St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CELECOXIB 100 MG PO CAPS [24500]

Facility

$4.62

Service Code	NDC 69367030101
Hospital Charge Code	69367030101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.31
Rate for Payer: Aetna Government	$2.31
Rate for Payer: Brighton Health Commercial	$3.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.14
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.00

CELECOXIB 100 MG PO CAPS [24500]

Facility

$4.62

Service Code	NDC 65862090801
Hospital Charge Code	65862090801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.31
Rate for Payer: Aetna Government	$2.31
Rate for Payer: Brighton Health Commercial	$3.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.14
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.00

CELECOXIB 100 MG PO CAPS [24500]

Facility

$4.37

Service Code	NDC 00904650261
Hospital Charge Code	00904650261
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$3.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.18
Rate for Payer: Aetna Government	$2.18
Rate for Payer: Brighton Health Commercial	$3.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.97
Rate for Payer: Group Health Inc Commercial	$2.18
Rate for Payer: Group Health Inc Medicare	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.84

CELECOXIB 100 MG PO CAPS [24500]

Facility

$4.62

Service Code	NDC 72241002305
Hospital Charge Code	72241002305
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.31
Rate for Payer: Aetna Government	$2.31
Rate for Payer: Brighton Health Commercial	$3.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.14
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.00

CELECOXIB 200 MG CAP

Facility

$8.68

Hospital Charge Code	41652045
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$6.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.34
Rate for Payer: Aetna Government	$4.34
Rate for Payer: Brighton Health Commercial	$6.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.90
Rate for Payer: Group Health Inc Commercial	$4.34
Rate for Payer: Group Health Inc Medicare	$3.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.34
Rate for Payer: Hamaspik Choice Inc Medicare	$4.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.64

CELECOXIB 200 MG CAP

Facility

$8.68

Hospital Charge Code	41642045
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$6.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.34
Rate for Payer: Aetna Government	$4.34
Rate for Payer: Brighton Health Commercial	$6.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.90
Rate for Payer: Group Health Inc Commercial	$4.34
Rate for Payer: Group Health Inc Medicare	$3.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.34
Rate for Payer: Hamaspik Choice Inc Medicare	$4.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.64

CELECOXIB 200 MG PO CAPS [24501]

Facility

$7.58

Service Code	NDC 00904650361
Hospital Charge Code	00904650361
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.79
Rate for Payer: Aetna Government	$3.79
Rate for Payer: Brighton Health Commercial	$5.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.15
Rate for Payer: Group Health Inc Commercial	$3.79
Rate for Payer: Group Health Inc Medicare	$2.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.79
Rate for Payer: Hamaspik Choice Inc Medicare	$3.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.93

CELECOXIB 200 MG PO CAPS [24501]

Facility

$2.43

Service Code	NDC 50268016911
Hospital Charge Code	50268016911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.21
Rate for Payer: Aetna Government	$1.21
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.65
Rate for Payer: Group Health Inc Commercial	$1.21
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.21
Rate for Payer: Hamaspik Choice Inc Medicare	$1.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.58

CELECOXIB 200 MG PO CAPS [24501]

Facility

$7.58

Service Code	NDC 69097042107
Hospital Charge Code	69097042107
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.79
Rate for Payer: Aetna Government	$3.79
Rate for Payer: Brighton Health Commercial	$5.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.15
Rate for Payer: Group Health Inc Commercial	$3.79
Rate for Payer: Group Health Inc Medicare	$2.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.79
Rate for Payer: Hamaspik Choice Inc Medicare	$3.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.93

CELECOXIB 200 MG PO CAPS [24501]

Facility

$7.58

Service Code	NDC 59762151701
Hospital Charge Code	59762151701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.79
Rate for Payer: Aetna Government	$3.79
Rate for Payer: Brighton Health Commercial	$5.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.16
Rate for Payer: Group Health Inc Commercial	$3.79
Rate for Payer: Group Health Inc Medicare	$2.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.79
Rate for Payer: Hamaspik Choice Inc Medicare	$3.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.93

CELECOXIB 200 MG PO CAPS [24501]

