St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CANCELLOUS BONE CLAMP 120-40MM

Facility

$256.00

Hospital Charge Code	40200255
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

CANCELLOUS CORTICAL SCRW3.5MMX32M

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	40201260
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

CANCELLOUS CORTICAL SCRW3.5MMX32M

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	40201260
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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 Medicare Advantage	$126.00
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	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

CANCELLOUS CORTICAL SCRW3.5MMX34M

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	40201261
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

CANCELLOUS CORTICAL SCRW3.5MMX34M

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	40201261
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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 Medicare Advantage	$126.00
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	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

CANCELLOUS CORTICAL SCRW3.5MMX38M

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	40201262
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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 Medicare Advantage	$126.00
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	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

CANCELLOUS CORTICAL SCRW3.5MMX38M

Facility

$120.00

Service Code	HCPCS C1713
Hospital Charge Code	40201262
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

CANCELLOUS CRUSHED 5CC

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	64903305
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

CANCELLOUS CRUSHED 5CC

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	64903305
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

CANCELLOUS CUBES 10CC

Facility

$462.50

Service Code	HCPCS C1713
Hospital Charge Code	64902820
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$231.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.25
Rate for Payer: Hamaspik Choice Inc Medicare	$231.25

CANCELLOUS CUBES 10CC

Facility

$462.50

Service Code	HCPCS C1713
Hospital Charge Code	64902820
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$485.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$277.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$231.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$265.94
Rate for Payer: EmblemHealth Commercial	$231.25
Rate for Payer: Fidelis Medicare Advantage	$485.62
Rate for Payer: Group Health Inc Commercial	$231.25
Rate for Payer: Group Health Inc Medicare	$161.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.25
Rate for Payer: Hamaspik Choice Inc Medicare	$231.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$300.62

CANCER 27.29

Facility

$52.03

Service Code	HCPCS 86316
Hospital Charge Code	40728132
Hospital Revenue Code	302
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$39.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.81
Rate for Payer: Aetna Government	$20.81
Rate for Payer: Affinity Essential Plan 1&2	$14.57
Rate for Payer: Affinity Essential Plan 3&4	$14.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.57
Rate for Payer: Brighton Health Commercial	$39.02
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cash Price	$20.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.00
Rate for Payer: Elderplan Medicare Advantage	$20.81
Rate for Payer: EmblemHealth Commercial	$20.81
Rate for Payer: Fidelis Essential Plan Aliesa	$17.69
Rate for Payer: Fidelis Essential Plan QHP	$18.52
Rate for Payer: Fidelis Medicare Advantage	$20.81
Rate for Payer: Fidelis Qualified Health Plan	$18.52
Rate for Payer: Group Health Inc Commercial	$20.81
Rate for Payer: Group Health Inc Medicare	$20.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.02
Rate for Payer: Hamaspik Choice Inc Medicare	$20.81
Rate for Payer: Healthfirst Medicare Advantage	$20.81
Rate for Payer: Healthfirst QHP	$20.81
Rate for Payer: Humana Medicare	$21.23
Rate for Payer: Senior Whole Health Medicare Advantage	$20.81
Rate for Payer: United Healthcare Commercial	$26.36
Rate for Payer: United Healthcare Medicare Advantage	$20.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16.65
Rate for Payer: Wellcare Medicare	$18.73

CANCER 27.29

Facility

$52.03

Service Code	HCPCS 86316
Hospital Charge Code	40728132
Hospital Revenue Code	302
Rate for Payer: Cash Price	$20.81

CANCER ANTIGEN (CA) 125

Facility

$52.03

Service Code	HCPCS 86304
Hospital Charge Code	40609143
Hospital Revenue Code	300
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$39.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.81
Rate for Payer: Aetna Government	$20.81
Rate for Payer: Affinity Essential Plan 1&2	$14.57
Rate for Payer: Affinity Essential Plan 3&4	$14.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.57
Rate for Payer: Brighton Health Commercial	$39.02
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cash Price	$20.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.00
Rate for Payer: Elderplan Medicare Advantage	$20.81
Rate for Payer: EmblemHealth Commercial	$20.81
Rate for Payer: Fidelis Essential Plan Aliesa	$17.69
Rate for Payer: Fidelis Essential Plan QHP	$18.52
Rate for Payer: Fidelis Medicare Advantage	$20.81
Rate for Payer: Fidelis Qualified Health Plan	$18.52
Rate for Payer: Group Health Inc Commercial	$20.81
Rate for Payer: Group Health Inc Medicare	$20.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.02
Rate for Payer: Hamaspik Choice Inc Medicare	$20.81
Rate for Payer: Healthfirst Medicare Advantage	$20.81
Rate for Payer: Healthfirst QHP	$20.81
Rate for Payer: Humana Medicare	$21.23
Rate for Payer: Senior Whole Health Medicare Advantage	$20.81
Rate for Payer: United Healthcare Commercial	$26.36
Rate for Payer: United Healthcare Medicare Advantage	$20.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16.65
Rate for Payer: Wellcare Medicare	$18.73

CANCER ANTIGEN (CA) 125

Facility

$52.03

Service Code	HCPCS 86304
Hospital Charge Code	40609143
Hospital Revenue Code	300
Rate for Payer: Cash Price	$20.81

