St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

COLD PACK

Facility

$9.57

Hospital Charge Code	40204801
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$7.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.78
Rate for Payer: Aetna Government	$4.78
Rate for Payer: Brighton Health Commercial	$7.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.51
Rate for Payer: Group Health Inc Commercial	$4.78
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.78
Rate for Payer: Hamaspik Choice Inc Medicare	$4.78

COLECTOMY

Facility

$3,992.25

Service Code	HCPCS 44140
Hospital Charge Code	40010655
Hospital Revenue Code	360
Min. Negotiated Rate	$1,397.29
Max. Negotiated Rate	$2,994.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,195.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,591.50
Rate for Payer: Aetna Government	$1,591.50
Rate for Payer: Brighton Health Commercial	$2,994.19
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$1,996.12
Rate for Payer: Group Health Inc Medicare	$1,397.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,996.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,996.12
Rate for Payer: United Healthcare Commercial	$1,496.00

COLECTOMY W/ ILEOSTOMY

Facility

$6,782.60

Service Code	HCPCS 44155
Hospital Charge Code	40019880
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$5,086.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,730.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,452.71
Rate for Payer: Aetna Government	$2,452.71
Rate for Payer: Brighton Health Commercial	$5,086.95
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	$3,391.30
Rate for Payer: Group Health Inc Medicare	$2,373.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,391.30
Rate for Payer: Hamaspik Choice Inc Medicare	$3,391.30
Rate for Payer: United Healthcare Commercial	$1,496.00

COLFLEX PARAD SPINE INTERLAM SZ10

Facility

$10,500.00

Service Code	HCPCS C1821
Hospital Charge Code	40004710
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00

COLFLEX PARAD SPINE INTERLAM SZ10

Facility

$10,500.00

Service Code	HCPCS C1821
Hospital Charge Code	40004710
Hospital Revenue Code	278
Min. Negotiated Rate	$1,609.27
Max. Negotiated Rate	$11,025.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,775.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,609.27
Rate for Payer: Aetna Government	$1,609.27
Rate for Payer: Brighton Health Commercial	$6,300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,037.50
Rate for Payer: EmblemHealth Commercial	$5,250.00
Rate for Payer: Fidelis Medicare Advantage	$11,025.00
Rate for Payer: Group Health Inc Commercial	$5,250.00
Rate for Payer: Group Health Inc Medicare	$3,675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,825.00

COLFLEX PARAD SPINE INTERLAM SZ12

Facility

$10,500.00

Service Code	HCPCS C1821
Hospital Charge Code	40004711
Hospital Revenue Code	278
Min. Negotiated Rate	$1,609.27
Max. Negotiated Rate	$11,025.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,775.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,609.27
Rate for Payer: Aetna Government	$1,609.27
Rate for Payer: Brighton Health Commercial	$6,300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,037.50
Rate for Payer: EmblemHealth Commercial	$5,250.00
Rate for Payer: Fidelis Medicare Advantage	$11,025.00
Rate for Payer: Group Health Inc Commercial	$5,250.00
Rate for Payer: Group Health Inc Medicare	$3,675.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,825.00

COLFLEX PARAD SPINE INTERLAM SZ12

Facility

$10,500.00

Service Code	HCPCS C1821
Hospital Charge Code	40004711
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,250.00

COLISTIMETHATE 150 MG INJ

Facility

$21.86

Service Code	HCPCS J0770
Hospital Charge Code	41652826
Hospital Revenue Code	636
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$15.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.78
Rate for Payer: Aetna Government	$15.78
Rate for Payer: Brighton Health Commercial	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.57
Rate for Payer: Group Health Inc Commercial	$10.93
Rate for Payer: Group Health Inc Medicare	$7.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13.61
Rate for Payer: SOMOS Essential	$13.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.21

COLISTIMETHATE 150 MG INJ

Facility

$21.86

Service Code	HCPCS J0770
Hospital Charge Code	41652826
Hospital Revenue Code	636
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93

COLISTIMETHATE 150 MG INJ

Facility

$21.86

Service Code	HCPCS J0770
Hospital Charge Code	41642826
Hospital Revenue Code	636
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$15.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.78
Rate for Payer: Aetna Government	$15.78
Rate for Payer: Brighton Health Commercial	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.57
Rate for Payer: Group Health Inc Commercial	$10.93
Rate for Payer: Group Health Inc Medicare	$7.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$13.61
Rate for Payer: SOMOS Essential	$13.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.21

COLISTIMETHATE 150 MG INJ

Facility

$21.86

Service Code	HCPCS J0770
Hospital Charge Code	41642826
Hospital Revenue Code	636
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93

COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR [160225]

Facility

$33.59

Service Code	HCPCS J0770
Hospital Charge Code	63323039306
Hospital Revenue Code	250
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$26.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.78
Rate for Payer: Aetna Government	$15.78
Rate for Payer: Brighton Health Commercial	$25.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.84
Rate for Payer: Group Health Inc Commercial	$16.80
Rate for Payer: Group Health Inc Medicare	$11.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.80
Rate for Payer: Hamaspik Choice Inc Medicare	$16.80
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$12.84
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$13.61
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$13.61
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$13.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.83

COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR [160225]

