St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CAL GLUC 2000MG NS 100ML-20MG/ML

Facility

$6.00

Hospital Charge Code	41657162
Hospital Revenue Code	250
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

CAL GLUC 5000MG/D5W 500ML PER 10

Facility

$7.00

Hospital Charge Code	41647157
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

CAL GLUC 5000MG/D5W 500ML PER 10

Facility

$7.00

Hospital Charge Code	41657157
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

CAL GLUC 5000MG NS 500ML-10MG/ML

Facility

$7.00

Hospital Charge Code	41647161
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

CAL GLUC 5000MG NS 500ML-10MG/ML

Facility

$7.00

Hospital Charge Code	41657161
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

CALIBRATED DRILL 4.3MM LONG

Facility

$237.60

Service Code	HCPCS C1713
Hospital Charge Code	40006463
Hospital Revenue Code	278
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$249.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$142.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.62
Rate for Payer: EmblemHealth Commercial	$118.80
Rate for Payer: Fidelis Medicare Advantage	$249.48
Rate for Payer: Group Health Inc Commercial	$118.80
Rate for Payer: Group Health Inc Medicare	$83.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.80
Rate for Payer: Hamaspik Choice Inc Medicare	$118.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.44

CALIBRATED DRILL 4.3MM LONG

Facility

$237.60

Service Code	HCPCS C1713
Hospital Charge Code	40006463
Hospital Revenue Code	278
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$118.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.80
Rate for Payer: Hamaspik Choice Inc Medicare	$118.80

CALIBRATED DRILL 4.3MM SHORT

Facility

$237.60

Service Code	HCPCS C1713
Hospital Charge Code	40006470
Hospital Revenue Code	278
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$118.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.80
Rate for Payer: Hamaspik Choice Inc Medicare	$118.80

CALIBRATED DRILL 4.3MM SHORT

Facility

$237.60

Service Code	HCPCS C1713
Hospital Charge Code	40006470
Hospital Revenue Code	278
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$249.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$142.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.62
Rate for Payer: EmblemHealth Commercial	$118.80
Rate for Payer: Fidelis Medicare Advantage	$249.48
Rate for Payer: Group Health Inc Commercial	$118.80
Rate for Payer: Group Health Inc Medicare	$83.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.80
Rate for Payer: Hamaspik Choice Inc Medicare	$118.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.44

CALIGOR DRAINAGE SYST.II EXTERNAL

Facility

$443.14

Hospital Charge Code	40203363
Hospital Revenue Code	272
Min. Negotiated Rate	$155.10
Max. Negotiated Rate	$354.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$243.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.57
Rate for Payer: Aetna Government	$221.57
Rate for Payer: Brighton Health Commercial	$332.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$354.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.34
Rate for Payer: Group Health Inc Commercial	$221.57
Rate for Payer: Group Health Inc Medicare	$155.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$221.57
Rate for Payer: Hamaspik Choice Inc Medicare	$221.57

CALIGOR DRAINAGE SYST.II EXTERNAL

Facility

$443.14

Hospital Charge Code	40009346
Hospital Revenue Code	272
Min. Negotiated Rate	$155.10
Max. Negotiated Rate	$354.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$243.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$221.57
Rate for Payer: Aetna Government	$221.57
Rate for Payer: Brighton Health Commercial	$332.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$354.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.34
Rate for Payer: Group Health Inc Commercial	$221.57
Rate for Payer: Group Health Inc Medicare	$155.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$221.57
Rate for Payer: Hamaspik Choice Inc Medicare	$221.57

CALIGOR TRAY CATH MAHURKAR

Facility

$954.90

Hospital Charge Code	40009353
Hospital Revenue Code	272
Min. Negotiated Rate	$334.22
Max. Negotiated Rate	$763.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$525.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$477.45
Rate for Payer: Aetna Government	$477.45
Rate for Payer: Brighton Health Commercial	$716.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$763.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$649.33
Rate for Payer: Group Health Inc Commercial	$477.45
Rate for Payer: Group Health Inc Medicare	$334.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$477.45
Rate for Payer: Hamaspik Choice Inc Medicare	$477.45

CALIGOR TRAY CATH MAHURKAR

Facility

$954.90

Hospital Charge Code	40203370
Hospital Revenue Code	272
Min. Negotiated Rate	$334.22
Max. Negotiated Rate	$763.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$525.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$477.45
Rate for Payer: Aetna Government	$477.45
Rate for Payer: Brighton Health Commercial	$716.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$763.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$649.33
Rate for Payer: Group Health Inc Commercial	$477.45
Rate for Payer: Group Health Inc Medicare	$334.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$477.45
Rate for Payer: Hamaspik Choice Inc Medicare	$477.45

CALIPER

Facility

$1,500.00

Hospital Charge Code	40209527
Hospital Revenue Code	270
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$750.00
Rate for Payer: Aetna Government	$750.00
Rate for Payer: Brighton Health Commercial	$1,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,020.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

CALIPERS CASTROVIEJO

Facility

$160.00

Hospital Charge Code	40200218
Hospital Revenue Code	270
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$128.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.00
Rate for Payer: Aetna Government	$80.00
Rate for Payer: Brighton Health Commercial	$120.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.80
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00

