St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

VARICELLA-ZOSTER AB, IGM

Facility

$32.20

Service Code	HCPCS 86787
Hospital Charge Code	40729383
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.88

VARICELLA-ZOSTER AB, IGM

Facility

$32.20

Service Code	HCPCS 86787
Hospital Charge Code	40729383
Hospital Revenue Code	300
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$24.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.88
Rate for Payer: Aetna Government	$12.88
Rate for Payer: Brighton Health Commercial	$24.15
Rate for Payer: Cash Price	$12.88
Rate for Payer: Cash Price	$12.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.32
Rate for Payer: Elderplan Medicare Advantage	$12.88
Rate for Payer: EmblemHealth Commercial	$12.88
Rate for Payer: Fidelis Essential Plan Aliesa	$10.95
Rate for Payer: Fidelis Essential Plan QHP	$11.46
Rate for Payer: Fidelis Medicare Advantage	$12.88
Rate for Payer: Fidelis Qualified Health Plan	$11.46
Rate for Payer: Group Health Inc Commercial	$12.88
Rate for Payer: Group Health Inc Medicare	$12.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.10
Rate for Payer: Hamaspik Choice Inc Medicare	$12.88
Rate for Payer: Healthfirst Medicare Advantage	$12.88
Rate for Payer: Healthfirst QHP	$12.88
Rate for Payer: Senior Whole Health Medicare Advantage	$12.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.30
Rate for Payer: Wellcare Medicare	$11.59

VARICELLA ZOSTER IMMUNE GLOBULIN 625 UNI

Facility

$190.00

Hospital Charge Code	41641669
Hospital Revenue Code	250
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$152.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.00
Rate for Payer: Aetna Government	$95.00
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.20
Rate for Payer: Group Health Inc Commercial	$95.00
Rate for Payer: Group Health Inc Medicare	$66.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.50

VARICELLA ZOSTER IMMUNE GLOBULIN 625 UNI

Facility

$190.00

Hospital Charge Code	41651669
Hospital Revenue Code	250
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$152.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.00
Rate for Payer: Aetna Government	$95.00
Rate for Payer: Brighton Health Commercial	$142.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.20
Rate for Payer: Group Health Inc Commercial	$95.00
Rate for Payer: Group Health Inc Medicare	$66.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.50

VARICELLA-ZOSTER V AB, IGG

Facility

$32.20

Service Code	HCPCS 86787
Hospital Charge Code	40729382
Hospital Revenue Code	300
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$24.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.88
Rate for Payer: Aetna Government	$12.88
Rate for Payer: Brighton Health Commercial	$24.15
Rate for Payer: Cash Price	$12.88
Rate for Payer: Cash Price	$12.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.32
Rate for Payer: Elderplan Medicare Advantage	$12.88
Rate for Payer: EmblemHealth Commercial	$12.88
Rate for Payer: Fidelis Essential Plan Aliesa	$10.95
Rate for Payer: Fidelis Essential Plan QHP	$11.46
Rate for Payer: Fidelis Medicare Advantage	$12.88
Rate for Payer: Fidelis Qualified Health Plan	$11.46
Rate for Payer: Group Health Inc Commercial	$12.88
Rate for Payer: Group Health Inc Medicare	$12.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.10
Rate for Payer: Hamaspik Choice Inc Medicare	$12.88
Rate for Payer: Healthfirst Medicare Advantage	$12.88
Rate for Payer: Healthfirst QHP	$12.88
Rate for Payer: Senior Whole Health Medicare Advantage	$12.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.30
Rate for Payer: Wellcare Medicare	$11.59

VARICELLA-ZOSTER V AB, IGG

Facility

$32.20

Service Code	HCPCS 86787
Hospital Charge Code	40729382
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.88

VARICELLA ZOSTER VIRUS CULTURE

Facility

$65.18

Service Code	HCPCS 87252
Hospital Charge Code	40619191
Hospital Revenue Code	300
Rate for Payer: Cash Price	$26.07

