St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ LEVEEN NDL ELEC 3.5/15/15

Facility

$2,100.00

Hospital Charge Code	41568526
Hospital Revenue Code	270
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,680.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,155.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,050.00
Rate for Payer: Aetna Government	$1,050.00
Rate for Payer: Brighton Health Commercial	$1,575.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,680.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,428.00
Rate for Payer: Group Health Inc Commercial	$1,050.00
Rate for Payer: Group Health Inc Medicare	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00

ZZ LEVEEN NDL ELEC 3.5/15/25

Facility

$2,100.00

Hospital Charge Code	41568527
Hospital Revenue Code	270
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,680.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,155.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,050.00
Rate for Payer: Aetna Government	$1,050.00
Rate for Payer: Brighton Health Commercial	$1,575.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,680.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,428.00
Rate for Payer: Group Health Inc Commercial	$1,050.00
Rate for Payer: Group Health Inc Medicare	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00

ZZ LEVEEN NDL ELEC 4.0/14/15

Facility

$2,400.00

Hospital Charge Code	41568523
Hospital Revenue Code	270
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,920.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,200.00
Rate for Payer: Aetna Government	$1,200.00
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,920.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,632.00
Rate for Payer: Group Health Inc Commercial	$1,200.00
Rate for Payer: Group Health Inc Medicare	$840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00

ZZ LEVEEN NDL ELEC 4.0/14/25

Facility

$2,400.00

Hospital Charge Code	41568524
Hospital Revenue Code	270
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,920.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,200.00
Rate for Payer: Aetna Government	$1,200.00
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,920.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,632.00
Rate for Payer: Group Health Inc Commercial	$1,200.00
Rate for Payer: Group Health Inc Medicare	$840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00

ZZ LEVEEN NDL ELEC 5.0/13/15

Facility

$3,000.00

Hospital Charge Code	41568521
Hospital Revenue Code	270
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$2,400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,500.00
Rate for Payer: Aetna Government	$1,500.00
Rate for Payer: Brighton Health Commercial	$2,250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,040.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

ZZ LEVEEN NDL ELEC 5.0/13/25

Facility

$3,000.00

Hospital Charge Code	41568522
Hospital Revenue Code	270
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$2,400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,500.00
Rate for Payer: Aetna Government	$1,500.00
Rate for Payer: Brighton Health Commercial	$2,250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,040.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

ZZ LIVER ACC BIOPSY SET

Facility

$968.15

Hospital Charge Code	41567323
Hospital Revenue Code	270
Min. Negotiated Rate	$338.85
Max. Negotiated Rate	$774.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$532.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$484.08
Rate for Payer: Aetna Government	$484.08
Rate for Payer: Brighton Health Commercial	$726.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$774.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$658.34
Rate for Payer: Group Health Inc Commercial	$484.08
Rate for Payer: Group Health Inc Medicare	$338.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$484.08
Rate for Payer: Hamaspik Choice Inc Medicare	$484.08

ZZ LIVER ACCESS/BIOPSY SET

Facility

$639.37

Hospital Charge Code	41569254
Hospital Revenue Code	270
Min. Negotiated Rate	$223.78
Max. Negotiated Rate	$511.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$351.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$319.68
Rate for Payer: Aetna Government	$319.68
Rate for Payer: Brighton Health Commercial	$479.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$511.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$434.77
Rate for Payer: Group Health Inc Commercial	$319.68
Rate for Payer: Group Health Inc Medicare	$223.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$319.68
Rate for Payer: Hamaspik Choice Inc Medicare	$319.68

ZZ LOCM 300-399MG/ML IODINE 1ML

Facility

$40.54

Service Code	HCPCS Q9967
Hospital Charge Code	41569596
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$32.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$30.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.57
Rate for Payer: Group Health Inc Commercial	$20.27
Rate for Payer: Group Health Inc Medicare	$14.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.27
Rate for Payer: Hamaspik Choice Inc Medicare	$20.27
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.35

