St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BOSTON SCI WALLFLEX BIL STENT

Facility

$5,610.00

Service Code	HCPCS C1874
Hospital Charge Code	40009117
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$5,890.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,085.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$3,366.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,805.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,225.75
Rate for Payer: EmblemHealth Commercial	$2,805.00
Rate for Payer: Fidelis Medicare Advantage	$5,890.50
Rate for Payer: Group Health Inc Commercial	$2,805.00
Rate for Payer: Group Health Inc Medicare	$1,963.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,805.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,805.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,646.50

BOSTON SCI WALLFLEX STENT 22X90MM

Facility

$5,170.92

Service Code	HCPCS C1876
Hospital Charge Code	40005500
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$5,429.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,844.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$3,102.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,585.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,973.28
Rate for Payer: EmblemHealth Commercial	$2,585.46
Rate for Payer: Fidelis Medicare Advantage	$5,429.47
Rate for Payer: Group Health Inc Commercial	$2,585.46
Rate for Payer: Group Health Inc Medicare	$1,809.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,585.46
Rate for Payer: Hamaspik Choice Inc Medicare	$2,585.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,361.10

BOSTON SCI WALLFLEX STENT 22X90MM

Facility

$5,170.92

Service Code	HCPCS C1876
Hospital Charge Code	40005500
Hospital Revenue Code	278
Min. Negotiated Rate	$2,585.46
Max. Negotiated Rate	$2,585.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,585.46
Rate for Payer: Hamaspik Choice Inc Medicare	$2,585.46

BOTTOM 3/4 CONTAINER HEIGHT 120MM

Facility

$448.18

Hospital Charge Code	40209547
Hospital Revenue Code	270
Min. Negotiated Rate	$156.86
Max. Negotiated Rate	$358.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$246.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$224.09
Rate for Payer: Aetna Government	$224.09
Rate for Payer: Brighton Health Commercial	$336.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$358.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$304.76
Rate for Payer: Group Health Inc Commercial	$224.09
Rate for Payer: Group Health Inc Medicare	$156.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$224.09
Rate for Payer: Hamaspik Choice Inc Medicare	$224.09

BOTULINUM TOXIN TYPE A 100 UNITS INJ

Facility

$19.00

Service Code	HCPCS J0585
Hospital Charge Code	41641593
Hospital Revenue Code	636
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$12.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.33
Rate for Payer: Aetna Government	$6.33
Rate for Payer: Affinity Essential Plan 1&2	$4.43
Rate for Payer: Affinity Essential Plan 3&4	$4.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.43
Rate for Payer: Brighton Health Commercial	$11.40
Rate for Payer: Cash Price	$6.33
Rate for Payer: Cash Price	$6.33
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.92
Rate for Payer: Elderplan Medicare Advantage	$6.33
Rate for Payer: EmblemHealth Commercial	$6.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.33
Rate for Payer: Fidelis Essential Plan Aliesa	$6.33
Rate for Payer: Fidelis Essential Plan QHP	$6.64
Rate for Payer: Fidelis Medicare Advantage	$6.33
Rate for Payer: Fidelis Qualified Health Plan	$6.64
Rate for Payer: Group Health Inc Commercial	$6.33
Rate for Payer: Group Health Inc Medicare	$6.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50
Rate for Payer: Healthfirst Medicare Advantage	$5.38
Rate for Payer: Healthfirst QHP	$6.33
Rate for Payer: Humana Medicare	$6.45
Rate for Payer: Senior Whole Health Medicare Advantage	$6.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.70
Rate for Payer: SOMOS Essential	$6.70
Rate for Payer: United Healthcare Commercial	$6.32
Rate for Payer: United Healthcare Medicare Advantage	$6.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.06
Rate for Payer: Wellcare Medicare	$6.01

