St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DOPAMINE HCL 40 MG/ML IV SOLN [2595]

Facility

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	00143925225
Hospital Revenue Code	278
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35

DOPAMINE HCL 40 MG/ML IV SOLN [2595]

Facility

$0.70

Service Code	HCPCS J1265
Hospital Charge Code	00143925225
Hospital Revenue Code	278
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: EmblemHealth Commercial	$0.35
Rate for Payer: Fidelis Medicare Advantage	$0.74
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
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	$0.46

DOPAMINE HCL 40 MG/ML IV SOLN [2595]

Facility

$0.91

Service Code	HCPCS J1265
Hospital Charge Code	00409582011
Hospital Revenue Code	278
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46

DOPPLER FLOW TESTING

Facility

$339.45

Service Code	HCPCS 93990 TC
Hospital Charge Code	41301532
Hospital Revenue Code	921
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.14
Rate for Payer: Aetna Government	$127.14
Rate for Payer: Affinity Essential Plan 1&2	$89.00
Rate for Payer: Affinity Essential Plan 3&4	$89.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$89.00
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Elderplan Medicare Advantage	$127.14
Rate for Payer: EmblemHealth Commercial	$127.14
Rate for Payer: Fidelis Essential Plan Aliesa	$108.07
Rate for Payer: Fidelis Essential Plan QHP	$113.15
Rate for Payer: Fidelis Medicare Advantage	$127.14
Rate for Payer: Fidelis Qualified Health Plan	$113.15
Rate for Payer: Group Health Inc Commercial	$127.14
Rate for Payer: Group Health Inc Medicare	$127.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$127.14
Rate for Payer: Healthfirst Medicare Advantage	$108.07
Rate for Payer: Healthfirst QHP	$127.14
Rate for Payer: Humana Medicare	$129.68
Rate for Payer: Senior Whole Health Medicare Advantage	$127.14
Rate for Payer: United Healthcare Commercial	$169.72
Rate for Payer: United Healthcare Medicare Advantage	$127.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101.71
Rate for Payer: Wellcare Medicare	$120.78

DOPPLER FLOW TESTING

Facility

$339.45

Service Code	HCPCS 93990 TC
Hospital Charge Code	41301532
Hospital Revenue Code	921
Rate for Payer: Cash Price	$127.14

DORAVIRINE 100 MG PO TABS [163010]

Facility

$70.43

Service Code	NDC 00006306901
Hospital Charge Code	00006306901
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$56.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.21
Rate for Payer: Aetna Government	$35.21
Rate for Payer: Brighton Health Commercial	$52.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.89
Rate for Payer: Group Health Inc Commercial	$35.21
Rate for Payer: Group Health Inc Medicare	$24.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.21
Rate for Payer: Hamaspik Choice Inc Medicare	$35.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.78

DORAVIRINE TABLET

Facility

$231.99

Hospital Charge Code	41640376
Hospital Revenue Code	250
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$185.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$116.00
Rate for Payer: Aetna Government	$116.00
Rate for Payer: Brighton Health Commercial	$173.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.75
Rate for Payer: Group Health Inc Commercial	$116.00
Rate for Payer: Group Health Inc Medicare	$81.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.00
Rate for Payer: Hamaspik Choice Inc Medicare	$116.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$150.79

DORAVIRINE TABLET

Facility

$231.99

Hospital Charge Code	41650376
Hospital Revenue Code	250
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$185.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$116.00
Rate for Payer: Aetna Government	$116.00
Rate for Payer: Brighton Health Commercial	$173.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.75
Rate for Payer: Group Health Inc Commercial	$116.00
Rate for Payer: Group Health Inc Medicare	$81.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.00
Rate for Payer: Hamaspik Choice Inc Medicare	$116.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$150.79