ZZ LOCM 300-399MG/ML IODINE 1ML

Facility

$92.85

Service Code	HCPCS Q9967
Hospital Charge Code	41569592
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$74.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$69.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.14
Rate for Payer: Group Health Inc Commercial	$46.42
Rate for Payer: Group Health Inc Medicare	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.42
Rate for Payer: Hamaspik Choice Inc Medicare	$46.42
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.35

ZZ LOCM 300-399MG/ML IODINE 1ML

Facility

$92.85

Service Code	HCPCS Q9967
Hospital Charge Code	41569590
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$74.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$69.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.14
Rate for Payer: Group Health Inc Commercial	$46.42
Rate for Payer: Group Health Inc Medicare	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.42
Rate for Payer: Hamaspik Choice Inc Medicare	$46.42
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.35

ZZ LOCM 300-399MG/ML IODINE 1ML

Facility

$50.33

Service Code	HCPCS Q9967
Hospital Charge Code	41569594
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$40.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$37.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.22
Rate for Payer: Group Health Inc Commercial	$25.16
Rate for Payer: Group Health Inc Medicare	$17.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.16
Rate for Payer: Hamaspik Choice Inc Medicare	$25.16
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.71

ZZ LOCM 300-399MG/ML IODINE 1ML

Facility

$32.60

Service Code	HCPCS Q9967
Hospital Charge Code	41569595
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$26.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$24.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.17
Rate for Payer: Group Health Inc Commercial	$16.30
Rate for Payer: Group Health Inc Medicare	$11.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.30
Rate for Payer: Hamaspik Choice Inc Medicare	$16.30
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.19

ZZ LONG SH 8.5 38 45 J RB

Facility

$119.78

Hospital Charge Code	41567041
Hospital Revenue Code	270
Min. Negotiated Rate	$41.92
Max. Negotiated Rate	$95.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.89
Rate for Payer: Aetna Government	$59.89
Rate for Payer: Brighton Health Commercial	$89.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.45
Rate for Payer: Group Health Inc Commercial	$59.89
Rate for Payer: Group Health Inc Medicare	$41.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.89
Rate for Payer: Hamaspik Choice Inc Medicare	$59.89

ZZ LONG SHTH 6 38 35 J RB

Facility

$119.78

Hospital Charge Code	41567038
Hospital Revenue Code	270
Min. Negotiated Rate	$41.92
Max. Negotiated Rate	$95.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.89
Rate for Payer: Aetna Government	$59.89
Rate for Payer: Brighton Health Commercial	$89.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.45
Rate for Payer: Group Health Inc Commercial	$59.89
Rate for Payer: Group Health Inc Medicare	$41.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.89
Rate for Payer: Hamaspik Choice Inc Medicare	$59.89

ZZ LONG SHTH 7 38 45 J RB

Facility

$119.78

Hospital Charge Code	41567039
Hospital Revenue Code	270
Min. Negotiated Rate	$41.92
Max. Negotiated Rate	$95.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.89
Rate for Payer: Aetna Government	$59.89
Rate for Payer: Brighton Health Commercial	$89.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.45
Rate for Payer: Group Health Inc Commercial	$59.89
Rate for Payer: Group Health Inc Medicare	$41.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.89
Rate for Payer: Hamaspik Choice Inc Medicare	$59.89

ZZ LONG SHTH 8 38 45 J RB

Facility

$119.78

Hospital Charge Code	41567040
Hospital Revenue Code	270
Min. Negotiated Rate	$41.92
Max. Negotiated Rate	$95.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.89
Rate for Payer: Aetna Government	$59.89
Rate for Payer: Brighton Health Commercial	$89.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.45
Rate for Payer: Group Health Inc Commercial	$59.89
Rate for Payer: Group Health Inc Medicare	$41.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.89
Rate for Payer: Hamaspik Choice Inc Medicare	$59.89

