St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCISSOR ENDO 5MM

Facility

$162.50

Hospital Charge Code	64903091
Hospital Revenue Code	270
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$130.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.25
Rate for Payer: Aetna Government	$81.25
Rate for Payer: Brighton Health Commercial	$121.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$130.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.50
Rate for Payer: Group Health Inc Commercial	$81.25
Rate for Payer: Group Health Inc Medicare	$56.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25

SCISSOR ENDO 5MM #5DCS

Facility

$902.00

Hospital Charge Code	40200442
Hospital Revenue Code	270
Min. Negotiated Rate	$315.70
Max. Negotiated Rate	$721.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$496.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$451.00
Rate for Payer: Aetna Government	$451.00
Rate for Payer: Brighton Health Commercial	$676.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$721.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$613.36
Rate for Payer: Group Health Inc Commercial	$451.00
Rate for Payer: Group Health Inc Medicare	$315.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$451.00
Rate for Payer: Hamaspik Choice Inc Medicare	$451.00

SCISSOR MAYO STR 6

Facility

$25.53

Hospital Charge Code	64903525
Hospital Revenue Code	270
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$20.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.76
Rate for Payer: Aetna Government	$12.76
Rate for Payer: Brighton Health Commercial	$19.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.36
Rate for Payer: Group Health Inc Commercial	$12.76
Rate for Payer: Group Health Inc Medicare	$8.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.76
Rate for Payer: Hamaspik Choice Inc Medicare	$12.76

SCISSORS BAND LISTER LG RING

Facility

$39.34

Hospital Charge Code	40200460
Hospital Revenue Code	270
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$31.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.67
Rate for Payer: Aetna Government	$19.67
Rate for Payer: Brighton Health Commercial	$29.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.75
Rate for Payer: Group Health Inc Commercial	$19.67
Rate for Payer: Group Health Inc Medicare	$13.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.67
Rate for Payer: Hamaspik Choice Inc Medicare	$19.67

SCISSORS ENDOPATH CURVED REPROC

Facility

$388.80

Hospital Charge Code	64905437
Hospital Revenue Code	270
Min. Negotiated Rate	$136.08
Max. Negotiated Rate	$311.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$213.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$194.40
Rate for Payer: Aetna Government	$194.40
Rate for Payer: Brighton Health Commercial	$291.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$311.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$264.38
Rate for Payer: Group Health Inc Commercial	$194.40
Rate for Payer: Group Health Inc Medicare	$136.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.40
Rate for Payer: Hamaspik Choice Inc Medicare	$194.40

SCISSORS MAYO CVD 6-3/4

Facility

$59.38

Hospital Charge Code	40200461
Hospital Revenue Code	270
Min. Negotiated Rate	$20.78
Max. Negotiated Rate	$47.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.69
Rate for Payer: Aetna Government	$29.69
Rate for Payer: Brighton Health Commercial	$44.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.38
Rate for Payer: Group Health Inc Commercial	$29.69
Rate for Payer: Group Health Inc Medicare	$20.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.69
Rate for Payer: Hamaspik Choice Inc Medicare	$29.69

SCISSORS MAYO STR 6-3/4

Facility

$55.14

Hospital Charge Code	40200462
Hospital Revenue Code	270
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$44.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.57
Rate for Payer: Aetna Government	$27.57
Rate for Payer: Brighton Health Commercial	$41.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.50
Rate for Payer: Group Health Inc Commercial	$27.57
Rate for Payer: Group Health Inc Medicare	$19.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.57
Rate for Payer: Hamaspik Choice Inc Medicare	$27.57

SCISSORS SUTURE WIRE ANGLED4-3/4

Facility

$150.00

Hospital Charge Code	40200463
Hospital Revenue Code	270
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Brighton Health Commercial	$112.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.00
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

SCI WALLFLEX STENT 22MMX27X90MM

Facility

$5,170.92

Service Code	HCPCS C1876
Hospital Charge Code	40005446
Hospital Revenue Code	278
Min. Negotiated Rate	$2,585.46
Max. Negotiated Rate	$2,585.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,585.46
Rate for Payer: Hamaspik Choice Inc Medicare	$2,585.46

