St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BIT DRILL TWIST 3.2MM DIA SHO

Facility

$307.50

Service Code	HCPCS C1713
Hospital Charge Code	64902746
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$153.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.75
Rate for Payer: Hamaspik Choice Inc Medicare	$153.75

BIT DRILL TWIST 3.2MM DIA SHO

Facility

$307.50

Service Code	HCPCS C1713
Hospital Charge Code	64902746
Hospital Revenue Code	278
Min. Negotiated Rate	$107.62
Max. Negotiated Rate	$322.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$169.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$184.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$153.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.81
Rate for Payer: EmblemHealth Commercial	$153.75
Rate for Payer: Fidelis Medicare Advantage	$322.88
Rate for Payer: Group Health Inc Commercial	$153.75
Rate for Payer: Group Health Inc Medicare	$107.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.75
Rate for Payer: Hamaspik Choice Inc Medicare	$153.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$199.88

BIT DRILL TWIST 3.5MM DIA 4.8

Facility

$201.25

Service Code	HCPCS C1713
Hospital Charge Code	64902843
Hospital Revenue Code	278
Min. Negotiated Rate	$70.44
Max. Negotiated Rate	$211.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$120.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.72
Rate for Payer: EmblemHealth Commercial	$100.62
Rate for Payer: Fidelis Medicare Advantage	$211.31
Rate for Payer: Group Health Inc Commercial	$100.62
Rate for Payer: Group Health Inc Medicare	$70.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.62
Rate for Payer: Hamaspik Choice Inc Medicare	$100.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.81

BIT DRILL TWIST 3.5MM DIA 4.8

Facility

$201.25

Service Code	HCPCS C1713
Hospital Charge Code	64902843
Hospital Revenue Code	278
Min. Negotiated Rate	$100.62
Max. Negotiated Rate	$100.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.62
Rate for Payer: Hamaspik Choice Inc Medicare	$100.62

BIT DRILL TWIST 3.5MM DIA STA

Facility

$223.75

Service Code	HCPCS C1713
Hospital Charge Code	64901996
Hospital Revenue Code	278
Min. Negotiated Rate	$78.31
Max. Negotiated Rate	$234.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$134.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$111.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.66
Rate for Payer: EmblemHealth Commercial	$111.88
Rate for Payer: Fidelis Medicare Advantage	$234.94
Rate for Payer: Group Health Inc Commercial	$111.88
Rate for Payer: Group Health Inc Medicare	$78.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.88
Rate for Payer: Hamaspik Choice Inc Medicare	$111.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.44

BIT DRILL TWIST 3.5MM DIA STA

Facility

$223.75

Service Code	HCPCS C1713
Hospital Charge Code	64901996
Hospital Revenue Code	278
Min. Negotiated Rate	$111.88
Max. Negotiated Rate	$111.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.88
Rate for Payer: Hamaspik Choice Inc Medicare	$111.88

Bite (Jawlock)

Facility

$26.58

Hospital Charge Code	40200615
Hospital Revenue Code	270
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$21.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.29
Rate for Payer: Aetna Government	$13.29
Rate for Payer: Brighton Health Commercial	$19.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.07
Rate for Payer: Group Health Inc Commercial	$13.29
Rate for Payer: Group Health Inc Medicare	$9.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.29
Rate for Payer: Hamaspik Choice Inc Medicare	$13.29

BITEWINGS-FOUR FILMS

Facility

$60.00

Service Code	HCPCS D0274
Hospital Charge Code	42300155
Hospital Revenue Code	361
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Brighton Health Commercial	$45.00
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
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	$283.37
Rate for Payer: EmblemHealth Commercial	$283.37
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$283.37
Rate for Payer: Group Health Inc Medicare	$283.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst Medicare Advantage	$240.86
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

BITEWINGS-FOUR FILMS

Facility

$60.00

Service Code	HCPCS D0274
Hospital Charge Code	42300155
Hospital Revenue Code	361
Rate for Payer: Cash Price	$283.37

