St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SET, THORACENTESIS

Facility

$7.46

Hospital Charge Code	64901014
Hospital Revenue Code	270
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$5.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.73
Rate for Payer: Aetna Government	$3.73
Rate for Payer: Brighton Health Commercial	$5.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.07
Rate for Payer: Group Health Inc Commercial	$3.73
Rate for Payer: Group Health Inc Medicare	$2.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.73
Rate for Payer: Hamaspik Choice Inc Medicare	$3.73

SET TUBIND STD BORE 7.6 NDLESS

Facility

$4.45

Hospital Charge Code	64902177
Hospital Revenue Code	270
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$3.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.22
Rate for Payer: Aetna Government	$2.22
Rate for Payer: Brighton Health Commercial	$3.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.03
Rate for Payer: Group Health Inc Commercial	$2.22
Rate for Payer: Group Health Inc Medicare	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.22
Rate for Payer: Hamaspik Choice Inc Medicare	$2.22

SET W/ PUMP SCROTAL 0 DEG CYL

Facility

$19,500.00

Service Code	HCPCS C1813
Hospital Charge Code	64902769
Hospital Revenue Code	278
Min. Negotiated Rate	$9,750.00
Max. Negotiated Rate	$9,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,750.00

SET W/ PUMP SCROTAL 0 DEG CYL

Facility

$19,500.00

Service Code	HCPCS C1813
Hospital Charge Code	64902769
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$20,475.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,725.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$11,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,212.50
Rate for Payer: EmblemHealth Commercial	$9,750.00
Rate for Payer: Fidelis Medicare Advantage	$20,475.00
Rate for Payer: Group Health Inc Commercial	$9,750.00
Rate for Payer: Group Health Inc Medicare	$6,825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,675.00

SEVELAMER 400 MG TAB

Facility

$3.06

Hospital Charge Code	41642634
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.53
Rate for Payer: Aetna Government	$1.53
Rate for Payer: Brighton Health Commercial	$2.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.08
Rate for Payer: Group Health Inc Commercial	$1.53
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.99

SEVELAMER 400 MG TAB

Facility

$3.06

Hospital Charge Code	41652634
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.53
Rate for Payer: Aetna Government	$1.53
Rate for Payer: Brighton Health Commercial	$2.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.08
Rate for Payer: Group Health Inc Commercial	$1.53
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.99

SEVELAMER 800 MG TAB

Facility

$6.12

Hospital Charge Code	41652646
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

SEVELAMER 800 MG TAB

Facility

$6.12

Hospital Charge Code	41642646
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

SEVELAMER CARBONATE 2.4 G PO PACK [99695]

Facility

$18.29

Service Code	NDC 65862093190
Hospital Charge Code	65862093190
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$14.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.14
Rate for Payer: Aetna Government	$9.14
Rate for Payer: Brighton Health Commercial	$13.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.43
Rate for Payer: Group Health Inc Commercial	$9.14
Rate for Payer: Group Health Inc Medicare	$6.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.14
Rate for Payer: Hamaspik Choice Inc Medicare	$9.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.89

SEVELAMER CARBONATE 2.4 G PO PACK [99695]

Facility

$18.29

Service Code	NDC 65862093108
Hospital Charge Code	65862093108
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$14.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.14
Rate for Payer: Aetna Government	$9.14
Rate for Payer: Brighton Health Commercial	$13.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.44
Rate for Payer: Group Health Inc Commercial	$9.14
Rate for Payer: Group Health Inc Medicare	$6.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.14
Rate for Payer: Hamaspik Choice Inc Medicare	$9.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.89

SEVELAMER CARBONATE 800 MG PO TABS [89201]

Facility

$2.22

Service Code	NDC 69097096793
Hospital Charge Code	69097096793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.11
Rate for Payer: Aetna Government	$1.11
Rate for Payer: Brighton Health Commercial	$1.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.51
Rate for Payer: Group Health Inc Commercial	$1.11
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11
Rate for Payer: Hamaspik Choice Inc Medicare	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.44

SEVELAMER CARBONATE 800 MG PO TABS [89201]

Facility

$6.10

Service Code	NDC 55111078927
Hospital Charge Code	55111078927
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

SEVELAMER CARBONATE 800 MG PO TABS [89201]

Facility

$2.22

Service Code	NDC 24979018646
Hospital Charge Code	24979018646
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.11
Rate for Payer: Aetna Government	$1.11
Rate for Payer: Brighton Health Commercial	$1.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.51
Rate for Payer: Group Health Inc Commercial	$1.11
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11
Rate for Payer: Hamaspik Choice Inc Medicare	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.44

SEVELAMER CARBONATE 800 MG PO TABS [89201]

Facility

$7.14

Service Code	NDC 58468013001
Hospital Charge Code	58468013001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.57
Rate for Payer: Aetna Government	$3.57
Rate for Payer: Brighton Health Commercial	$5.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.85
Rate for Payer: Group Health Inc Commercial	$3.57
Rate for Payer: Group Health Inc Medicare	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.57
Rate for Payer: Hamaspik Choice Inc Medicare	$3.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.64

SEVELAMER CARBONATE 800 MG PO TABS [89201]

