St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

S NON LOCKING SCRW 3.5X18MM

Facility

$112.00

Service Code	HCPCS C1776
Hospital Charge Code	40205022
Hospital Revenue Code	278
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00

S NON LOCKING SCRW 3.5X18MM

Facility

$112.00

Service Code	HCPCS C1776
Hospital Charge Code	40205022
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$67.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.40
Rate for Payer: EmblemHealth Commercial	$56.00
Rate for Payer: Fidelis Medicare Advantage	$117.60
Rate for Payer: Group Health Inc Commercial	$56.00
Rate for Payer: Group Health Inc Medicare	$39.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.80

S&N OXINUM 36MM+12/14 TAPER HEAD

Facility

$3,936.00

Service Code	HCPCS C1776
Hospital Charge Code	40006500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,968.00
Max. Negotiated Rate	$1,968.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,968.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,968.00

S&N OXINUM 36MM+12/14 TAPER HEAD

Facility

$3,936.00

Service Code	HCPCS C1776
Hospital Charge Code	40006500
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,132.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,164.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,361.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,968.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,263.20
Rate for Payer: EmblemHealth Commercial	$1,968.00
Rate for Payer: Fidelis Medicare Advantage	$4,132.80
Rate for Payer: Group Health Inc Commercial	$1,968.00
Rate for Payer: Group Health Inc Medicare	$1,377.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,968.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,968.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,558.40

S&N RESURF PATELLAR 32MMX7.5MM

Facility

$3,210.00

Service Code	HCPCS C1776
Hospital Charge Code	40006507
Hospital Revenue Code	278
Min. Negotiated Rate	$1,605.00
Max. Negotiated Rate	$1,605.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,605.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,605.00

S&N RESURF PATELLAR 32MMX7.5MM

Facility

$3,210.00

Service Code	HCPCS C1776
Hospital Charge Code	40006507
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,370.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,765.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,926.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,605.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,845.75
Rate for Payer: EmblemHealth Commercial	$1,605.00
Rate for Payer: Fidelis Medicare Advantage	$3,370.50
Rate for Payer: Group Health Inc Commercial	$1,605.00
Rate for Payer: Group Health Inc Medicare	$1,123.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,605.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,605.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,086.50

S/N TROCAR K-WIRE

Facility

$49.58

Hospital Charge Code	40205817
Hospital Revenue Code	270
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$39.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.79
Rate for Payer: Aetna Government	$24.79
Rate for Payer: Brighton Health Commercial	$37.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.71
Rate for Payer: Group Health Inc Commercial	$24.79
Rate for Payer: Group Health Inc Medicare	$17.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.79
Rate for Payer: Hamaspik Choice Inc Medicare	$24.79

SOBIOPSY SOFT TISSUE NECK/THROAT

Facility

$4,157.25

Service Code	HCPCS 21550
Hospital Charge Code	30306660
Hospital Revenue Code	510
Min. Negotiated Rate	$233.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
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	$1,874.89
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst Medicare Advantage	$1,593.66
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

SOBIOPSY SOFT TISSUE NECK/THROAT

Facility

$4,157.25

Service Code	HCPCS 21550
Hospital Charge Code	30306660
Hospital Revenue Code	510
Rate for Payer: Cash Price	$1,874.89

SOD BICARB 4% 5ML VIAL

Facility

$11.52

Hospital Charge Code	41646492
Hospital Revenue Code	250
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$9.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.76
Rate for Payer: Aetna Government	$5.76
Rate for Payer: Brighton Health Commercial	$8.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.83
Rate for Payer: Group Health Inc Commercial	$5.76
Rate for Payer: Group Health Inc Medicare	$4.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.76
Rate for Payer: Hamaspik Choice Inc Medicare	$5.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.49

SOD BICARB 4% 5ML VIAL

Facility

$11.52

Hospital Charge Code	41656492
Hospital Revenue Code	250
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$9.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.76
Rate for Payer: Aetna Government	$5.76
Rate for Payer: Brighton Health Commercial	$8.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.83
Rate for Payer: Group Health Inc Commercial	$5.76
Rate for Payer: Group Health Inc Medicare	$4.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.76
Rate for Payer: Hamaspik Choice Inc Medicare	$5.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.49

SOD CHLORIDE 7% 4ML INH

Facility

$0.42

Hospital Charge Code	41658438
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

SOD CHLORIDE 7% 4ML INH

Facility

$0.42

Hospital Charge Code	41648438
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN [11394]

Facility

$0.19

Service Code	NDC 00121119000
Hospital Charge Code	00121119000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
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	$0.12

SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN [11394]

Facility

$0.19

Service Code	NDC 00121119030
Hospital Charge Code	00121119030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
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	$0.12