BITEWINGS-SINGLE FILM

Facility

$20.00

Service Code	HCPCS D0270
Hospital Charge Code	42300140
Hospital Revenue Code	361
Rate for Payer: Cash Price	$105.08

BITEWINGS-SINGLE FILM

Facility

$20.00

Service Code	HCPCS D0270
Hospital Charge Code	42300140
Hospital Revenue Code	361
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.08
Rate for Payer: Aetna Government	$105.08
Rate for Payer: Affinity Essential Plan 1&2	$73.56
Rate for Payer: Affinity Essential Plan 3&4	$73.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$73.56
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$105.08
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	$105.08
Rate for Payer: EmblemHealth Commercial	$105.08
Rate for Payer: Fidelis Essential Plan Aliesa	$89.32
Rate for Payer: Fidelis Essential Plan QHP	$93.52
Rate for Payer: Fidelis Medicare Advantage	$105.08
Rate for Payer: Fidelis Qualified Health Plan	$93.52
Rate for Payer: Group Health Inc Commercial	$105.08
Rate for Payer: Group Health Inc Medicare	$105.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.08
Rate for Payer: Healthfirst Medicare Advantage	$89.32
Rate for Payer: Healthfirst QHP	$105.08
Rate for Payer: Humana Medicare	$107.18
Rate for Payer: Senior Whole Health Medicare Advantage	$105.08
Rate for Payer: United Healthcare Medicare Advantage	$105.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84.06
Rate for Payer: Wellcare Medicare	$99.83

BITEWINGS - THREE FILMS

Facility

$50.00

Service Code	HCPCS D0273
Hospital Charge Code	42303417
Hospital Revenue Code	361
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
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	$283.37
Rate for Payer: EmblemHealth Commercial	$283.37
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$283.37
Rate for Payer: Group Health Inc Medicare	$283.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst Medicare Advantage	$240.86
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

BITEWINGS - THREE FILMS

Facility

$50.00

Service Code	HCPCS D0273
Hospital Charge Code	42303417
Hospital Revenue Code	361
Rate for Payer: Cash Price	$283.37

BITEWINGS-TWO FILMS

Facility

$35.00

Service Code	HCPCS D0272
Hospital Charge Code	42300145
Hospital Revenue Code	361
Rate for Payer: Cash Price	$105.08

BITEWINGS-TWO FILMS

Facility

$35.00

Service Code	HCPCS D0272
Hospital Charge Code	42300145
Hospital Revenue Code	361
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.08
Rate for Payer: Aetna Government	$105.08
Rate for Payer: Affinity Essential Plan 1&2	$73.56
Rate for Payer: Affinity Essential Plan 3&4	$73.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$73.56
Rate for Payer: Brighton Health Commercial	$26.25
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$105.08
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	$105.08
Rate for Payer: EmblemHealth Commercial	$105.08
Rate for Payer: Fidelis Essential Plan Aliesa	$89.32
Rate for Payer: Fidelis Essential Plan QHP	$93.52
Rate for Payer: Fidelis Medicare Advantage	$105.08
Rate for Payer: Fidelis Qualified Health Plan	$93.52
Rate for Payer: Group Health Inc Commercial	$105.08
Rate for Payer: Group Health Inc Medicare	$105.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$105.08
Rate for Payer: Healthfirst Medicare Advantage	$89.32
Rate for Payer: Healthfirst QHP	$105.08
Rate for Payer: Humana Medicare	$107.18
Rate for Payer: Senior Whole Health Medicare Advantage	$105.08
Rate for Payer: United Healthcare Medicare Advantage	$105.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84.06
Rate for Payer: Wellcare Medicare	$99.83

BIT,T2 4.2X340 TRI FLAT DRILL

Facility

$170.00

Hospital Charge Code	40005912
Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.00
Rate for Payer: Aetna Government	$85.00
Rate for Payer: Brighton Health Commercial	$127.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.60
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL) [430160216]

