St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TERBUTALINE 2.5 MG TAB

Facility

$0.45

Hospital Charge Code	41644091
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

TERBUTALINE 2.5 MG TAB

Facility

$0.45

Hospital Charge Code	41654091
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

TERBUTALINE SULFATE 1 MG/ML IJ SOLN [11507]

Facility

$4.80

Service Code	HCPCS J3105
Hospital Charge Code	00143974601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$6.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.26
Rate for Payer: Group Health Inc Commercial	$2.40
Rate for Payer: Group Health Inc Medicare	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.09
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$6.45
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$6.45
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$6.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

TERBUTALINE SULFATE 1 MG/ML IJ SOLN [11507]

Facility

$23.64

Service Code	HCPCS J3105
Hospital Charge Code	63323066501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$18.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$17.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.08
Rate for Payer: Group Health Inc Commercial	$11.82
Rate for Payer: Group Health Inc Medicare	$8.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.82
Rate for Payer: Hamaspik Choice Inc Medicare	$11.82
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.09
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$6.45
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$6.45
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$6.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.37

TERBUTALINE SULFATE 1 MG/ML IJ SOLN [11507]

Facility

$4.80

Service Code	HCPCS J3105
Hospital Charge Code	00143974610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$6.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.26
Rate for Payer: Group Health Inc Commercial	$2.40
Rate for Payer: Group Health Inc Medicare	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.09
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$6.45
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$6.45
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$6.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

TERBUTALINE SULFATE 2.5 MG PO TABS [11508]

Facility

$5.44

Service Code	NDC 00527131801
Hospital Charge Code	00527131801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.72
Rate for Payer: Aetna Government	$2.72
Rate for Payer: Brighton Health Commercial	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.70
Rate for Payer: Group Health Inc Commercial	$2.72
Rate for Payer: Group Health Inc Medicare	$1.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.72
Rate for Payer: Hamaspik Choice Inc Medicare	$2.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.54

TERBUTALINE SULFATE 2.5 MG PO TABS [11508]

Facility

$5.44

Service Code	NDC 00115261101
Hospital Charge Code	00115261101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.72
Rate for Payer: Aetna Government	$2.72
Rate for Payer: Brighton Health Commercial	$4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.70
Rate for Payer: Group Health Inc Commercial	$2.72
Rate for Payer: Group Health Inc Medicare	$1.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.72
Rate for Payer: Hamaspik Choice Inc Medicare	$2.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.54

TERUMO 6FR DESTIION SLENDER SHEAT

Facility

$887.50

Hospital Charge Code	66520511
Hospital Revenue Code	270
Min. Negotiated Rate	$310.62
Max. Negotiated Rate	$710.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$488.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$443.75
Rate for Payer: Aetna Government	$443.75
Rate for Payer: Brighton Health Commercial	$665.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$710.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$603.50
Rate for Payer: Group Health Inc Commercial	$443.75
Rate for Payer: Group Health Inc Medicare	$310.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$443.75
Rate for Payer: Hamaspik Choice Inc Medicare	$443.75

TERUMO FINECROSS MICROCATHETER

Facility

$850.00

Hospital Charge Code	66572916
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$680.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$467.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$425.00
Rate for Payer: Aetna Government	$425.00
Rate for Payer: Brighton Health Commercial	$637.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$680.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$578.00
Rate for Payer: Group Health Inc Commercial	$425.00
Rate for Payer: Group Health Inc Medicare	$297.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$425.00
Rate for Payer: Hamaspik Choice Inc Medicare	$425.00

TERUMO FR.11 PINN SHEATH

Facility

$194.00

Hospital Charge Code	40208132
Hospital Revenue Code	270
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$155.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$97.00
Rate for Payer: Aetna Government	$97.00
Rate for Payer: Brighton Health Commercial	$145.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.92
Rate for Payer: Group Health Inc Commercial	$97.00
Rate for Payer: Group Health Inc Medicare	$67.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.00
Rate for Payer: Hamaspik Choice Inc Medicare	$97.00

TERUMO GLIDEWIRE 0.035 X 260CM

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	66520510
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$656.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$312.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$359.38
Rate for Payer: EmblemHealth Commercial	$312.50
Rate for Payer: Fidelis Medicare Advantage	$656.25
Rate for Payer: Group Health Inc Commercial	$312.50
Rate for Payer: Group Health Inc Medicare	$218.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$312.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$406.25

TERUMO GLIDEWIRE 0.035 X 260CM

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	66520510
Hospital Revenue Code	278
Min. Negotiated Rate	$312.50
Max. Negotiated Rate	$312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$312.50

TERUMO GLIDEWIRE 150CM ANGLED

Facility

$61.52

Service Code	HCPCS C1713
Hospital Charge Code	40206280
Hospital Revenue Code	278
Min. Negotiated Rate	$21.53
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$36.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.37
Rate for Payer: EmblemHealth Commercial	$30.76
Rate for Payer: Fidelis Medicare Advantage	$64.60
Rate for Payer: Group Health Inc Commercial	$30.76
Rate for Payer: Group Health Inc Medicare	$21.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.76
Rate for Payer: Hamaspik Choice Inc Medicare	$30.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.99

TERUMO GLIDEWIRE 150CM ANGLED

Facility

$61.52

Service Code	HCPCS C1713
Hospital Charge Code	40206280
Hospital Revenue Code	278
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.76
Rate for Payer: Hamaspik Choice Inc Medicare	$30.76

