St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BACITRA-NEOMYCIN-POLYMYXIN-HC 1 % OP OINT [849]

Facility

$18.59

Service Code	NDC 24208078555
Hospital Charge Code	24208078555
Hospital Revenue Code	250
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$14.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.29
Rate for Payer: Aetna Government	$9.29
Rate for Payer: Brighton Health Commercial	$13.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.64
Rate for Payer: Group Health Inc Commercial	$9.29
Rate for Payer: Group Health Inc Medicare	$6.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.29
Rate for Payer: Hamaspik Choice Inc Medicare	$9.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.08

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

$47,612.36

Service Code	MSDRG 519
Min. Negotiated Rate	$16,101.63
Max. Negotiated Rate	$47,612.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29,027.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34,627.17
Rate for Payer: Aetna Government	$34,627.17
Rate for Payer: Brighton Health Commercial	$28,544.70
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35,319.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33,995.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$28,054.75
Rate for Payer: Elderplan Medicare Advantage	$32,895.81
Rate for Payer: EmblemHealth Commercial	$16,880.70
Rate for Payer: Fidelis Medicare Advantage	$34,627.17
Rate for Payer: Group Health Inc Commercial	$34,627.17
Rate for Payer: Group Health Inc Medicare	$34,627.17
Rate for Payer: Hamaspik Choice Inc Medicare	$34,627.17
Rate for Payer: Healthfirst Medicare Advantage	$16,101.63
Rate for Payer: Humana Medicare	$47,612.36
Rate for Payer: Senior Whole Health Medicare Advantage	$34,627.17
Rate for Payer: United Healthcare Commercial	$39,149.55
Rate for Payer: United Healthcare Medicare Advantage	$34,627.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34,627.17
Rate for Payer: Wellcare Medicare	$32,895.81

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

$79,707.06

Service Code	MSDRG 518
Min. Negotiated Rate	$26,955.48
Max. Negotiated Rate	$79,707.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53,845.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57,968.77
Rate for Payer: Aetna Government	$57,968.77
Rate for Payer: Brighton Health Commercial	$52,951.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$59,128.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63,062.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$52,042.24
Rate for Payer: Elderplan Medicare Advantage	$55,070.33
Rate for Payer: EmblemHealth Commercial	$31,314.20
Rate for Payer: Fidelis Medicare Advantage	$57,968.77
Rate for Payer: Group Health Inc Commercial	$57,968.77
Rate for Payer: Group Health Inc Medicare	$57,968.77
Rate for Payer: Hamaspik Choice Inc Medicare	$57,968.77
Rate for Payer: Healthfirst Medicare Advantage	$26,955.48
Rate for Payer: Humana Medicare	$79,707.06
Rate for Payer: Senior Whole Health Medicare Advantage	$57,968.77
Rate for Payer: United Healthcare Commercial	$72,623.35
Rate for Payer: United Healthcare Medicare Advantage	$57,968.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57,968.77
Rate for Payer: Wellcare Medicare	$55,070.33

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$37,371.14

Service Code	MSDRG 520
Min. Negotiated Rate	$12,275.10
Max. Negotiated Rate	$37,371.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,107.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27,179.01
Rate for Payer: Aetna Government	$27,179.01
Rate for Payer: Brighton Health Commercial	$20,756.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27,722.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24,720.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$20,400.48
Rate for Payer: Elderplan Medicare Advantage	$25,820.06
Rate for Payer: EmblemHealth Commercial	$12,275.10
Rate for Payer: Fidelis Medicare Advantage	$27,179.01
Rate for Payer: Group Health Inc Commercial	$27,179.01
Rate for Payer: Group Health Inc Medicare	$27,179.01
Rate for Payer: Hamaspik Choice Inc Medicare	$27,179.01
Rate for Payer: Healthfirst Medicare Advantage	$12,638.24
Rate for Payer: Humana Medicare	$37,371.14
Rate for Payer: Senior Whole Health Medicare Advantage	$27,179.01
Rate for Payer: United Healthcare Commercial	$28,468.24
Rate for Payer: United Healthcare Medicare Advantage	$27,179.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,179.01
Rate for Payer: Wellcare Medicare	$25,820.06