Facility

$2.43

Service Code	NDC 50268016915
Hospital Charge Code	50268016915
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.21
Rate for Payer: Aetna Government	$1.21
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.65
Rate for Payer: Group Health Inc Commercial	$1.21
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.21
Rate for Payer: Hamaspik Choice Inc Medicare	$1.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.58

CELECOXIB 200 MG PO CAPS [24501]

Facility

$7.58

Service Code	NDC 72241002405
Hospital Charge Code	72241002405
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.79
Rate for Payer: Aetna Government	$3.79
Rate for Payer: Brighton Health Commercial	$5.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.16
Rate for Payer: Group Health Inc Commercial	$3.79
Rate for Payer: Group Health Inc Medicare	$2.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.79
Rate for Payer: Hamaspik Choice Inc Medicare	$3.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.93

CELIAC PLEX DEST NEUROLY

Facility

$2,459.50

Service Code	HCPCS 64680
Hospital Charge Code	30305729
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Affinity Essential Plan 1&2	$737.84
Rate for Payer: Affinity Essential Plan 3&4	$737.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$737.84
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
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	$1,054.06
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Humana Medicare	$1,075.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

CELIAC PLEX DEST NEUROLY

Facility

$2,459.50

Service Code	HCPCS 64680
Hospital Charge Code	30305729
Hospital Revenue Code	510
Rate for Payer: Cash Price	$1,054.06

CELIAC PLEXUS

Facility

$2,459.50

Service Code	HCPCS 64530
Hospital Charge Code	30305038
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Affinity Essential Plan 1&2	$737.84
Rate for Payer: Affinity Essential Plan 3&4	$737.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$737.84
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
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	$1,054.06
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Humana Medicare	$1,075.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

CELIAC PLEXUS

Facility

$2,459.50

Service Code	HCPCS 64530
Hospital Charge Code	30305038
Hospital Revenue Code	510
Rate for Payer: Cash Price	$1,054.06

CELL BLOCK

Facility

$149.83

Service Code	HCPCS 88305
Hospital Charge Code	40635499
Hospital Revenue Code	312
Rate for Payer: Cash Price	$62.66

CELL BLOCK

Facility

$149.83

Service Code	HCPCS 88305
Hospital Charge Code	40635499
Hospital Revenue Code	312
Min. Negotiated Rate	$43.86
Max. Negotiated Rate	$82.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.66
Rate for Payer: Aetna Government	$62.66
Rate for Payer: Affinity Essential Plan 1&2	$43.86
Rate for Payer: Affinity Essential Plan 3&4	$43.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.86
Rate for Payer: Brighton Health Commercial	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$62.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.56
Rate for Payer: Elderplan Medicare Advantage	$62.66
Rate for Payer: EmblemHealth Commercial	$62.66
Rate for Payer: Fidelis Essential Plan Aliesa	$53.26
Rate for Payer: Fidelis Essential Plan QHP	$55.77
Rate for Payer: Fidelis Medicare Advantage	$62.66
Rate for Payer: Fidelis Qualified Health Plan	$55.77
Rate for Payer: Group Health Inc Commercial	$62.66
Rate for Payer: Group Health Inc Medicare	$62.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.92
Rate for Payer: Hamaspik Choice Inc Medicare	$62.66
Rate for Payer: Healthfirst Medicare Advantage	$62.66
Rate for Payer: Healthfirst QHP	$62.66
Rate for Payer: Humana Medicare	$63.91
Rate for Payer: Senior Whole Health Medicare Advantage	$62.66
Rate for Payer: United Healthcare Medicare Advantage	$62.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.13
Rate for Payer: Wellcare Medicare	$56.39

