Commercial	$2,200.00
Rate for Payer: Group Health Inc Medicare	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,860.00

TICAGRELOR 90MG TABLET

Facility OP

$7.56

Hospital Charge Code	41647008
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.78
Rate for Payer: Aetna Government	$3.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.14
Rate for Payer: Group Health Inc Commercial	$3.78
Rate for Payer: Group Health Inc Medicare	$2.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.78
Rate for Payer: Hamaspik Choice Inc Medicare	$3.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.91

TICAGRELOR 90MG TABLET

Facility OP

$7.56

Hospital Charge Code	41657008
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.78
Rate for Payer: Aetna Government	$3.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.14
Rate for Payer: Group Health Inc Commercial	$3.78
Rate for Payer: Group Health Inc Medicare	$2.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.78
Rate for Payer: Hamaspik Choice Inc Medicare	$3.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.91

TICAGRELOR - NF- ASTRAZENECA

Facility OP

$15.95

Hospital Charge Code	41640217
Hospital Revenue Code	250
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$12.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.98
Rate for Payer: Aetna Government	$7.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.85
Rate for Payer: Group Health Inc Commercial	$7.98
Rate for Payer: Group Health Inc Medicare	$5.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.98
Rate for Payer: Hamaspik Choice Inc Medicare	$7.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.37

TICAGRELOR - NF- ASTRAZENECA

Facility OP

$15.95

Hospital Charge Code	41650217
Hospital Revenue Code	250
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$12.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.98
Rate for Payer: Aetna Government	$7.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.85
Rate for Payer: Group Health Inc Commercial	$7.98
Rate for Payer: Group Health Inc Medicare	$5.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.98
Rate for Payer: Hamaspik Choice Inc Medicare	$7.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.37

TICRON BLUE SUTURE

Facility OP

$207.90

Hospital Charge Code	64907077
Hospital Revenue Code	270
Min. Negotiated Rate	$72.76
Max. Negotiated Rate	$166.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$103.95
Rate for Payer: Aetna Government	$103.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$166.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$141.37
Rate for Payer: Group Health Inc Commercial	$103.95
Rate for Payer: Group Health Inc Medicare	$72.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.95
Rate for Payer: Hamaspik Choice Inc Medicare	$103.95

TIDAL DRAINAGE SET

Facility OP

$6.03

Hospital Charge Code	40206030
Hospital Revenue Code	270
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02

TIGECYCLINE 100MG/D5W 100ML - 1MG

Facility OP

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41658422
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.67
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.71
Rate for Payer: SOMOS Essential	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

TIGECYCLINE 100MG/D5W 100ML - 1MG

Facility IP

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41658422
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

TIGECYCLINE 100MG/DW 100ML - 1MG

Facility IP

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41648422
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

TIGECYCLINE 100MG/DW 100ML - 1MG

Facility OP

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41648422
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.67
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.71
Rate for Payer: SOMOS Essential	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

TIGECYCLINE 50 MG INJ

Facility OP

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41654782
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.67
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.71
Rate for Payer: SOMOS Essential	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

TIGECYCLINE 50 MG INJ

Facility OP

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41644782
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.67
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.71
Rate for Payer: SOMOS Essential	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

TIGECYCLINE 50 MG INJ

Facility IP

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41644782
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

TIGECYCLINE 50 MG INJ

Facility IP

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41654782
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

TIGEMINAL NERVE

Facility OP

$792.83

Service Code	HCPCS 64400
Hospital Charge Code	30105540
Hospital Revenue Code	450
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$342.51
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
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: Elderplan Medicare Advantage	$342.51
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$58.22
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$342.51
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

TIGEMINAL NERVE

Facility OP

$792.83

Service Code	HCPCS 64400
Hospital Charge Code	30305020
Hospital Revenue Code	510
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
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: Elderplan Medicare Advantage	$342.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$58.22
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
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	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$64.69
Rate for Payer: Healthfirst Medicare Advantage	$291.13
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$342.51
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

TIGERLOOP

Facility OP

$13.44

Hospital Charge Code	64905873
Hospital Revenue Code	270
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$10.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.72
Rate for Payer: Aetna Government	$6.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.14
Rate for Payer: Group Health Inc Commercial	$6.72
Rate for Payer: Group Health Inc Medicare	$4.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.72
Rate for Payer: Hamaspik Choice Inc Medicare	$6.72

TIGER NEEDLE EXPRESS

Facility OP

$450.00

Hospital Charge Code	64906037
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$225.00
Rate for Payer: Aetna Government	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$306.00
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

TIGHTROPE BUTTON EXT

Facility OP

$805.00

Hospital Charge Code	64905887
Hospital Revenue Code	270
Min. Negotiated Rate	$281.75
Max. Negotiated Rate	$644.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$442.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.50
Rate for Payer: Aetna Government	$402.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$644.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$547.40
Rate for Payer: Group Health Inc Commercial	$402.50
Rate for Payer: Group Health Inc Medicare	$281.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.50
Rate for Payer: Hamaspik Choice Inc Medicare	$402.50

TIGHTROPE SYNDESMOSIS XP 8925

Facility OP

$2,990.00

Hospital Charge Code	64906656
Hospital Revenue Code	279
Min. Negotiated Rate	$1,046.50
Max. Negotiated Rate	$2,392.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,644.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,495.00
Rate for Payer: Aetna Government	$1,495.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,392.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,033.20
Rate for Payer: Group Health Inc Commercial	$1,495.00
Rate for Payer: Group Health Inc Medicare	$1,046.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,495.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,495.00

Price Transparency.

All Charges