St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BAXTER FIBRIN SEALANT (TISSEEL)

Facility

$1,175.40

Service Code	HCPCS C9250
Hospital Charge Code	40209572
Hospital Revenue Code	636
Min. Negotiated Rate	$92.91
Max. Negotiated Rate	$764.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$646.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$132.73
Rate for Payer: Aetna Government	$132.73
Rate for Payer: Affinity Essential Plan 1&2	$92.91
Rate for Payer: Affinity Essential Plan 3&4	$92.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$92.91
Rate for Payer: Brighton Health Commercial	$705.24
Rate for Payer: Cash Price	$132.73
Rate for Payer: Cash Price	$132.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$132.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$587.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$675.86
Rate for Payer: Elderplan Medicare Advantage	$132.73
Rate for Payer: EmblemHealth Commercial	$132.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$132.73
Rate for Payer: Fidelis Essential Plan Aliesa	$132.73
Rate for Payer: Fidelis Essential Plan QHP	$139.37
Rate for Payer: Fidelis Medicare Advantage	$132.73
Rate for Payer: Fidelis Qualified Health Plan	$139.37
Rate for Payer: Group Health Inc Commercial	$132.73
Rate for Payer: Group Health Inc Medicare	$132.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$587.70
Rate for Payer: Hamaspik Choice Inc Medicare	$587.70
Rate for Payer: Healthfirst Medicare Advantage	$112.82
Rate for Payer: Healthfirst QHP	$132.73
Rate for Payer: Humana Medicare	$135.39
Rate for Payer: Senior Whole Health Medicare Advantage	$132.73
Rate for Payer: United Healthcare Commercial	$180.54
Rate for Payer: United Healthcare Medicare Advantage	$132.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$764.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$106.19
Rate for Payer: Wellcare Medicare	$126.10

BAXTER FIBRIN SEALANT (TISSEEL)

Facility

$1,175.40

Service Code	HCPCS C9250
Hospital Charge Code	40209572
Hospital Revenue Code	636
Min. Negotiated Rate	$587.70
Max. Negotiated Rate	$587.70
Rate for Payer: Cash Price	$132.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$587.70
Rate for Payer: Hamaspik Choice Inc Medicare	$587.70

BB-TAK THREADED 13226

Facility

$216.00

Hospital Charge Code	64906645
Hospital Revenue Code	270
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$172.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.00
Rate for Payer: Aetna Government	$108.00
Rate for Payer: Brighton Health Commercial	$162.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.88
Rate for Payer: Group Health Inc Commercial	$108.00
Rate for Payer: Group Health Inc Medicare	$75.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.00
Rate for Payer: Hamaspik Choice Inc Medicare	$108.00

BBT TRAUMA

Facility

$10,171.88

Hospital Charge Code	64902813
Hospital Revenue Code	279
Min. Negotiated Rate	$3,560.16
Max. Negotiated Rate	$8,137.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,594.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,085.94
Rate for Payer: Aetna Government	$5,085.94
Rate for Payer: Brighton Health Commercial	$7,628.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,137.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,916.88
Rate for Payer: Group Health Inc Commercial	$5,085.94
Rate for Payer: Group Health Inc Medicare	$3,560.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,085.94
Rate for Payer: Hamaspik Choice Inc Medicare	$5,085.94

B. BURGDORFERI IGG/IGM ABS,CSF

Facility

$42.58

Service Code	HCPCS 86618
Hospital Charge Code	40729351
Hospital Revenue Code	300
Rate for Payer: Cash Price	$17.03

