St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 4 MEQ/ML IV SOLN [7322]

Facility

$0.27

Service Code	NDC 63323009301
Hospital Charge Code	63323009301
Hospital Revenue Code	278
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

SODIUM CHLORIDE 4 MEQ/ML IV SOLN [7322]

Facility

$0.27

Service Code	NDC 63323009330
Hospital Charge Code	63323009330
Hospital Revenue Code	278
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

SODIUM CHLORIDE 4 MEQ/ML IV SOLN [7322]

Facility

$0.27

Service Code	NDC 63323009301
Hospital Charge Code	63323009301
Hospital Revenue Code	278
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Fidelis Medicare Advantage	$0.28
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

SODIUM CHLORIDE 5% OPHTHALMIC SOLN

Facility

$7.70

Hospital Charge Code	41643498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.85
Rate for Payer: Aetna Government	$3.85
Rate for Payer: Brighton Health Commercial	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: Group Health Inc Commercial	$3.85
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85
Rate for Payer: Hamaspik Choice Inc Medicare	$3.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.00

SODIUM CHLORIDE 5% OPHTHALMIC SOLN

Facility

$7.70

Hospital Charge Code	41653498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.85
Rate for Payer: Aetna Government	$3.85
Rate for Payer: Brighton Health Commercial	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: Group Health Inc Commercial	$3.85
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85
Rate for Payer: Hamaspik Choice Inc Medicare	$3.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.00

SODIUM CHLORIDE 7 % IN NEBU [82134]

Facility

$0.20

Service Code	NDC 00487900730
Hospital Charge Code	00487900730
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

SODIUM CHLORIDE 9%

Facility

$2.10

Hospital Charge Code	41657025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.05
Rate for Payer: Aetna Government	$1.05
Rate for Payer: Brighton Health Commercial	$1.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.43
Rate for Payer: Group Health Inc Commercial	$1.05
Rate for Payer: Group Health Inc Medicare	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.05
Rate for Payer: Hamaspik Choice Inc Medicare	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.36

SODIUM CHLORIDE BTL 0.9 250ML

Facility

$3.17

Hospital Charge Code	64902217
Hospital Revenue Code	270
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$2.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.58
Rate for Payer: Aetna Government	$1.58
Rate for Payer: Brighton Health Commercial	$2.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.16
Rate for Payer: Group Health Inc Commercial	$1.58
Rate for Payer: Group Health Inc Medicare	$1.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.58
Rate for Payer: Hamaspik Choice Inc Medicare	$1.58

SODIUM CHLORIDE (HYPERTONIC) 5 % OP SOLN [7332]

Facility

$0.35

Service Code	NDC 00536125494
Hospital Charge Code	00536125494
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

SODIUM CHLORIDE, IRRIG, 0.9 ,USP

Facility

$22.98

Hospital Charge Code	64902526
Hospital Revenue Code	270
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$18.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.49
Rate for Payer: Aetna Government	$11.49
Rate for Payer: Brighton Health Commercial	$17.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.63
Rate for Payer: Group Health Inc Commercial	$11.49
Rate for Payer: Group Health Inc Medicare	$8.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.49
Rate for Payer: Hamaspik Choice Inc Medicare	$11.49

SODIUM CHLORIDE (PF) 0.9 % IJ SOLN [168927]

Facility

$0.11

Service Code	NDC 00409488802
Hospital Charge Code	00409488802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

SODIUM CHLORIDE (PF) 0.9 % IJ SOLN [168927]

Facility

$0.11

Service Code	NDC 00409488810
Hospital Charge Code	00409488810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

SODIUM CHLORIDE (PF) 0.9 % IJ SOLN [168927]

Facility

$0.25

Service Code	NDC 00409488801
Hospital Charge Code	00409488801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

SODIUM CHLORIDE (PF) 0.9 % IJ SOLN [168927]

Facility

$0.12

Service Code	NDC 63323018610
Hospital Charge Code	63323018610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

SODIUM CHLORIDE (PF) 0.9 % IJ SOLN [168927]

Facility

$0.11

Service Code	NDC 63323018603
Hospital Charge Code	63323018603
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

