St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CONE FEM TRI AUG

Facility

$17,178.75

Service Code	HCPCS C1776
Hospital Charge Code	64907221
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$18,037.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,448.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$10,307.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,589.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,877.78
Rate for Payer: EmblemHealth Commercial	$8,589.38
Rate for Payer: Fidelis Medicare Advantage	$18,037.69
Rate for Payer: Group Health Inc Commercial	$8,589.38
Rate for Payer: Group Health Inc Medicare	$6,012.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,589.38
Rate for Payer: Hamaspik Choice Inc Medicare	$8,589.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,166.19

CONE FEM TRI AUG

Facility

$17,178.75

Service Code	HCPCS C1776
Hospital Charge Code	64907221
Hospital Revenue Code	278
Min. Negotiated Rate	$8,589.38
Max. Negotiated Rate	$8,589.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,589.38
Rate for Payer: Hamaspik Choice Inc Medicare	$8,589.38

CONE PROX ARCOS OFFSET REV

Facility

$19,312.00

Hospital Charge Code	64906709
Hospital Revenue Code	279
Min. Negotiated Rate	$6,759.20
Max. Negotiated Rate	$15,449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,621.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,656.00
Rate for Payer: Aetna Government	$9,656.00
Rate for Payer: Brighton Health Commercial	$14,484.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15,449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,132.16
Rate for Payer: Group Health Inc Commercial	$9,656.00
Rate for Payer: Group Health Inc Medicare	$6,759.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,656.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,656.00

CONE PROX STD ARCOS REV

Facility

$19,312.00

Hospital Charge Code	64906708
Hospital Revenue Code	279
Min. Negotiated Rate	$6,759.20
Max. Negotiated Rate	$15,449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,621.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,656.00
Rate for Payer: Aetna Government	$9,656.00
Rate for Payer: Brighton Health Commercial	$14,484.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15,449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,132.16
Rate for Payer: Group Health Inc Commercial	$9,656.00
Rate for Payer: Group Health Inc Medicare	$6,759.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,656.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,656.00

CONE SYM TRI AUG

Facility

$15,084.38

Service Code	HCPCS C1776
Hospital Charge Code	64907219
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$15,838.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,296.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$9,050.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,542.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,673.52
Rate for Payer: EmblemHealth Commercial	$7,542.19
Rate for Payer: Fidelis Medicare Advantage	$15,838.60
Rate for Payer: Group Health Inc Commercial	$7,542.19
Rate for Payer: Group Health Inc Medicare	$5,279.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,542.19
Rate for Payer: Hamaspik Choice Inc Medicare	$7,542.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,804.85

CONE SYM TRI AUG

Facility

$15,084.38

Service Code	HCPCS C1776
Hospital Charge Code	64907219
Hospital Revenue Code	278
Min. Negotiated Rate	$7,542.19
Max. Negotiated Rate	$7,542.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,542.19
Rate for Payer: Hamaspik Choice Inc Medicare	$7,542.19

CON FOAM PAD (EGG CRATE)

Facility

$39.33

Hospital Charge Code	40207638
Hospital Revenue Code	270
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$31.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.66
Rate for Payer: Aetna Government	$19.66
Rate for Payer: Brighton Health Commercial	$29.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.74
Rate for Payer: Group Health Inc Commercial	$19.66
Rate for Payer: Group Health Inc Medicare	$13.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.66
Rate for Payer: Hamaspik Choice Inc Medicare	$19.66

CONICAL EXTRACTOR

Facility

$368.00

Service Code	HCPCS C1713
Hospital Charge Code	40006156
Hospital Revenue Code	278
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$184.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00

CONICAL EXTRACTOR

Facility

$368.00

Service Code	HCPCS C1713
Hospital Charge Code	40006156
Hospital Revenue Code	278
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$386.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$220.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$184.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$211.60
Rate for Payer: EmblemHealth Commercial	$184.00
Rate for Payer: Fidelis Medicare Advantage	$386.40
Rate for Payer: Group Health Inc Commercial	$184.00
Rate for Payer: Group Health Inc Medicare	$128.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.00
Rate for Payer: Hamaspik Choice Inc Medicare	$184.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.20