BACKBOARD WOOD 72L X 16W

Facility

$233.98

Hospital Charge Code	64903674
Hospital Revenue Code	270
Min. Negotiated Rate	$81.89
Max. Negotiated Rate	$187.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$128.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$116.99
Rate for Payer: Aetna Government	$116.99
Rate for Payer: Brighton Health Commercial	$175.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$187.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$159.11
Rate for Payer: Group Health Inc Commercial	$116.99
Rate for Payer: Group Health Inc Medicare	$81.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.99
Rate for Payer: Hamaspik Choice Inc Medicare	$116.99

BACK SUP ULTRALIGN TLSO L

Facility

$755.38

Hospital Charge Code	64903744
Hospital Revenue Code	270
Min. Negotiated Rate	$264.38
Max. Negotiated Rate	$604.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$415.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.69
Rate for Payer: Aetna Government	$377.69
Rate for Payer: Brighton Health Commercial	$566.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$604.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$513.66
Rate for Payer: Group Health Inc Commercial	$377.69
Rate for Payer: Group Health Inc Medicare	$264.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.69
Rate for Payer: Hamaspik Choice Inc Medicare	$377.69

BACK SUP ULTRALIGN TLSO M

Facility

$755.38

Hospital Charge Code	64903742
Hospital Revenue Code	270
Min. Negotiated Rate	$264.38
Max. Negotiated Rate	$604.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$415.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.69
Rate for Payer: Aetna Government	$377.69
Rate for Payer: Brighton Health Commercial	$566.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$604.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$513.66
Rate for Payer: Group Health Inc Commercial	$377.69
Rate for Payer: Group Health Inc Medicare	$264.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.69
Rate for Payer: Hamaspik Choice Inc Medicare	$377.69

BACK SUP ULTRALIGN TLSO S

Facility

$755.38

Hospital Charge Code	64903740
Hospital Revenue Code	270
Min. Negotiated Rate	$264.38
Max. Negotiated Rate	$604.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$415.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.69
Rate for Payer: Aetna Government	$377.69
Rate for Payer: Brighton Health Commercial	$566.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$604.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$513.66
Rate for Payer: Group Health Inc Commercial	$377.69
Rate for Payer: Group Health Inc Medicare	$264.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.69
Rate for Payer: Hamaspik Choice Inc Medicare	$377.69

BACK SUP ULTRALIGN TLSO XL

Facility

$755.38

Hospital Charge Code	64903746
Hospital Revenue Code	270
Min. Negotiated Rate	$264.38
Max. Negotiated Rate	$604.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$415.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.69
Rate for Payer: Aetna Government	$377.69
Rate for Payer: Brighton Health Commercial	$566.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$604.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$513.66
Rate for Payer: Group Health Inc Commercial	$377.69
Rate for Payer: Group Health Inc Medicare	$264.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.69
Rate for Payer: Hamaspik Choice Inc Medicare	$377.69

BACK SUP ULTRALIGN TLSO XXL

Facility

$755.38

Hospital Charge Code	64903748
Hospital Revenue Code	270
Min. Negotiated Rate	$264.38
Max. Negotiated Rate	$604.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$415.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.69
Rate for Payer: Aetna Government	$377.69
Rate for Payer: Brighton Health Commercial	$566.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$604.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$513.66
Rate for Payer: Group Health Inc Commercial	$377.69
Rate for Payer: Group Health Inc Medicare	$264.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.69
Rate for Payer: Hamaspik Choice Inc Medicare	$377.69

BACLOFEN 10 MG PO TABS [860]

Facility

$0.56

Service Code	NDC 63739047910
Hospital Charge Code	63739047910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

BACLOFEN 10 MG PO TABS [860]

Facility

$2.47

Service Code	NDC 52817032010
Hospital Charge Code	52817032010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.61

BACLOFEN 10 MG PO TABS [860]

Facility

$2.47

Service Code	NDC 00172409660
Hospital Charge Code	00172409660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.61

BACLOFEN 10 MG PO TABS [860]

Facility

$0.50

Service Code	NDC 00904647561
Hospital Charge Code	00904647561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

BACLOFEN 10 MG TAB

Facility

$0.10

Hospital Charge Code	41653286
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

BACLOFEN 10 MG TAB

Facility

$0.10

Hospital Charge Code	41643286
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

BACLOFEN 20 MG PO TABS [861]

Facility

$5.13

Service Code	NDC 00603240721
Hospital Charge Code	00603240721
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$4.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.56
Rate for Payer: Aetna Government	$2.56
Rate for Payer: Brighton Health Commercial	$3.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.49
Rate for Payer: Group Health Inc Commercial	$2.56
Rate for Payer: Group Health Inc Medicare	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.56
Rate for Payer: Hamaspik Choice Inc Medicare	$2.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.33

