St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CEPHALEXIN 250 MG/5ML PO SUSR [9502]

Facility

$0.29

Service Code	NDC 09999123404
Hospital Charge Code	68180044101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

CEPHALEXIN 250 MG/5ML PO SUSR [9502]

Facility

$0.29

Service Code	NDC 09999123404
Hospital Charge Code	00093417773
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

CEPHALEXIN 250 MG/5ML PO SUSR [9502]

Facility

$0.29

Service Code	NDC 09999123404
Hospital Charge Code	67877054588
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

CEPHALEXIN 250 MG/5ML PO SUSR [9502]

Facility

$0.20

Service Code	NDC 67877054568
Hospital Charge Code	67877054568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

CEPHALEXIN 250 MG/5ML PO SUSR [9502]

Facility

$0.29

Service Code	NDC 00093417773
Hospital Charge Code	00093417773
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

CEPHALEXIN 250 MG/5 ML SUSP

Facility

$0.11

Hospital Charge Code	41643504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

CEPHALEXIN 250 MG/5 ML SUSP

Facility

$0.11

Hospital Charge Code	41653504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

CEPHALEXIN 250MG/5ML UD

Facility

$1.52

Hospital Charge Code	41656556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Brighton Health Commercial	$1.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: Group Health Inc Commercial	$0.76
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76
Rate for Payer: Hamaspik Choice Inc Medicare	$0.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

CEPHALEXIN 250 MG CAP

Facility

$0.04

Hospital Charge Code	41651655
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

CEPHALEXIN 250 MG CAP

Facility

$0.04

Hospital Charge Code	41641655
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

CEPHALEXIN 250 MG PO CAPS [9499]

Facility

$0.71

Service Code	NDC 60687015201
Hospital Charge Code	60687015201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

CEPHALEXIN 250 MG PO CAPS [9499]

Facility

$0.68

Service Code	NDC 50268015115
Hospital Charge Code	50268015115
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

CEPHALEXIN 250 MG PO CAPS [9499]

Facility

$0.69

Service Code	NDC 68180012101
Hospital Charge Code	68180012101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.45

CEPHALEXIN 500 MG CAP

Facility

$0.04

Hospital Charge Code	41651656
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

CEPHALEXIN 500 MG CAP

Facility

$0.04

Hospital Charge Code	41641656
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

CEPHALEXIN 500 MG PO CAPS [9500]

Facility

$1.22

Service Code	NDC 50268015215
Hospital Charge Code	50268015215
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.83
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

CEPHALEXIN 500 MG PO CAPS [9500]

Facility

$1.97

Service Code	NDC 67877021901
Hospital Charge Code	67877021901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.99
Rate for Payer: Aetna Government	$0.99
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.34
Rate for Payer: Group Health Inc Commercial	$0.99
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99
Rate for Payer: Hamaspik Choice Inc Medicare	$0.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.28

CEPHALEXIN 500 MG PO CAPS [9500]

Facility

$1.22

Service Code	NDC 50268015211
Hospital Charge Code	50268015211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.83
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

CEPHALEXIN 500 MG PO CAPS [9500]

Facility

$1.33

Service Code	NDC 65862001901
Hospital Charge Code	65862001901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.67
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67
Rate for Payer: Hamaspik Choice Inc Medicare	$0.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.86

CEPHALEXIN 500 MG PO CAPS [9500]

Facility

$1.35

Service Code	NDC 60687016301
Hospital Charge Code	60687016301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.92
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.88

CEPHALOMETRIC FILM

Facility

$137.50

Service Code	HCPCS D0340
Hospital Charge Code	42300190
Hospital Revenue Code	361
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.08
Rate for Payer: Aetna Government	$105.08
Rate for Payer: Affinity Essential Plan 1&2	$73.56
Rate for Payer: Affinity Essential Plan 3&4	$73.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$73.56
Rate for Payer: Brighton Health Commercial	$103.12
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$105.08
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	$105.08
Rate for Payer: EmblemHealth Commercial	$105.08
Rate for Payer: Fidelis Essential Plan Aliesa	$89.32
Rate for Payer: Fidelis Essential Plan QHP	$93.52
Rate for Payer: Fidelis Medicare Advantage	$105.08
Rate for Payer: Fidelis Qualified Health Plan	$93.52
Rate for Payer: Group Health Inc Commercial	$105.08
Rate for Payer: Group Health Inc Medicare	$105.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.75
Rate for Payer: Hamaspik Choice Inc Medicare	$105.08
Rate for Payer: Healthfirst Medicare Advantage	$89.32
Rate for Payer: Healthfirst QHP	$105.08
Rate for Payer: Humana Medicare	$107.18
Rate for Payer: Senior Whole Health Medicare Advantage	$105.08
Rate for Payer: United Healthcare Medicare Advantage	$105.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84.06
Rate for Payer: Wellcare Medicare	$99.83

CEPHALOMETRIC FILM

Facility

$137.50

Service Code	HCPCS D0340
Hospital Charge Code	42300190
Hospital Revenue Code	361
Rate for Payer: Cash Price	$105.08

CERAMIC HEAD 2.5MM 32MM

Facility

$2,518.00

Service Code	HCPCS C1776
Hospital Charge Code	40200529
Hospital Revenue Code	278
Min. Negotiated Rate	$1,259.00
Max. Negotiated Rate	$1,259.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,259.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,259.00

CERAMIC HEAD 2.5MM 32MM

Facility

$2,518.00

Service Code	HCPCS C1776
Hospital Charge Code	40200529
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,643.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,384.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,510.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,259.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,447.85
Rate for Payer: EmblemHealth Commercial	$1,259.00
Rate for Payer: Fidelis Medicare Advantage	$2,643.90
Rate for Payer: Group Health Inc Commercial	$1,259.00
Rate for Payer: Group Health Inc Medicare	$881.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,259.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,259.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,636.70

CERA RING STANDARD

Facility

$35.42

Service Code	HCPCS A4385
Hospital Charge Code	40005170
Hospital Revenue Code	272
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$28.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.10
Rate for Payer: Aetna Government	$3.10
Rate for Payer: Brighton Health Commercial	$26.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.09
Rate for Payer: Group Health Inc Commercial	$17.71
Rate for Payer: Group Health Inc Medicare	$12.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.71
Rate for Payer: Hamaspik Choice Inc Medicare	$17.71

Know your out-of-pocket cost for care.

All Charges