CONIZATION OF CERVIX

Facility

$7,566.13

Service Code	HCPCS 57522
Hospital Charge Code	40054084
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$5,674.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,615.39
Rate for Payer: Aetna Government	$3,615.39
Rate for Payer: Affinity Essential Plan 1&2	$2,530.77
Rate for Payer: Affinity Essential Plan 3&4	$2,530.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,530.77
Rate for Payer: Brighton Health Commercial	$5,674.60
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,615.39
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	$3,615.39
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,073.08
Rate for Payer: Fidelis Essential Plan QHP	$3,217.70
Rate for Payer: Fidelis Medicare Advantage	$3,615.39
Rate for Payer: Fidelis Qualified Health Plan	$3,217.70
Rate for Payer: Group Health Inc Commercial	$3,615.39
Rate for Payer: Group Health Inc Medicare	$3,615.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,783.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3,615.39
Rate for Payer: Healthfirst Medicare Advantage	$3,073.08
Rate for Payer: Healthfirst QHP	$3,615.39
Rate for Payer: Humana Medicare	$3,687.70
Rate for Payer: Senior Whole Health Medicare Advantage	$3,615.39
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,615.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,615.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,892.31
Rate for Payer: Wellcare Medicare	$3,434.62

CONIZATION OF CERVIX

Facility

$7,566.13

Service Code	HCPCS 57522
Hospital Charge Code	40054084
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,615.39

Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision

Facility

$3,687.70

Service Code	CPT 57522
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$3,687.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,615.39
Rate for Payer: Aetna Government	$3,615.39
Rate for Payer: Affinity Essential Plan 1&2	$2,530.77
Rate for Payer: Affinity Essential Plan 3&4	$2,530.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,530.77
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,615.39
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	$3,615.39
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,073.08
Rate for Payer: Fidelis Essential Plan QHP	$3,217.70
Rate for Payer: Fidelis Medicare Advantage	$3,615.39
Rate for Payer: Fidelis Qualified Health Plan	$3,217.70
Rate for Payer: Group Health Inc Commercial	$3,615.39
Rate for Payer: Group Health Inc Medicare	$3,615.39
Rate for Payer: Hamaspik Choice Inc Medicare	$3,615.39
Rate for Payer: Healthfirst Medicare Advantage	$3,073.08
Rate for Payer: Healthfirst QHP	$3,615.39
Rate for Payer: Humana Medicare	$3,687.70
Rate for Payer: Senior Whole Health Medicare Advantage	$3,615.39
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,615.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,615.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,892.31
Rate for Payer: Wellcare Medicare	$3,434.62

CONJUGATED ESTROGENS 0.625 MG TAB

Facility

$4.00

Hospital Charge Code	41653961
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

CONJUGATED ESTROGENS 0.625 MG TAB

Facility

$4.00

Hospital Charge Code	41643961
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

CONJUGATED ESTROGENS 1.25 MG TAB

Facility

$4.00

Hospital Charge Code	41654026
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

CONJUGATED ESTROGENS 1.25 MG TAB

Facility

$4.00

Hospital Charge Code	41644026
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

CONJUGATED ESTROGENS 25 MG INJ

Facility

$700.00

Service Code	HCPCS J1410
Hospital Charge Code	41640134
Hospital Revenue Code	636
Min. Negotiated Rate	$260.50
Max. Negotiated Rate	$455.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$372.15
Rate for Payer: Aetna Government	$372.15
Rate for Payer: Affinity Essential Plan 1&2	$260.50
Rate for Payer: Affinity Essential Plan 3&4	$260.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$260.50
Rate for Payer: Brighton Health Commercial	$420.00
Rate for Payer: Cash Price	$372.15
Rate for Payer: Cash Price	$372.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$372.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: Elderplan Medicare Advantage	$372.15
Rate for Payer: EmblemHealth Commercial	$372.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$372.15
Rate for Payer: Fidelis Essential Plan Aliesa	$372.15
Rate for Payer: Fidelis Essential Plan QHP	$390.75
Rate for Payer: Fidelis Medicare Advantage	$372.15
Rate for Payer: Fidelis Qualified Health Plan	$390.75
Rate for Payer: Group Health Inc Commercial	$372.15
Rate for Payer: Group Health Inc Medicare	$372.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: Healthfirst Medicare Advantage	$316.32
Rate for Payer: Healthfirst QHP	$372.15
Rate for Payer: Humana Medicare	$379.59
Rate for Payer: Senior Whole Health Medicare Advantage	$372.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$394.71
Rate for Payer: SOMOS Essential	$394.71
Rate for Payer: United Healthcare Commercial	$355.52
Rate for Payer: United Healthcare Medicare Advantage	$372.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$297.72
Rate for Payer: Wellcare Medicare	$353.54