ZZ LOW DOSE IRIDIUM SEEDS/ RIBBON

Facility

$2,550.00

Service Code	HCPCS C1719
Hospital Charge Code	41569953
Hospital Revenue Code	278
Min. Negotiated Rate	$338.30
Max. Negotiated Rate	$1,657.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,402.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$422.88
Rate for Payer: Aetna Government	$422.88
Rate for Payer: Brighton Health Commercial	$1,530.00
Rate for Payer: Cash Price	$422.88
Rate for Payer: Cash Price	$422.88
Rate for Payer: Cash Price	$422.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$422.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,466.25
Rate for Payer: Elderplan Medicare Advantage	$422.88
Rate for Payer: EmblemHealth Commercial	$1,275.00
Rate for Payer: Fidelis Medicare Advantage	$422.88
Rate for Payer: Group Health Inc Commercial	$422.88
Rate for Payer: Group Health Inc Medicare	$422.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00
Rate for Payer: Healthfirst Medicare Advantage	$359.45
Rate for Payer: Healthfirst QHP	$422.88
Rate for Payer: Senior Whole Health Medicare Advantage	$422.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,657.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$338.30

ZZ LOW DOSE IRIDIUM SEEDS/ RIBBON

Facility

$2,550.00

Service Code	HCPCS C1719
Hospital Charge Code	41569953
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Cash Price	$422.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00

ZZ LUMAXGRF 70-073-80CM

Facility

$352.96

Hospital Charge Code	41569823
Hospital Revenue Code	270
Min. Negotiated Rate	$123.54
Max. Negotiated Rate	$282.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$176.48
Rate for Payer: Aetna Government	$176.48
Rate for Payer: Brighton Health Commercial	$264.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$282.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.01
Rate for Payer: Group Health Inc Commercial	$176.48
Rate for Payer: Group Health Inc Medicare	$123.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.48
Rate for Payer: Hamaspik Choice Inc Medicare	$176.48

ZZ LUMAXGRF 80-086-80CM

Facility

$325.89

Hospital Charge Code	41569821
Hospital Revenue Code	270
Min. Negotiated Rate	$114.06
Max. Negotiated Rate	$260.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$162.94
Rate for Payer: Aetna Government	$162.94
Rate for Payer: Brighton Health Commercial	$244.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.61
Rate for Payer: Group Health Inc Commercial	$162.94
Rate for Payer: Group Health Inc Medicare	$114.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.94
Rate for Payer: Hamaspik Choice Inc Medicare	$162.94

ZZ LUMINEX STENT 10X40 6F

Facility

$4,394.25

Service Code	HCPCS C1874
Hospital Charge Code	41569760
Hospital Revenue Code	278
Min. Negotiated Rate	$2,197.12
Max. Negotiated Rate	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12

ZZ LUMINEX STENT 10X40 6F

Facility

$4,394.25

Service Code	HCPCS C1874
Hospital Charge Code	41569760
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,613.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,416.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,636.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,197.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,526.69
Rate for Payer: EmblemHealth Commercial	$2,197.12
Rate for Payer: Fidelis Medicare Advantage	$4,613.96
Rate for Payer: Group Health Inc Commercial	$2,197.12
Rate for Payer: Group Health Inc Medicare	$1,537.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,197.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2,197.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,856.26

ZZ LUMINEX STENT 10X60 6F

Facility

$4,521.83

Service Code	HCPCS C1874
Hospital Charge Code	41569761
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,747.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,487.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,713.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,260.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,600.05
Rate for Payer: EmblemHealth Commercial	$2,260.92
Rate for Payer: Fidelis Medicare Advantage	$4,747.92
Rate for Payer: Group Health Inc Commercial	$2,260.92
Rate for Payer: Group Health Inc Medicare	$1,582.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,260.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,260.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,939.19

ZZ LUMINEX STENT 10X60 6F

Facility

$4,521.83

Service Code	HCPCS C1874
Hospital Charge Code	41569761
Hospital Revenue Code	278
Min. Negotiated Rate	$2,260.92
Max. Negotiated Rate	$2,260.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,260.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2,260.92

Know your out-of-pocket cost for care.

All Charges