St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CLONIDINE HCL 0.2 MG PO TABS [1756]

Facility

$0.31

Service Code	NDC 52817018100
Hospital Charge Code	52817018100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

CLONIDINE HCL 0.3 MG PO TABS [1757]

Facility

$0.52

Service Code	NDC 00228212910
Hospital Charge Code	00228212910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

CLONIDINE HCL 0.3 MG PO TABS [1757]

Facility

$0.52

Service Code	NDC 52817018210
Hospital Charge Code	52817018210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

CLOPIDOGREL 300 MG TAB

Facility

$43.00

Hospital Charge Code	41654848
Hospital Revenue Code	250
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$34.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.50
Rate for Payer: Aetna Government	$21.50
Rate for Payer: Brighton Health Commercial	$32.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.24
Rate for Payer: Group Health Inc Commercial	$21.50
Rate for Payer: Group Health Inc Medicare	$15.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.50
Rate for Payer: Hamaspik Choice Inc Medicare	$21.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.95

CLOPIDOGREL 300 MG TAB

Facility

$43.00

Hospital Charge Code	41644848
Hospital Revenue Code	250
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$34.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.50
Rate for Payer: Aetna Government	$21.50
Rate for Payer: Brighton Health Commercial	$32.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.24
Rate for Payer: Group Health Inc Commercial	$21.50
Rate for Payer: Group Health Inc Medicare	$15.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.50
Rate for Payer: Hamaspik Choice Inc Medicare	$21.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.95

CLOPIDOGREL 75 MG TAB

Facility

$13.00

Hospital Charge Code	41641866
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

CLOPIDOGREL 75 MG TAB

Facility

$13.00

Hospital Charge Code	41651866
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

CLOPIDOGREL BISULFATE 75 MG PO TABS [22142]

Facility

$6.96

Service Code	NDC 50228012405
Hospital Charge Code	50228012405
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.48
Rate for Payer: Aetna Government	$3.48
Rate for Payer: Brighton Health Commercial	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.73
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

CLOPIDOGREL BISULFATE 75 MG PO TABS [22142]

Facility

$4.36

Service Code	NDC 00904629461
Hospital Charge Code	00904629461
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

CLOPIDOGREL BISULFATE 75 MG PO TABS [22142]

Facility

$6.96

Service Code	NDC 55111019690
Hospital Charge Code	55111019690
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.48
Rate for Payer: Aetna Government	$3.48
Rate for Payer: Brighton Health Commercial	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.73
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

CLOPIDOGREL BISULFATE 75 MG PO TABS [22142]

Facility

$6.96

Service Code	NDC 16729021816
Hospital Charge Code	16729021816
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.48
Rate for Payer: Aetna Government	$3.48
Rate for Payer: Brighton Health Commercial	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.73
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

CLOSED REDUCTION - ANKLE

Facility

$629.63

Service Code	HCPCS 27816
Hospital Charge Code	40021445
Hospital Revenue Code	360
Rate for Payer: Cash Price	$272.71

CLOSED REDUCTION - ANKLE

Facility

$629.63

Service Code	HCPCS 27816
Hospital Charge Code	40021445
Hospital Revenue Code	360
Min. Negotiated Rate	$190.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$272.71
Rate for Payer: Aetna Government	$272.71
Rate for Payer: Affinity Essential Plan 1&2	$190.90
Rate for Payer: Affinity Essential Plan 3&4	$190.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$190.90
Rate for Payer: Brighton Health Commercial	$472.22
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$272.71
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	$272.71
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$231.80
Rate for Payer: Fidelis Essential Plan QHP	$242.71
Rate for Payer: Fidelis Medicare Advantage	$272.71
Rate for Payer: Fidelis Qualified Health Plan	$242.71
Rate for Payer: Group Health Inc Commercial	$272.71
Rate for Payer: Group Health Inc Medicare	$272.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$314.82
Rate for Payer: Hamaspik Choice Inc Medicare	$272.71
Rate for Payer: Healthfirst Medicare Advantage	$231.80
Rate for Payer: Healthfirst QHP	$272.71
Rate for Payer: Humana Medicare	$278.16
Rate for Payer: Senior Whole Health Medicare Advantage	$272.71
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$272.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$272.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$218.17
Rate for Payer: Wellcare Medicare	$259.07

