St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TOTAL CARE SPORT BED

Facility

$293.98

Hospital Charge Code	40208000
Hospital Revenue Code	270
Min. Negotiated Rate	$102.89
Max. Negotiated Rate	$235.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$146.99
Rate for Payer: Aetna Government	$146.99
Rate for Payer: Brighton Health Commercial	$220.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.91
Rate for Payer: Group Health Inc Commercial	$146.99
Rate for Payer: Group Health Inc Medicare	$102.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.99
Rate for Payer: Hamaspik Choice Inc Medicare	$146.99

TOTAL FIRST MPJ IMPLANT

Facility

$18,117.83

Service Code	HCPCS 26531
Hospital Charge Code	40082755
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

TOTAL FIRST MPJ IMPLANT

Facility

$18,117.83

Service Code	HCPCS 26531
Hospital Charge Code	40082755
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$13,588.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Brighton Health Commercial	$13,588.37
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
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	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

TOTAL HEMOGLOBIN

Facility

$5.93

Service Code	HCPCS 85018
Hospital Charge Code	40602660
Hospital Revenue Code	305
Rate for Payer: Cash Price	$2.37

TOTAL HEMOGLOBIN

Facility

$5.93

Service Code	HCPCS 85018
Hospital Charge Code	40602660
Hospital Revenue Code	305
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.37
Rate for Payer: Aetna Government	$2.37
Rate for Payer: Brighton Health Commercial	$4.45
Rate for Payer: Cash Price	$2.37
Rate for Payer: Cash Price	$2.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.18
Rate for Payer: Elderplan Medicare Advantage	$2.37
Rate for Payer: EmblemHealth Commercial	$2.37
Rate for Payer: Fidelis Essential Plan Aliesa	$2.01
Rate for Payer: Fidelis Essential Plan QHP	$2.11
Rate for Payer: Fidelis Medicare Advantage	$2.37
Rate for Payer: Fidelis Qualified Health Plan	$2.11
Rate for Payer: Group Health Inc Commercial	$2.37
Rate for Payer: Group Health Inc Medicare	$2.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.96
Rate for Payer: Hamaspik Choice Inc Medicare	$2.37
Rate for Payer: Healthfirst Medicare Advantage	$2.37
Rate for Payer: Healthfirst QHP	$2.37
Rate for Payer: Senior Whole Health Medicare Advantage	$2.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.90
Rate for Payer: Wellcare Medicare	$2.13

TOTAL HIP REPLACEMENT

Facility

$36,044.28

Service Code	HCPCS 27130
Hospital Charge Code	40021675
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$27,033.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16,751.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15,219.83
Rate for Payer: Aetna Government	$15,219.83
Rate for Payer: Brighton Health Commercial	$27,033.21
Rate for Payer: Cash Price	$15,219.83
Rate for Payer: Cash Price	$15,219.83
Rate for Payer: Cash Price	$15,219.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15,219.83
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: Elderplan Medicare Advantage	$15,219.83
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$12,936.86
Rate for Payer: Fidelis Essential Plan QHP	$13,545.65
Rate for Payer: Fidelis Medicare Advantage	$15,219.83
Rate for Payer: Fidelis Qualified Health Plan	$13,545.65
Rate for Payer: Group Health Inc Commercial	$15,219.83
Rate for Payer: Group Health Inc Medicare	$15,219.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,022.14
Rate for Payer: Hamaspik Choice Inc Medicare	$15,219.83
Rate for Payer: Healthfirst Medicare Advantage	$12,936.86
Rate for Payer: Healthfirst QHP	$15,219.83
Rate for Payer: Senior Whole Health Medicare Advantage	$15,219.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,219.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12,175.86
Rate for Payer: Wellcare Medicare	$14,458.84

TOTAL HIP REPLACEMENT

Facility

$36,044.28

Service Code	HCPCS 27130
Hospital Charge Code	40021675
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,219.83

TOTAL IRON BINDING CAPACITY

Facility

$21.85

Service Code	HCPCS 83550
Hospital Charge Code	40602650
Hospital Revenue Code	301
Rate for Payer: Cash Price	$8.74

