St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BIOPSY-VULVA PERINEUM

Facility

$1,933.73

Service Code	HCPCS 56605
Hospital Charge Code	30302439
Hospital Revenue Code	510
Rate for Payer: Cash Price	$929.66

BIOPSY-VULVA PERINEUM

Facility

$1,933.73

Service Code	HCPCS 56605
Hospital Charge Code	30300027
Hospital Revenue Code	510
Rate for Payer: Cash Price	$929.66

BIOPSY-VULVA PERINEUM

Facility

$1,933.73

Service Code	HCPCS 56605
Hospital Charge Code	30302439
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$929.66
Rate for Payer: Aetna Government	$929.66
Rate for Payer: Affinity Essential Plan 1&2	$650.76
Rate for Payer: Affinity Essential Plan 3&4	$650.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$650.76
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$929.66
Rate for Payer: Cash Price	$929.66
Rate for Payer: Cash Price	$929.66
Rate for Payer: Cash Price	$929.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$929.66
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	$929.66
Rate for Payer: Fidelis Essential Plan Aliesa	$790.21
Rate for Payer: Fidelis Essential Plan QHP	$827.40
Rate for Payer: Fidelis Medicare Advantage	$929.66
Rate for Payer: Fidelis Qualified Health Plan	$827.40
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	$966.86
Rate for Payer: Hamaspik Choice Inc Medicare	$929.66
Rate for Payer: Healthfirst Medicare Advantage	$790.21
Rate for Payer: Healthfirst QHP	$929.66
Rate for Payer: Humana Medicare	$948.25
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$929.66
Rate for Payer: Senior Whole Health Medicare Advantage	$929.66
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$929.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$929.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$743.73
Rate for Payer: Wellcare Medicare	$883.18

BIOPSY-VULVA PERINEUM

Facility

$1,933.73

Service Code	HCPCS 56605
Hospital Charge Code	40010606
Hospital Revenue Code	360
Rate for Payer: Cash Price	$929.66

BIOPSY-VULVA PERINEUM

Facility

$1,933.73

Service Code	HCPCS 56605
Hospital Charge Code	30300027
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$929.66
Rate for Payer: Aetna Government	$929.66
Rate for Payer: Affinity Essential Plan 1&2	$650.76
Rate for Payer: Affinity Essential Plan 3&4	$650.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$650.76
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$929.66
Rate for Payer: Cash Price	$929.66
Rate for Payer: Cash Price	$929.66
Rate for Payer: Cash Price	$929.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$929.66
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	$929.66
Rate for Payer: Fidelis Essential Plan Aliesa	$790.21
Rate for Payer: Fidelis Essential Plan QHP	$827.40
Rate for Payer: Fidelis Medicare Advantage	$929.66
Rate for Payer: Fidelis Qualified Health Plan	$827.40
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	$966.86
Rate for Payer: Hamaspik Choice Inc Medicare	$929.66
Rate for Payer: Healthfirst Medicare Advantage	$790.21
Rate for Payer: Healthfirst QHP	$929.66
Rate for Payer: Humana Medicare	$948.25
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$929.66
Rate for Payer: Senior Whole Health Medicare Advantage	$929.66
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$929.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$929.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$743.73
Rate for Payer: Wellcare Medicare	$883.18

BIOPSY WIRE GUIDED CYTO BRUSH

Facility

$316.00

Hospital Charge Code	40200279
Hospital Revenue Code	270
Min. Negotiated Rate	$110.60
Max. Negotiated Rate	$252.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$173.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$158.00
Rate for Payer: Aetna Government	$158.00
Rate for Payer: Brighton Health Commercial	$237.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$252.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$214.88
Rate for Payer: Group Health Inc Commercial	$158.00
Rate for Payer: Group Health Inc Medicare	$110.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.00
Rate for Payer: Hamaspik Choice Inc Medicare	$158.00

BIO RINGLOC BI-POL

Facility

$3,002.27

Service Code	HCPCS C1776
Hospital Charge Code	40004052
Hospital Revenue Code	278
Min. Negotiated Rate	$1,501.14
Max. Negotiated Rate	$1,501.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,501.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1,501.14

