St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SLEEVE UNITRAX V40 )MM STD

Facility

$603.00

Service Code	HCPCS C1713
Hospital Charge Code	64901457
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$633.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$331.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$361.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$301.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$346.72
Rate for Payer: EmblemHealth Commercial	$301.50
Rate for Payer: Fidelis Medicare Advantage	$633.15
Rate for Payer: Group Health Inc Commercial	$301.50
Rate for Payer: Group Health Inc Medicare	$211.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$301.50
Rate for Payer: Hamaspik Choice Inc Medicare	$301.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$391.95

SLIDE HEMOCULT/SERACULT

Facility

$1.03

Hospital Charge Code	64901887
Hospital Revenue Code	270
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: Group Health Inc Commercial	$0.52
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.52
Rate for Payer: Hamaspik Choice Inc Medicare	$0.52

SLIDE MICRO FROSTED

Facility

$1.94

Hospital Charge Code	64901296
Hospital Revenue Code	270
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.32
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97

SLIDE MICRO MAILER

Facility

$2.77

Hospital Charge Code	64901926
Hospital Revenue Code	270
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.88
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38

SLIMLINE EZ 365MM

Facility

$847.08

Hospital Charge Code	64904460
Hospital Revenue Code	270
Min. Negotiated Rate	$296.48
Max. Negotiated Rate	$677.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$465.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$423.54
Rate for Payer: Aetna Government	$423.54
Rate for Payer: Brighton Health Commercial	$635.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$677.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$576.01
Rate for Payer: Group Health Inc Commercial	$423.54
Rate for Payer: Group Health Inc Medicare	$296.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$423.54
Rate for Payer: Hamaspik Choice Inc Medicare	$423.54

SLIMLINE EZ LASER FIBER-365

Facility

$2,140.00

Hospital Charge Code	40201001
Hospital Revenue Code	270
Min. Negotiated Rate	$749.00
Max. Negotiated Rate	$1,712.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,177.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,070.00
Rate for Payer: Aetna Government	$1,070.00
Rate for Payer: Brighton Health Commercial	$1,605.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,712.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,455.20
Rate for Payer: Group Health Inc Commercial	$1,070.00
Rate for Payer: Group Health Inc Medicare	$749.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,070.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,070.00

SLING ADVANT-FIT TRASNVAG SYST

Facility

$606.38

Hospital Charge Code	64904834
Hospital Revenue Code	270
Min. Negotiated Rate	$212.23
Max. Negotiated Rate	$485.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$333.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$303.19
Rate for Payer: Aetna Government	$303.19
Rate for Payer: Brighton Health Commercial	$454.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$485.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$412.34
Rate for Payer: Group Health Inc Commercial	$303.19
Rate for Payer: Group Health Inc Medicare	$212.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.19
Rate for Payer: Hamaspik Choice Inc Medicare	$303.19

SLING-FEMALE STRESS INCONT

Facility

$12,937.43

Service Code	HCPCS 57288
Hospital Charge Code	40129502
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,751.94

SLING-FEMALE STRESS INCONT

Facility

$12,937.43

Service Code	HCPCS 57288
Hospital Charge Code	40129502
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$9,703.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,751.94
Rate for Payer: Aetna Government	$5,751.94
Rate for Payer: Brighton Health Commercial	$9,703.07
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5,751.94
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	$5,751.94
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$4,889.15
Rate for Payer: Fidelis Essential Plan QHP	$5,119.23
Rate for Payer: Fidelis Medicare Advantage	$5,751.94
Rate for Payer: Fidelis Qualified Health Plan	$5,119.23
Rate for Payer: Group Health Inc Commercial	$5,751.94
Rate for Payer: Group Health Inc Medicare	$5,751.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,468.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5,751.94
Rate for Payer: Healthfirst Medicare Advantage	$4,889.15
Rate for Payer: Healthfirst QHP	$5,751.94
Rate for Payer: Senior Whole Health Medicare Advantage	$5,751.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,751.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,601.55
Rate for Payer: Wellcare Medicare	$5,464.34

SLING-MALE INCONTINENCE

Facility

$24,435.75

Service Code	HCPCS 53440
Hospital Charge Code	40129500
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$18,326.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14,844.80
Rate for Payer: Aetna Government	$14,844.80
Rate for Payer: Brighton Health Commercial	$18,326.81
Rate for Payer: Cash Price	$14,844.80
Rate for Payer: Cash Price	$14,844.80
Rate for Payer: Cash Price	$14,844.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14,844.80
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	$14,844.80
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$12,618.08
Rate for Payer: Fidelis Essential Plan QHP	$13,211.87
Rate for Payer: Fidelis Medicare Advantage	$14,844.80
Rate for Payer: Fidelis Qualified Health Plan	$13,211.87
Rate for Payer: Group Health Inc Commercial	$14,844.80
Rate for Payer: Group Health Inc Medicare	$14,844.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,217.88
Rate for Payer: Hamaspik Choice Inc Medicare	$14,844.80
Rate for Payer: Healthfirst Medicare Advantage	$12,618.08
Rate for Payer: Healthfirst QHP	$14,844.80
Rate for Payer: Senior Whole Health Medicare Advantage	$14,844.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,844.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11,875.84
Rate for Payer: Wellcare Medicare	$14,102.56