SCI WALLFLEX STENT 22MMX27X90MM

Facility

$5,170.92

Service Code	HCPCS C1876
Hospital Charge Code	40005446
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$5,429.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,844.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$3,102.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,585.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,973.28
Rate for Payer: EmblemHealth Commercial	$2,585.46
Rate for Payer: Fidelis Medicare Advantage	$5,429.47
Rate for Payer: Group Health Inc Commercial	$2,585.46
Rate for Payer: Group Health Inc Medicare	$1,809.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,585.46
Rate for Payer: Hamaspik Choice Inc Medicare	$2,585.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,361.10

SCLERECTOMY

Facility

$6,123.70

Service Code	HCPCS 66160
Hospital Charge Code	40072540
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,694.88

SCLERECTOMY

Facility

$6,123.70

Service Code	HCPCS 66160
Hospital Charge Code	40072540
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$4,592.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,694.88
Rate for Payer: Aetna Government	$2,694.88
Rate for Payer: Affinity Essential Plan 1&2	$1,886.42
Rate for Payer: Affinity Essential Plan 3&4	$1,886.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,886.42
Rate for Payer: Brighton Health Commercial	$4,592.78
Rate for Payer: Cash Price	$2,694.88
Rate for Payer: Cash Price	$2,694.88
Rate for Payer: Cash Price	$2,694.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,694.88
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	$2,694.88
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,290.65
Rate for Payer: Fidelis Essential Plan QHP	$2,398.44
Rate for Payer: Fidelis Medicare Advantage	$2,694.88
Rate for Payer: Fidelis Qualified Health Plan	$2,398.44
Rate for Payer: Group Health Inc Commercial	$2,694.88
Rate for Payer: Group Health Inc Medicare	$2,694.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,061.85
Rate for Payer: Hamaspik Choice Inc Medicare	$2,694.88
Rate for Payer: Healthfirst Medicare Advantage	$2,290.65
Rate for Payer: Healthfirst QHP	$2,694.88
Rate for Payer: Humana Medicare	$2,748.78
Rate for Payer: Senior Whole Health Medicare Advantage	$2,694.88
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$2,694.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,694.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,155.90
Rate for Payer: Wellcare Medicare	$2,560.14

SCLEROTX FLUID COLLECTION

Facility

$1,847.58

Service Code	HCPCS 49185
Hospital Charge Code	41103928
Hospital Revenue Code	320
Rate for Payer: Cash Price	$1,874.89

SCLEROTX FLUID COLLECTION

Facility

$1,847.58

Service Code	HCPCS 49185
Hospital Charge Code	41103928
Hospital Revenue Code	320
Min. Negotiated Rate	$923.79
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Affinity Essential Plan 1&2	$1,312.42
Rate for Payer: Affinity Essential Plan 3&4	$1,312.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,312.42
Rate for Payer: Brighton Health Commercial	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
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	$1,874.89
Rate for Payer: EmblemHealth Commercial	$1,312.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,593.66
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$1,687.40
Rate for Payer: Group Health Inc Medicare	$1,687.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Humana Medicare	$1,912.39
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: United Healthcare Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

SCOPE LITHOVUE

Facility

$3,750.00

Service Code	HCPCS C1474
Hospital Charge Code	64907500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,875.00

SCOPE LITHOVUE

Facility

$3,750.00

Service Code	HCPCS C1474
Hospital Charge Code	64907500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$3,937.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,062.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,875.00
Rate for Payer: Aetna Government	$1,875.00
Rate for Payer: Brighton Health Commercial	$2,250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,156.25
Rate for Payer: EmblemHealth Commercial	$1,875.00
Rate for Payer: Fidelis Medicare Advantage	$3,937.50
Rate for Payer: Group Health Inc Commercial	$1,875.00
Rate for Payer: Group Health Inc Medicare	$1,312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,437.50