B. BURGDORFERI IGG/IGM ABS,CSF

Facility

$42.58

Service Code	HCPCS 86618
Hospital Charge Code	40729351
Hospital Revenue Code	300
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$31.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.03
Rate for Payer: Aetna Government	$17.03
Rate for Payer: Affinity Essential Plan 1&2	$11.92
Rate for Payer: Affinity Essential Plan 3&4	$11.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.92
Rate for Payer: Brighton Health Commercial	$31.94
Rate for Payer: Cash Price	$17.03
Rate for Payer: Cash Price	$17.03
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.91
Rate for Payer: Elderplan Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$17.03
Rate for Payer: Fidelis Essential Plan Aliesa	$14.48
Rate for Payer: Fidelis Essential Plan QHP	$15.16
Rate for Payer: Fidelis Medicare Advantage	$17.03
Rate for Payer: Fidelis Qualified Health Plan	$15.16
Rate for Payer: Group Health Inc Commercial	$17.03
Rate for Payer: Group Health Inc Medicare	$17.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.29
Rate for Payer: Hamaspik Choice Inc Medicare	$17.03
Rate for Payer: Healthfirst Medicare Advantage	$17.03
Rate for Payer: Healthfirst QHP	$17.03
Rate for Payer: Humana Medicare	$17.37
Rate for Payer: Senior Whole Health Medicare Advantage	$17.03
Rate for Payer: United Healthcare Commercial	$21.57
Rate for Payer: United Healthcare Medicare Advantage	$17.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.62
Rate for Payer: Wellcare Medicare	$15.33

BCG LIVE 50 MG IS SUSR [21570]

Facility

$196.02

Service Code	HCPCS J9030
Hospital Charge Code	00052060202
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$156.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.85
Rate for Payer: Aetna Government	$2.85
Rate for Payer: Brighton Health Commercial	$147.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$156.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.29
Rate for Payer: Group Health Inc Commercial	$98.01
Rate for Payer: Group Health Inc Medicare	$68.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.01
Rate for Payer: Hamaspik Choice Inc Medicare	$98.01
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2.89
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$3.06
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$3.06
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.41

BCG VACCINE 50MG (NF)

Facility

$222.52

Service Code	HCPCS J3490
Hospital Charge Code	41649547
Hospital Revenue Code	636
Min. Negotiated Rate	$111.26
Max. Negotiated Rate	$111.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.26
Rate for Payer: Hamaspik Choice Inc Medicare	$111.26

BCG VACCINE 50MG (NF)

Facility

$222.52

Service Code	HCPCS J3490
Hospital Charge Code	41659547
Hospital Revenue Code	636
Min. Negotiated Rate	$111.26
Max. Negotiated Rate	$111.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.26
Rate for Payer: Hamaspik Choice Inc Medicare	$111.26

BCG VACCINE 50MG (NF)

Facility

$222.52

Service Code	HCPCS J3490
Hospital Charge Code	41659547
Hospital Revenue Code	636
Min. Negotiated Rate	$77.88
Max. Negotiated Rate	$144.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$111.26
Rate for Payer: Aetna Government	$111.26
Rate for Payer: Brighton Health Commercial	$133.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$111.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.95
Rate for Payer: Group Health Inc Commercial	$111.26
Rate for Payer: Group Health Inc Medicare	$77.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.26
Rate for Payer: Hamaspik Choice Inc Medicare	$111.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.64

BCG VACCINE 50MG (NF)

Facility

$222.52

Service Code	HCPCS J3490
Hospital Charge Code	41649547
Hospital Revenue Code	636
Min. Negotiated Rate	$77.88
Max. Negotiated Rate	$144.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$111.26
Rate for Payer: Aetna Government	$111.26
Rate for Payer: Brighton Health Commercial	$133.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$111.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.95
Rate for Payer: Group Health Inc Commercial	$111.26
Rate for Payer: Group Health Inc Medicare	$77.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.26
Rate for Payer: Hamaspik Choice Inc Medicare	$111.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.64

BCG VACCINE,PERCUTANEOUS

Facility

$56.70

Service Code	HCPCS 90585
Hospital Charge Code	30300148
Hospital Revenue Code	636
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.35
Rate for Payer: Hamaspik Choice Inc Medicare	$28.35