Facility

$3.46

Service Code	NDC 00904670706
Hospital Charge Code	00904670706
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$2.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.73
Rate for Payer: Aetna Government	$1.73
Rate for Payer: Brighton Health Commercial	$2.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.35
Rate for Payer: Group Health Inc Commercial	$1.73
Rate for Payer: Group Health Inc Medicare	$1.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.73
Rate for Payer: Hamaspik Choice Inc Medicare	$1.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.25

SEVELAMER CARBONATE 800 MG PO TABS [89201]

Facility

$6.10

Service Code	NDC 65162005827
Hospital Charge Code	65162005827
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

SEVELAMER CARBONATE 800MG TAB

Facility

$1.15

Hospital Charge Code	41643892
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.58
Rate for Payer: Aetna Government	$0.58
Rate for Payer: Brighton Health Commercial	$0.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58
Rate for Payer: Hamaspik Choice Inc Medicare	$0.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.75

SEVELAMER CARBONATE 800MG TAB

Facility

$1.15

Hospital Charge Code	41653892
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.58
Rate for Payer: Aetna Government	$0.58
Rate for Payer: Brighton Health Commercial	$0.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58
Rate for Payer: Hamaspik Choice Inc Medicare	$0.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.75

SEVELAMER CARBONATE POWDER

Facility

$45.72

Hospital Charge Code	41640318
Hospital Revenue Code	250
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$36.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.86
Rate for Payer: Aetna Government	$22.86
Rate for Payer: Brighton Health Commercial	$34.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.09
Rate for Payer: Group Health Inc Commercial	$22.86
Rate for Payer: Group Health Inc Medicare	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.86
Rate for Payer: Hamaspik Choice Inc Medicare	$22.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.72

SEVELAMER CARBONATE POWDER

Facility

$45.72

Hospital Charge Code	41650318
Hospital Revenue Code	250
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$36.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.86
Rate for Payer: Aetna Government	$22.86
Rate for Payer: Brighton Health Commercial	$34.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.09
Rate for Payer: Group Health Inc Commercial	$22.86
Rate for Payer: Group Health Inc Medicare	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.86
Rate for Payer: Hamaspik Choice Inc Medicare	$22.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.72

SEVOFLURANE IN SOLN [15119]

Facility

$0.65

Service Code	NDC 10019065164
Hospital Charge Code	10019065164
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

SEX HORM BINDING GLOB, SERUM

Facility

$54.33

Service Code	HCPCS 84270
Hospital Charge Code	40609115
Hospital Revenue Code	300
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$40.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.73
Rate for Payer: Aetna Government	$21.73
Rate for Payer: Brighton Health Commercial	$40.75
Rate for Payer: Cash Price	$21.73
Rate for Payer: Cash Price	$21.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.24
Rate for Payer: Elderplan Medicare Advantage	$21.73
Rate for Payer: EmblemHealth Commercial	$21.73
Rate for Payer: Fidelis Essential Plan Aliesa	$18.47
Rate for Payer: Fidelis Essential Plan QHP	$19.34
Rate for Payer: Fidelis Medicare Advantage	$21.73
Rate for Payer: Fidelis Qualified Health Plan	$19.34
Rate for Payer: Group Health Inc Commercial	$21.73
Rate for Payer: Group Health Inc Medicare	$21.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.16
Rate for Payer: Hamaspik Choice Inc Medicare	$21.73
Rate for Payer: Healthfirst Medicare Advantage	$21.73
Rate for Payer: Healthfirst QHP	$21.73
Rate for Payer: Senior Whole Health Medicare Advantage	$21.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.38
Rate for Payer: Wellcare Medicare	$19.56

SEX HORM BINDING GLOB, SERUM

Facility

$54.33

Service Code	HCPCS 84270
Hospital Charge Code	40609115
Hospital Revenue Code	300
Rate for Payer: Cash Price	$21.73

SEX HORMONE BINDING GLOBULIN

Facility

$54.33

Service Code	HCPCS 84270
Hospital Charge Code	40608232
Hospital Revenue Code	301
Rate for Payer: Cash Price	$21.73

SEX HORMONE BINDING GLOBULIN

Facility

$54.33

Service Code	HCPCS 84270
Hospital Charge Code	40608232
Hospital Revenue Code	301
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$40.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.73
Rate for Payer: Aetna Government	$21.73
Rate for Payer: Brighton Health Commercial	$40.75
Rate for Payer: Cash Price	$21.73
Rate for Payer: Cash Price	$21.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.24
Rate for Payer: Elderplan Medicare Advantage	$21.73
Rate for Payer: EmblemHealth Commercial	$21.73
Rate for Payer: Fidelis Essential Plan Aliesa	$18.47
Rate for Payer: Fidelis Essential Plan QHP	$19.34
Rate for Payer: Fidelis Medicare Advantage	$21.73
Rate for Payer: Fidelis Qualified Health Plan	$19.34
Rate for Payer: Group Health Inc Commercial	$21.73
Rate for Payer: Group Health Inc Medicare	$21.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.16
Rate for Payer: Hamaspik Choice Inc Medicare	$21.73
Rate for Payer: Healthfirst Medicare Advantage	$21.73
Rate for Payer: Healthfirst QHP	$21.73
Rate for Payer: Senior Whole Health Medicare Advantage	$21.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.38
Rate for Payer: Wellcare Medicare	$19.56

Know your out-of-pocket cost for care.

All Charges