SCOPOLAMINE 0.25% SOLUTION

Facility

$5.00

Hospital Charge Code	41650845
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

SCOPOLAMINE 0.25% SOLUTION

Facility

$5.00

Hospital Charge Code	41640845
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

SCOPOLAMINE 1 MG/3DAYS TD PT72 [128147]

Facility

$25.56

Service Code	NDC 10019055390
Hospital Charge Code	10019055390
Hospital Revenue Code	250
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$20.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.78
Rate for Payer: Aetna Government	$12.78
Rate for Payer: Brighton Health Commercial	$19.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.38
Rate for Payer: Group Health Inc Commercial	$12.78
Rate for Payer: Group Health Inc Medicare	$8.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.78
Rate for Payer: Hamaspik Choice Inc Medicare	$12.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.61

SCOPOLAMINE 1 MG/3DAYS TD PT72 [128147]

Facility

$19.26

Service Code	NDC 45802058084
Hospital Charge Code	45802058084
Hospital Revenue Code	250
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$15.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.63
Rate for Payer: Aetna Government	$9.63
Rate for Payer: Brighton Health Commercial	$14.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.10
Rate for Payer: Group Health Inc Commercial	$9.63
Rate for Payer: Group Health Inc Medicare	$6.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.63
Rate for Payer: Hamaspik Choice Inc Medicare	$9.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.52

SCOPOLAMINE 1 MG/3DAYS TD PT72 [128147]

Facility

$22.97

Service Code	NDC 00378647044
Hospital Charge Code	00378647044
Hospital Revenue Code	250
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$18.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.49
Rate for Payer: Aetna Government	$11.49
Rate for Payer: Brighton Health Commercial	$17.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.62
Rate for Payer: Group Health Inc Commercial	$11.49
Rate for Payer: Group Health Inc Medicare	$8.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.49
Rate for Payer: Hamaspik Choice Inc Medicare	$11.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.93

SCOPOLAMINE 1 MG/3DAYS TD PT72 [128147]

Facility

$25.56

Service Code	NDC 10019055304
Hospital Charge Code	10019055304
Hospital Revenue Code	250
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$20.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.78
Rate for Payer: Aetna Government	$12.78
Rate for Payer: Brighton Health Commercial	$19.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.38
Rate for Payer: Group Health Inc Commercial	$12.78
Rate for Payer: Group Health Inc Medicare	$8.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.78
Rate for Payer: Hamaspik Choice Inc Medicare	$12.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.61

SCOPOLAMINE 1 MG/3DAYS TD PT72 [128147]

Facility

$23.00

Service Code	NDC 45802058062
Hospital Charge Code	45802058062
Hospital Revenue Code	250
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$18.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.50
Rate for Payer: Aetna Government	$11.50
Rate for Payer: Brighton Health Commercial	$17.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.64
Rate for Payer: Group Health Inc Commercial	$11.50
Rate for Payer: Group Health Inc Medicare	$8.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.50
Rate for Payer: Hamaspik Choice Inc Medicare	$11.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.95

SCOPOLAMINE 1 MG/3DAYS TD PT72 [128147]

Facility

$22.97

Service Code	NDC 00378647097
Hospital Charge Code	00378647097
Hospital Revenue Code	250
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$18.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.49
Rate for Payer: Aetna Government	$11.49
Rate for Payer: Brighton Health Commercial	$17.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.62
Rate for Payer: Group Health Inc Commercial	$11.49
Rate for Payer: Group Health Inc Medicare	$8.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.49
Rate for Payer: Hamaspik Choice Inc Medicare	$11.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.93

SCOPOLAMINE PATCH

Facility

$22.42

Hospital Charge Code	41645255
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$17.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.21
Rate for Payer: Aetna Government	$11.21
Rate for Payer: Brighton Health Commercial	$16.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.25
Rate for Payer: Group Health Inc Commercial	$11.21
Rate for Payer: Group Health Inc Medicare	$7.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.21
Rate for Payer: Hamaspik Choice Inc Medicare	$11.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.57

Know your out-of-pocket cost for care.

All Charges