CANCER ANTIGEN (CA) 15-3

Facility

$52.03

Service Code	HCPCS 86300
Hospital Charge Code	40609141
Hospital Revenue Code	300
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$39.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.81
Rate for Payer: Aetna Government	$20.81
Rate for Payer: Affinity Essential Plan 1&2	$14.57
Rate for Payer: Affinity Essential Plan 3&4	$14.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.57
Rate for Payer: Brighton Health Commercial	$39.02
Rate for Payer: Cash Price	$20.81
Rate for Payer: Cash Price	$20.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.00
Rate for Payer: Elderplan Medicare Advantage	$20.81
Rate for Payer: EmblemHealth Commercial	$20.81
Rate for Payer: Fidelis Essential Plan Aliesa	$17.69
Rate for Payer: Fidelis Essential Plan QHP	$18.52
Rate for Payer: Fidelis Medicare Advantage	$20.81
Rate for Payer: Fidelis Qualified Health Plan	$18.52
Rate for Payer: Group Health Inc Commercial	$20.81
Rate for Payer: Group Health Inc Medicare	$20.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.02
Rate for Payer: Hamaspik Choice Inc Medicare	$20.81
Rate for Payer: Healthfirst Medicare Advantage	$20.81
Rate for Payer: Healthfirst QHP	$20.81
Rate for Payer: Humana Medicare	$21.23
Rate for Payer: Senior Whole Health Medicare Advantage	$20.81
Rate for Payer: United Healthcare Commercial	$26.36
Rate for Payer: United Healthcare Medicare Advantage	$20.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16.65
Rate for Payer: Wellcare Medicare	$18.73

CANCER ANTIGEN (CA) 15-3

Facility

$52.03

Service Code	HCPCS 86300
Hospital Charge Code	40609141
Hospital Revenue Code	300
Rate for Payer: Cash Price	$20.81

CANDESARTAN 16 MG TAB

Facility

$5.03

Hospital Charge Code	41643008
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.52
Rate for Payer: Aetna Government	$2.52
Rate for Payer: Brighton Health Commercial	$3.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.42
Rate for Payer: Group Health Inc Commercial	$2.52
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.52
Rate for Payer: Hamaspik Choice Inc Medicare	$2.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.27

CANDESARTAN 16 MG TAB

Facility

$5.03

Hospital Charge Code	41653008
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.52
Rate for Payer: Aetna Government	$2.52
Rate for Payer: Brighton Health Commercial	$3.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.42
Rate for Payer: Group Health Inc Commercial	$2.52
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.52
Rate for Payer: Hamaspik Choice Inc Medicare	$2.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.27

CANDESARTAN 4 MG TAB

Facility

$5.04

Hospital Charge Code	41654636
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.52
Rate for Payer: Aetna Government	$2.52
Rate for Payer: Brighton Health Commercial	$3.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.43
Rate for Payer: Group Health Inc Commercial	$2.52
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.52
Rate for Payer: Hamaspik Choice Inc Medicare	$2.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

CANDESARTAN 4 MG TAB

Facility

$5.04

Hospital Charge Code	41644636
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.52
Rate for Payer: Aetna Government	$2.52
Rate for Payer: Brighton Health Commercial	$3.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.43
Rate for Payer: Group Health Inc Commercial	$2.52
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.52
Rate for Payer: Hamaspik Choice Inc Medicare	$2.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

CANDESARTAN 8 MG TAB

Facility

$5.04

Hospital Charge Code	41644815
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.52
Rate for Payer: Aetna Government	$2.52
Rate for Payer: Brighton Health Commercial	$3.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.43
Rate for Payer: Group Health Inc Commercial	$2.52
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.52
Rate for Payer: Hamaspik Choice Inc Medicare	$2.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

CANDESARTAN 8 MG TAB

Facility

$5.04

Hospital Charge Code	41654815
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.52
Rate for Payer: Aetna Government	$2.52
Rate for Payer: Brighton Health Commercial	$3.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.43
Rate for Payer: Group Health Inc Commercial	$2.52
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.52
Rate for Payer: Hamaspik Choice Inc Medicare	$2.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.28

CANDESARTAN CILEXETIL 16 MG PO TABS [23231]

Facility

$5.39

Service Code	NDC 60687024195
Hospital Charge Code	60687024195
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$4.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.70
Rate for Payer: Aetna Government	$2.70
Rate for Payer: Brighton Health Commercial	$4.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.67
Rate for Payer: Group Health Inc Commercial	$2.70
Rate for Payer: Group Health Inc Medicare	$1.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.70
Rate for Payer: Hamaspik Choice Inc Medicare	$2.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.50

CANDESARTAN CILEXETIL 16 MG PO TABS [23231]

Facility

$5.39

Service Code	NDC 60687024125
Hospital Charge Code	60687024125
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$4.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.69
Rate for Payer: Aetna Government	$2.69
Rate for Payer: Brighton Health Commercial	$4.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.66
Rate for Payer: Group Health Inc Commercial	$2.69
Rate for Payer: Group Health Inc Medicare	$1.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.69
Rate for Payer: Hamaspik Choice Inc Medicare	$2.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.50

Know your out-of-pocket cost for care.

All Charges