St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SENNA 8.6 MG TAB

Facility

$0.06

Hospital Charge Code	41644092
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

SENNA 8.6 MG TAB

Facility

$0.06

Hospital Charge Code	41654092
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

SENNOSIDES 8.6 MG PO TABS [11349]

Facility

$0.05

Service Code	NDC 00904725261
Hospital Charge Code	00904725261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

SENNOSIDES 8.6 MG PO TABS [11349]

Facility

$0.03

Service Code	NDC 57896045101
Hospital Charge Code	57896045101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

SENNOSIDES 8.6 MG PO TABS [11349]

Facility

$0.02

Service Code	NDC 49483008010
Hospital Charge Code	49483008010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

SENNOSIDES 8.6 MG PO TABS [11349]

Facility

$0.01

Service Code	NDC 00904672580
Hospital Charge Code	00904672580
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

SENNOSIDES 8.6 MG PO TABS [11349]

Facility

$0.08

Service Code	NDC 00904652261
Hospital Charge Code	00904652261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

SENN RETRACTOR SHARP DEL DBL END

Facility

$21.15

Hospital Charge Code	64905587
Hospital Revenue Code	270
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$16.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.58
Rate for Payer: Aetna Government	$10.58
Rate for Payer: Brighton Health Commercial	$15.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.38
Rate for Payer: Group Health Inc Commercial	$10.58
Rate for Payer: Group Health Inc Medicare	$7.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.58
Rate for Payer: Hamaspik Choice Inc Medicare	$10.58

SENORINEURAL ACUITY LEVEL TEST

Facility

$101.25

Service Code	HCPCS 92575
Hospital Charge Code	42004509
Hospital Revenue Code	471
Min. Negotiated Rate	$32.47
Max. Negotiated Rate	$158.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.38
Rate for Payer: Aetna Government	$46.38
Rate for Payer: Affinity Essential Plan 1&2	$32.47
Rate for Payer: Affinity Essential Plan 3&4	$32.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$32.47
Rate for Payer: Brighton Health Commercial	$75.94
Rate for Payer: Cash Price	$46.38
Rate for Payer: Cash Price	$46.38
Rate for Payer: Cash Price	$46.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$46.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.85
Rate for Payer: Elderplan Medicare Advantage	$46.38
Rate for Payer: EmblemHealth Commercial	$46.38
Rate for Payer: Fidelis Essential Plan Aliesa	$39.42
Rate for Payer: Fidelis Essential Plan QHP	$41.28
Rate for Payer: Fidelis Medicare Advantage	$46.38
Rate for Payer: Fidelis Qualified Health Plan	$41.28
Rate for Payer: Group Health Inc Commercial	$46.38
Rate for Payer: Group Health Inc Medicare	$46.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.62
Rate for Payer: Hamaspik Choice Inc Medicare	$46.38
Rate for Payer: Healthfirst Medicare Advantage	$39.42
Rate for Payer: Healthfirst QHP	$46.38
Rate for Payer: Humana Medicare	$47.31
Rate for Payer: Senior Whole Health Medicare Advantage	$46.38
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$46.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.10
Rate for Payer: Wellcare Medicare	$44.06

SENORINEURAL ACUITY LEVEL TEST

Facility

$101.25

Service Code	HCPCS 92575
Hospital Charge Code	42004509
Hospital Revenue Code	471
Rate for Payer: Cash Price	$46.38

SENSIA PACEMAKER

Facility

$7,484.00

Service Code	HCPCS C1786
Hospital Charge Code	66574668
Hospital Revenue Code	275
Min. Negotiated Rate	$1,116.69
Max. Negotiated Rate	$7,858.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,116.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,116.69
Rate for Payer: Aetna Government	$1,116.69
Rate for Payer: Brighton Health Commercial	$4,490.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,742.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,303.30
Rate for Payer: EmblemHealth Commercial	$3,742.00
Rate for Payer: Fidelis Medicare Advantage	$7,858.20
Rate for Payer: Group Health Inc Commercial	$3,742.00
Rate for Payer: Group Health Inc Medicare	$2,619.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,742.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,742.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,864.60

SENSIA SEDRO 1 PACEMAKER

Facility

$10,600.00

Service Code	HCPCS C2621
Hospital Charge Code	40209641
Hospital Revenue Code	275
Min. Negotiated Rate	$3,640.47
Max. Negotiated Rate	$11,130.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,830.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,640.47
Rate for Payer: Aetna Government	$3,640.47
Rate for Payer: Brighton Health Commercial	$6,360.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,095.00
Rate for Payer: EmblemHealth Commercial	$5,300.00
Rate for Payer: Fidelis Medicare Advantage	$11,130.00
Rate for Payer: Group Health Inc Commercial	$5,300.00
Rate for Payer: Group Health Inc Medicare	$3,710.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,890.00

SENSITIVITY TEST SOLUTION FT-12

Facility

$117.10

Hospital Charge Code	64903045
Hospital Revenue Code	270
Min. Negotiated Rate	$40.98
Max. Negotiated Rate	$93.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$58.55
Rate for Payer: Aetna Government	$58.55
Rate for Payer: Brighton Health Commercial	$87.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.63
Rate for Payer: Group Health Inc Commercial	$58.55
Rate for Payer: Group Health Inc Medicare	$40.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.55
Rate for Payer: Hamaspik Choice Inc Medicare	$58.55