BACLOFEN 20 MG PO TABS [861]

Facility

$1.09

Service Code	NDC 00904647661
Hospital Charge Code	00904647661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

BACLOFEN 20 MG TAB

Facility

$0.17

Hospital Charge Code	41653287
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

BACLOFEN 20 MG TAB

Facility

$0.17

Hospital Charge Code	41643287
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

BACLOFEN SUSPENSION 5 MG/ML

Facility

$1.00

Hospital Charge Code	41645265
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BACLOFEN SUSPENSION 5 MG/ML

Facility

$1.00

Hospital Charge Code	41655265
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

$55,536.87

Service Code	MSDRG 095
Min. Negotiated Rate	$18,781.56
Max. Negotiated Rate	$55,536.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35,155.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40,390.45
Rate for Payer: Aetna Government	$40,390.45
Rate for Payer: Brighton Health Commercial	$34,570.90
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$41,198.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41,172.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$33,977.52
Rate for Payer: Elderplan Medicare Advantage	$38,370.93
Rate for Payer: EmblemHealth Commercial	$20,444.50
Rate for Payer: Fidelis Medicare Advantage	$40,390.45
Rate for Payer: Group Health Inc Commercial	$40,390.45
Rate for Payer: Group Health Inc Medicare	$40,390.45
Rate for Payer: Hamaspik Choice Inc Medicare	$40,390.45
Rate for Payer: Healthfirst Medicare Advantage	$18,781.56
Rate for Payer: Humana Medicare	$55,536.87
Rate for Payer: Senior Whole Health Medicare Advantage	$40,390.45
Rate for Payer: United Healthcare Commercial	$47,414.59
Rate for Payer: United Healthcare Medicare Advantage	$40,390.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40,390.45
Rate for Payer: Wellcare Medicare	$38,370.93

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

$79,152.18

Service Code	MSDRG 094
Min. Negotiated Rate	$26,767.83
Max. Negotiated Rate	$79,152.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53,416.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57,565.22
Rate for Payer: Aetna Government	$57,565.22
Rate for Payer: Brighton Health Commercial	$52,529.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$58,716.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62,560.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$51,627.53
Rate for Payer: Elderplan Medicare Advantage	$54,686.96
Rate for Payer: EmblemHealth Commercial	$31,064.70
Rate for Payer: Fidelis Medicare Advantage	$57,565.22
Rate for Payer: Group Health Inc Commercial	$57,565.22
Rate for Payer: Group Health Inc Medicare	$57,565.22
Rate for Payer: Hamaspik Choice Inc Medicare	$57,565.22
Rate for Payer: Healthfirst Medicare Advantage	$26,767.83
Rate for Payer: Humana Medicare	$79,152.18
Rate for Payer: Senior Whole Health Medicare Advantage	$57,565.22
Rate for Payer: United Healthcare Commercial	$72,044.63
Rate for Payer: United Healthcare Medicare Advantage	$57,565.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57,565.22
Rate for Payer: Wellcare Medicare	$54,686.96

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$51,637.55

Service Code	MSDRG 096
Min. Negotiated Rate	$17,462.88
Max. Negotiated Rate	$51,637.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32,139.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37,554.58
Rate for Payer: Aetna Government	$37,554.58
Rate for Payer: Brighton Health Commercial	$31,605.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$38,305.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37,641.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$31,063.17
Rate for Payer: Elderplan Medicare Advantage	$35,676.85
Rate for Payer: EmblemHealth Commercial	$18,690.90
Rate for Payer: Fidelis Medicare Advantage	$37,554.58
Rate for Payer: Group Health Inc Commercial	$37,554.58
Rate for Payer: Group Health Inc Medicare	$37,554.58
Rate for Payer: Hamaspik Choice Inc Medicare	$37,554.58
Rate for Payer: Healthfirst Medicare Advantage	$17,462.88
Rate for Payer: Humana Medicare	$51,637.55
Rate for Payer: Senior Whole Health Medicare Advantage	$37,554.58
Rate for Payer: United Healthcare Commercial	$43,347.69
Rate for Payer: United Healthcare Medicare Advantage	$37,554.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37,554.58
Rate for Payer: Wellcare Medicare	$35,676.85

Know your out-of-pocket cost for care.

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