VARICELLA ZOSTER VIRUS CULTURE

Facility

$65.18

Service Code	HCPCS 87252
Hospital Charge Code	40619191
Hospital Revenue Code	300
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$48.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.07
Rate for Payer: Aetna Government	$26.07
Rate for Payer: Brighton Health Commercial	$48.88
Rate for Payer: Cash Price	$26.07
Rate for Payer: Cash Price	$26.07
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$26.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.06
Rate for Payer: Elderplan Medicare Advantage	$26.07
Rate for Payer: EmblemHealth Commercial	$26.07
Rate for Payer: Fidelis Essential Plan Aliesa	$22.16
Rate for Payer: Fidelis Essential Plan QHP	$23.20
Rate for Payer: Fidelis Medicare Advantage	$26.07
Rate for Payer: Fidelis Qualified Health Plan	$23.20
Rate for Payer: Group Health Inc Commercial	$26.07
Rate for Payer: Group Health Inc Medicare	$26.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.59
Rate for Payer: Hamaspik Choice Inc Medicare	$26.07
Rate for Payer: Healthfirst Medicare Advantage	$26.07
Rate for Payer: Healthfirst QHP	$26.07
Rate for Payer: Senior Whole Health Medicare Advantage	$26.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.86
Rate for Payer: Wellcare Medicare	$23.46

VARICOCELECTOMY

Facility

$9,417.43

Service Code	HCPCS 55535
Hospital Charge Code	40123070
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,748.99

VARICOCELECTOMY

Facility

$9,417.43

Service Code	HCPCS 55535
Hospital Charge Code	40123070
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$8,748.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,748.99
Rate for Payer: Aetna Government	$8,748.99
Rate for Payer: Brighton Health Commercial	$7,063.07
Rate for Payer: Cash Price	$8,748.99
Rate for Payer: Cash Price	$8,748.99
Rate for Payer: Cash Price	$8,748.99
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,748.99
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	$8,748.99
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,436.64
Rate for Payer: Fidelis Essential Plan QHP	$7,786.60
Rate for Payer: Fidelis Medicare Advantage	$8,748.99
Rate for Payer: Fidelis Qualified Health Plan	$7,786.60
Rate for Payer: Group Health Inc Commercial	$8,748.99
Rate for Payer: Group Health Inc Medicare	$8,748.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,708.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8,748.99
Rate for Payer: Healthfirst Medicare Advantage	$7,436.64
Rate for Payer: Healthfirst QHP	$8,748.99
Rate for Payer: Senior Whole Health Medicare Advantage	$8,748.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,748.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,999.19
Rate for Payer: Wellcare Medicare	$8,311.54

VARIZIG 125 UNITS

Facility

$3,899.00

Hospital Charge Code	41648411
Hospital Revenue Code	250
Min. Negotiated Rate	$1,364.65
Max. Negotiated Rate	$3,119.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,144.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,949.50
Rate for Payer: Aetna Government	$1,949.50
Rate for Payer: Brighton Health Commercial	$2,924.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,119.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,651.32
Rate for Payer: Group Health Inc Commercial	$1,949.50
Rate for Payer: Group Health Inc Medicare	$1,364.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,949.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,949.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,534.35

VARIZIG 125 UNITS

Facility

$3,899.00

Hospital Charge Code	41658411
Hospital Revenue Code	250
Min. Negotiated Rate	$1,364.65
Max. Negotiated Rate	$3,119.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,144.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,949.50
Rate for Payer: Aetna Government	$1,949.50
Rate for Payer: Brighton Health Commercial	$2,924.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,119.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,651.32
Rate for Payer: Group Health Inc Commercial	$1,949.50
Rate for Payer: Group Health Inc Medicare	$1,364.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,949.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,949.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,534.35

VASC SOLN VENTURE OTW CATH 5821

Facility

$1,400.00

Service Code	HCPCS C1751
Hospital Charge Code	66526591
Hospital Revenue Code	278
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$1,470.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$770.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.08
Rate for Payer: Aetna Government	$7.08
Rate for Payer: Brighton Health Commercial	$840.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$805.00
Rate for Payer: EmblemHealth Commercial	$700.00
Rate for Payer: Fidelis Medicare Advantage	$1,470.00
Rate for Payer: Group Health Inc Commercial	$700.00
Rate for Payer: Group Health Inc Medicare	$490.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$910.00

VASC SOLN VENTURE OTW CATH 5821

Facility

$1,400.00

Service Code	HCPCS C1751
Hospital Charge Code	66526591
Hospital Revenue Code	278
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$700.00

Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)

Facility

$20,278.00

Service Code	CPT 37242
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$20,278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
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	$20,278.00
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$17,236.30
Rate for Payer: Fidelis Essential Plan QHP	$18,047.42
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Fidelis Qualified Health Plan	$18,047.42
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20,278.00
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20,278.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40
Rate for Payer: Wellcare Medicare	$19,264.10

