St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SPINAL PROCEDURES WITH MCC

Facility

$104,064.72

Service Code	MSDRG 028
Min. Negotiated Rate	$42,265.75
Max. Negotiated Rate	$104,064.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88,854.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$90,894.09
Rate for Payer: Aetna Government	$90,894.09
Rate for Payer: Brighton Health Commercial	$87,378.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$92,711.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104,064.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$85,878.67
Rate for Payer: Elderplan Medicare Advantage	$86,349.39
Rate for Payer: EmblemHealth Commercial	$51,673.80
Rate for Payer: Fidelis Medicare Advantage	$90,894.09
Rate for Payer: Group Health Inc Commercial	$90,894.09
Rate for Payer: Group Health Inc Medicare	$90,894.09
Rate for Payer: Hamaspik Choice Inc Medicare	$90,894.09
Rate for Payer: Healthfirst Medicare Advantage	$42,265.75
Rate for Payer: Senior Whole Health Medicare Advantage	$90,894.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$90,894.09
Rate for Payer: Wellcare Medicare	$86,349.39

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$40,276.04

Service Code	MSDRG 030
Min. Negotiated Rate	$18,361.13
Max. Negotiated Rate	$40,276.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34,193.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39,486.31
Rate for Payer: Aetna Government	$39,486.31
Rate for Payer: Brighton Health Commercial	$33,625.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$40,276.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40,046.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$33,048.35
Rate for Payer: Elderplan Medicare Advantage	$37,511.99
Rate for Payer: EmblemHealth Commercial	$19,885.40
Rate for Payer: Fidelis Medicare Advantage	$39,486.31
Rate for Payer: Group Health Inc Commercial	$39,486.31
Rate for Payer: Group Health Inc Medicare	$39,486.31
Rate for Payer: Hamaspik Choice Inc Medicare	$39,486.31
Rate for Payer: Healthfirst Medicare Advantage	$18,361.13
Rate for Payer: Senior Whole Health Medicare Advantage	$39,486.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39,486.31
Rate for Payer: Wellcare Medicare	$37,511.99

SPINAL PROSTHES COFLEX 12MM

Facility

$13,125.00

Service Code	HCPCS C1776
Hospital Charge Code	64905212
Hospital Revenue Code	278
Min. Negotiated Rate	$6,562.50
Max. Negotiated Rate	$6,562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6,562.50

SPINAL PROSTHES COFLEX 12MM

Facility

$13,125.00

Service Code	HCPCS C1776
Hospital Charge Code	64905212
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$13,781.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,218.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$7,875.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,562.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,546.88
Rate for Payer: EmblemHealth Commercial	$6,562.50
Rate for Payer: Fidelis Medicare Advantage	$13,781.25
Rate for Payer: Group Health Inc Commercial	$6,562.50
Rate for Payer: Group Health Inc Medicare	$4,593.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6,562.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,531.25

SPINAL PUNCT DRAIN CEBROSPINE FLU

Facility

$1,893.13

Service Code	HCPCS 62272
Hospital Charge Code	30305793
Hospital Revenue Code	450
Rate for Payer: Cash Price	$799.72

SPINAL PUNCT DRAIN CEBROSPINE FLU

Facility

$1,893.13

Service Code	HCPCS 62272
Hospital Charge Code	30105793
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.72
Rate for Payer: Aetna Government	$799.72
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$799.72
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.72
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	$799.72
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$679.76
Rate for Payer: Fidelis Essential Plan QHP	$711.75
Rate for Payer: Fidelis Medicare Advantage	$799.72
Rate for Payer: Fidelis Qualified Health Plan	$711.75
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	$946.56
Rate for Payer: Hamaspik Choice Inc Medicare	$799.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$799.72
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$799.72
Rate for Payer: Senior Whole Health Medicare Advantage	$799.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$639.78
Rate for Payer: Wellcare Medicare	$759.73

