St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR [160216]

Facility

$1,137.27

Service Code	HCPCS J0583
Hospital Charge Code	00781315894
Hospital Revenue Code	278
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1,194.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$625.50
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	$682.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$568.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$653.93
Rate for Payer: EmblemHealth Commercial	$568.63
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	$1,194.13
Rate for Payer: Fidelis Qualified Health Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$568.63
Rate for Payer: Group Health Inc Medicare	$398.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$568.63
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	$739.22
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	00781315895
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

$1,137.27

Service Code	HCPCS J0583
Hospital Charge Code	00781315894
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

$108.00

Service Code	HCPCS J0583
Hospital Charge Code	83634040010
Hospital Revenue Code	278
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.00
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00

BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR [160216]

Facility

$1,137.27

Service Code	HCPCS J0583
Hospital Charge Code	00781315895
Hospital Revenue Code	278
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1,194.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$625.50
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	$682.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$568.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$653.93
Rate for Payer: EmblemHealth Commercial	$568.63
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	$1,194.13
Rate for Payer: Fidelis Qualified Health Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$568.63
Rate for Payer: Group Health Inc Medicare	$398.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$568.63
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	$739.22
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	$0.29
Max. Negotiated Rate	$1,194.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$625.50
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	$682.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$568.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$653.93
Rate for Payer: EmblemHealth Commercial	$568.63
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	$1,194.13
Rate for Payer: Fidelis Qualified Health Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$568.63
Rate for Payer: Group Health Inc Medicare	$398.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$568.63
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	$739.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.24

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

$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 TRIFLUOROACETATE 250 MG IV SOLR [160216]

Facility

$1,137.27

Service Code	HCPCS J0583
Hospital Charge Code	16729027567
Hospital Revenue Code	278
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1,194.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$625.50
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	$682.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$568.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$653.93
Rate for Payer: EmblemHealth Commercial	$568.63
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	$1,194.13
Rate for Payer: Fidelis Qualified Health Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$568.63
Rate for Payer: Group Health Inc Medicare	$398.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$568.63
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	$739.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.24

BLADDER CARE SILICONE-16F

Facility

$42.88

Hospital Charge Code	40207611
Hospital Revenue Code	270
Min. Negotiated Rate	$15.01
Max. Negotiated Rate	$34.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.44
Rate for Payer: Aetna Government	$21.44
Rate for Payer: Brighton Health Commercial	$32.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.16
Rate for Payer: Group Health Inc Commercial	$21.44
Rate for Payer: Group Health Inc Medicare	$15.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.44
Rate for Payer: Hamaspik Choice Inc Medicare	$21.44

BLADDER CARE SILICONE-18F

Facility

$42.88

Hospital Charge Code	40207612
Hospital Revenue Code	270
Min. Negotiated Rate	$15.01
Max. Negotiated Rate	$34.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.44
Rate for Payer: Aetna Government	$21.44
Rate for Payer: Brighton Health Commercial	$32.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.16
Rate for Payer: Group Health Inc Commercial	$21.44
Rate for Payer: Group Health Inc Medicare	$15.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.44
Rate for Payer: Hamaspik Choice Inc Medicare	$21.44

BLADDER CARE TRAY

Facility

$27.29

Hospital Charge Code	40207610
Hospital Revenue Code	270
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$21.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.64
Rate for Payer: Aetna Government	$13.64
Rate for Payer: Brighton Health Commercial	$20.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.56
Rate for Payer: Group Health Inc Commercial	$13.64
Rate for Payer: Group Health Inc Medicare	$9.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.64
Rate for Payer: Hamaspik Choice Inc Medicare	$13.64

BLADDER FUNCTION TEST

Facility

$1,770.90

Service Code	HCPCS 51728
Hospital Charge Code	30302527
Hospital Revenue Code	510
Rate for Payer: Cash Price	$789.96

BLADDER FUNCTION TEST

Facility

$1,770.90

Service Code	HCPCS 51728
Hospital Charge Code	30302527
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$789.96
Rate for Payer: Aetna Government	$789.96
Rate for Payer: Affinity Essential Plan 1&2	$552.97
Rate for Payer: Affinity Essential Plan 3&4	$552.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$552.97
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$789.96
Rate for Payer: Cash Price	$789.96
Rate for Payer: Cash Price	$789.96
Rate for Payer: Cash Price	$789.96
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$789.96
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	$789.96
Rate for Payer: Fidelis Essential Plan Aliesa	$671.47
Rate for Payer: Fidelis Essential Plan QHP	$703.06
Rate for Payer: Fidelis Medicare Advantage	$789.96
Rate for Payer: Fidelis Qualified Health Plan	$703.06
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$885.45
Rate for Payer: Hamaspik Choice Inc Medicare	$789.96
Rate for Payer: Healthfirst Medicare Advantage	$671.47
Rate for Payer: Healthfirst QHP	$789.96
Rate for Payer: Humana Medicare	$805.76
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$789.96
Rate for Payer: Senior Whole Health Medicare Advantage	$789.96
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$789.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$789.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$631.97
Rate for Payer: Wellcare Medicare	$750.46

