St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RESOLUTE ONYX 4.50X26

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521665
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 4.50X30

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521666
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 4.50X30

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521666
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 4.50X33

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521664
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 4.50X33

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521664
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 5.00X12

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521667
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 5.00X12

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521667
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 5.00X15

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521668
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 5.00X15

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521668
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 5.00X18

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521669
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 5.00X18

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521669
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 5.00X22

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521670
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 5.00X22

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521670
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 5.00X26

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521671
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESOLUTE ONYX 5.00X26

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521671
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 5.00X30

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521672
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

RESOLUTE ONYX 5.00X30

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	66521672
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$28,889.82

Service Code	MSDRG 178
Min. Negotiated Rate	$8,460.95
Max. Negotiated Rate	$28,889.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,548.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21,010.78
Rate for Payer: Aetna Government	$21,010.78
Rate for Payer: Brighton Health Commercial	$14,307.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21,431.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17,039.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,061.58
Rate for Payer: Elderplan Medicare Advantage	$19,960.24
Rate for Payer: EmblemHealth Commercial	$8,460.95
Rate for Payer: Fidelis Medicare Advantage	$21,010.78
Rate for Payer: Group Health Inc Commercial	$21,010.78
Rate for Payer: Group Health Inc Medicare	$21,010.78
Rate for Payer: Hamaspik Choice Inc Medicare	$21,010.78
Rate for Payer: Healthfirst Medicare Advantage	$9,770.01
Rate for Payer: Humana Medicare	$28,889.82
Rate for Payer: Senior Whole Health Medicare Advantage	$21,010.78
Rate for Payer: United Healthcare Commercial	$19,622.50
Rate for Payer: United Healthcare Medicare Advantage	$21,010.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,010.78
Rate for Payer: Wellcare Medicare	$19,960.24

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$42,422.13

Service Code	MSDRG 177
Min. Negotiated Rate	$14,346.39
Max. Negotiated Rate	$42,422.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25,013.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30,852.46
Rate for Payer: Aetna Government	$30,852.46
Rate for Payer: Brighton Health Commercial	$24,597.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$31,469.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29,295.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$24,175.60
Rate for Payer: Elderplan Medicare Advantage	$29,309.84
Rate for Payer: EmblemHealth Commercial	$14,546.60
Rate for Payer: Fidelis Medicare Advantage	$30,852.46
Rate for Payer: Group Health Inc Commercial	$30,852.46
Rate for Payer: Group Health Inc Medicare	$30,852.46
Rate for Payer: Hamaspik Choice Inc Medicare	$30,852.46
Rate for Payer: Healthfirst Medicare Advantage	$14,346.39
Rate for Payer: Humana Medicare	$42,422.13
Rate for Payer: Senior Whole Health Medicare Advantage	$30,852.46
Rate for Payer: United Healthcare Commercial	$33,736.31
Rate for Payer: United Healthcare Medicare Advantage	$30,852.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30,852.46
Rate for Payer: Wellcare Medicare	$29,309.84

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$24,630.14

Service Code	MSDRG 179
Min. Negotiated Rate	$6,545.30
Max. Negotiated Rate	$24,630.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,254.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17,912.83
Rate for Payer: Aetna Government	$17,912.83
Rate for Payer: Brighton Health Commercial	$11,067.85
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18,271.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13,181.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,877.88
Rate for Payer: Elderplan Medicare Advantage	$17,017.19
Rate for Payer: EmblemHealth Commercial	$6,545.30
Rate for Payer: Fidelis Medicare Advantage	$17,912.83
Rate for Payer: Group Health Inc Commercial	$17,912.83
Rate for Payer: Group Health Inc Medicare	$17,912.83
Rate for Payer: Hamaspik Choice Inc Medicare	$17,912.83
Rate for Payer: Healthfirst Medicare Advantage	$8,329.47
Rate for Payer: Humana Medicare	$24,630.14
Rate for Payer: Senior Whole Health Medicare Advantage	$17,912.83
Rate for Payer: United Healthcare Commercial	$15,179.75
Rate for Payer: United Healthcare Medicare Advantage	$17,912.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17,912.83
Rate for Payer: Wellcare Medicare	$17,017.19