BIO RINGLOC BI-POL

Facility

$3,002.27

Service Code	HCPCS C1776
Hospital Charge Code	40004052
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,152.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,651.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,801.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,501.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,726.31
Rate for Payer: EmblemHealth Commercial	$1,501.14
Rate for Payer: Fidelis Medicare Advantage	$3,152.38
Rate for Payer: Group Health Inc Commercial	$1,501.14
Rate for Payer: Group Health Inc Medicare	$1,050.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,501.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1,501.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,951.48

BIOTRON EDORA 8DR-T PACE 407145

Facility

$10,950.00

Service Code	HCPCS C1785
Hospital Charge Code	66573270
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$11,497.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,022.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
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

BIOTRON ELUNA 8 DR-T PACE 394929

Facility

$9,950.00

Service Code	HCPCS C1785
Hospital Charge Code	66576677
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$10,447.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,472.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$5,970.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,721.25
Rate for Payer: EmblemHealth Commercial	$4,975.00
Rate for Payer: Fidelis Medicare Advantage	$10,447.50
Rate for Payer: Group Health Inc Commercial	$4,975.00
Rate for Payer: Group Health Inc Medicare	$3,482.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,467.50

BIOTRON ELUNA 8DR-T PACE 394969

Facility

$9,950.00

Service Code	HCPCS C1785
Hospital Charge Code	66573250
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$10,447.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,472.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$5,970.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,721.25
Rate for Payer: EmblemHealth Commercial	$4,975.00
Rate for Payer: Fidelis Medicare Advantage	$10,447.50
Rate for Payer: Group Health Inc Commercial	$4,975.00
Rate for Payer: Group Health Inc Medicare	$3,482.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,467.50

BIOTRON ELUNA 8 SR-T PPM- 394971

Facility

$9,450.00

Service Code	HCPCS C1786
Hospital Charge Code	66573460
Hospital Revenue Code	275
Min. Negotiated Rate	$1,116.69
Max. Negotiated Rate	$9,922.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,197.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,116.69
Rate for Payer: Aetna Government	$1,116.69
Rate for Payer: Brighton Health Commercial	$5,670.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,725.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,433.75
Rate for Payer: EmblemHealth Commercial	$4,725.00
Rate for Payer: Fidelis Medicare Advantage	$9,922.50
Rate for Payer: Group Health Inc Commercial	$4,725.00
Rate for Payer: Group Health Inc Medicare	$3,307.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,725.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,142.50

BIOTRON ETRINSA 8 DR-T 394931

Facility

$8,300.00

Service Code	HCPCS C1785
Hospital Charge Code	66573341
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$8,715.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,565.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$4,980.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,772.50
Rate for Payer: EmblemHealth Commercial	$4,150.00
Rate for Payer: Fidelis Medicare Advantage	$8,715.00
Rate for Payer: Group Health Inc Commercial	$4,150.00
Rate for Payer: Group Health Inc Medicare	$2,905.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,395.00

BIOTRONIK ACTICOR VR

Facility

$32,500.00

Service Code	HCPCS C1722
Hospital Charge Code	66571492
Hospital Revenue Code	278
Min. Negotiated Rate	$16,250.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16,250.00

BIOTRONIK ACTICOR VR

Facility

$32,500.00

Service Code	HCPCS C1722
Hospital Charge Code	66571492
Hospital Revenue Code	278
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$34,125.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17,875.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$19,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$18,687.50
Rate for Payer: EmblemHealth Commercial	$16,250.00
Rate for Payer: Fidelis Medicare Advantage	$34,125.00
Rate for Payer: Group Health Inc Commercial	$16,250.00
Rate for Payer: Group Health Inc Medicare	$11,375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,125.00

BIOTRONIK EDORA 8 DR-T 407145

Facility

$10,950.00

Service Code	HCPCS C1785
Hospital Charge Code	66573149
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$11,497.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,022.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
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

BIOTRONIK ILIVIA 7 DR-T 404623

Facility

$28,500.00

Service Code	HCPCS C1721
Hospital Charge Code	66573165
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$29,925.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,675.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Brighton Health Commercial	$17,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16,387.50
Rate for Payer: EmblemHealth Commercial	$14,250.00
Rate for Payer: Fidelis Medicare Advantage	$29,925.00
Rate for Payer: Group Health Inc Commercial	$14,250.00
Rate for Payer: Group Health Inc Medicare	$9,975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18,525.00