Facility

$120.00

Service Code	HCPCS J0583
Hospital Charge Code	55150021010
Hospital Revenue Code	278
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$324.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Affinity Essential Plan 1&2	$7.29
Rate for Payer: Affinity Essential Plan 3&4	$7.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.24
Rate for Payer: Amida Care Medicaid	$3.24
Rate for Payer: Brighton Health Commercial	$72.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$324.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3.24
Rate for Payer: Fidelis Essential Plan QHP	$3.24
Rate for Payer: Fidelis Medicare Advantage	$126.00
Rate for Payer: Fidelis Qualified Health Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.24
Rate for Payer: Healthfirst Essential Plan	$7.29
Rate for Payer: Healthfirst QHP	$3.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.24
Rate for Payer: SOMOS Essential	$3.24
Rate for Payer: United Healthcare Essential Plan 1&2	$7.29
Rate for Payer: United Healthcare Essential Plan 3&4	$3.56
Rate for Payer: United Healthcare Medicaid	$3.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.24

BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL) [430160216]

Facility

$120.00

Service Code	HCPCS J0583
Hospital Charge Code	55150021010
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

BIVALIRUDIN 250 MG INJ

Facility

$0.90

Service Code	HCPCS J0583
Hospital Charge Code	41655612
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45

BIVALIRUDIN 250 MG INJ

Facility

$0.90

Hospital Charge Code	41645612
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45

BIVALIRUDIN 250 MG INJ

Facility

$0.90

Service Code	HCPCS J0583
Hospital Charge Code	41655612
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$324.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Affinity Essential Plan 1&2	$7.29
Rate for Payer: Affinity Essential Plan 3&4	$7.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.24
Rate for Payer: Amida Care Medicaid	$3.24
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$324.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3.24
Rate for Payer: Fidelis Essential Plan QHP	$3.24
Rate for Payer: Fidelis Qualified Health Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.24
Rate for Payer: Healthfirst Essential Plan	$7.29
Rate for Payer: Healthfirst QHP	$3.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.24
Rate for Payer: SOMOS Essential	$3.24
Rate for Payer: United Healthcare Essential Plan 1&2	$7.29
Rate for Payer: United Healthcare Essential Plan 3&4	$3.56
Rate for Payer: United Healthcare Medicaid	$3.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.24

BIVALIRUDIN 250 MG INJ

Facility

$0.90

Hospital Charge Code	41645612
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR [160216]

Facility

$108.00

Service Code	HCPCS J0583
Hospital Charge Code	83634040010
Hospital Revenue Code	278
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$324.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Affinity Essential Plan 1&2	$7.29
Rate for Payer: Affinity Essential Plan 3&4	$7.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.24
Rate for Payer: Amida Care Medicaid	$3.24
Rate for Payer: Brighton Health Commercial	$64.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.10
Rate for Payer: EmblemHealth Commercial	$54.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$324.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3.24
Rate for Payer: Fidelis Essential Plan QHP	$3.24
Rate for Payer: Fidelis Medicare Advantage	$113.40
Rate for Payer: Fidelis Qualified Health Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$54.00
Rate for Payer: Group Health Inc Medicare	$37.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.24
Rate for Payer: Healthfirst Essential Plan	$7.29
Rate for Payer: Healthfirst QHP	$3.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.24
Rate for Payer: SOMOS Essential	$3.24
Rate for Payer: United Healthcare Essential Plan 1&2	$7.29
Rate for Payer: United Healthcare Essential Plan 3&4	$3.56
Rate for Payer: United Healthcare Medicaid	$3.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.24

BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR [160216]

Facility

$1,137.27

Service Code	HCPCS J0583
Hospital Charge Code	70436002582
Hospital Revenue Code	278
Min. Negotiated Rate	$568.63
Max. Negotiated Rate	$568.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$568.63
Rate for Payer: Hamaspik Choice Inc Medicare	$568.63

BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR [160216]

Facility

$120.00

Service Code	HCPCS J0583
Hospital Charge Code	55150021010
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

Know your out-of-pocket cost for care.

All Charges