TOTAL IRON BINDING CAPACITY

Facility

$21.85

Service Code	HCPCS 83550
Hospital Charge Code	40602650
Hospital Revenue Code	301
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$16.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.74
Rate for Payer: Aetna Government	$8.74
Rate for Payer: Brighton Health Commercial	$16.39
Rate for Payer: Cash Price	$8.74
Rate for Payer: Cash Price	$8.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.76
Rate for Payer: Elderplan Medicare Advantage	$8.74
Rate for Payer: EmblemHealth Commercial	$8.74
Rate for Payer: Fidelis Essential Plan Aliesa	$7.43
Rate for Payer: Fidelis Essential Plan QHP	$7.78
Rate for Payer: Fidelis Medicare Advantage	$8.74
Rate for Payer: Fidelis Qualified Health Plan	$7.78
Rate for Payer: Group Health Inc Commercial	$8.74
Rate for Payer: Group Health Inc Medicare	$8.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8.74
Rate for Payer: Healthfirst Medicare Advantage	$8.74
Rate for Payer: Healthfirst QHP	$8.74
Rate for Payer: Senior Whole Health Medicare Advantage	$8.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.99
Rate for Payer: Wellcare Medicare	$7.87

TOTAL KNEE REPLACEMENT

Facility

$36,044.28

Service Code	HCPCS 27447
Hospital Charge Code	40021700
Hospital Revenue Code	360
Rate for Payer: Cash Price	$15,219.83

TOTAL KNEE REPLACEMENT

Facility

$36,044.28

Service Code	HCPCS 27447
Hospital Charge Code	40021700
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$44,507.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44,507.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15,219.83
Rate for Payer: Aetna Government	$15,219.83
Rate for Payer: Brighton Health Commercial	$27,033.21
Rate for Payer: Cash Price	$15,219.83
Rate for Payer: Cash Price	$15,219.83
Rate for Payer: Cash Price	$15,219.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15,219.83
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: Elderplan Medicare Advantage	$15,219.83
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$12,936.86
Rate for Payer: Fidelis Essential Plan QHP	$13,545.65
Rate for Payer: Fidelis Medicare Advantage	$15,219.83
Rate for Payer: Fidelis Qualified Health Plan	$13,545.65
Rate for Payer: Group Health Inc Commercial	$15,219.83
Rate for Payer: Group Health Inc Medicare	$15,219.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,022.14
Rate for Payer: Hamaspik Choice Inc Medicare	$15,219.83
Rate for Payer: Healthfirst Medicare Advantage	$12,936.86
Rate for Payer: Healthfirst QHP	$15,219.83
Rate for Payer: Senior Whole Health Medicare Advantage	$15,219.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,219.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12,175.86
Rate for Payer: Wellcare Medicare	$14,458.84

TOTAL KNEE SYSTEM

Facility

$5,297.91

Hospital Charge Code	40207010
Hospital Revenue Code	270
Min. Negotiated Rate	$1,854.27
Max. Negotiated Rate	$4,238.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,913.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,648.96
Rate for Payer: Aetna Government	$2,648.96
Rate for Payer: Brighton Health Commercial	$3,973.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,238.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,602.58
Rate for Payer: Group Health Inc Commercial	$2,648.96
Rate for Payer: Group Health Inc Medicare	$1,854.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,648.96
Rate for Payer: Hamaspik Choice Inc Medicare	$2,648.96

TOTAL KNEE/TIBIAL

Facility

$5,411.56

Service Code	HCPCS C1776
Hospital Charge Code	40203098
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,682.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,976.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,246.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,705.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,111.65
Rate for Payer: EmblemHealth Commercial	$2,705.78
Rate for Payer: Fidelis Medicare Advantage	$5,682.14
Rate for Payer: Group Health Inc Commercial	$2,705.78
Rate for Payer: Group Health Inc Medicare	$1,894.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,705.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2,705.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,517.51

TOTAL KNEE/TIBIAL

Facility

$5,411.56

Service Code	HCPCS C1776
Hospital Charge Code	40203098
Hospital Revenue Code	278
Min. Negotiated Rate	$2,705.78
Max. Negotiated Rate	$2,705.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,705.78
Rate for Payer: Hamaspik Choice Inc Medicare	$2,705.78

TOTAL KNEE UNIV TIBI BSE PLTE SZ3

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	40200322
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,993.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,663.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,996.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,330.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,829.50
Rate for Payer: EmblemHealth Commercial	$3,330.00
Rate for Payer: Fidelis Medicare Advantage	$6,993.00
Rate for Payer: Group Health Inc Commercial	$3,330.00
Rate for Payer: Group Health Inc Medicare	$2,331.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,330.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,329.00

TOTAL KNEE UNIV TIBI BSE PLTE SZ3

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	40200322
Hospital Revenue Code	278
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$3,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,330.00

TOTAL KNE UNIV TIBI BSE PLTSIZE4

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	40200323
Hospital Revenue Code	278
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$3,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,330.00

