St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SYSTEM PERI 1.25 145 SC

Facility

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905320
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$20,278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,668.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Brighton Health Commercial	$5,092.50
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,880.31
Rate for Payer: Elderplan Medicare Advantage	$20,278.00
Rate for Payer: EmblemHealth Commercial	$4,243.75
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,516.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40

SYSTEM PERI 1.50 145

Facility

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905318
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$4,243.75
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75

SYSTEM PERI 1.50 145

Facility

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905318
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$20,278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,668.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Brighton Health Commercial	$5,092.50
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,880.31
Rate for Payer: Elderplan Medicare Advantage	$20,278.00
Rate for Payer: EmblemHealth Commercial	$4,243.75
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,516.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40

SYSTEM PERI 1.50 145 SC

Facility

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905321
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$4,243.75
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75

SYSTEM PERI 1.50 145 SC

Facility

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905321
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$20,278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,668.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Brighton Health Commercial	$5,092.50
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,880.31
Rate for Payer: Elderplan Medicare Advantage	$20,278.00
Rate for Payer: EmblemHealth Commercial	$4,243.75
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,516.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40

SYSTEM PERI 2.00 145 SC

Facility

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905322
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$20,278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,668.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Brighton Health Commercial	$5,092.50
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,880.31
Rate for Payer: Elderplan Medicare Advantage	$20,278.00
Rate for Payer: EmblemHealth Commercial	$4,243.75
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,516.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40

SYSTEM PERI 2.00 145 SC

Facility

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905322
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$4,243.75
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75

SYSTEM PERI SALINE INFUS PUMP

Facility

$12,487.50

Hospital Charge Code	64905323
Hospital Revenue Code	279
Min. Negotiated Rate	$4,370.62
Max. Negotiated Rate	$9,990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,868.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,243.75
Rate for Payer: Aetna Government	$6,243.75
Rate for Payer: Brighton Health Commercial	$9,365.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,990.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,491.50
Rate for Payer: Group Health Inc Commercial	$6,243.75
Rate for Payer: Group Health Inc Medicare	$4,370.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$6,243.75

SYSTEM PERI VS LUB 100ML BAGS

Facility

$22.50

Hospital Charge Code	64905325
Hospital Revenue Code	279
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$18.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.25
Rate for Payer: Aetna Government	$11.25
Rate for Payer: Brighton Health Commercial	$16.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.30
Rate for Payer: Group Health Inc Commercial	$11.25
Rate for Payer: Group Health Inc Medicare	$7.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.25
Rate for Payer: Hamaspik Choice Inc Medicare	$11.25

SYSTEM PERI VTCK RADIOPAQ TAPE

Facility

$3,875.00

Hospital Charge Code	64905327
Hospital Revenue Code	279
Min. Negotiated Rate	$1,356.25
Max. Negotiated Rate	$3,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,131.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,937.50
Rate for Payer: Aetna Government	$1,937.50
Rate for Payer: Brighton Health Commercial	$2,906.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,635.00
Rate for Payer: Group Health Inc Commercial	$1,937.50
Rate for Payer: Group Health Inc Medicare	$1,356.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,937.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,937.50

SYSTEM PERI VWIRE ADV.014

Facility

$95.00

Hospital Charge Code	64905324
Hospital Revenue Code	279
Min. Negotiated Rate	$33.25
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.50
Rate for Payer: Aetna Government	$47.50
Rate for Payer: Brighton Health Commercial	$71.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.60
Rate for Payer: Group Health Inc Commercial	$47.50
Rate for Payer: Group Health Inc Medicare	$33.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.50
Rate for Payer: Hamaspik Choice Inc Medicare	$47.50

SYSTEM PERPLQ EXC DS DST VSL STD

Facility

$5,990.00

Hospital Charge Code	64906763
Hospital Revenue Code	279
Min. Negotiated Rate	$2,096.50
Max. Negotiated Rate	$4,792.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,294.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,995.00
Rate for Payer: Aetna Government	$2,995.00
Rate for Payer: Brighton Health Commercial	$4,492.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,792.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,073.20
Rate for Payer: Group Health Inc Commercial	$2,995.00
Rate for Payer: Group Health Inc Medicare	$2,096.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,995.00

SYSTEM SEALANT DURASEAL 5ML

Facility

$1,675.00

Hospital Charge Code	64904681
Hospital Revenue Code	270
Min. Negotiated Rate	$586.25
Max. Negotiated Rate	$1,340.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$921.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$837.50
Rate for Payer: Aetna Government	$837.50
Rate for Payer: Brighton Health Commercial	$1,256.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,340.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,139.00
Rate for Payer: Group Health Inc Commercial	$837.50
Rate for Payer: Group Health Inc Medicare	$586.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$837.50
Rate for Payer: Hamaspik Choice Inc Medicare	$837.50

SYSTEM SLING INCISON ALTIS7.75CML

Facility

$3,230.00

Service Code	HCPCS L8699
Hospital Charge Code	64906237
Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.00
Max. Negotiated Rate	$1,615.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,615.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,615.00