TERUMO GUIDE WIRE .035X150CM

Facility

$61.40

Service Code	HCPCS C1769
Hospital Charge Code	40205598
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$64.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$36.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.30
Rate for Payer: EmblemHealth Commercial	$30.70
Rate for Payer: Fidelis Medicare Advantage	$64.47
Rate for Payer: Group Health Inc Commercial	$30.70
Rate for Payer: Group Health Inc Medicare	$21.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.70
Rate for Payer: Hamaspik Choice Inc Medicare	$30.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.91

TERUMO GUIDE WIRE .035X150CM

Facility

$61.40

Service Code	HCPCS C1769
Hospital Charge Code	40205598
Hospital Revenue Code	278
Min. Negotiated Rate	$30.70
Max. Negotiated Rate	$30.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.70
Rate for Payer: Hamaspik Choice Inc Medicare	$30.70

TERUMO PINNACLE INTO SHEATH

Facility

$19.00

Service Code	HCPCS C1894
Hospital Charge Code	40206283
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$19.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$11.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.92
Rate for Payer: EmblemHealth Commercial	$9.50
Rate for Payer: Fidelis Medicare Advantage	$19.95
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.35

TERUMO PINNACLE INTO SHEATH

Facility

$19.00

Service Code	HCPCS C1894
Hospital Charge Code	40206283
Hospital Revenue Code	278
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

TERUMO RF GILDECATH COBRA 4FR

Facility

$103.50

Service Code	HCPCS C1887
Hospital Charge Code	40208127
Hospital Revenue Code	278
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$51.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.75
Rate for Payer: Hamaspik Choice Inc Medicare	$51.75

TERUMO RF GILDECATH COBRA 4FR

Facility

$103.50

Service Code	HCPCS C1887
Hospital Charge Code	40208127
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$108.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$62.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.51
Rate for Payer: EmblemHealth Commercial	$51.75
Rate for Payer: Fidelis Medicare Advantage	$108.68
Rate for Payer: Group Health Inc Commercial	$51.75
Rate for Payer: Group Health Inc Medicare	$36.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.75
Rate for Payer: Hamaspik Choice Inc Medicare	$51.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.28

TEST CHECK STREP A BD

Facility

$113.28

Hospital Charge Code	64903271
Hospital Revenue Code	270
Min. Negotiated Rate	$39.65
Max. Negotiated Rate	$90.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.64
Rate for Payer: Aetna Government	$56.64
Rate for Payer: Brighton Health Commercial	$84.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.03
Rate for Payer: Group Health Inc Commercial	$56.64
Rate for Payer: Group Health Inc Medicare	$39.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.64
Rate for Payer: Hamaspik Choice Inc Medicare	$56.64

TESTES PROCEDURES WITH CC/MCC

Facility

$37,502.27

Service Code	MSDRG 711
Min. Negotiated Rate	$17,096.62
Max. Negotiated Rate	$37,502.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31,302.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36,766.93
Rate for Payer: Aetna Government	$36,766.93
Rate for Payer: Brighton Health Commercial	$30,782.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$37,502.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36,660.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$30,253.70
Rate for Payer: Elderplan Medicare Advantage	$34,928.58
Rate for Payer: EmblemHealth Commercial	$18,203.90
Rate for Payer: Fidelis Medicare Advantage	$36,766.93
Rate for Payer: Group Health Inc Commercial	$36,766.93
Rate for Payer: Group Health Inc Medicare	$36,766.93
Rate for Payer: Hamaspik Choice Inc Medicare	$36,766.93
Rate for Payer: Healthfirst Medicare Advantage	$17,096.62
Rate for Payer: Senior Whole Health Medicare Advantage	$36,766.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36,766.93
Rate for Payer: Wellcare Medicare	$34,928.58

TESTES PROCEDURES WITHOUT CC/MCC

Facility

$24,284.00

Service Code	MSDRG 712
Min. Negotiated Rate	$10,190.50
Max. Negotiated Rate	$24,284.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17,522.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23,807.84
Rate for Payer: Aetna Government	$23,807.84
Rate for Payer: Brighton Health Commercial	$17,231.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$24,284.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20,522.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$16,936.03
Rate for Payer: Elderplan Medicare Advantage	$22,617.45
Rate for Payer: EmblemHealth Commercial	$10,190.50
Rate for Payer: Fidelis Medicare Advantage	$23,807.84
Rate for Payer: Group Health Inc Commercial	$23,807.84
Rate for Payer: Group Health Inc Medicare	$23,807.84
Rate for Payer: Hamaspik Choice Inc Medicare	$23,807.84
Rate for Payer: Healthfirst Medicare Advantage	$11,070.65
Rate for Payer: Senior Whole Health Medicare Advantage	$23,807.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23,807.84
Rate for Payer: Wellcare Medicare	$22,617.45

TESTICULAR PROSTHESIS

Facility

$3,500.00

Service Code	HCPCS C1813
Hospital Charge Code	40205193
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.00
Max. Negotiated Rate	$3,775.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,925.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$2,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,012.50
Rate for Payer: EmblemHealth Commercial	$1,750.00
Rate for Payer: Fidelis Medicare Advantage	$3,675.00
Rate for Payer: Group Health Inc Commercial	$1,750.00
Rate for Payer: Group Health Inc Medicare	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,275.00

TESTICULAR PROSTHESIS

Facility

$3,500.00

Service Code	HCPCS C1813
Hospital Charge Code	40205193
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,750.00

Know your out-of-pocket cost for care.

All Charges