BCG VACCINE,PERCUTANEOUS

Facility

$56.70

Service Code	HCPCS 90585
Hospital Charge Code	30300148
Hospital Revenue Code	636
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$160.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$160.21
Rate for Payer: Aetna Government	$160.21
Rate for Payer: Brighton Health Commercial	$34.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.60
Rate for Payer: Group Health Inc Commercial	$28.35
Rate for Payer: Group Health Inc Medicare	$19.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.35
Rate for Payer: Hamaspik Choice Inc Medicare	$28.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.86

BCR/ABL1 GENE MAJOR BP

Facility

$409.90

Service Code	HCPCS 81206
Hospital Charge Code	30305425
Hospital Revenue Code	310
Min. Negotiated Rate	$114.77
Max. Negotiated Rate	$327.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$225.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.96
Rate for Payer: Aetna Government	$163.96
Rate for Payer: Affinity Essential Plan 1&2	$114.77
Rate for Payer: Affinity Essential Plan 3&4	$114.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$114.77
Rate for Payer: Brighton Health Commercial	$163.96
Rate for Payer: Cash Price	$163.96
Rate for Payer: Cash Price	$163.96
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$163.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$327.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.73
Rate for Payer: Elderplan Medicare Advantage	$163.96
Rate for Payer: EmblemHealth Commercial	$163.96
Rate for Payer: Fidelis Essential Plan Aliesa	$139.37
Rate for Payer: Fidelis Essential Plan QHP	$145.92
Rate for Payer: Fidelis Medicare Advantage	$163.96
Rate for Payer: Fidelis Qualified Health Plan	$145.92
Rate for Payer: Group Health Inc Commercial	$163.96
Rate for Payer: Group Health Inc Medicare	$163.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.95
Rate for Payer: Hamaspik Choice Inc Medicare	$163.96
Rate for Payer: Healthfirst Medicare Advantage	$163.96
Rate for Payer: Healthfirst QHP	$163.96
Rate for Payer: Humana Medicare	$167.24
Rate for Payer: Senior Whole Health Medicare Advantage	$163.96
Rate for Payer: United Healthcare Medicare Advantage	$163.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$131.17
Rate for Payer: Wellcare Medicare	$147.56

BCR/ABL1 GENE MAJOR BP

Facility

$409.90

Service Code	HCPCS 81206
Hospital Charge Code	30305425
Hospital Revenue Code	310
Rate for Payer: Cash Price	$163.96

BCR/ABL1 GENE MINOR BP

Facility

$362.10

Service Code	HCPCS 81207
Hospital Charge Code	30305426
Hospital Revenue Code	310
Rate for Payer: Cash Price	$144.84

BCR/ABL1 GENE MINOR BP

Facility

$362.10

Service Code	HCPCS 81207
Hospital Charge Code	30305426
Hospital Revenue Code	310
Min. Negotiated Rate	$101.39
Max. Negotiated Rate	$289.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$144.84
Rate for Payer: Aetna Government	$144.84
Rate for Payer: Affinity Essential Plan 1&2	$101.39
Rate for Payer: Affinity Essential Plan 3&4	$101.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$101.39
Rate for Payer: Brighton Health Commercial	$144.84
Rate for Payer: Cash Price	$144.84
Rate for Payer: Cash Price	$144.84
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$144.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$289.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$246.23
Rate for Payer: Elderplan Medicare Advantage	$144.84
Rate for Payer: EmblemHealth Commercial	$144.84
Rate for Payer: Fidelis Essential Plan Aliesa	$123.11
Rate for Payer: Fidelis Essential Plan QHP	$128.91
Rate for Payer: Fidelis Medicare Advantage	$144.84
Rate for Payer: Fidelis Qualified Health Plan	$128.91
Rate for Payer: Group Health Inc Commercial	$144.84
Rate for Payer: Group Health Inc Medicare	$144.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.05
Rate for Payer: Hamaspik Choice Inc Medicare	$144.84
Rate for Payer: Healthfirst Medicare Advantage	$144.84
Rate for Payer: Healthfirst QHP	$144.84
Rate for Payer: Humana Medicare	$147.74
Rate for Payer: Senior Whole Health Medicare Advantage	$144.84
Rate for Payer: United Healthcare Medicare Advantage	$144.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$115.87
Rate for Payer: Wellcare Medicare	$130.36