Facility

$33.60

Service Code	HCPCS J0770
Hospital Charge Code	70594002304
Hospital Revenue Code	250
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$26.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.78
Rate for Payer: Aetna Government	$15.78
Rate for Payer: Brighton Health Commercial	$25.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.85
Rate for Payer: Group Health Inc Commercial	$16.80
Rate for Payer: Group Health Inc Medicare	$11.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.80
Rate for Payer: Hamaspik Choice Inc Medicare	$16.80
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$12.84
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$13.61
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$13.61
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$13.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.84

COLLAGENASE 10GM TOPICAL OINTMENT

Facility

$175.57

Hospital Charge Code	41657809
Hospital Revenue Code	250
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$140.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$87.78
Rate for Payer: Aetna Government	$87.78
Rate for Payer: Brighton Health Commercial	$131.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.39
Rate for Payer: Group Health Inc Commercial	$87.78
Rate for Payer: Group Health Inc Medicare	$61.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.78
Rate for Payer: Hamaspik Choice Inc Medicare	$87.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.12

COLLAGENASE 10GM TOPICAL OINTMENT

Facility

$175.57

Hospital Charge Code	41647809
Hospital Revenue Code	250
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$140.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$87.78
Rate for Payer: Aetna Government	$87.78
Rate for Payer: Brighton Health Commercial	$131.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.39
Rate for Payer: Group Health Inc Commercial	$87.78
Rate for Payer: Group Health Inc Medicare	$61.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.78
Rate for Payer: Hamaspik Choice Inc Medicare	$87.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.12

COLLAGENASE 250 UNIT/GM EX OINT [9682]

Facility

$11.50

Service Code	NDC 50484001090
Hospital Charge Code	50484001090
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$9.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.75
Rate for Payer: Aetna Government	$5.75
Rate for Payer: Brighton Health Commercial	$8.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.82
Rate for Payer: Group Health Inc Commercial	$5.75
Rate for Payer: Group Health Inc Medicare	$4.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.75
Rate for Payer: Hamaspik Choice Inc Medicare	$5.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.47

COLLAGENASE 250 UNIT/GM EX OINT [9682]

Facility

$12.09

Service Code	NDC 50484001030
Hospital Charge Code	50484001030
Hospital Revenue Code	250
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$9.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.05
Rate for Payer: Aetna Government	$6.05
Rate for Payer: Brighton Health Commercial	$9.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.22
Rate for Payer: Group Health Inc Commercial	$6.05
Rate for Payer: Group Health Inc Medicare	$4.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.05
Rate for Payer: Hamaspik Choice Inc Medicare	$6.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.86

COLLAGENASE 30G

Facility

$155.00

Hospital Charge Code	41657170
Hospital Revenue Code	250
Min. Negotiated Rate	$54.25
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.50
Rate for Payer: Aetna Government	$77.50
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.75

COLLAGENASE 30G

Facility

$155.00

Hospital Charge Code	41647170
Hospital Revenue Code	250
Min. Negotiated Rate	$54.25
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.50
Rate for Payer: Aetna Government	$77.50
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.75

COLLAGENASE OINT 15 GRAMS

Facility

$52.00

Hospital Charge Code	41653621
Hospital Revenue Code	250
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$41.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.00
Rate for Payer: Aetna Government	$26.00
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.36
Rate for Payer: Group Health Inc Commercial	$26.00
Rate for Payer: Group Health Inc Medicare	$18.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.00
Rate for Payer: Hamaspik Choice Inc Medicare	$26.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.80

COLLAGENASE OINT 15 GRAMS

Facility

$52.00

Hospital Charge Code	41643621
Hospital Revenue Code	250
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$41.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.00
Rate for Payer: Aetna Government	$26.00
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.36
Rate for Payer: Group Health Inc Commercial	$26.00
Rate for Payer: Group Health Inc Medicare	$18.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.00
Rate for Payer: Hamaspik Choice Inc Medicare	$26.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.80

COLLAGENASE OINT 30 GRAMS

Facility

$155.00

Hospital Charge Code	41645596
Hospital Revenue Code	250
Min. Negotiated Rate	$54.25
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.50
Rate for Payer: Aetna Government	$77.50
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.75

COLLAGENASE OINT 30 GRAMS

Facility

$155.00

Hospital Charge Code	41655596
Hospital Revenue Code	250
Min. Negotiated Rate	$54.25
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.50
Rate for Payer: Aetna Government	$77.50
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: Group Health Inc Commercial	$77.50
Rate for Payer: Group Health Inc Medicare	$54.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50
Rate for Payer: Hamaspik Choice Inc Medicare	$77.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$100.75

COLLAGEN, PURACOL ULTRA

Facility

$45.40

Hospital Charge Code	40201964
Hospital Revenue Code	270
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$36.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.70
Rate for Payer: Aetna Government	$22.70
Rate for Payer: Brighton Health Commercial	$34.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.87
Rate for Payer: Group Health Inc Commercial	$22.70
Rate for Payer: Group Health Inc Medicare	$15.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.70
Rate for Payer: Hamaspik Choice Inc Medicare	$22.70

COLLAR CERVICAL ASPEN LG

Facility

$8.53

Hospital Charge Code	64901896
Hospital Revenue Code	270
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.26
Rate for Payer: Aetna Government	$4.26
Rate for Payer: Brighton Health Commercial	$6.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.80
Rate for Payer: Group Health Inc Commercial	$4.26
Rate for Payer: Group Health Inc Medicare	$2.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.26
Rate for Payer: Hamaspik Choice Inc Medicare	$4.26

Know your out-of-pocket cost for care.

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