CALPROTECTIN, FECAL

Facility

$49.08

Service Code	HCPCS 83993
Hospital Charge Code	40609106
Hospital Revenue Code	300
Rate for Payer: Cash Price	$19.63

CALPROTECTIN, FECAL

Facility

$49.08

Service Code	HCPCS 83993
Hospital Charge Code	40609106
Hospital Revenue Code	300
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$36.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.63
Rate for Payer: Aetna Government	$19.63
Rate for Payer: Affinity Essential Plan 1&2	$13.74
Rate for Payer: Affinity Essential Plan 3&4	$13.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.74
Rate for Payer: Brighton Health Commercial	$36.81
Rate for Payer: Cash Price	$19.63
Rate for Payer: Cash Price	$19.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.39
Rate for Payer: Elderplan Medicare Advantage	$19.63
Rate for Payer: EmblemHealth Commercial	$19.63
Rate for Payer: Fidelis Essential Plan Aliesa	$16.69
Rate for Payer: Fidelis Essential Plan QHP	$17.47
Rate for Payer: Fidelis Medicare Advantage	$19.63
Rate for Payer: Fidelis Qualified Health Plan	$17.47
Rate for Payer: Group Health Inc Commercial	$19.63
Rate for Payer: Group Health Inc Medicare	$19.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.54
Rate for Payer: Hamaspik Choice Inc Medicare	$19.63
Rate for Payer: Healthfirst Medicare Advantage	$19.63
Rate for Payer: Healthfirst QHP	$19.63
Rate for Payer: Humana Medicare	$20.02
Rate for Payer: Senior Whole Health Medicare Advantage	$19.63
Rate for Payer: United Healthcare Commercial	$24.86
Rate for Payer: United Healthcare Medicare Advantage	$19.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.70
Rate for Payer: Wellcare Medicare	$17.67

CANAL PREP AND FITTING OF PREFORM

Facility

$157.34

Service Code	HCPCS D3950
Hospital Charge Code	42300820
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

CANAL PREP AND FITTING OF PREFORM

Facility

$157.34

Service Code	HCPCS D3950
Hospital Charge Code	42300820
Hospital Revenue Code	361
Min. Negotiated Rate	$78.67
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$118.00
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.67
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

CANAVAN DISEASE, DNA

Facility

$118.13

Service Code	HCPCS 81200
Hospital Charge Code	40603050
Hospital Revenue Code	300
Rate for Payer: Cash Price	$47.25

CANAVAN DISEASE, DNA

Facility

$118.13

Service Code	HCPCS 81200
Hospital Charge Code	40603050
Hospital Revenue Code	300
Min. Negotiated Rate	$33.08
Max. Negotiated Rate	$94.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.25
Rate for Payer: Aetna Government	$47.25
Rate for Payer: Affinity Essential Plan 1&2	$33.08
Rate for Payer: Affinity Essential Plan 3&4	$33.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$33.08
Rate for Payer: Brighton Health Commercial	$88.60
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$47.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.33
Rate for Payer: Elderplan Medicare Advantage	$47.25
Rate for Payer: EmblemHealth Commercial	$47.25
Rate for Payer: Fidelis Essential Plan Aliesa	$40.16
Rate for Payer: Fidelis Essential Plan QHP	$42.05
Rate for Payer: Fidelis Medicare Advantage	$47.25
Rate for Payer: Fidelis Qualified Health Plan	$42.05
Rate for Payer: Group Health Inc Commercial	$47.25
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.06
Rate for Payer: Hamaspik Choice Inc Medicare	$47.25
Rate for Payer: Healthfirst Medicare Advantage	$47.25
Rate for Payer: Healthfirst QHP	$47.25
Rate for Payer: Humana Medicare	$48.20
Rate for Payer: Senior Whole Health Medicare Advantage	$47.25
Rate for Payer: United Healthcare Commercial	$42.52
Rate for Payer: United Healthcare Medicare Advantage	$47.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.80
Rate for Payer: Wellcare Medicare	$42.52

CAN BISHP-HRMN B-D HUB TIP OY

Facility

$52.00

Hospital Charge Code	64905560
Hospital Revenue Code	270
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$41.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.00
Rate for Payer: Aetna Government	$26.00
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.36
Rate for Payer: Group Health Inc Commercial	$26.00
Rate for Payer: Group Health Inc Medicare	$18.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.00
Rate for Payer: Hamaspik Choice Inc Medicare	$26.00

CANCELLO-PURE BONE WEDGE

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	40202371
Hospital Revenue Code	278
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00

CANCELLO-PURE BONE WEDGE

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	40202371
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,020.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$977.50
Rate for Payer: EmblemHealth Commercial	$850.00
Rate for Payer: Fidelis Medicare Advantage	$1,785.00
Rate for Payer: Group Health Inc Commercial	$850.00
Rate for Payer: Group Health Inc Medicare	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,105.00

CANCELLOUS BONE CLAMP

Facility

$256.00

Hospital Charge Code	40200990
Hospital Revenue Code	270
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$204.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$140.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$128.00
Rate for Payer: Aetna Government	$128.00
Rate for Payer: Brighton Health Commercial	$192.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$174.08
Rate for Payer: Group Health Inc Commercial	$128.00
Rate for Payer: Group Health Inc Medicare	$89.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.00
Rate for Payer: Hamaspik Choice Inc Medicare	$128.00

Know your out-of-pocket cost for care.

All Charges