St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC CARDIAC OUTPUT TUBING

Facility

$614.00

Hospital Charge Code	66540238
Hospital Revenue Code	480
Min. Negotiated Rate	$214.90
Max. Negotiated Rate	$491.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$337.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$307.00
Rate for Payer: Aetna Government	$307.00
Rate for Payer: Brighton Health Commercial	$460.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$491.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$417.52
Rate for Payer: Group Health Inc Commercial	$307.00
Rate for Payer: Group Health Inc Medicare	$214.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.00
Rate for Payer: Hamaspik Choice Inc Medicare	$307.00
Rate for Payer: United Healthcare Commercial	$316.00

CC CARDIOPULMONARY RESUSCITATION

Facility

$766.58

Service Code	HCPCS 92950
Hospital Charge Code	66528381
Hospital Revenue Code	481
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,215.78
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

CC CARDIOPULMONARY RESUSCITATION

Facility

$766.58

Service Code	HCPCS 92950
Hospital Charge Code	66528381
Hospital Revenue Code	481
Rate for Payer: Cash Price	$362.98

CC CARDIOVERSION , ELECTIVE

Facility

$1,624.80

Service Code	HCPCS 92960
Hospital Charge Code	66528380
Hospital Revenue Code	480
Min. Negotiated Rate	$316.00
Max. Negotiated Rate	$1,299.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$893.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$752.63
Rate for Payer: Aetna Government	$752.63
Rate for Payer: Affinity Essential Plan 1&2	$526.84
Rate for Payer: Affinity Essential Plan 3&4	$526.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$526.84
Rate for Payer: Brighton Health Commercial	$1,218.60
Rate for Payer: Cash Price	$752.63
Rate for Payer: Cash Price	$752.63
Rate for Payer: Cash Price	$752.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$752.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,299.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.86
Rate for Payer: Elderplan Medicare Advantage	$752.63
Rate for Payer: EmblemHealth Commercial	$752.63
Rate for Payer: Fidelis Essential Plan Aliesa	$639.74
Rate for Payer: Fidelis Essential Plan QHP	$669.84
Rate for Payer: Fidelis Medicare Advantage	$752.63
Rate for Payer: Fidelis Qualified Health Plan	$669.84
Rate for Payer: Group Health Inc Commercial	$752.63
Rate for Payer: Group Health Inc Medicare	$752.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.40
Rate for Payer: Hamaspik Choice Inc Medicare	$752.63
Rate for Payer: Healthfirst Medicare Advantage	$639.74
Rate for Payer: Healthfirst QHP	$752.63
Rate for Payer: Humana Medicare	$767.68
Rate for Payer: Senior Whole Health Medicare Advantage	$752.63
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$752.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$752.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$602.10
Rate for Payer: Wellcare Medicare	$715.00

CC CARDIOVERSION , ELECTIVE

Facility

$1,624.80

Service Code	HCPCS 92960
Hospital Charge Code	66528380
Hospital Revenue Code	480
Rate for Payer: Cash Price	$752.63

CC CARDIOVERSION, ELECTIVE, INT

Facility

$1,624.80

Service Code	HCPCS 92961
Hospital Charge Code	66528670
Hospital Revenue Code	480
Min. Negotiated Rate	$316.00
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$752.63
Rate for Payer: Aetna Government	$752.63
Rate for Payer: Affinity Essential Plan 1&2	$526.84
Rate for Payer: Affinity Essential Plan 3&4	$526.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$526.84
Rate for Payer: Brighton Health Commercial	$1,218.60
Rate for Payer: Cash Price	$752.63
Rate for Payer: Cash Price	$752.63
Rate for Payer: Cash Price	$752.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$752.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,299.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.86
Rate for Payer: Elderplan Medicare Advantage	$752.63
Rate for Payer: EmblemHealth Commercial	$752.63
Rate for Payer: Fidelis Essential Plan Aliesa	$639.74
Rate for Payer: Fidelis Essential Plan QHP	$669.84
Rate for Payer: Fidelis Medicare Advantage	$752.63
Rate for Payer: Fidelis Qualified Health Plan	$669.84
Rate for Payer: Group Health Inc Commercial	$752.63
Rate for Payer: Group Health Inc Medicare	$752.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.40
Rate for Payer: Hamaspik Choice Inc Medicare	$752.63
Rate for Payer: Healthfirst Medicare Advantage	$639.74
Rate for Payer: Healthfirst QHP	$752.63
Rate for Payer: Humana Medicare	$767.68
Rate for Payer: Senior Whole Health Medicare Advantage	$752.63
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$752.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$752.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$602.10
Rate for Payer: Wellcare Medicare	$715.00

CC CARDIOVERSION, ELECTIVE, INT

Facility

$1,624.80

Service Code	HCPCS 92961
Hospital Charge Code	66528670
Hospital Revenue Code	480
Rate for Payer: Cash Price	$752.63

CC CARTOID ANGIO, SEL BILAT INJ

Facility

$1,796.70

Service Code	HCPCS 36100
Hospital Charge Code	66528397
Hospital Revenue Code	360
Min. Negotiated Rate	$172.63
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$172.63
Rate for Payer: Aetna Government	$172.63
Rate for Payer: Brighton Health Commercial	$1,347.52
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	$898.35
Rate for Payer: Group Health Inc Medicare	$628.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$898.35
Rate for Payer: Hamaspik Choice Inc Medicare	$898.35
Rate for Payer: United Healthcare Commercial	$1,113.00

