St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BIPOLAR LOOP ELECTRODE

Facility

$250.00

Hospital Charge Code	64905753
Hospital Revenue Code	270
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.00
Rate for Payer: Aetna Government	$125.00
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.00
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

BISACODYL 10 MG RECTAL

Facility

$1.00

Hospital Charge Code	41650414
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BISACODYL 10 MG RECTAL

Facility

$1.00

Hospital Charge Code	41640414
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BISACODYL 10 MG RE SUPP [1080]

Facility

$0.32

Service Code	NDC 00574705050
Hospital Charge Code	00574705050
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

BISACODYL 10 MG RE SUPP [1080]

Facility

$0.42

Service Code	NDC 00574705012
Hospital Charge Code	00574705012
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

BISACODYL 5 MG PO TBEC [1079]

Facility

$0.02

Service Code	NDC 00904674860
Hospital Charge Code	00904674860
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

BISACODYL 5 MG PO TBEC [1079]

Facility

$0.07

Service Code	NDC 00904640761
Hospital Charge Code	00904640761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

BISACODYL 5 MG TAB

Facility

$0.05

Hospital Charge Code	41653103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

BISACODYL 5 MG TAB

Facility

$0.05

Hospital Charge Code	41643103
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP [1090]

Facility

$0.02

Service Code	NDC 00536128636
Hospital Charge Code	00536128636
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

BISMUTH SUBSALICYLATE 262 MG/15 ML SUSP

Facility

$1.00

Hospital Charge Code	41650691
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BISMUTH SUBSALICYLATE 262 MG/15 ML SUSP

Facility

$1.00

Hospital Charge Code	41640691
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BISMUTH SUBSALICYLATE 262 MG CHEW TAB

Facility

$1.00

Hospital Charge Code	41654981
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BISMUTH SUBSALICYLATE 262 MG CHEW TAB

Facility

$1.00

Hospital Charge Code	41644981
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BISMUTH SUBSALICYLATE 262 MG PO CHEW [9284]

Facility

$0.13

Service Code	NDC 00904131546
Hospital Charge Code	00904131546
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	$0.09
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

BISMUTH SUBSALICYLATE 262 MG PO CHEW [9284]

Facility

$0.09

Service Code	NDC 00904720546
Hospital Charge Code	00904720546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

BISMUTH SUBSALICYLATE 524MG/30 UD

Facility

$4.80

Hospital Charge Code	41647919
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.40
Rate for Payer: Aetna Government	$2.40
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

BISMUUTH SUBSALICYLATE 524MG/30 U

Facility

$4.80

Hospital Charge Code	41657919
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.40
Rate for Payer: Aetna Government	$2.40
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

BIT 20 HOLD STRIGHT

Facility

$1,054.68

Hospital Charge Code	64906029
Hospital Revenue Code	270
Min. Negotiated Rate	$369.14
Max. Negotiated Rate	$843.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$580.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$527.34
Rate for Payer: Aetna Government	$527.34
Rate for Payer: Brighton Health Commercial	$791.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$843.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$717.18
Rate for Payer: Group Health Inc Commercial	$527.34
Rate for Payer: Group Health Inc Medicare	$369.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$527.34
Rate for Payer: Hamaspik Choice Inc Medicare	$527.34

BIT DRILL

Facility

$455.00

Service Code	HCPCS C1713
Hospital Charge Code	64907232
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$477.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$273.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$227.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$261.62
Rate for Payer: EmblemHealth Commercial	$227.50
Rate for Payer: Fidelis Medicare Advantage	$477.75
Rate for Payer: Group Health Inc Commercial	$227.50
Rate for Payer: Group Health Inc Medicare	$159.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.50
Rate for Payer: Hamaspik Choice Inc Medicare	$227.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.75

BIT DRILL

Facility

$455.00

Service Code	HCPCS C1713
Hospital Charge Code	64907232
Hospital Revenue Code	278
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.50
Rate for Payer: Hamaspik Choice Inc Medicare	$227.50

BIT DRILL 1.0X50M 6M STOP-6010506

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64906520
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

BIT DRILL 1.0X50M 6M STOP-6010506

Facility

$100.00

Service Code	HCPCS C1713
Hospital Charge Code	64906520
Hospital Revenue Code	278
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

BIT DRILL 1.2MM -6009504

Facility

$219.22

Service Code	HCPCS C1713
Hospital Charge Code	64906695
Hospital Revenue Code	278
Min. Negotiated Rate	$76.73
Max. Negotiated Rate	$230.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$120.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$131.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.05
Rate for Payer: EmblemHealth Commercial	$109.61
Rate for Payer: Fidelis Medicare Advantage	$230.18
Rate for Payer: Group Health Inc Commercial	$109.61
Rate for Payer: Group Health Inc Medicare	$76.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.61
Rate for Payer: Hamaspik Choice Inc Medicare	$109.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$142.49

BIT DRILL 1.2MM -6009504

Facility

$219.22

Service Code	HCPCS C1713
Hospital Charge Code	64906695
Hospital Revenue Code	278
Min. Negotiated Rate	$109.61
Max. Negotiated Rate	$109.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.61
Rate for Payer: Hamaspik Choice Inc Medicare	$109.61

Know your out-of-pocket cost for care.

All Charges