BOTULINUM TOXIN TYPE A 100 UNITS INJ

Facility

$19.00

Service Code	HCPCS J0585
Hospital Charge Code	41651593
Hospital Revenue Code	636
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$12.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.33
Rate for Payer: Aetna Government	$6.33
Rate for Payer: Affinity Essential Plan 1&2	$4.43
Rate for Payer: Affinity Essential Plan 3&4	$4.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.43
Rate for Payer: Brighton Health Commercial	$11.40
Rate for Payer: Cash Price	$6.33
Rate for Payer: Cash Price	$6.33
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.92
Rate for Payer: Elderplan Medicare Advantage	$6.33
Rate for Payer: EmblemHealth Commercial	$6.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.33
Rate for Payer: Fidelis Essential Plan Aliesa	$6.33
Rate for Payer: Fidelis Essential Plan QHP	$6.64
Rate for Payer: Fidelis Medicare Advantage	$6.33
Rate for Payer: Fidelis Qualified Health Plan	$6.64
Rate for Payer: Group Health Inc Commercial	$6.33
Rate for Payer: Group Health Inc Medicare	$6.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50
Rate for Payer: Healthfirst Medicare Advantage	$5.38
Rate for Payer: Healthfirst QHP	$6.33
Rate for Payer: Humana Medicare	$6.45
Rate for Payer: Senior Whole Health Medicare Advantage	$6.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.70
Rate for Payer: SOMOS Essential	$6.70
Rate for Payer: United Healthcare Commercial	$6.32
Rate for Payer: United Healthcare Medicare Advantage	$6.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.06
Rate for Payer: Wellcare Medicare	$6.01

BOTULINUM TOXIN TYPE A 100 UNITS INJ

Facility

$19.00

Service Code	HCPCS J0585
Hospital Charge Code	41641593
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Cash Price	$6.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

BOTULINUM TOXIN TYPE A 100 UNITS INJ

Facility

$19.00

Service Code	HCPCS J0585
Hospital Charge Code	41651593
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Cash Price	$6.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

BOVINE CAROTID GRAFT 5MM X 39CM

Facility

$3,425.00

Service Code	HCPCS C1768
Hospital Charge Code	64906220
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$3,596.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,883.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$2,055.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,712.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,969.38
Rate for Payer: EmblemHealth Commercial	$1,712.50
Rate for Payer: Fidelis Medicare Advantage	$3,596.25
Rate for Payer: Group Health Inc Commercial	$1,712.50
Rate for Payer: Group Health Inc Medicare	$1,198.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,712.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,712.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,226.25

BOVINE CAROTID GRAFT 5MM X 39CM

Facility

$3,425.00

Service Code	HCPCS C1768
Hospital Charge Code	64906220
Hospital Revenue Code	278
Min. Negotiated Rate	$1,712.50
Max. Negotiated Rate	$1,712.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,712.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,712.50

BOVINE CAROTID GRAFT 5MM X 43CM

Facility

$1,419.00

Service Code	HCPCS C1768
Hospital Charge Code	40002337
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,489.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$851.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$709.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$815.92
Rate for Payer: EmblemHealth Commercial	$709.50
Rate for Payer: Fidelis Medicare Advantage	$1,489.95
Rate for Payer: Group Health Inc Commercial	$709.50
Rate for Payer: Group Health Inc Medicare	$496.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$709.50
Rate for Payer: Hamaspik Choice Inc Medicare	$709.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$922.35

BOVINE CAROTID GRAFT 5MM X 43CM

Facility

$1,419.00

Service Code	HCPCS C1768
Hospital Charge Code	64906216
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,489.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$851.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$709.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$815.92
Rate for Payer: EmblemHealth Commercial	$709.50
Rate for Payer: Fidelis Medicare Advantage	$1,489.95
Rate for Payer: Group Health Inc Commercial	$709.50
Rate for Payer: Group Health Inc Medicare	$496.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$709.50
Rate for Payer: Hamaspik Choice Inc Medicare	$709.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$922.35

BOVINE CAROTID GRAFT 5MM X 43CM

Facility

$1,419.00

Service Code	HCPCS C1768
Hospital Charge Code	40002337
Hospital Revenue Code	278
Min. Negotiated Rate	$709.50
Max. Negotiated Rate	$709.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$709.50
Rate for Payer: Hamaspik Choice Inc Medicare	$709.50

BOVINE CAROTID GRAFT 5MM X 43CM

Facility

$1,419.00

Service Code	HCPCS C1768
Hospital Charge Code	64906216
Hospital Revenue Code	278
Min. Negotiated Rate	$709.50
Max. Negotiated Rate	$709.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$709.50
Rate for Payer: Hamaspik Choice Inc Medicare	$709.50

BOWEL RESECTION

Facility

$4,205.72

Service Code	HCPCS 44202
Hospital Charge Code	40010635
Hospital Revenue Code	360
Min. Negotiated Rate	$1,472.00
Max. Negotiated Rate	$3,154.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,313.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,646.66
Rate for Payer: Aetna Government	$1,646.66
Rate for Payer: Brighton Health Commercial	$3,154.29
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	$2,102.86
Rate for Payer: Group Health Inc Medicare	$1,472.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,102.86
Rate for Payer: Hamaspik Choice Inc Medicare	$2,102.86
Rate for Payer: United Healthcare Commercial	$2,683.00