BD DEXA BONE/AXIAL HIP/PELV/SPINE

Facility

$339.45

Service Code	HCPCS 77080 TC
Hospital Charge Code	41101000
Hospital Revenue Code	320
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$186.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.14
Rate for Payer: Aetna Government	$127.14
Rate for Payer: Affinity Essential Plan 1&2	$89.00
Rate for Payer: Affinity Essential Plan 3&4	$89.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$89.00
Rate for Payer: Brighton Health Commercial	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$141.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.43
Rate for Payer: Elderplan Medicare Advantage	$127.14
Rate for Payer: EmblemHealth Commercial	$89.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$108.07
Rate for Payer: Fidelis Essential Plan Aliesa	$108.07
Rate for Payer: Fidelis Essential Plan QHP	$113.15
Rate for Payer: Fidelis Medicare Advantage	$127.14
Rate for Payer: Fidelis Qualified Health Plan	$113.15
Rate for Payer: Group Health Inc Commercial	$114.43
Rate for Payer: Group Health Inc Medicare	$114.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$127.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.43
Rate for Payer: Healthfirst Medicare Advantage	$127.14
Rate for Payer: Healthfirst QHP	$127.14
Rate for Payer: Humana Medicare	$129.68
Rate for Payer: Senior Whole Health Medicare Advantage	$127.14
Rate for Payer: United Healthcare Medicare Advantage	$127.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101.71
Rate for Payer: Wellcare Medicare	$120.78

BD DEXA BONE/AXIAL HIP/PELV/SPINE

Facility

$339.45

Service Code	HCPCS 77080 TC
Hospital Charge Code	41101000
Hospital Revenue Code	320
Rate for Payer: Cash Price	$127.14

BD DEXA BONE/PERI RAD/WRIST/HEEL

Facility

$241.73

Service Code	HCPCS 77081 TC
Hospital Charge Code	41101003
Hospital Revenue Code	320
Min. Negotiated Rate	$54.38
Max. Negotiated Rate	$132.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.08
Rate for Payer: Aetna Government	$105.08
Rate for Payer: Affinity Essential Plan 1&2	$73.56
Rate for Payer: Affinity Essential Plan 3&4	$73.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$73.56
Rate for Payer: Brighton Health Commercial	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.38
Rate for Payer: Elderplan Medicare Advantage	$105.08
Rate for Payer: EmblemHealth Commercial	$73.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$89.32
Rate for Payer: Fidelis Essential Plan Aliesa	$89.32
Rate for Payer: Fidelis Essential Plan QHP	$93.52
Rate for Payer: Fidelis Medicare Advantage	$105.08
Rate for Payer: Fidelis Qualified Health Plan	$93.52
Rate for Payer: Group Health Inc Commercial	$94.57
Rate for Payer: Group Health Inc Medicare	$94.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.86
Rate for Payer: Hamaspik Choice Inc Medicare	$105.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$94.57
Rate for Payer: Healthfirst Medicare Advantage	$105.08
Rate for Payer: Healthfirst QHP	$105.08
Rate for Payer: Humana Medicare	$107.18
Rate for Payer: Senior Whole Health Medicare Advantage	$105.08
Rate for Payer: United Healthcare Medicare Advantage	$105.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84.06
Rate for Payer: Wellcare Medicare	$99.83

BD DEXA BONE/PERI RAD/WRIST/HEEL

Facility

$241.73

Service Code	HCPCS 77081 TC
Hospital Charge Code	41101003
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

BEACON TIP ROYAL FLUSH PLUS

Facility

$49.00

Hospital Charge Code	64905085
Hospital Revenue Code	270
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.50
Rate for Payer: Aetna Government	$24.50
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50

BEARING 10MM VE L 4-11 EF

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905895
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

BEARING 10MM VE L 4-11 EF

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905895
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

BEARING ANATOMIC MENISCAL

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907423
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
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

Know your out-of-pocket cost for care.

All Charges