St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DARBEPOETIN ALPHA ERSD 25MCG/1ML

Facility

$122.06

Hospital Charge Code	41656076
Hospital Revenue Code	250
Min. Negotiated Rate	$42.72
Max. Negotiated Rate	$97.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.03
Rate for Payer: Aetna Government	$61.03
Rate for Payer: Brighton Health Commercial	$91.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$97.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.00
Rate for Payer: Group Health Inc Commercial	$61.03
Rate for Payer: Group Health Inc Medicare	$42.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.03
Rate for Payer: Hamaspik Choice Inc Medicare	$61.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$79.34

DARBEPOETIN ALPHA ERSD 40 MCG/1ML

Facility

$195.32

Hospital Charge Code	41656079
Hospital Revenue Code	250
Min. Negotiated Rate	$68.36
Max. Negotiated Rate	$156.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$107.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$97.66
Rate for Payer: Aetna Government	$97.66
Rate for Payer: Brighton Health Commercial	$146.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$156.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.82
Rate for Payer: Group Health Inc Commercial	$97.66
Rate for Payer: Group Health Inc Medicare	$68.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.66
Rate for Payer: Hamaspik Choice Inc Medicare	$97.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$126.96

DARBEPOETIN ALPHA ERSD 60 MCG/1ML

Facility

$292.98

Hospital Charge Code	41656077
Hospital Revenue Code	250
Min. Negotiated Rate	$102.54
Max. Negotiated Rate	$234.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$146.49
Rate for Payer: Aetna Government	$146.49
Rate for Payer: Brighton Health Commercial	$219.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$234.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$199.23
Rate for Payer: Group Health Inc Commercial	$146.49
Rate for Payer: Group Health Inc Medicare	$102.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.49
Rate for Payer: Hamaspik Choice Inc Medicare	$146.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$190.44

DARBEPOETIN APLHA ERSD 100MCG/1ML

Facility

$488.32

Hospital Charge Code	41656080
Hospital Revenue Code	250
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$390.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$244.16
Rate for Payer: Aetna Government	$244.16
Rate for Payer: Brighton Health Commercial	$366.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$390.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$332.06
Rate for Payer: Group Health Inc Commercial	$244.16
Rate for Payer: Group Health Inc Medicare	$170.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$244.16
Rate for Payer: Hamaspik Choice Inc Medicare	$244.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$317.41

DARBEPOETIN APLHA ERSD 200MCG/1ML

Facility

$944.40

Hospital Charge Code	41656078
Hospital Revenue Code	250
Min. Negotiated Rate	$330.54
Max. Negotiated Rate	$755.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$519.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$472.20
Rate for Payer: Aetna Government	$472.20
Rate for Payer: Brighton Health Commercial	$708.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$755.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$642.19
Rate for Payer: Group Health Inc Commercial	$472.20
Rate for Payer: Group Health Inc Medicare	$330.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$472.20
Rate for Payer: Hamaspik Choice Inc Medicare	$472.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$613.86

DARUNAVIR 400 MG TAB

Facility

$33.86

Hospital Charge Code	41645080
Hospital Revenue Code	250
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$27.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.93
Rate for Payer: Aetna Government	$16.93
Rate for Payer: Brighton Health Commercial	$25.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.02
Rate for Payer: Group Health Inc Commercial	$16.93
Rate for Payer: Group Health Inc Medicare	$11.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.93
Rate for Payer: Hamaspik Choice Inc Medicare	$16.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.01

DARUNAVIR 400 MG TAB

Facility

$33.86

Hospital Charge Code	41655080
Hospital Revenue Code	250
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$27.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.93
Rate for Payer: Aetna Government	$16.93
Rate for Payer: Brighton Health Commercial	$25.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.02
Rate for Payer: Group Health Inc Commercial	$16.93
Rate for Payer: Group Health Inc Medicare	$11.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.93
Rate for Payer: Hamaspik Choice Inc Medicare	$16.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.01

DARUNAVIR 600 MG PO TABS [183754]

Facility

$43.16

Service Code	NDC 59676056201
Hospital Charge Code	59676056201
Hospital Revenue Code	250
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$34.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.58
Rate for Payer: Aetna Government	$21.58
Rate for Payer: Brighton Health Commercial	$32.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.35
Rate for Payer: Group Health Inc Commercial	$21.58
Rate for Payer: Group Health Inc Medicare	$15.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.58
Rate for Payer: Hamaspik Choice Inc Medicare	$21.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.06