CLOSED REDUCTION FEMUR

Facility

$653.13

Service Code	HCPCS 27501
Hospital Charge Code	40029519
Hospital Revenue Code	360
Rate for Payer: Cash Price	$272.71

CLOSED REDUCTION FEMUR

Facility

$653.13

Service Code	HCPCS 27501
Hospital Charge Code	40029519
Hospital Revenue Code	360
Min. Negotiated Rate	$190.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$272.71
Rate for Payer: Aetna Government	$272.71
Rate for Payer: Affinity Essential Plan 1&2	$190.90
Rate for Payer: Affinity Essential Plan 3&4	$190.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$190.90
Rate for Payer: Brighton Health Commercial	$489.85
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$272.71
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	$272.71
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$231.80
Rate for Payer: Fidelis Essential Plan QHP	$242.71
Rate for Payer: Fidelis Medicare Advantage	$272.71
Rate for Payer: Fidelis Qualified Health Plan	$242.71
Rate for Payer: Group Health Inc Commercial	$272.71
Rate for Payer: Group Health Inc Medicare	$272.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.56
Rate for Payer: Hamaspik Choice Inc Medicare	$272.71
Rate for Payer: Healthfirst Medicare Advantage	$231.80
Rate for Payer: Healthfirst QHP	$272.71
Rate for Payer: Humana Medicare	$278.16
Rate for Payer: Senior Whole Health Medicare Advantage	$272.71
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$272.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$272.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$218.17
Rate for Payer: Wellcare Medicare	$259.07

CLOSED REDUCTION - HAND

Facility

$655.22

Service Code	HCPCS 26600
Hospital Charge Code	30302007
Hospital Revenue Code	510
Min. Negotiated Rate	$190.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$272.71
Rate for Payer: Aetna Government	$272.71
Rate for Payer: Affinity Essential Plan 1&2	$190.90
Rate for Payer: Affinity Essential Plan 3&4	$190.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$190.90
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$272.71
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	$272.71
Rate for Payer: Fidelis Essential Plan Aliesa	$231.80
Rate for Payer: Fidelis Essential Plan QHP	$242.71
Rate for Payer: Fidelis Medicare Advantage	$272.71
Rate for Payer: Fidelis Qualified Health Plan	$242.71
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	$327.61
Rate for Payer: Hamaspik Choice Inc Medicare	$272.71
Rate for Payer: Healthfirst Medicare Advantage	$231.80
Rate for Payer: Healthfirst QHP	$272.71
Rate for Payer: Humana Medicare	$278.16
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$272.71
Rate for Payer: Senior Whole Health Medicare Advantage	$272.71
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$272.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$272.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$218.17
Rate for Payer: Wellcare Medicare	$259.07

CLOSED REDUCTION - HAND

Facility

$655.22

Service Code	HCPCS 26600
Hospital Charge Code	40021455
Hospital Revenue Code	360
Rate for Payer: Cash Price	$272.71

CLOSED REDUCTION - HAND

Facility

$655.22

Service Code	HCPCS 26600
Hospital Charge Code	40021455
Hospital Revenue Code	360
Min. Negotiated Rate	$190.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$272.71
Rate for Payer: Aetna Government	$272.71
Rate for Payer: Affinity Essential Plan 1&2	$190.90
Rate for Payer: Affinity Essential Plan 3&4	$190.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$190.90
Rate for Payer: Brighton Health Commercial	$491.42
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$272.71
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	$272.71
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$231.80
Rate for Payer: Fidelis Essential Plan QHP	$242.71
Rate for Payer: Fidelis Medicare Advantage	$272.71
Rate for Payer: Fidelis Qualified Health Plan	$242.71
Rate for Payer: Group Health Inc Commercial	$272.71
Rate for Payer: Group Health Inc Medicare	$272.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$327.61
Rate for Payer: Hamaspik Choice Inc Medicare	$272.71
Rate for Payer: Healthfirst Medicare Advantage	$231.80
Rate for Payer: Healthfirst QHP	$272.71
Rate for Payer: Humana Medicare	$278.16
Rate for Payer: Senior Whole Health Medicare Advantage	$272.71
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$272.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$272.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$218.17
Rate for Payer: Wellcare Medicare	$259.07

CLOSED REDUCTION - HAND

Facility

$655.22

Service Code	HCPCS 26600
Hospital Charge Code	30103028
Hospital Revenue Code	450
Rate for Payer: Cash Price	$272.71