DORNASE ALFA 2.5MG/2.5ML

Facility

$109.45

Service Code	HCPCS J7639
Hospital Charge Code	41649601
Hospital Revenue Code	636
Min. Negotiated Rate	$38.31
Max. Negotiated Rate	$71.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.80
Rate for Payer: Aetna Government	$47.80
Rate for Payer: Brighton Health Commercial	$65.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.93
Rate for Payer: Group Health Inc Commercial	$54.72
Rate for Payer: Group Health Inc Medicare	$38.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.72
Rate for Payer: Hamaspik Choice Inc Medicare	$54.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.16
Rate for Payer: SOMOS Essential	$55.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.14

DORNASE ALFA 2.5MG/2.5ML

Facility

$109.45

Service Code	HCPCS J7639
Hospital Charge Code	41659601
Hospital Revenue Code	636
Min. Negotiated Rate	$38.31
Max. Negotiated Rate	$71.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.80
Rate for Payer: Aetna Government	$47.80
Rate for Payer: Brighton Health Commercial	$65.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.93
Rate for Payer: Group Health Inc Commercial	$54.72
Rate for Payer: Group Health Inc Medicare	$38.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.72
Rate for Payer: Hamaspik Choice Inc Medicare	$54.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.16
Rate for Payer: SOMOS Essential	$55.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.14

DORNASE ALFA 2.5MG/2.5ML

Facility

$109.45

Service Code	HCPCS J7639
Hospital Charge Code	41649601
Hospital Revenue Code	636
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$54.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.72
Rate for Payer: Hamaspik Choice Inc Medicare	$54.72

DORNASE ALFA 2.5MG/2.5ML

Facility

$109.45

Service Code	HCPCS J7639
Hospital Charge Code	41659601
Hospital Revenue Code	636
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$54.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.72
Rate for Payer: Hamaspik Choice Inc Medicare	$54.72

DORNASE ALFA 2.5 MG/2.5ML IN SOLN [12211]

Facility

$62.34

Service Code	HCPCS J7639
Hospital Charge Code	50242010040
Hospital Revenue Code	250
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$55.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.80
Rate for Payer: Aetna Government	$47.80
Rate for Payer: Brighton Health Commercial	$46.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.39
Rate for Payer: Group Health Inc Commercial	$31.17
Rate for Payer: Group Health Inc Medicare	$21.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.17
Rate for Payer: Hamaspik Choice Inc Medicare	$31.17
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$52.03
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$55.16
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$55.16
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$55.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.52

DORNASE ALFA 2.5 MG/2.5ML IN SOLN [12211]

Facility

$62.34

Service Code	HCPCS J7639
Hospital Charge Code	50242010039
Hospital Revenue Code	250
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$55.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.80
Rate for Payer: Aetna Government	$47.80
Rate for Payer: Brighton Health Commercial	$46.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.39
Rate for Payer: Group Health Inc Commercial	$31.17
Rate for Payer: Group Health Inc Medicare	$21.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.17
Rate for Payer: Hamaspik Choice Inc Medicare	$31.17
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$52.03
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$55.16
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$55.16
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$55.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.52

DORSAL SLIT

Facility

$5,365.58

Service Code	HCPCS 54001
Hospital Charge Code	40123110
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$4,024.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,355.42
Rate for Payer: Aetna Government	$2,355.42
Rate for Payer: Affinity Essential Plan 1&2	$1,648.79
Rate for Payer: Affinity Essential Plan 3&4	$1,648.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,648.79
Rate for Payer: Brighton Health Commercial	$4,024.18
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,355.42
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	$2,355.42
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,002.11
Rate for Payer: Fidelis Essential Plan QHP	$2,096.32
Rate for Payer: Fidelis Medicare Advantage	$2,355.42
Rate for Payer: Fidelis Qualified Health Plan	$2,096.32
Rate for Payer: Group Health Inc Commercial	$2,355.42
Rate for Payer: Group Health Inc Medicare	$2,355.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,355.42
Rate for Payer: Healthfirst Medicare Advantage	$2,002.11
Rate for Payer: Healthfirst QHP	$2,355.42
Rate for Payer: Humana Medicare	$2,402.53
Rate for Payer: Senior Whole Health Medicare Advantage	$2,355.42
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$2,355.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,355.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,884.34
Rate for Payer: Wellcare Medicare	$2,237.65