SOD HYALURONATE 23MG/ML 0.6ML

Facility

$127.50

Hospital Charge Code	41659549
Hospital Revenue Code	250
Min. Negotiated Rate	$44.62
Max. Negotiated Rate	$102.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.75
Rate for Payer: Aetna Government	$63.75
Rate for Payer: Brighton Health Commercial	$95.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.70
Rate for Payer: Group Health Inc Commercial	$63.75
Rate for Payer: Group Health Inc Medicare	$44.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.75
Rate for Payer: Hamaspik Choice Inc Medicare	$63.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.88

SOD HYALURONATE 23MG/ML 0.6ML

Facility

$127.50

Hospital Charge Code	41649549
Hospital Revenue Code	250
Min. Negotiated Rate	$44.62
Max. Negotiated Rate	$102.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.75
Rate for Payer: Aetna Government	$63.75
Rate for Payer: Brighton Health Commercial	$95.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.70
Rate for Payer: Group Health Inc Commercial	$63.75
Rate for Payer: Group Health Inc Medicare	$44.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.75
Rate for Payer: Hamaspik Choice Inc Medicare	$63.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.88

SOD HYPOCHLORITE 0.125% TOP SOLN

Facility

$18.00

Hospital Charge Code	41655977
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$14.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.00
Rate for Payer: Aetna Government	$9.00
Rate for Payer: Brighton Health Commercial	$13.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.24
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

SOD HYPOCHLORITE 0.125% TOP SOLN

Facility

$18.00

Hospital Charge Code	41645977
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$14.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.00
Rate for Payer: Aetna Government	$9.00
Rate for Payer: Brighton Health Commercial	$13.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.24
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

SODIUM

Facility

$12.03

Service Code	HCPCS 84295
Hospital Charge Code	40602060
Hospital Revenue Code	301
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$9.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.81
Rate for Payer: Aetna Government	$4.81
Rate for Payer: Brighton Health Commercial	$9.02
Rate for Payer: Cash Price	$4.81
Rate for Payer: Cash Price	$4.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.47
Rate for Payer: Elderplan Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$4.81
Rate for Payer: Fidelis Essential Plan Aliesa	$4.09
Rate for Payer: Fidelis Essential Plan QHP	$4.28
Rate for Payer: Fidelis Medicare Advantage	$4.81
Rate for Payer: Fidelis Qualified Health Plan	$4.28
Rate for Payer: Group Health Inc Commercial	$4.81
Rate for Payer: Group Health Inc Medicare	$4.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$4.81
Rate for Payer: Healthfirst Medicare Advantage	$4.81
Rate for Payer: Healthfirst QHP	$4.81
Rate for Payer: Senior Whole Health Medicare Advantage	$4.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.85
Rate for Payer: Wellcare Medicare	$4.33

SODIUM

Facility

$12.03

Service Code	HCPCS 84295
Hospital Charge Code	40602060
Hospital Revenue Code	301
Rate for Payer: Cash Price	$4.81

SODIUM 24 HOUR URINE

Facility

$12.65

Service Code	HCPCS 84300
Hospital Charge Code	40602625
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$9.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.06
Rate for Payer: Aetna Government	$5.06
Rate for Payer: Brighton Health Commercial	$9.49
Rate for Payer: Cash Price	$5.06
Rate for Payer: Cash Price	$5.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.54
Rate for Payer: Elderplan Medicare Advantage	$5.06
Rate for Payer: EmblemHealth Commercial	$5.06
Rate for Payer: Fidelis Essential Plan Aliesa	$4.30
Rate for Payer: Fidelis Essential Plan QHP	$4.50
Rate for Payer: Fidelis Medicare Advantage	$5.06
Rate for Payer: Fidelis Qualified Health Plan	$4.50
Rate for Payer: Group Health Inc Commercial	$5.06
Rate for Payer: Group Health Inc Medicare	$5.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.32
Rate for Payer: Hamaspik Choice Inc Medicare	$5.06
Rate for Payer: Healthfirst Medicare Advantage	$5.06
Rate for Payer: Healthfirst QHP	$5.06
Rate for Payer: Senior Whole Health Medicare Advantage	$5.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.05
Rate for Payer: Wellcare Medicare	$4.55

SODIUM 24 HOUR URINE

Facility

$12.65

Service Code	HCPCS 84300
Hospital Charge Code	40602625
Hospital Revenue Code	301
Rate for Payer: Cash Price	$5.06

SODIUM ACETATE 2 MEQ/ML INJ

Facility

$1.20

Hospital Charge Code	41653926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.60
Rate for Payer: Aetna Government	$0.60
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.78

SODIUM ACETATE 2 MEQ/ML INJ

Facility

$1.20

Hospital Charge Code	41643926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.60
Rate for Payer: Aetna Government	$0.60
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.78

Know your out-of-pocket cost for care.

All Charges