CLOSED REDUCTION - HAND

Facility

$655.22

Service Code	HCPCS 26600
Hospital Charge Code	30302007
Hospital Revenue Code	510
Rate for Payer: Cash Price	$272.71

CLOSED REDUCTION - HAND

Facility

$655.22

Service Code	HCPCS 26600
Hospital Charge Code	30103028
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$272.71
Rate for Payer: Aetna Government	$272.71
Rate for Payer: Affinity Essential Plan 1&2	$190.90
Rate for Payer: Affinity Essential Plan 3&4	$190.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$190.90
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$272.71
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$272.71
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	$272.71
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$231.80
Rate for Payer: Fidelis Essential Plan QHP	$242.71
Rate for Payer: Fidelis Medicare Advantage	$272.71
Rate for Payer: Fidelis Qualified Health Plan	$242.71
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$327.61
Rate for Payer: Hamaspik Choice Inc Medicare	$272.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$272.71
Rate for Payer: Humana Medicare	$278.16
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$272.71
Rate for Payer: Senior Whole Health Medicare Advantage	$272.71
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$272.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$272.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$218.17
Rate for Payer: Wellcare Medicare	$259.07

CLOSED REDUCTION HUMERUS

Facility

$653.13

Service Code	HCPCS 24500
Hospital Charge Code	40029804
Hospital Revenue Code	360
Min. Negotiated Rate	$190.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$272.71
Rate for Payer: Aetna Government	$272.71
Rate for Payer: Affinity Essential Plan 1&2	$190.90
Rate for Payer: Affinity Essential Plan 3&4	$190.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$190.90
Rate for Payer: Brighton Health Commercial	$489.85
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$272.71
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	$272.71
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$231.80
Rate for Payer: Fidelis Essential Plan QHP	$242.71
Rate for Payer: Fidelis Medicare Advantage	$272.71
Rate for Payer: Fidelis Qualified Health Plan	$242.71
Rate for Payer: Group Health Inc Commercial	$272.71
Rate for Payer: Group Health Inc Medicare	$272.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.56
Rate for Payer: Hamaspik Choice Inc Medicare	$272.71
Rate for Payer: Healthfirst Medicare Advantage	$231.80
Rate for Payer: Healthfirst QHP	$272.71
Rate for Payer: Humana Medicare	$278.16
Rate for Payer: Senior Whole Health Medicare Advantage	$272.71
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$272.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$272.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$218.17
Rate for Payer: Wellcare Medicare	$259.07

CLOSED REDUCTION HUMERUS

Facility

$653.13

Service Code	HCPCS 24500
Hospital Charge Code	40029804
Hospital Revenue Code	360
Rate for Payer: Cash Price	$272.71

CLOSED REDUCTION - LEG

Facility

$653.13

Service Code	HCPCS 27230
Hospital Charge Code	40021460
Hospital Revenue Code	360
Min. Negotiated Rate	$190.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$272.71
Rate for Payer: Aetna Government	$272.71
Rate for Payer: Affinity Essential Plan 1&2	$190.90
Rate for Payer: Affinity Essential Plan 3&4	$190.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$190.90
Rate for Payer: Brighton Health Commercial	$489.85
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Cash Price	$272.71
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$272.71
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	$272.71
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$231.80
Rate for Payer: Fidelis Essential Plan QHP	$242.71
Rate for Payer: Fidelis Medicare Advantage	$272.71
Rate for Payer: Fidelis Qualified Health Plan	$242.71
Rate for Payer: Group Health Inc Commercial	$272.71
Rate for Payer: Group Health Inc Medicare	$272.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.56
Rate for Payer: Hamaspik Choice Inc Medicare	$272.71
Rate for Payer: Healthfirst Medicare Advantage	$231.80
Rate for Payer: Healthfirst QHP	$272.71
Rate for Payer: Humana Medicare	$278.16
Rate for Payer: Senior Whole Health Medicare Advantage	$272.71
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$272.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$272.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$218.17
Rate for Payer: Wellcare Medicare	$259.07

CLOSED REDUCTION - LEG

Facility

$653.13

Service Code	HCPCS 27230
Hospital Charge Code	40021460
Hospital Revenue Code	360
Rate for Payer: Cash Price	$272.71

Know your out-of-pocket cost for care.

All Charges