DORSAL SLIT

Facility

$5,365.58

Service Code	HCPCS 54001
Hospital Charge Code	40123110
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,355.42

DORZOLAMIDE 2% OPHTHALMIC SOLN

Facility

$26.40

Hospital Charge Code	41644583
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$21.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.20
Rate for Payer: Aetna Government	$13.20
Rate for Payer: Brighton Health Commercial	$19.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.95
Rate for Payer: Group Health Inc Commercial	$13.20
Rate for Payer: Group Health Inc Medicare	$9.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.20
Rate for Payer: Hamaspik Choice Inc Medicare	$13.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.16

DORZOLAMIDE 2% OPHTHALMIC SOLN

Facility

$26.40

Hospital Charge Code	41654583
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$21.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.20
Rate for Payer: Aetna Government	$13.20
Rate for Payer: Brighton Health Commercial	$19.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.95
Rate for Payer: Group Health Inc Commercial	$13.20
Rate for Payer: Group Health Inc Medicare	$9.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.20
Rate for Payer: Hamaspik Choice Inc Medicare	$13.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.16

DORZOLAMIDE HCL 2 % OP SOLN [14471]

Facility

$4.08

Service Code	NDC 69315030410
Hospital Charge Code	69315030410
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.77
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.65

DORZOLAMIDE HCL 2 % OP SOLN [14471]

Facility

$4.59

Service Code	NDC 24208048510
Hospital Charge Code	24208048510
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$3.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.29
Rate for Payer: Aetna Government	$2.29
Rate for Payer: Brighton Health Commercial	$3.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.12
Rate for Payer: Group Health Inc Commercial	$2.29
Rate for Payer: Group Health Inc Medicare	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.29
Rate for Payer: Hamaspik Choice Inc Medicare	$2.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.98

DORZOLAMIDE HCL 2 % OP SOLN [14471]

Facility

$6.68

Service Code	NDC 50383023210
Hospital Charge Code	50383023210
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.34
Rate for Payer: Aetna Government	$3.34
Rate for Payer: Brighton Health Commercial	$5.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.54
Rate for Payer: Group Health Inc Commercial	$3.34
Rate for Payer: Group Health Inc Medicare	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.34
Rate for Payer: Hamaspik Choice Inc Medicare	$3.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.34

DORZOLAMIDE HCL 2 % OP SOLN [14471]

Facility

$6.68

Service Code	NDC 61314001910
Hospital Charge Code	61314001910
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.34
Rate for Payer: Aetna Government	$3.34
Rate for Payer: Brighton Health Commercial	$5.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.54
Rate for Payer: Group Health Inc Commercial	$3.34
Rate for Payer: Group Health Inc Medicare	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.34
Rate for Payer: Hamaspik Choice Inc Medicare	$3.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.34

DORZOLAMIDE HCL 2 % OP SOLN [14471]

Facility

$6.68

Service Code	NDC 42571014126
Hospital Charge Code	42571014126
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.34
Rate for Payer: Aetna Government	$3.34
Rate for Payer: Brighton Health Commercial	$5.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.54
Rate for Payer: Group Health Inc Commercial	$3.34
Rate for Payer: Group Health Inc Medicare	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.34
Rate for Payer: Hamaspik Choice Inc Medicare	$3.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.34

DOUCHE SET

Facility

$6.73

Hospital Charge Code	40201210
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

DOWEL BONE LIFENET PCD

Facility

$2,443.75

Service Code	HCPCS C1713
Hospital Charge Code	64907000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,221.88
Max. Negotiated Rate	$1,221.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,221.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1,221.88

Know your out-of-pocket cost for care.

All Charges