SLING-MALE INCONTINENCE

Facility

$24,435.75

Service Code	HCPCS 53440
Hospital Charge Code	40129500
Hospital Revenue Code	360
Rate for Payer: Cash Price	$14,844.80

SLIPPER ADULT XLG BEIGE SS

Facility

$1.56

Hospital Charge Code	64902119
Hospital Revenue Code	270
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$1.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.06
Rate for Payer: Group Health Inc Commercial	$0.78
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78

SLIPPERS GREEN UNIVERSAL

Facility

$2.49

Hospital Charge Code	64901875
Hospital Revenue Code	270
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$1.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.69
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24

SLIPPERS MEDIUM

Facility

$2.96

Hospital Charge Code	64901138
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$2.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$2.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.01
Rate for Payer: Group Health Inc Commercial	$1.48
Rate for Payer: Group Health Inc Medicare	$1.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.48
Rate for Payer: Hamaspik Choice Inc Medicare	$1.48

SLIPPERS TODDLER AQUA SZ.6.5-13

Facility

$1.33

Hospital Charge Code	64901510
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.67
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67
Rate for Payer: Hamaspik Choice Inc Medicare	$0.67

SLIPPERS YOUTH SZ.9-13 CRANBERRY

Facility

$1.33

Hospital Charge Code	64901512
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.67
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67
Rate for Payer: Hamaspik Choice Inc Medicare	$0.67

SLIPPER TERRY RUBBER SOLE ADLT

Facility

$8.72

Hospital Charge Code	64903396
Hospital Revenue Code	270
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$6.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.36
Rate for Payer: Aetna Government	$4.36
Rate for Payer: Brighton Health Commercial	$6.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.93
Rate for Payer: Group Health Inc Commercial	$4.36
Rate for Payer: Group Health Inc Medicare	$3.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.36
Rate for Payer: Hamaspik Choice Inc Medicare	$4.36

SLIPPER TERRY RUBBER SOLE ADULT

Facility

$8.74

Hospital Charge Code	64903393
Hospital Revenue Code	270
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$6.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.37
Rate for Payer: Aetna Government	$4.37
Rate for Payer: Brighton Health Commercial	$6.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.94
Rate for Payer: Group Health Inc Commercial	$4.37
Rate for Payer: Group Health Inc Medicare	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.37
Rate for Payer: Hamaspik Choice Inc Medicare	$4.37

SLITTING OF PREPUCE (EXCEPT NB)

Facility

$5,365.58

Service Code	HCPCS 54001
Hospital Charge Code	30105923
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,355.42
Rate for Payer: Aetna Government	$2,355.42
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$2,355.42
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,355.42
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	$2,355.42
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,002.11
Rate for Payer: Fidelis Essential Plan QHP	$2,096.32
Rate for Payer: Fidelis Medicare Advantage	$2,355.42
Rate for Payer: Fidelis Qualified Health Plan	$2,096.32
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,355.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$2,355.42
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2,355.42
Rate for Payer: Senior Whole Health Medicare Advantage	$2,355.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,355.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,884.34
Rate for Payer: Wellcare Medicare	$2,237.65

SLITTING OF PREPUCE (EXCEPT NB)

Facility

$5,365.58

Service Code	HCPCS 54001
Hospital Charge Code	30305923
Hospital Revenue Code	450
Rate for Payer: Cash Price	$2,355.42

SLITTING OF PREPUCE (EXCEPT NB)

Facility

$5,365.58

Service Code	HCPCS 54001
Hospital Charge Code	30305923
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,355.42
Rate for Payer: Aetna Government	$2,355.42
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$2,355.42
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,355.42
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	$2,355.42
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,002.11
Rate for Payer: Fidelis Essential Plan QHP	$2,096.32
Rate for Payer: Fidelis Medicare Advantage	$2,355.42
Rate for Payer: Fidelis Qualified Health Plan	$2,096.32
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,355.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$2,355.42
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2,355.42
Rate for Payer: Senior Whole Health Medicare Advantage	$2,355.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,355.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,884.34
Rate for Payer: Wellcare Medicare	$2,237.65

SLITTING OF PREPUCE (EXCEPT NB)

Facility

$5,365.58

Service Code	HCPCS 54001
Hospital Charge Code	30105923
Hospital Revenue Code	450
Rate for Payer: Cash Price	$2,355.42

SLOTTED MALLET

Facility

$1,368.00

Service Code	HCPCS C1713
Hospital Charge Code	40006157
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,436.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$752.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$820.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$684.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$786.60
Rate for Payer: EmblemHealth Commercial	$684.00
Rate for Payer: Fidelis Medicare Advantage	$1,436.40
Rate for Payer: Group Health Inc Commercial	$684.00
Rate for Payer: Group Health Inc Medicare	$478.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$684.00
Rate for Payer: Hamaspik Choice Inc Medicare	$684.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$889.20

SLOTTED MALLET

Facility

$1,368.00

Service Code	HCPCS C1713
Hospital Charge Code	40006157
Hospital Revenue Code	278
Min. Negotiated Rate	$684.00
Max. Negotiated Rate	$684.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$684.00
Rate for Payer: Hamaspik Choice Inc Medicare	$684.00

SLP STUDY, UNATTENDED

Facility

$419.03

Service Code	HCPCS 95800 TC
Hospital Charge Code	30304505
Hospital Revenue Code	510
Rate for Payer: Cash Price	$180.64

Know your out-of-pocket cost for care.

All Charges