SODIUM CHLORIDE (PF) 0.9 % IJ SOLN [168927]

Facility

$0.12

Service Code	NDC 63323018601
Hospital Charge Code	63323018601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

SODIUM CITRATE-CITRIC ACID LIQUID

Facility

$1.02

Hospital Charge Code	41653472
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
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	$0.69
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

SODIUM CITRATE-CITRIC ACID LIQUID

Facility

$1.02

Hospital Charge Code	41643472
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
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	$0.69
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

SODIUM, FECAL

Facility

$12.15

Service Code	HCPCS 84302
Hospital Charge Code	40609899
Hospital Revenue Code	301
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$9.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.86
Rate for Payer: Aetna Government	$4.86
Rate for Payer: Brighton Health Commercial	$9.11
Rate for Payer: Cash Price	$4.86
Rate for Payer: Cash Price	$4.86
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.86
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	$4.86
Rate for Payer: EmblemHealth Commercial	$4.86
Rate for Payer: Fidelis Essential Plan Aliesa	$4.13
Rate for Payer: Fidelis Essential Plan QHP	$4.33
Rate for Payer: Fidelis Medicare Advantage	$4.86
Rate for Payer: Fidelis Qualified Health Plan	$4.33
Rate for Payer: Group Health Inc Commercial	$4.86
Rate for Payer: Group Health Inc Medicare	$4.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.08
Rate for Payer: Hamaspik Choice Inc Medicare	$4.86
Rate for Payer: Healthfirst Medicare Advantage	$4.86
Rate for Payer: Healthfirst QHP	$4.86
Rate for Payer: Senior Whole Health Medicare Advantage	$4.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.89
Rate for Payer: Wellcare Medicare	$4.37

SODIUM, FECAL

Facility

$12.15

Service Code	HCPCS 84302
Hospital Charge Code	40609899
Hospital Revenue Code	301
Rate for Payer: Cash Price	$4.86

SODIUM HYALURONATE 1.4% INTRAOCULAR INJ

Facility

$78.00

Hospital Charge Code	41645037
Hospital Revenue Code	250
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$62.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.00
Rate for Payer: Aetna Government	$39.00
Rate for Payer: Brighton Health Commercial	$58.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.04
Rate for Payer: Group Health Inc Commercial	$39.00
Rate for Payer: Group Health Inc Medicare	$27.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.00
Rate for Payer: Hamaspik Choice Inc Medicare	$39.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.70

SODIUM HYALURONATE 1.4% INTRAOCULAR INJ

Facility

$78.00

Hospital Charge Code	41655037
Hospital Revenue Code	250
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$62.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.00
Rate for Payer: Aetna Government	$39.00
Rate for Payer: Brighton Health Commercial	$58.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.04
Rate for Payer: Group Health Inc Commercial	$39.00
Rate for Payer: Group Health Inc Medicare	$27.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.00
Rate for Payer: Hamaspik Choice Inc Medicare	$39.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.70

SODIUM HYALURONATE + CHONDROITIN INTRAOC

Facility

$345.00

Hospital Charge Code	41652066
Hospital Revenue Code	250
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$276.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.50
Rate for Payer: Aetna Government	$172.50
Rate for Payer: Brighton Health Commercial	$258.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$276.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

SODIUM HYALURONATE + CHONDROITIN INTRAOC

Facility

$345.00

Hospital Charge Code	41642066
Hospital Revenue Code	250
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$276.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.50
Rate for Payer: Aetna Government	$172.50
Rate for Payer: Brighton Health Commercial	$258.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$276.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$224.25

SODIUM HYALURONATE INTRA-ARTICULAR 8 MG/

Facility

$530.00

Hospital Charge Code	41644748
Hospital Revenue Code	250
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.00
Rate for Payer: Aetna Government	$265.00
Rate for Payer: Brighton Health Commercial	$397.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$424.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.40
Rate for Payer: Group Health Inc Commercial	$265.00
Rate for Payer: Group Health Inc Medicare	$185.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$265.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$344.50

Know your out-of-pocket cost for care.

All Charges