St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DRAPE C-ARM COVER

Facility

$8.46

Hospital Charge Code	40200420
Hospital Revenue Code	270
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$6.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.23
Rate for Payer: Aetna Government	$4.23
Rate for Payer: Brighton Health Commercial	$6.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.75
Rate for Payer: Group Health Inc Commercial	$4.23
Rate for Payer: Group Health Inc Medicare	$2.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.23
Rate for Payer: Hamaspik Choice Inc Medicare	$4.23

DRAPE CHEST/BREAST

Facility

$14.05

Hospital Charge Code	40202189
Hospital Revenue Code	270
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$11.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.02
Rate for Payer: Aetna Government	$7.02
Rate for Payer: Brighton Health Commercial	$10.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.55
Rate for Payer: Group Health Inc Commercial	$7.02
Rate for Payer: Group Health Inc Medicare	$4.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.02
Rate for Payer: Hamaspik Choice Inc Medicare	$7.02

DRAPE GAMMA PROBE NAVIGATOR

Facility

$96.12

Hospital Charge Code	40205967
Hospital Revenue Code	270
Min. Negotiated Rate	$33.64
Max. Negotiated Rate	$76.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.06
Rate for Payer: Aetna Government	$48.06
Rate for Payer: Brighton Health Commercial	$72.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.36
Rate for Payer: Group Health Inc Commercial	$48.06
Rate for Payer: Group Health Inc Medicare	$33.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.06
Rate for Payer: Hamaspik Choice Inc Medicare	$48.06

DRAPE HALF BODY OXIMETRY

Facility

$925.00

Service Code	HCPCS C1725
Hospital Charge Code	64907176
Hospital Revenue Code	278
Min. Negotiated Rate	$462.50
Max. Negotiated Rate	$462.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$462.50
Rate for Payer: Hamaspik Choice Inc Medicare	$462.50

DRAPE HALF BODY OXIMETRY

Facility

$925.00

Service Code	HCPCS C1725
Hospital Charge Code	64907176
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$971.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$508.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$555.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$462.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$531.88
Rate for Payer: EmblemHealth Commercial	$462.50
Rate for Payer: Fidelis Medicare Advantage	$971.25
Rate for Payer: Group Health Inc Commercial	$462.50
Rate for Payer: Group Health Inc Medicare	$323.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$462.50
Rate for Payer: Hamaspik Choice Inc Medicare	$462.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$601.25

DRAPE INSTRUMENT MAGNETIC MEDIUM

Facility

$22.70

Hospital Charge Code	40202190
Hospital Revenue Code	270
Min. Negotiated Rate	$7.94
Max. Negotiated Rate	$18.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.35
Rate for Payer: Aetna Government	$11.35
Rate for Payer: Brighton Health Commercial	$17.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.44
Rate for Payer: Group Health Inc Commercial	$11.35
Rate for Payer: Group Health Inc Medicare	$7.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.35
Rate for Payer: Hamaspik Choice Inc Medicare	$11.35

DRAPE LASAR ARM

Facility

$36.65

Hospital Charge Code	40200422
Hospital Revenue Code	270
Min. Negotiated Rate	$12.83
Max. Negotiated Rate	$29.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.32
Rate for Payer: Aetna Government	$18.32
Rate for Payer: Brighton Health Commercial	$27.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.92
Rate for Payer: Group Health Inc Commercial	$18.32
Rate for Payer: Group Health Inc Medicare	$12.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.32
Rate for Payer: Hamaspik Choice Inc Medicare	$18.32

DRAPE MINI C-ARM 54X63

Facility

$276.36

Hospital Charge Code	64906669
Hospital Revenue Code	270
Min. Negotiated Rate	$96.73
Max. Negotiated Rate	$221.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$138.18
Rate for Payer: Aetna Government	$138.18
Rate for Payer: Brighton Health Commercial	$207.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$221.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.92
Rate for Payer: Group Health Inc Commercial	$138.18
Rate for Payer: Group Health Inc Medicare	$96.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.18
Rate for Payer: Hamaspik Choice Inc Medicare	$138.18

DRAPE STERI 1010 3M

Facility

$3.43

Hospital Charge Code	40200423
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.72
Rate for Payer: Aetna Government	$1.72
Rate for Payer: Brighton Health Commercial	$2.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.33
Rate for Payer: Group Health Inc Commercial	$1.72
Rate for Payer: Group Health Inc Medicare	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.72
Rate for Payer: Hamaspik Choice Inc Medicare	$1.72

DRAPE STERI U 1015 3M

Facility

$8.88

Hospital Charge Code	40200425
Hospital Revenue Code	270
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$7.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.44
Rate for Payer: Aetna Government	$4.44
Rate for Payer: Brighton Health Commercial	$6.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.04
Rate for Payer: Group Health Inc Commercial	$4.44
Rate for Payer: Group Health Inc Medicare	$3.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.44
Rate for Payer: Hamaspik Choice Inc Medicare	$4.44

DRAPE TRUP LINGEMAN STERILE

Facility

$68.22

Hospital Charge Code	40205983
Hospital Revenue Code	270
Min. Negotiated Rate	$23.88
Max. Negotiated Rate	$54.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.11
Rate for Payer: Aetna Government	$34.11
Rate for Payer: Brighton Health Commercial	$51.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.39
Rate for Payer: Group Health Inc Commercial	$34.11
Rate for Payer: Group Health Inc Medicare	$23.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.11
Rate for Payer: Hamaspik Choice Inc Medicare	$34.11