BLADDER NECK SUSPENSION

Facility

$5,804.26

Service Code	HCPCS 51940
Hospital Charge Code	40122900
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$4,353.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,192.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,029.04
Rate for Payer: Aetna Government	$2,029.04
Rate for Payer: Brighton Health Commercial	$4,353.20
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$2,902.13
Rate for Payer: Group Health Inc Medicare	$2,031.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,902.13
Rate for Payer: Hamaspik Choice Inc Medicare	$2,902.13
Rate for Payer: United Healthcare Commercial	$1,496.00

BLADE 10MM X 3 OST

Facility

$158.63

Hospital Charge Code	64905817
Hospital Revenue Code	270
Min. Negotiated Rate	$55.52
Max. Negotiated Rate	$126.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$79.32
Rate for Payer: Aetna Government	$79.32
Rate for Payer: Brighton Health Commercial	$118.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.87
Rate for Payer: Group Health Inc Commercial	$79.32
Rate for Payer: Group Health Inc Medicare	$55.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.32
Rate for Payer: Hamaspik Choice Inc Medicare	$79.32

BLADE 10MM X 5 OST

Facility

$425.00

Hospital Charge Code	64905819
Hospital Revenue Code	270
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$340.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$233.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$212.50
Rate for Payer: Aetna Government	$212.50
Rate for Payer: Brighton Health Commercial	$318.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$340.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$289.00
Rate for Payer: Group Health Inc Commercial	$212.50
Rate for Payer: Group Health Inc Medicare	$148.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.50
Rate for Payer: Hamaspik Choice Inc Medicare	$212.50

BLADE 15.0 X 9.0MM .017IN

Facility

$21.45

Hospital Charge Code	64904573
Hospital Revenue Code	270
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$17.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.72
Rate for Payer: Aetna Government	$10.72
Rate for Payer: Brighton Health Commercial	$16.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.59
Rate for Payer: Group Health Inc Commercial	$10.72
Rate for Payer: Group Health Inc Medicare	$7.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.72
Rate for Payer: Hamaspik Choice Inc Medicare	$10.72

BLADE 2.9 TRUCLEAR INCIS

Facility

$1,773.75

Hospital Charge Code	64905919
Hospital Revenue Code	270
Min. Negotiated Rate	$620.81
Max. Negotiated Rate	$1,419.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$975.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$886.88
Rate for Payer: Aetna Government	$886.88
Rate for Payer: Brighton Health Commercial	$1,330.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,419.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,206.15
Rate for Payer: Group Health Inc Commercial	$886.88
Rate for Payer: Group Health Inc Medicare	$620.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$886.88
Rate for Payer: Hamaspik Choice Inc Medicare	$886.88

BLADE 30 X 12.5MM .017IN

Facility

$21.88

Hospital Charge Code	64904575
Hospital Revenue Code	270
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$17.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.94
Rate for Payer: Aetna Government	$10.94
Rate for Payer: Brighton Health Commercial	$16.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.88
Rate for Payer: Group Health Inc Commercial	$10.94
Rate for Payer: Group Health Inc Medicare	$7.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.94
Rate for Payer: Hamaspik Choice Inc Medicare	$10.94

BLADE 4.5MM CRVD FULL RAD ELITE

Facility

$134.12

Hospital Charge Code	40205979
Hospital Revenue Code	270
Min. Negotiated Rate	$46.94
Max. Negotiated Rate	$107.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.06
Rate for Payer: Aetna Government	$67.06
Rate for Payer: Brighton Health Commercial	$100.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.20
Rate for Payer: Group Health Inc Commercial	$67.06
Rate for Payer: Group Health Inc Medicare	$46.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.06
Rate for Payer: Hamaspik Choice Inc Medicare	$67.06

BLADE 4.5MM INCISOR

Facility

$827.43

Hospital Charge Code	64903123
Hospital Revenue Code	270
Min. Negotiated Rate	$289.60
Max. Negotiated Rate	$661.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$455.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$413.72
Rate for Payer: Aetna Government	$413.72
Rate for Payer: Brighton Health Commercial	$620.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$661.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$562.65
Rate for Payer: Group Health Inc Commercial	$413.72
Rate for Payer: Group Health Inc Medicare	$289.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$413.72
Rate for Payer: Hamaspik Choice Inc Medicare	$413.72

BLADE CALCAR

Facility

$425.00

Hospital Charge Code	64907234
Hospital Revenue Code	270
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$340.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$233.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$212.50
Rate for Payer: Aetna Government	$212.50
Rate for Payer: Brighton Health Commercial	$318.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$340.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$289.00
Rate for Payer: Group Health Inc Commercial	$212.50
Rate for Payer: Group Health Inc Medicare	$148.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.50
Rate for Payer: Hamaspik Choice Inc Medicare	$212.50

BLADE CLIPPER REPLACEMENT ASSY

Facility

$6.00

Hospital Charge Code	64901112
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00

BLADE,CLIPPER,SURGICOTDE

Facility

$5.98

Hospital Charge Code	64902063
Hospital Revenue Code	270
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$4.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.99
Rate for Payer: Aetna Government	$2.99
Rate for Payer: Brighton Health Commercial	$4.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.07
Rate for Payer: Group Health Inc Commercial	$2.99
Rate for Payer: Group Health Inc Medicare	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.99
Rate for Payer: Hamaspik Choice Inc Medicare	$2.99

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