DARUNAVIR 600 MG TAB

Facility

$33.86

Hospital Charge Code	41655056
Hospital Revenue Code	250
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$27.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.93
Rate for Payer: Aetna Government	$16.93
Rate for Payer: Brighton Health Commercial	$25.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.02
Rate for Payer: Group Health Inc Commercial	$16.93
Rate for Payer: Group Health Inc Medicare	$11.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.93
Rate for Payer: Hamaspik Choice Inc Medicare	$16.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.01

DARUNAVIR 600 MG TAB

Facility

$33.86

Hospital Charge Code	41645056
Hospital Revenue Code	250
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$27.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.93
Rate for Payer: Aetna Government	$16.93
Rate for Payer: Brighton Health Commercial	$25.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.02
Rate for Payer: Group Health Inc Commercial	$16.93
Rate for Payer: Group Health Inc Medicare	$11.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.93
Rate for Payer: Hamaspik Choice Inc Medicare	$16.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.01

DARUNAVIR 800 MG PO TABS [183755]

Facility

$75.43

Service Code	NDC 59651008630
Hospital Charge Code	59651008630
Hospital Revenue Code	250
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$60.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.72
Rate for Payer: Aetna Government	$37.72
Rate for Payer: Brighton Health Commercial	$56.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.29
Rate for Payer: Group Health Inc Commercial	$37.72
Rate for Payer: Group Health Inc Medicare	$26.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.72
Rate for Payer: Hamaspik Choice Inc Medicare	$37.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.03

DARUNAVIR 800 MG PO TABS [183755]

Facility

$86.33

Service Code	NDC 59676056630
Hospital Charge Code	59676056630
Hospital Revenue Code	250
Min. Negotiated Rate	$30.21
Max. Negotiated Rate	$69.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.16
Rate for Payer: Aetna Government	$43.16
Rate for Payer: Brighton Health Commercial	$64.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.70
Rate for Payer: Group Health Inc Commercial	$43.16
Rate for Payer: Group Health Inc Medicare	$30.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.16
Rate for Payer: Hamaspik Choice Inc Medicare	$43.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.11

DARUNAVIR-COBICISTAT 800-150 MG PO TABS [127552]

Facility

$98.67

Service Code	NDC 59676057530
Hospital Charge Code	59676057530
Hospital Revenue Code	250
Min. Negotiated Rate	$34.53
Max. Negotiated Rate	$78.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.33
Rate for Payer: Aetna Government	$49.33
Rate for Payer: Brighton Health Commercial	$74.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.09
Rate for Payer: Group Health Inc Commercial	$49.33
Rate for Payer: Group Health Inc Medicare	$34.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.33
Rate for Payer: Hamaspik Choice Inc Medicare	$49.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$64.13

DARUNAVIR/COBICISTAT 800-150MG TA

Facility

$128.60

Hospital Charge Code	41656632
Hospital Revenue Code	250
Min. Negotiated Rate	$45.01
Max. Negotiated Rate	$102.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.30
Rate for Payer: Aetna Government	$64.30
Rate for Payer: Brighton Health Commercial	$96.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.45
Rate for Payer: Group Health Inc Commercial	$64.30
Rate for Payer: Group Health Inc Medicare	$45.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.30
Rate for Payer: Hamaspik Choice Inc Medicare	$64.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.59

DARUNAVIR/COBICISTAT/EMTRICITABIN

Facility

$309.88

Hospital Charge Code	41658893
Hospital Revenue Code	250
Min. Negotiated Rate	$108.46
Max. Negotiated Rate	$247.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$154.94
Rate for Payer: Aetna Government	$154.94
Rate for Payer: Brighton Health Commercial	$232.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$247.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.72
Rate for Payer: Group Health Inc Commercial	$154.94
Rate for Payer: Group Health Inc Medicare	$108.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.94
Rate for Payer: Hamaspik Choice Inc Medicare	$154.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$201.42

DARUNAVIR/COBICISTAT/EMTRICITABIN

Facility

$309.88

Hospital Charge Code	41648893
Hospital Revenue Code	250
Min. Negotiated Rate	$108.46
Max. Negotiated Rate	$247.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$154.94
Rate for Payer: Aetna Government	$154.94
Rate for Payer: Brighton Health Commercial	$232.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$247.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$210.72
Rate for Payer: Group Health Inc Commercial	$154.94
Rate for Payer: Group Health Inc Medicare	$108.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.94
Rate for Payer: Hamaspik Choice Inc Medicare	$154.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$201.42