CELLULITIS WITH MCC

Facility

$38,438.91

Service Code	MSDRG 602
Min. Negotiated Rate	$12,755.30
Max. Negotiated Rate	$38,438.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,933.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27,955.57
Rate for Payer: Aetna Government	$27,955.57
Rate for Payer: Brighton Health Commercial	$21,568.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$28,514.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25,687.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$21,198.54
Rate for Payer: Elderplan Medicare Advantage	$26,557.79
Rate for Payer: EmblemHealth Commercial	$12,755.30
Rate for Payer: Fidelis Medicare Advantage	$27,955.57
Rate for Payer: Group Health Inc Commercial	$27,955.57
Rate for Payer: Group Health Inc Medicare	$27,955.57
Rate for Payer: Hamaspik Choice Inc Medicare	$27,955.57
Rate for Payer: Healthfirst Medicare Advantage	$12,999.34
Rate for Payer: Humana Medicare	$38,438.91
Rate for Payer: Senior Whole Health Medicare Advantage	$27,955.57
Rate for Payer: United Healthcare Commercial	$29,581.91
Rate for Payer: United Healthcare Medicare Advantage	$27,955.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,955.57
Rate for Payer: Wellcare Medicare	$26,557.79

CELLULITIS WITHOUT MCC

Facility

$26,944.93

Service Code	MSDRG 603
Min. Negotiated Rate	$7,586.30
Max. Negotiated Rate	$26,944.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13,044.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19,596.31
Rate for Payer: Aetna Government	$19,596.31
Rate for Payer: Brighton Health Commercial	$12,828.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19,988.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15,277.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,607.97
Rate for Payer: Elderplan Medicare Advantage	$18,616.49
Rate for Payer: EmblemHealth Commercial	$7,586.30
Rate for Payer: Fidelis Medicare Advantage	$19,596.31
Rate for Payer: Group Health Inc Commercial	$19,596.31
Rate for Payer: Group Health Inc Medicare	$19,596.31
Rate for Payer: Hamaspik Choice Inc Medicare	$19,596.31
Rate for Payer: Healthfirst Medicare Advantage	$9,112.28
Rate for Payer: Humana Medicare	$26,944.93
Rate for Payer: Senior Whole Health Medicare Advantage	$19,596.31
Rate for Payer: United Healthcare Commercial	$17,594.03
Rate for Payer: United Healthcare Medicare Advantage	$19,596.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19,596.31
Rate for Payer: Wellcare Medicare	$18,616.49

CEMENT BONE COBALT MV 40/20 SOFT

Facility

$962.50

Hospital Charge Code	64904864
Hospital Revenue Code	270
Min. Negotiated Rate	$336.88
Max. Negotiated Rate	$770.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$529.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$481.25
Rate for Payer: Aetna Government	$481.25
Rate for Payer: Brighton Health Commercial	$721.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$770.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$654.50
Rate for Payer: Group Health Inc Commercial	$481.25
Rate for Payer: Group Health Inc Medicare	$336.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$481.25
Rate for Payer: Hamaspik Choice Inc Medicare	$481.25

CEMENT BONE PALACOS R

Facility

$186.00

Service Code	HCPCS C1713
Hospital Charge Code	40209586
Hospital Revenue Code	278
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$195.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$111.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.95
Rate for Payer: EmblemHealth Commercial	$93.00
Rate for Payer: Fidelis Medicare Advantage	$195.30
Rate for Payer: Group Health Inc Commercial	$93.00
Rate for Payer: Group Health Inc Medicare	$65.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.00
Rate for Payer: Hamaspik Choice Inc Medicare	$93.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.90

CEMENT BONE PALACOS R

Facility

$186.00

Service Code	HCPCS C1713
Hospital Charge Code	40209586
Hospital Revenue Code	278
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$93.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.00
Rate for Payer: Hamaspik Choice Inc Medicare	$93.00

CEMENT BONE PALACOS R 1X40G

Facility

$550.00

Hospital Charge Code	64906468
Hospital Revenue Code	279
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.00
Rate for Payer: Aetna Government	$275.00
Rate for Payer: Brighton Health Commercial	$412.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.00
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

CEMENT BONE RADIOPAQ W/GEN

Facility

$1,550.00

Hospital Charge Code	64904693
Hospital Revenue Code	270
Min. Negotiated Rate	$542.50
Max. Negotiated Rate	$1,240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$852.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$775.00
Rate for Payer: Aetna Government	$775.00
Rate for Payer: Brighton Health Commercial	$1,162.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,054.00
Rate for Payer: Group Health Inc Commercial	$775.00
Rate for Payer: Group Health Inc Medicare	$542.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$775.00

Know your out-of-pocket cost for care.

All Charges