BIOTRONIK INTICA ICD

Facility

$40,000.00

Service Code	HCPCS C1882
Hospital Charge Code	66571498
Hospital Revenue Code	275
Min. Negotiated Rate	$4,752.01
Max. Negotiated Rate	$42,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,000.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,752.01
Rate for Payer: Aetna Government	$4,752.01
Rate for Payer: Brighton Health Commercial	$24,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,000.00
Rate for Payer: EmblemHealth Commercial	$20,000.00
Rate for Payer: Fidelis Medicare Advantage	$42,000.00
Rate for Payer: Group Health Inc Commercial	$20,000.00
Rate for Payer: Group Health Inc Medicare	$14,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,000.00

BIOTRONIK IPERIA ICD 392423

Facility

$28,500.00

Service Code	HCPCS C1721
Hospital Charge Code	66576688
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$29,925.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,675.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Brighton Health Commercial	$17,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16,387.50
Rate for Payer: EmblemHealth Commercial	$14,250.00
Rate for Payer: Fidelis Medicare Advantage	$29,925.00
Rate for Payer: Group Health Inc Commercial	$14,250.00
Rate for Payer: Group Health Inc Medicare	$9,975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18,525.00

BIOTRONIK IPERIA VR-T 393032

Facility

$39,669.12

Service Code	HCPCS C1722
Hospital Charge Code	66576680
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$41,652.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,818.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$23,801.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,834.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,809.74
Rate for Payer: EmblemHealth Commercial	$19,834.56
Rate for Payer: Fidelis Medicare Advantage	$41,652.58
Rate for Payer: Group Health Inc Commercial	$19,834.56
Rate for Payer: Group Health Inc Medicare	$13,884.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,834.56
Rate for Payer: Hamaspik Choice Inc Medicare	$19,834.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,784.93

BIOTRONIK IVENTRA VRT-DX 399436

Facility

$26,600.00

Service Code	HCPCS C1722
Hospital Charge Code	66576690
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$27,930.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,630.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$15,960.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15,295.00
Rate for Payer: EmblemHealth Commercial	$13,300.00
Rate for Payer: Fidelis Medicare Advantage	$27,930.00
Rate for Payer: Group Health Inc Commercial	$13,300.00
Rate for Payer: Group Health Inc Medicare	$9,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$13,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17,290.00

BIOTRONIK LINOX SMART S 65CM

Facility

$6,700.00

Service Code	HCPCS C1777
Hospital Charge Code	66573258
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$7,035.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,685.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Brighton Health Commercial	$4,020.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,852.50
Rate for Payer: EmblemHealth Commercial	$3,350.00
Rate for Payer: Fidelis Medicare Advantage	$7,035.00
Rate for Payer: Group Health Inc Commercial	$3,350.00
Rate for Payer: Group Health Inc Medicare	$2,345.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,355.00

BIOTRONIK PK PAPYRUS COVERD STENT

Facility

$7,500.00

Service Code	HCPCS C1874
Hospital Charge Code	66521180
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00

BIOTRONIK PK PAPYRUS COVERD STENT

Facility

$7,500.00

Service Code	HCPCS C1874
Hospital Charge Code	66521180
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$7,875.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,125.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$4,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,312.50
Rate for Payer: EmblemHealth Commercial	$3,750.00
Rate for Payer: Fidelis Medicare Advantage	$7,875.00
Rate for Payer: Group Health Inc Commercial	$3,750.00
Rate for Payer: Group Health Inc Medicare	$2,625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,875.00

BIOTRONIK PLEXA MRI S65 402266

Facility

$7,100.00

Service Code	HCPCS C1777
Hospital Charge Code	66573164
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$7,455.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,905.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Brighton Health Commercial	$4,260.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,082.50
Rate for Payer: EmblemHealth Commercial	$3,550.00
Rate for Payer: Fidelis Medicare Advantage	$7,455.00
Rate for Payer: Group Health Inc Commercial	$3,550.00
Rate for Payer: Group Health Inc Medicare	$2,485.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,615.00

Know your out-of-pocket cost for care.

All Charges