BOWL MIX CEMNT ADV CARTRDGE 180GR

Facility

$1,912.50

Hospital Charge Code	64904270
Hospital Revenue Code	270
Min. Negotiated Rate	$669.38
Max. Negotiated Rate	$1,530.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,051.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$956.25
Rate for Payer: Aetna Government	$956.25
Rate for Payer: Brighton Health Commercial	$1,434.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,530.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,300.50
Rate for Payer: Group Health Inc Commercial	$956.25
Rate for Payer: Group Health Inc Medicare	$669.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$956.25
Rate for Payer: Hamaspik Choice Inc Medicare	$956.25

BOWL QUIK-VAC CEMENT MIXING

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40205059
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$78.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: EmblemHealth Commercial	$65.00
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

BOWL QUIK-VAC CEMENT MIXING

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40205059
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

BOWL QUIK-VAC CEMENT MIXING

Facility

$160.80

Hospital Charge Code	64904432
Hospital Revenue Code	270
Min. Negotiated Rate	$56.28
Max. Negotiated Rate	$128.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.40
Rate for Payer: Aetna Government	$80.40
Rate for Payer: Brighton Health Commercial	$120.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.34
Rate for Payer: Group Health Inc Commercial	$80.40
Rate for Payer: Group Health Inc Medicare	$56.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.40
Rate for Payer: Hamaspik Choice Inc Medicare	$80.40

BOWL,STERILE,MEDIUM

Facility

$1.56

Hospital Charge Code	64901736
Hospital Revenue Code	270
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$1.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.06
Rate for Payer: Group Health Inc Commercial	$0.78
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78

BOX RTS BASIC COMPLETE MEMORY

Facility

$77.90

Hospital Charge Code	64903115
Hospital Revenue Code	270
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$62.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.95
Rate for Payer: Aetna Government	$38.95
Rate for Payer: Brighton Health Commercial	$58.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$52.97
Rate for Payer: Group Health Inc Commercial	$38.95
Rate for Payer: Group Health Inc Medicare	$27.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.95
Rate for Payer: Hamaspik Choice Inc Medicare	$38.95

B PERTUSSIS, NASOPHAR CULTURE

Facility

$21.55

Service Code	HCPCS 87070
Hospital Charge Code	40619185
Hospital Revenue Code	300
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$16.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.62
Rate for Payer: Aetna Government	$8.62
Rate for Payer: Affinity Essential Plan 1&2	$6.03
Rate for Payer: Affinity Essential Plan 3&4	$6.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.03
Rate for Payer: Brighton Health Commercial	$16.16
Rate for Payer: Cash Price	$8.62
Rate for Payer: Cash Price	$8.62
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.59
Rate for Payer: Elderplan Medicare Advantage	$8.62
Rate for Payer: EmblemHealth Commercial	$8.62
Rate for Payer: Fidelis Essential Plan Aliesa	$7.33
Rate for Payer: Fidelis Essential Plan QHP	$7.67
Rate for Payer: Fidelis Medicare Advantage	$8.62
Rate for Payer: Fidelis Qualified Health Plan	$7.67
Rate for Payer: Group Health Inc Commercial	$8.62
Rate for Payer: Group Health Inc Medicare	$8.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.78
Rate for Payer: Hamaspik Choice Inc Medicare	$8.62
Rate for Payer: Healthfirst Medicare Advantage	$8.62
Rate for Payer: Healthfirst QHP	$8.62
Rate for Payer: Humana Medicare	$8.79
Rate for Payer: Senior Whole Health Medicare Advantage	$8.62
Rate for Payer: United Healthcare Commercial	$10.91
Rate for Payer: United Healthcare Medicare Advantage	$8.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.90
Rate for Payer: Wellcare Medicare	$7.76

B PERTUSSIS, NASOPHAR CULTURE

Facility

$21.55

Service Code	HCPCS 87070
Hospital Charge Code	40619185
Hospital Revenue Code	300
Rate for Payer: Cash Price	$8.62

BRACELET ALLERGY (YELLOW)

Facility

$0.21

Hospital Charge Code	64901153
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11

BRACELET ID INFANT 4PART

Facility

$0.47

Hospital Charge Code	64903234
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.32
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24

Know your out-of-pocket cost for care.

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