DARUNAVIR/COBICSTAT 800-150MG TAB

Facility

$128.60

Hospital Charge Code	41646632
Hospital Revenue Code	250
Min. Negotiated Rate	$45.01
Max. Negotiated Rate	$102.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.30
Rate for Payer: Aetna Government	$64.30
Rate for Payer: Brighton Health Commercial	$96.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.45
Rate for Payer: Group Health Inc Commercial	$64.30
Rate for Payer: Group Health Inc Medicare	$45.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.30
Rate for Payer: Hamaspik Choice Inc Medicare	$64.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.59

DARUN-COBIC-EMTRICIT-TENOFAF 800-150-200-10 MG PO TABS [162631]

Facility

$188.68

Service Code	NDC 59676080030
Hospital Charge Code	59676080030
Hospital Revenue Code	250
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$150.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$94.34
Rate for Payer: Aetna Government	$94.34
Rate for Payer: Brighton Health Commercial	$141.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.30
Rate for Payer: Group Health Inc Commercial	$94.34
Rate for Payer: Group Health Inc Medicare	$66.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.34
Rate for Payer: Hamaspik Choice Inc Medicare	$94.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$122.64

DATASENSOR W/10' CABLE ADULT

Facility

$312.50

Hospital Charge Code	64903158
Hospital Revenue Code	270
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.25
Rate for Payer: Aetna Government	$156.25
Rate for Payer: Brighton Health Commercial	$234.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.50
Rate for Payer: Group Health Inc Commercial	$156.25
Rate for Payer: Group Health Inc Medicare	$109.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25

DAV-BAR MSH VNT LW BIORSRB 4.5 IN

Facility

$1,520.00

Service Code	HCPCS C1781
Hospital Charge Code	40204258
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,596.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$836.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$912.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$760.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$874.00
Rate for Payer: EmblemHealth Commercial	$760.00
Rate for Payer: Fidelis Medicare Advantage	$1,596.00
Rate for Payer: Group Health Inc Commercial	$760.00
Rate for Payer: Group Health Inc Medicare	$532.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$760.00
Rate for Payer: Hamaspik Choice Inc Medicare	$760.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$988.00

DAV-BAR MSH VNT LW BIORSRB 4.5 IN

Facility

$1,520.00

Service Code	HCPCS C1781
Hospital Charge Code	40204258
Hospital Revenue Code	278
Min. Negotiated Rate	$760.00
Max. Negotiated Rate	$760.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$760.00
Rate for Payer: Hamaspik Choice Inc Medicare	$760.00

DAV MESH VENTRA ELLIPSE 4X6

Facility

$762.00

Service Code	HCPCS C1781
Hospital Charge Code	40008304
Hospital Revenue Code	278
Min. Negotiated Rate	$381.00
Max. Negotiated Rate	$381.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$381.00
Rate for Payer: Hamaspik Choice Inc Medicare	$381.00

DAV MESH VENTRA ELLIPSE 4X6

Facility

$762.00

Service Code	HCPCS C1781
Hospital Charge Code	40008304
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$800.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$419.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$457.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$381.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$438.15
Rate for Payer: EmblemHealth Commercial	$381.00
Rate for Payer: Fidelis Medicare Advantage	$800.10
Rate for Payer: Group Health Inc Commercial	$381.00
Rate for Payer: Group Health Inc Medicare	$266.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$381.00
Rate for Payer: Hamaspik Choice Inc Medicare	$381.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$495.30

DAVOL MESH 4X4 3/4 OVAL

Facility

$838.00

Service Code	HCPCS C1781
Hospital Charge Code	40206234
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$879.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$460.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$502.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$419.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$481.85
Rate for Payer: EmblemHealth Commercial	$419.00
Rate for Payer: Fidelis Medicare Advantage	$879.90
Rate for Payer: Group Health Inc Commercial	$419.00
Rate for Payer: Group Health Inc Medicare	$293.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$419.00
Rate for Payer: Hamaspik Choice Inc Medicare	$419.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$544.70

DAVOL MESH 4X4 3/4 OVAL

Facility

$838.00

Service Code	HCPCS C1781
Hospital Charge Code	40206234
Hospital Revenue Code	278
Min. Negotiated Rate	$419.00
Max. Negotiated Rate	$419.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$419.00
Rate for Payer: Hamaspik Choice Inc Medicare	$419.00

Know your out-of-pocket cost for care.

All Charges