SENSOR ACUMEN IQ

Facility

$217.50

Hospital Charge Code	64907174
Hospital Revenue Code	270
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$174.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.75
Rate for Payer: Aetna Government	$108.75
Rate for Payer: Brighton Health Commercial	$163.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$147.90
Rate for Payer: Group Health Inc Commercial	$108.75
Rate for Payer: Group Health Inc Medicare	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.75
Rate for Payer: Hamaspik Choice Inc Medicare	$108.75

SENSOR, ADHESIVE, ADULT, 18IN 1U

Facility

$18.13

Hospital Charge Code	64906205
Hospital Revenue Code	270
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$14.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.06
Rate for Payer: Aetna Government	$9.06
Rate for Payer: Brighton Health Commercial	$13.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.33
Rate for Payer: Group Health Inc Commercial	$9.06
Rate for Payer: Group Health Inc Medicare	$6.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.06
Rate for Payer: Hamaspik Choice Inc Medicare	$9.06

SENSOR, ADHESIVE, NEO / ADULT 1U

Facility

$14.38

Hospital Charge Code	64906211
Hospital Revenue Code	270
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$11.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.19
Rate for Payer: Aetna Government	$7.19
Rate for Payer: Brighton Health Commercial	$10.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Group Health Inc Commercial	$7.19
Rate for Payer: Group Health Inc Medicare	$5.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.19
Rate for Payer: Hamaspik Choice Inc Medicare	$7.19

SENSOR, ADHESIVE, NEONATAL,RD SET

Facility

$89.12

Hospital Charge Code	64902155
Hospital Revenue Code	270
Min. Negotiated Rate	$31.19
Max. Negotiated Rate	$71.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.56
Rate for Payer: Aetna Government	$44.56
Rate for Payer: Brighton Health Commercial	$66.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.60
Rate for Payer: Group Health Inc Commercial	$44.56
Rate for Payer: Group Health Inc Medicare	$31.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.56
Rate for Payer: Hamaspik Choice Inc Medicare	$44.56

SENSOR, ADHESIVE, PEDI, 18IN 1U

Facility

$23.75

Hospital Charge Code	64906207
Hospital Revenue Code	270
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$19.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.88
Rate for Payer: Aetna Government	$11.88
Rate for Payer: Brighton Health Commercial	$17.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.15
Rate for Payer: Group Health Inc Commercial	$11.88
Rate for Payer: Group Health Inc Medicare	$8.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.88
Rate for Payer: Hamaspik Choice Inc Medicare	$11.88

SENSOR, ADHESIVE, PEDI, 3',SNGL

Facility

$475.00

Hospital Charge Code	64906208
Hospital Revenue Code	270
Min. Negotiated Rate	$166.25
Max. Negotiated Rate	$380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$237.50
Rate for Payer: Aetna Government	$237.50
Rate for Payer: Brighton Health Commercial	$356.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$380.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.00
Rate for Payer: Group Health Inc Commercial	$237.50
Rate for Payer: Group Health Inc Medicare	$166.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.50
Rate for Payer: Hamaspik Choice Inc Medicare	$237.50

SENSOR DISPOSABLE NEOTEMP A

Facility

$10.00

Hospital Charge Code	64903431
Hospital Revenue Code	270
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

SENSOR DISPOSABLE NEOTEMP B

Facility

$10.00

Hospital Charge Code	64903433
Hospital Revenue Code	270
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

SENSOR DISPOSABLE NEOTEMP C

Facility

$22.50

Hospital Charge Code	64903435
Hospital Revenue Code	270
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$18.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.25
Rate for Payer: Aetna Government	$11.25
Rate for Payer: Brighton Health Commercial	$16.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.30
Rate for Payer: Group Health Inc Commercial	$11.25
Rate for Payer: Group Health Inc Medicare	$7.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.25
Rate for Payer: Hamaspik Choice Inc Medicare	$11.25

SENSOR ELITE

Facility

$13.12

Hospital Charge Code	64907175
Hospital Revenue Code	270
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$10.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.56
Rate for Payer: Aetna Government	$6.56
Rate for Payer: Brighton Health Commercial	$9.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.92
Rate for Payer: Group Health Inc Commercial	$6.56
Rate for Payer: Group Health Inc Medicare	$4.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.56
Rate for Payer: Hamaspik Choice Inc Medicare	$6.56

SENSOR FLOTRAC AC SENSOR

Facility

$832.00

Hospital Charge Code	64901649
Hospital Revenue Code	270
Min. Negotiated Rate	$291.20
Max. Negotiated Rate	$665.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$457.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$416.00
Rate for Payer: Aetna Government	$416.00
Rate for Payer: Brighton Health Commercial	$624.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$665.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$565.76
Rate for Payer: Group Health Inc Commercial	$416.00
Rate for Payer: Group Health Inc Medicare	$291.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$416.00
Rate for Payer: Hamaspik Choice Inc Medicare	$416.00

SENSOR, INFANT, ADHES, M-LNCS 18

Facility

$23.75

Hospital Charge Code	64906209
Hospital Revenue Code	270
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$19.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.88
Rate for Payer: Aetna Government	$11.88
Rate for Payer: Brighton Health Commercial	$17.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.15
Rate for Payer: Group Health Inc Commercial	$11.88
Rate for Payer: Group Health Inc Medicare	$8.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.88
Rate for Payer: Hamaspik Choice Inc Medicare	$11.88

Know your out-of-pocket cost for care.

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