TOTAL KNE UNIV TIBI BSE PLTSIZE4

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	40200323
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,993.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,663.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,996.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,330.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,829.50
Rate for Payer: EmblemHealth Commercial	$3,330.00
Rate for Payer: Fidelis Medicare Advantage	$6,993.00
Rate for Payer: Group Health Inc Commercial	$3,330.00
Rate for Payer: Group Health Inc Medicare	$2,331.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,330.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,329.00

TOTAL SHOULDER SYSTEM

Facility

$3,820.52

Hospital Charge Code	40207012
Hospital Revenue Code	270
Min. Negotiated Rate	$1,337.18
Max. Negotiated Rate	$3,056.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,101.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,910.26
Rate for Payer: Aetna Government	$1,910.26
Rate for Payer: Brighton Health Commercial	$2,865.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,056.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,597.95
Rate for Payer: Group Health Inc Commercial	$1,910.26
Rate for Payer: Group Health Inc Medicare	$1,337.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,910.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1,910.26

Total thyroid lobectomy, unilateral; with or without isthmusectomy

Facility

$6,672.53

Service Code	CPT 60220
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,672.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,672.53
Rate for Payer: Aetna Government	$6,672.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,672.53
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	$6,672.53
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$5,671.65
Rate for Payer: Fidelis Essential Plan QHP	$5,938.55
Rate for Payer: Fidelis Medicare Advantage	$6,672.53
Rate for Payer: Fidelis Qualified Health Plan	$5,938.55
Rate for Payer: Group Health Inc Commercial	$6,672.53
Rate for Payer: Group Health Inc Medicare	$6,672.53
Rate for Payer: Hamaspik Choice Inc Medicare	$6,672.53
Rate for Payer: Healthfirst Medicare Advantage	$5,671.65
Rate for Payer: Healthfirst QHP	$6,672.53
Rate for Payer: Senior Whole Health Medicare Advantage	$6,672.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,672.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,338.02
Rate for Payer: Wellcare Medicare	$6,338.90

TOUCH PREP DURING F/S PROCEDURE

Facility

$1,902.65

Service Code	HCPCS 88333
Hospital Charge Code	40635403
Hospital Revenue Code	312
Min. Negotiated Rate	$33.45
Max. Negotiated Rate	$1,046.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,046.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$994.39
Rate for Payer: Aetna Government	$994.39
Rate for Payer: Brighton Health Commercial	$994.39
Rate for Payer: Cash Price	$994.39
Rate for Payer: Cash Price	$994.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$994.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.45
Rate for Payer: Elderplan Medicare Advantage	$994.39
Rate for Payer: EmblemHealth Commercial	$994.39
Rate for Payer: Fidelis Essential Plan Aliesa	$845.23
Rate for Payer: Fidelis Essential Plan QHP	$885.01
Rate for Payer: Fidelis Medicare Advantage	$994.39
Rate for Payer: Fidelis Qualified Health Plan	$885.01
Rate for Payer: Group Health Inc Commercial	$994.39
Rate for Payer: Group Health Inc Medicare	$994.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$951.32
Rate for Payer: Hamaspik Choice Inc Medicare	$994.39
Rate for Payer: Healthfirst Medicare Advantage	$994.39
Rate for Payer: Healthfirst QHP	$994.39
Rate for Payer: Senior Whole Health Medicare Advantage	$994.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$994.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$795.51
Rate for Payer: Wellcare Medicare	$894.95

TOUCH PREP DURING F/S PROCEDURE

Facility

$1,902.65

Service Code	HCPCS 88333
Hospital Charge Code	40635403
Hospital Revenue Code	312
Rate for Payer: Cash Price	$994.39

TOUCH PUMP

Facility

$10,450.00

Hospital Charge Code	64906033
Hospital Revenue Code	270
Min. Negotiated Rate	$3,657.50
Max. Negotiated Rate	$8,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,747.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,225.00
Rate for Payer: Aetna Government	$5,225.00
Rate for Payer: Brighton Health Commercial	$7,837.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,106.00
Rate for Payer: Group Health Inc Commercial	$5,225.00
Rate for Payer: Group Health Inc Medicare	$3,657.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,225.00

TOURNIQUET BLUE

Facility

$0.29

Hospital Charge Code	64901850
Hospital Revenue Code	270
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

TOWEL DRAPE POLYLINED

Facility

$0.36

Hospital Charge Code	40209470
Hospital Revenue Code	270
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18

Know your out-of-pocket cost for care.

All Charges