SYSTEM SLING INCISON ALTIS7.75CML

Facility

$3,230.00

Service Code	HCPCS L8699
Hospital Charge Code	64906237
Hospital Revenue Code	278
Min. Negotiated Rate	$1,130.50
Max. Negotiated Rate	$3,391.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,776.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,615.00
Rate for Payer: Aetna Government	$1,615.00
Rate for Payer: Brighton Health Commercial	$1,938.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,615.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,857.25
Rate for Payer: EmblemHealth Commercial	$1,615.00
Rate for Payer: Fidelis Medicare Advantage	$3,391.50
Rate for Payer: Group Health Inc Commercial	$1,615.00
Rate for Payer: Group Health Inc Medicare	$1,130.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,615.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,615.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,099.50

SYSTEM SPACER EXPANDABLE

Facility

$2.50

Hospital Charge Code	64907384
Hospital Revenue Code	270
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$2.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.25
Rate for Payer: Aetna Government	$1.25
Rate for Payer: Brighton Health Commercial	$1.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.70
Rate for Payer: Group Health Inc Commercial	$1.25
Rate for Payer: Group Health Inc Medicare	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1.25

SYSTEM,SPINAL VISTA-S 11X14

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64904880
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

SYSTEM,SPINAL VISTA-S 11X14

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64904880
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

SYSTEM STANDARD SNARE 27-45MM

Facility

$875.00

Hospital Charge Code	64902138
Hospital Revenue Code	270
Min. Negotiated Rate	$306.25
Max. Negotiated Rate	$700.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$481.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$437.50
Rate for Payer: Aetna Government	$437.50
Rate for Payer: Brighton Health Commercial	$656.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$595.00
Rate for Payer: Group Health Inc Commercial	$437.50
Rate for Payer: Group Health Inc Medicare	$306.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50

SYSTEM TISSUE MGT 10G

Facility

$159.56

Hospital Charge Code	41301572
Hospital Revenue Code	270
Min. Negotiated Rate	$55.85
Max. Negotiated Rate	$127.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$79.78
Rate for Payer: Aetna Government	$79.78
Rate for Payer: Brighton Health Commercial	$119.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.50
Rate for Payer: Group Health Inc Commercial	$79.78
Rate for Payer: Group Health Inc Medicare	$55.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.78
Rate for Payer: Hamaspik Choice Inc Medicare	$79.78

SYSTEM TOETAC FIXATION

Facility

$5,225.00

Hospital Charge Code	64907380
Hospital Revenue Code	279
Min. Negotiated Rate	$1,828.75
Max. Negotiated Rate	$4,180.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,873.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,612.50
Rate for Payer: Aetna Government	$2,612.50
Rate for Payer: Brighton Health Commercial	$3,918.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,553.00
Rate for Payer: Group Health Inc Commercial	$2,612.50
Rate for Payer: Group Health Inc Medicare	$1,828.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,612.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,612.50

SYSTEM TRUESPAN

Facility

$1,710.00

Hospital Charge Code	64907415
Hospital Revenue Code	270
Min. Negotiated Rate	$598.50
Max. Negotiated Rate	$1,368.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$940.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$855.00
Rate for Payer: Aetna Government	$855.00
Rate for Payer: Brighton Health Commercial	$1,282.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,368.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,162.80
Rate for Payer: Group Health Inc Commercial	$855.00
Rate for Payer: Group Health Inc Medicare	$598.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$855.00
Rate for Payer: Hamaspik Choice Inc Medicare	$855.00

SYSTEM TRUESPAN 12 DEGREE

Facility

$642.00

Hospital Charge Code	64906306
Hospital Revenue Code	270
Min. Negotiated Rate	$224.70
Max. Negotiated Rate	$513.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$353.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$321.00
Rate for Payer: Aetna Government	$321.00
Rate for Payer: Brighton Health Commercial	$481.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$513.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$436.56
Rate for Payer: Group Health Inc Commercial	$321.00
Rate for Payer: Group Health Inc Medicare	$224.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.00
Rate for Payer: Hamaspik Choice Inc Medicare	$321.00

SYSTEM TRUESPAN 24-DEGREE

Facility

$1,212.00

Hospital Charge Code	64906761
Hospital Revenue Code	279
Min. Negotiated Rate	$424.20
Max. Negotiated Rate	$969.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$666.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$606.00
Rate for Payer: Aetna Government	$606.00
Rate for Payer: Brighton Health Commercial	$909.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$969.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$824.16
Rate for Payer: Group Health Inc Commercial	$606.00
Rate for Payer: Group Health Inc Medicare	$424.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$606.00
Rate for Payer: Hamaspik Choice Inc Medicare	$606.00

SYSTEM URINE COLLECTION

Facility

$121.25

Hospital Charge Code	64901180
Hospital Revenue Code	270
Min. Negotiated Rate	$42.44
Max. Negotiated Rate	$97.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.62
Rate for Payer: Aetna Government	$60.62
Rate for Payer: Brighton Health Commercial	$90.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$97.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.45
Rate for Payer: Group Health Inc Commercial	$60.62
Rate for Payer: Group Health Inc Medicare	$42.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.62
Rate for Payer: Hamaspik Choice Inc Medicare	$60.62

Know your out-of-pocket cost for care.

All Charges