Facility

$12,721.98

Service Code	CPT 37243
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$12,721.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12,721.98
Rate for Payer: Aetna Government	$12,721.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12,721.98
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	$12,721.98
Rate for Payer: EmblemHealth Commercial	$12,721.98
Rate for Payer: Fidelis Essential Plan Aliesa	$10,813.68
Rate for Payer: Fidelis Essential Plan QHP	$11,322.56
Rate for Payer: Fidelis Medicare Advantage	$12,721.98
Rate for Payer: Fidelis Qualified Health Plan	$11,322.56
Rate for Payer: Group Health Inc Commercial	$12,721.98
Rate for Payer: Group Health Inc Medicare	$12,721.98
Rate for Payer: Hamaspik Choice Inc Medicare	$12,721.98
Rate for Payer: Healthfirst Medicare Advantage	$10,813.68
Rate for Payer: Healthfirst QHP	$12,721.98
Rate for Payer: Senior Whole Health Medicare Advantage	$12,721.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,721.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10,177.58
Rate for Payer: Wellcare Medicare	$12,085.88

VASCULAR GRAFT 1

Facility

$23.51

Service Code	HCPCS C1768
Hospital Charge Code	40200231
Hospital Revenue Code	278
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$11.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.76
Rate for Payer: Hamaspik Choice Inc Medicare	$11.76

VASCULAR GRAFT 1

Facility

$23.51

Service Code	HCPCS C1768
Hospital Charge Code	40200231
Hospital Revenue Code	278
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$322.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$14.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.52
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Fidelis Medicare Advantage	$24.69
Rate for Payer: Group Health Inc Commercial	$11.76
Rate for Payer: Group Health Inc Medicare	$8.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.76
Rate for Payer: Hamaspik Choice Inc Medicare	$11.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.28

VASCULAR GRAFT (S47045)

Facility

$1,200.00

Service Code	HCPCS C1768
Hospital Charge Code	40200232
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

VASCULAR GRAFT (S47045)

Facility

$1,200.00

Service Code	HCPCS C1768
Hospital Charge Code	40200232
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

VASCULAR GRAFT (V06080)

Facility

$1,348.04

Hospital Charge Code	40202090
Hospital Revenue Code	270
Min. Negotiated Rate	$471.81
Max. Negotiated Rate	$1,078.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$741.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$674.02
Rate for Payer: Aetna Government	$674.02
Rate for Payer: Brighton Health Commercial	$1,011.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,078.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$916.67
Rate for Payer: Group Health Inc Commercial	$674.02
Rate for Payer: Group Health Inc Medicare	$471.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$674.02
Rate for Payer: Hamaspik Choice Inc Medicare	$674.02

VASCULAR GRAFT (V47050)

Facility

$1,075.88

Hospital Charge Code	40202080
Hospital Revenue Code	270
Min. Negotiated Rate	$376.56
Max. Negotiated Rate	$860.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$591.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$537.94
Rate for Payer: Aetna Government	$537.94
Rate for Payer: Brighton Health Commercial	$806.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$860.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$731.60
Rate for Payer: Group Health Inc Commercial	$537.94
Rate for Payer: Group Health Inc Medicare	$376.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$537.94
Rate for Payer: Hamaspik Choice Inc Medicare	$537.94

VASCULAR SOL GUIDELINER CATHETER

Facility

$790.00

Hospital Charge Code	66572918
Hospital Revenue Code	272
Min. Negotiated Rate	$276.50
Max. Negotiated Rate	$632.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$434.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$395.00
Rate for Payer: Aetna Government	$395.00
Rate for Payer: Brighton Health Commercial	$592.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$632.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$537.20
Rate for Payer: Group Health Inc Commercial	$395.00
Rate for Payer: Group Health Inc Medicare	$276.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$395.00

VASCULAR SOL GUIDELINER XL CATH

Facility

$838.00

Hospital Charge Code	66572917
Hospital Revenue Code	272
Min. Negotiated Rate	$293.30
Max. Negotiated Rate	$670.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$460.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$419.00
Rate for Payer: Aetna Government	$419.00
Rate for Payer: Brighton Health Commercial	$628.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$670.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$569.84
Rate for Payer: Group Health Inc Commercial	$419.00
Rate for Payer: Group Health Inc Medicare	$293.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$419.00
Rate for Payer: Hamaspik Choice Inc Medicare	$419.00

VASCULAR STUDY, COMPLETE

Facility

$705.83

Service Code	HCPCS 93975 TC
Hospital Charge Code	41301527
Hospital Revenue Code	921
Rate for Payer: Cash Price	$283.37

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