RESPIRATORY NEOPLASMS WITH CC

Facility

$31,071.16

Service Code	MSDRG 181
Min. Negotiated Rate	$9,441.93
Max. Negotiated Rate	$31,071.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16,235.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22,597.21
Rate for Payer: Aetna Government	$22,597.21
Rate for Payer: Brighton Health Commercial	$15,965.95
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$23,049.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,014.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$15,691.91
Rate for Payer: Elderplan Medicare Advantage	$21,467.35
Rate for Payer: EmblemHealth Commercial	$9,441.93
Rate for Payer: Fidelis Medicare Advantage	$22,597.21
Rate for Payer: Group Health Inc Commercial	$22,597.21
Rate for Payer: Group Health Inc Medicare	$22,597.21
Rate for Payer: Hamaspik Choice Inc Medicare	$22,597.21
Rate for Payer: Healthfirst Medicare Advantage	$10,507.70
Rate for Payer: Humana Medicare	$31,071.16
Rate for Payer: Senior Whole Health Medicare Advantage	$22,597.21
Rate for Payer: United Healthcare Commercial	$21,897.58
Rate for Payer: United Healthcare Medicare Advantage	$22,597.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22,597.21
Rate for Payer: Wellcare Medicare	$21,467.35

RESPIRATORY NEOPLASMS WITH MCC

Facility

$43,219.21

Service Code	MSDRG 180
Min. Negotiated Rate	$14,615.95
Max. Negotiated Rate	$43,219.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25,629.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31,432.15
Rate for Payer: Aetna Government	$31,432.15
Rate for Payer: Brighton Health Commercial	$25,203.90
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$32,060.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30,016.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$24,771.30
Rate for Payer: Elderplan Medicare Advantage	$29,860.54
Rate for Payer: EmblemHealth Commercial	$14,905.10
Rate for Payer: Fidelis Medicare Advantage	$31,432.15
Rate for Payer: Group Health Inc Commercial	$31,432.15
Rate for Payer: Group Health Inc Medicare	$31,432.15
Rate for Payer: Hamaspik Choice Inc Medicare	$31,432.15
Rate for Payer: Healthfirst Medicare Advantage	$14,615.95
Rate for Payer: Humana Medicare	$43,219.21
Rate for Payer: Senior Whole Health Medicare Advantage	$31,432.15
Rate for Payer: United Healthcare Commercial	$34,567.58
Rate for Payer: United Healthcare Medicare Advantage	$31,432.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31,432.15
Rate for Payer: Wellcare Medicare	$29,860.54

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$25,307.03

Service Code	MSDRG 182
Min. Negotiated Rate	$6,508.43
Max. Negotiated Rate	$25,307.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,191.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18,405.11
Rate for Payer: Aetna Government	$18,405.11
Rate for Payer: Brighton Health Commercial	$11,005.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18,773.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13,794.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,383.79
Rate for Payer: Elderplan Medicare Advantage	$17,484.85
Rate for Payer: EmblemHealth Commercial	$6,508.43
Rate for Payer: Fidelis Medicare Advantage	$18,405.11
Rate for Payer: Group Health Inc Commercial	$18,405.11
Rate for Payer: Group Health Inc Medicare	$18,405.11
Rate for Payer: Hamaspik Choice Inc Medicare	$18,405.11
Rate for Payer: Healthfirst Medicare Advantage	$8,558.38
Rate for Payer: Humana Medicare	$25,307.03
Rate for Payer: Senior Whole Health Medicare Advantage	$18,405.11
Rate for Payer: United Healthcare Commercial	$15,885.74
Rate for Payer: United Healthcare Medicare Advantage	$18,405.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18,405.11
Rate for Payer: Wellcare Medicare	$17,484.85

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$25,766.55

Service Code	MSDRG 204
Min. Negotiated Rate	$7,056.37
Max. Negotiated Rate	$25,766.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,133.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18,739.31
Rate for Payer: Aetna Government	$18,739.31
Rate for Payer: Brighton Health Commercial	$11,932.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19,114.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,210.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,727.25
Rate for Payer: Elderplan Medicare Advantage	$17,802.34
Rate for Payer: EmblemHealth Commercial	$7,056.37
Rate for Payer: Fidelis Medicare Advantage	$18,739.31
Rate for Payer: Group Health Inc Commercial	$18,739.31
Rate for Payer: Group Health Inc Medicare	$18,739.31
Rate for Payer: Hamaspik Choice Inc Medicare	$18,739.31
Rate for Payer: Healthfirst Medicare Advantage	$8,713.78
Rate for Payer: Humana Medicare	$25,766.55
Rate for Payer: Senior Whole Health Medicare Advantage	$18,739.31
Rate for Payer: United Healthcare Commercial	$16,365.01
Rate for Payer: United Healthcare Medicare Advantage	$18,739.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18,739.31
Rate for Payer: Wellcare Medicare	$17,802.34

RESPIRATORY SYNCYTIAL AG IF

Facility

$33.55

Service Code	HCPCS 87280
Hospital Charge Code	40613064
Hospital Revenue Code	300
Rate for Payer: Cash Price	$13.42

Know your out-of-pocket cost for care.

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