CC CARTOID ANGIO, SELECTIVE BILAT

Facility

$1,872.25

Service Code	HCPCS 36227
Hospital Charge Code	66528396
Hospital Revenue Code	320
Min. Negotiated Rate	$127.38
Max. Negotiated Rate	$4,065.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.38
Rate for Payer: Aetna Government	$127.38
Rate for Payer: Brighton Health Commercial	$1,404.19
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: Group Health Inc Commercial	$936.12
Rate for Payer: Group Health Inc Medicare	$655.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$936.12
Rate for Payer: Hamaspik Choice Inc Medicare	$936.12

CC CATH 5F 100CM AR MOD H749

Facility

$719.03

Hospital Charge Code	66520131
Hospital Revenue Code	480
Min. Negotiated Rate	$251.66
Max. Negotiated Rate	$575.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$395.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$359.52
Rate for Payer: Aetna Government	$359.52
Rate for Payer: Brighton Health Commercial	$539.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$488.94
Rate for Payer: Group Health Inc Commercial	$359.52
Rate for Payer: Group Health Inc Medicare	$251.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.52
Rate for Payer: Hamaspik Choice Inc Medicare	$359.52
Rate for Payer: United Healthcare Commercial	$316.00

CC CATH 5F 100CM FL4.5 H749

Facility

$298.20

Hospital Charge Code	66520133
Hospital Revenue Code	480
Min. Negotiated Rate	$104.37
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$164.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$149.10
Rate for Payer: Aetna Government	$149.10
Rate for Payer: Brighton Health Commercial	$223.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$238.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$202.78
Rate for Payer: Group Health Inc Commercial	$149.10
Rate for Payer: Group Health Inc Medicare	$104.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.10
Rate for Payer: Hamaspik Choice Inc Medicare	$149.10
Rate for Payer: United Healthcare Commercial	$316.00

CC CATH 5F 100CM FL5 H749

Facility

$715.88

Hospital Charge Code	66520132
Hospital Revenue Code	480
Min. Negotiated Rate	$250.56
Max. Negotiated Rate	$572.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$393.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$357.94
Rate for Payer: Aetna Government	$357.94
Rate for Payer: Brighton Health Commercial	$536.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$572.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$486.80
Rate for Payer: Group Health Inc Commercial	$357.94
Rate for Payer: Group Health Inc Medicare	$250.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$357.94
Rate for Payer: Hamaspik Choice Inc Medicare	$357.94
Rate for Payer: United Healthcare Commercial	$316.00

CC CATH CARON DIAG RAD TIG 4.0 5

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520201
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

CC CATH CARON DIAG RAD TIG 4.0 5

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520201
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: EmblemHealth Commercial	$110.00
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

CC CATH CONTAMINATION SHIELD ARRO

Facility

$22.00

Hospital Charge Code	66528267
Hospital Revenue Code	270
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$17.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.00
Rate for Payer: Aetna Government	$11.00
Rate for Payer: Brighton Health Commercial	$16.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.96
Rate for Payer: Group Health Inc Commercial	$11.00
Rate for Payer: Group Health Inc Medicare	$7.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11.00

CC CATH CORON DIAG RAD CRV 4.0 6

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520204
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

CC CATH CORON DIAG RAD CRV 4.0 6

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520204
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: EmblemHealth Commercial	$110.00
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

CC CATH CORON DIAG RAD TIG 4.5 5

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520202
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: EmblemHealth Commercial	$110.00
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

CC CATH CORON DIAG RAD TIG 4.5 5

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520202
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

CC CATH CORON DIA RAD CRV 3.5 5F

Facility

$220.00

Hospital Charge Code	66520126
Hospital Revenue Code	480
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$110.00
Rate for Payer: Aetna Government	$110.00
Rate for Payer: Brighton Health Commercial	$165.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.60
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: United Healthcare Commercial	$316.00

CC CATH CORON DIA RAD CRV 3.5 5F

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520203
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: EmblemHealth Commercial	$110.00
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

CC CATH CORON DIA RAD CRV 3.5 5F

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	66520203
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

CC CATHERS JL 4.0 5F

Facility

$400.00

Hospital Charge Code	66528807
Hospital Revenue Code	480
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.00
Rate for Payer: Aetna Government	$200.00
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00
Rate for Payer: United Healthcare Commercial	$316.00

CC CATHETER 5FR AR2 100CM

Facility

$224.00

Hospital Charge Code	66520208
Hospital Revenue Code	481
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$112.00
Rate for Payer: Aetna Government	$112.00
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,215.78
Rate for Payer: Group Health Inc Commercial	$112.00
Rate for Payer: Group Health Inc Medicare	$78.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.00
Rate for Payer: Hamaspik Choice Inc Medicare	$112.00

CC CATHETERS JR 4 5F

Facility

$44.80

Hospital Charge Code	66528812
Hospital Revenue Code	480
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.40
Rate for Payer: Aetna Government	$22.40
Rate for Payer: Brighton Health Commercial	$33.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.46
Rate for Payer: Group Health Inc Commercial	$22.40
Rate for Payer: Group Health Inc Medicare	$15.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.40
Rate for Payer: Hamaspik Choice Inc Medicare	$22.40
Rate for Payer: United Healthcare Commercial	$316.00

Know your out-of-pocket cost for care.

All Charges