CONJUGATED ESTROGENS 25 MG INJ

Facility

$700.00

Service Code	HCPCS J1410
Hospital Charge Code	41650134
Hospital Revenue Code	636
Min. Negotiated Rate	$260.50
Max. Negotiated Rate	$455.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$372.15
Rate for Payer: Aetna Government	$372.15
Rate for Payer: Affinity Essential Plan 1&2	$260.50
Rate for Payer: Affinity Essential Plan 3&4	$260.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$260.50
Rate for Payer: Brighton Health Commercial	$420.00
Rate for Payer: Cash Price	$372.15
Rate for Payer: Cash Price	$372.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$372.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: Elderplan Medicare Advantage	$372.15
Rate for Payer: EmblemHealth Commercial	$372.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$372.15
Rate for Payer: Fidelis Essential Plan Aliesa	$372.15
Rate for Payer: Fidelis Essential Plan QHP	$390.75
Rate for Payer: Fidelis Medicare Advantage	$372.15
Rate for Payer: Fidelis Qualified Health Plan	$390.75
Rate for Payer: Group Health Inc Commercial	$372.15
Rate for Payer: Group Health Inc Medicare	$372.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: Healthfirst Medicare Advantage	$316.32
Rate for Payer: Healthfirst QHP	$372.15
Rate for Payer: Humana Medicare	$379.59
Rate for Payer: Senior Whole Health Medicare Advantage	$372.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$394.71
Rate for Payer: SOMOS Essential	$394.71
Rate for Payer: United Healthcare Commercial	$355.52
Rate for Payer: United Healthcare Medicare Advantage	$372.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$297.72
Rate for Payer: Wellcare Medicare	$353.54

CONJUGATED ESTROGENS 25 MG INJ

Facility

$700.00

Service Code	HCPCS J1410
Hospital Charge Code	41640134
Hospital Revenue Code	636
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Cash Price	$372.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

CONJUGATED ESTROGENS 25 MG INJ

Facility

$700.00

Service Code	HCPCS J1410
Hospital Charge Code	41650134
Hospital Revenue Code	636
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Cash Price	$372.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

CONJUGATED ESTROGENS VAGINAL CREAM 42.5

Facility

$205.00

Hospital Charge Code	41650987
Hospital Revenue Code	250
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$164.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$102.50
Rate for Payer: Aetna Government	$102.50
Rate for Payer: Brighton Health Commercial	$153.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.40
Rate for Payer: Group Health Inc Commercial	$102.50
Rate for Payer: Group Health Inc Medicare	$71.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$133.25

CONJUGATED ESTROGENS VAGINAL CREAM 42.5

Facility

$205.00

Hospital Charge Code	41640987
Hospital Revenue Code	250
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$164.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$102.50
Rate for Payer: Aetna Government	$102.50
Rate for Payer: Brighton Health Commercial	$153.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.40
Rate for Payer: Group Health Inc Commercial	$102.50
Rate for Payer: Group Health Inc Medicare	$71.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$102.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$133.25

CONJUGATE+HEP B VFC DIP,TET,PERT

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640265
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

CONJUGATE+HEP B VFC DIP,TET,PERT

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41640265
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

CONJUGATE+HEP B VFC DIP,TET,PERT

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41650265
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

Know your out-of-pocket cost for care.

All Charges