SPINAL PUNCT DRAIN CEBROSPINE FLU

Facility

$1,893.13

Service Code	HCPCS 62272
Hospital Charge Code	30305793
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.72
Rate for Payer: Aetna Government	$799.72
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$799.72
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.72
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	$799.72
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$679.76
Rate for Payer: Fidelis Essential Plan QHP	$711.75
Rate for Payer: Fidelis Medicare Advantage	$799.72
Rate for Payer: Fidelis Qualified Health Plan	$711.75
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	$946.56
Rate for Payer: Hamaspik Choice Inc Medicare	$799.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$799.72
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$799.72
Rate for Payer: Senior Whole Health Medicare Advantage	$799.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$639.78
Rate for Payer: Wellcare Medicare	$759.73

SPINAL PUNCT DRAIN CEBROSPINE FLU

Facility

$1,893.13

Service Code	HCPCS 62272
Hospital Charge Code	30105793
Hospital Revenue Code	450
Rate for Payer: Cash Price	$799.72

Spinal puncture, lumbar, diagnostic;

Facility

$2,915.00

Service Code	CPT 62270
Hospital Revenue Code	361
Min. Negotiated Rate	$639.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.72
Rate for Payer: Aetna Government	$799.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.72
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	$799.72
Rate for Payer: EmblemHealth Commercial	$799.72
Rate for Payer: Fidelis Essential Plan Aliesa	$679.76
Rate for Payer: Fidelis Essential Plan QHP	$711.75
Rate for Payer: Fidelis Medicare Advantage	$799.72
Rate for Payer: Fidelis Qualified Health Plan	$711.75
Rate for Payer: Group Health Inc Commercial	$799.72
Rate for Payer: Group Health Inc Medicare	$799.72
Rate for Payer: Hamaspik Choice Inc Medicare	$799.72
Rate for Payer: Healthfirst Medicare Advantage	$679.76
Rate for Payer: Healthfirst QHP	$799.72
Rate for Payer: Senior Whole Health Medicare Advantage	$799.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$639.78
Rate for Payer: Wellcare Medicare	$759.73

SPINAL RODS 3.5-6.OMM

Facility

$905.40

Service Code	HCPCS C1713
Hospital Charge Code	40205805
Hospital Revenue Code	278
Min. Negotiated Rate	$452.70
Max. Negotiated Rate	$452.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$452.70
Rate for Payer: Hamaspik Choice Inc Medicare	$452.70

SPINAL RODS 3.5-6.OMM

Facility

$905.40

Service Code	HCPCS C1713
Hospital Charge Code	40205805
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$950.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$497.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$543.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$452.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.60
Rate for Payer: EmblemHealth Commercial	$452.70
Rate for Payer: Fidelis Medicare Advantage	$950.67
Rate for Payer: Group Health Inc Commercial	$452.70
Rate for Payer: Group Health Inc Medicare	$316.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$452.70
Rate for Payer: Hamaspik Choice Inc Medicare	$452.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$588.51

SPINAL RODS 6.0MM

Facility

$3,297.63

Service Code	HCPCS C1713
Hospital Charge Code	40205262
Hospital Revenue Code	278
Min. Negotiated Rate	$1,648.82
Max. Negotiated Rate	$1,648.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,648.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,648.82

SPINAL RODS 6.0MM

Facility

$3,297.63

Service Code	HCPCS C1713
Hospital Charge Code	40205262
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,462.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,813.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,978.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,648.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,896.14
Rate for Payer: EmblemHealth Commercial	$1,648.82
Rate for Payer: Fidelis Medicare Advantage	$3,462.51
Rate for Payer: Group Health Inc Commercial	$1,648.82
Rate for Payer: Group Health Inc Medicare	$1,154.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,648.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,648.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,143.46

SPINAL SPACER 11X11X5MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64904215
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,250.00

SPINAL SPACER 11X11X5MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64904215
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,725.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,475.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,587.50
Rate for Payer: EmblemHealth Commercial	$2,250.00
Rate for Payer: Fidelis Medicare Advantage	$4,725.00
Rate for Payer: Group Health Inc Commercial	$2,250.00
Rate for Payer: Group Health Inc Medicare	$1,575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,925.00

SPINAL TRAY W 25 GA NEEDLE

Facility

$36.38

Hospital Charge Code	64903806
Hospital Revenue Code	270
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$29.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.19
Rate for Payer: Aetna Government	$18.19
Rate for Payer: Brighton Health Commercial	$27.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.74
Rate for Payer: Group Health Inc Commercial	$18.19
Rate for Payer: Group Health Inc Medicare	$12.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.19
Rate for Payer: Hamaspik Choice Inc Medicare	$18.19

SPINE HEALOS11 BONE GFT STP 16ML

Facility

$5,270.00

Service Code	HCPCS C1713
Hospital Charge Code	40209114
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,533.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,898.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,162.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,635.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,030.25
Rate for Payer: EmblemHealth Commercial	$2,635.00
Rate for Payer: Fidelis Medicare Advantage	$5,533.50
Rate for Payer: Group Health Inc Commercial	$2,635.00
Rate for Payer: Group Health Inc Medicare	$1,844.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,635.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,635.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,425.50

SPINE HEALOS11 BONE GFT STP 16ML

Facility

$5,270.00

Service Code	HCPCS C1713
Hospital Charge Code	40209114
Hospital Revenue Code	278
Min. Negotiated Rate	$2,635.00
Max. Negotiated Rate	$2,635.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,635.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,635.00

SPINE HEALOSLL BON GRFT STRPS16ML

Facility

$5,040.00

Service Code	HCPCS C1713
Hospital Charge Code	40009114
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,292.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,772.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,024.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,898.00
Rate for Payer: EmblemHealth Commercial	$2,520.00
Rate for Payer: Fidelis Medicare Advantage	$5,292.00
Rate for Payer: Group Health Inc Commercial	$2,520.00
Rate for Payer: Group Health Inc Medicare	$1,764.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,520.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,520.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,276.00

SPINE HEALOSLL BON GRFT STRPS16ML

Facility

$5,040.00

Service Code	HCPCS C1713
Hospital Charge Code	40009114
Hospital Revenue Code	278
Min. Negotiated Rate	$2,520.00
Max. Negotiated Rate	$2,520.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,520.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,520.00

SPINE IMPLANT CERV 17MM H

Facility

$10,950.00

Service Code	HCPCS C1776
Hospital Charge Code	64905047
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$11,497.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,022.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$6,570.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,475.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,296.25
Rate for Payer: EmblemHealth Commercial	$5,475.00
Rate for Payer: Fidelis Medicare Advantage	$11,497.50
Rate for Payer: Group Health Inc Commercial	$5,475.00
Rate for Payer: Group Health Inc Medicare	$3,832.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,475.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,117.50

SPINE IMPLANT CERV 17MM H

Facility

$10,950.00

Service Code	HCPCS C1776
Hospital Charge Code	64905047
Hospital Revenue Code	278
Min. Negotiated Rate	$5,475.00
Max. Negotiated Rate	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,475.00

SP INFUSION OF CATH FIBRIN SHEATH

Facility

$937.70

Service Code	HCPCS 36593 TC
Hospital Charge Code	41561835
Hospital Revenue Code	361
Min. Negotiated Rate	$328.20
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$515.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$468.85
Rate for Payer: Aetna Government	$468.85
Rate for Payer: Brighton Health Commercial	$703.28
Rate for Payer: Cash Price	$391.64
Rate for Payer: Cash Price	$391.64
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: Group Health Inc Commercial	$468.85
Rate for Payer: Group Health Inc Medicare	$328.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$468.85
Rate for Payer: Hamaspik Choice Inc Medicare	$468.85

SP INFUSION OF CATH FIBRIN SHEATH

Facility

$937.70

Service Code	HCPCS 36593 TC
Hospital Charge Code	41561835
Hospital Revenue Code	361
Rate for Payer: Cash Price	$391.64

SP INJ CHOLANGIO EXT CATH

Facility

$9,417.43

Service Code	HCPCS 47531 TC
Hospital Charge Code	41548038
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$7,063.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,179.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,708.72
Rate for Payer: Aetna Government	$4,708.72
Rate for Payer: Brighton Health Commercial	$7,063.07
Rate for Payer: Cash Price	$4,000.83
Rate for Payer: Cash Price	$4,000.83
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: Group Health Inc Commercial	$4,708.72
Rate for Payer: Group Health Inc Medicare	$3,296.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,708.72
Rate for Payer: Hamaspik Choice Inc Medicare	$4,708.72

Know your out-of-pocket cost for care.

All Charges