DRAPE XRAY CASSETTE (24 LNG)

Facility

$12.00

Hospital Charge Code	40202192
Hospital Revenue Code	270
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

DRAWING BLOOD FOR SPECIMEN

Facility

$9.71

Service Code	HCPCS 36415
Hospital Charge Code	30300179
Hospital Revenue Code	300
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$926.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.57
Rate for Payer: Aetna Government	$8.57
Rate for Payer: Affinity Essential Plan 1&2	$20.84
Rate for Payer: Affinity Essential Plan 3&4	$20.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.26
Rate for Payer: Amida Care Medicaid	$9.26
Rate for Payer: Brighton Health Commercial	$7.28
Rate for Payer: Cash Price	$8.83
Rate for Payer: Cash Price	$8.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: Elderplan Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$8.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$926.00
Rate for Payer: Fidelis Essential Plan Aliesa	$9.26
Rate for Payer: Fidelis Essential Plan QHP	$9.26
Rate for Payer: Fidelis Medicare Advantage	$8.57
Rate for Payer: Fidelis Qualified Health Plan	$9.72
Rate for Payer: Group Health Inc Commercial	$8.57
Rate for Payer: Group Health Inc Medicare	$8.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.26
Rate for Payer: Hamaspik Choice Inc Medicare	$8.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.26
Rate for Payer: Healthfirst Essential Plan	$20.84
Rate for Payer: Healthfirst Medicare Advantage	$7.28
Rate for Payer: Healthfirst QHP	$9.26
Rate for Payer: Humana Medicare	$8.74
Rate for Payer: Senior Whole Health Medicare Advantage	$8.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.26
Rate for Payer: SOMOS Essential	$20.84
Rate for Payer: United Healthcare Commercial	$2.70
Rate for Payer: United Healthcare Essential Plan 1&2	$20.84
Rate for Payer: United Healthcare Essential Plan 3&4	$10.19
Rate for Payer: United Healthcare Medicaid	$9.26
Rate for Payer: United Healthcare Medicare Advantage	$8.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.86
Rate for Payer: Wellcare Medicare	$7.71

DRAWING BLOOD FOR SPECIMEN

Facility

$9.71

Service Code	HCPCS 36415
Hospital Charge Code	30300179
Hospital Revenue Code	300
Rate for Payer: Cash Price	$8.83

DRAWING BLOOD FROM SPECIMEN

Facility

$9.71

Service Code	HCPCS 36415
Hospital Charge Code	30103226
Hospital Revenue Code	300
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$926.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.57
Rate for Payer: Aetna Government	$8.57
Rate for Payer: Affinity Essential Plan 1&2	$20.84
Rate for Payer: Affinity Essential Plan 3&4	$20.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.26
Rate for Payer: Amida Care Medicaid	$9.26
Rate for Payer: Brighton Health Commercial	$7.28
Rate for Payer: Cash Price	$8.83
Rate for Payer: Cash Price	$8.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: Elderplan Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$8.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$926.00
Rate for Payer: Fidelis Essential Plan Aliesa	$9.26
Rate for Payer: Fidelis Essential Plan QHP	$9.26
Rate for Payer: Fidelis Medicare Advantage	$8.57
Rate for Payer: Fidelis Qualified Health Plan	$9.72
Rate for Payer: Group Health Inc Commercial	$8.57
Rate for Payer: Group Health Inc Medicare	$8.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.26
Rate for Payer: Hamaspik Choice Inc Medicare	$8.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.26
Rate for Payer: Healthfirst Essential Plan	$20.84
Rate for Payer: Healthfirst Medicare Advantage	$7.28
Rate for Payer: Healthfirst QHP	$9.26
Rate for Payer: Humana Medicare	$8.74
Rate for Payer: Senior Whole Health Medicare Advantage	$8.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.26
Rate for Payer: SOMOS Essential	$20.84
Rate for Payer: United Healthcare Commercial	$2.70
Rate for Payer: United Healthcare Essential Plan 1&2	$20.84
Rate for Payer: United Healthcare Essential Plan 3&4	$10.19
Rate for Payer: United Healthcare Medicaid	$9.26
Rate for Payer: United Healthcare Medicare Advantage	$8.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.86
Rate for Payer: Wellcare Medicare	$7.71

DRAWING BLOOD FROM SPECIMEN

Facility

$9.71

Service Code	HCPCS 36415
Hospital Charge Code	30103226
Hospital Revenue Code	300
Rate for Payer: Cash Price	$8.83

DREASSING AQUACEL AG FOAM 6X6

Facility

$32.52

Hospital Charge Code	64905728
Hospital Revenue Code	270
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$26.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.26
Rate for Payer: Aetna Government	$16.26
Rate for Payer: Brighton Health Commercial	$24.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.11
Rate for Payer: Group Health Inc Commercial	$16.26
Rate for Payer: Group Health Inc Medicare	$11.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.26
Rate for Payer: Hamaspik Choice Inc Medicare	$16.26

DRESS/DEBRID P THICK BURN S

Facility

$529.23

Service Code	HCPCS 16020
Hospital Charge Code	42500455
Hospital Revenue Code	361
Min. Negotiated Rate	$162.06
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Affinity Essential Plan 1&2	$162.06
Rate for Payer: Affinity Essential Plan 3&4	$162.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$162.06
Rate for Payer: Brighton Health Commercial	$396.92
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: EmblemHealth Commercial	$231.52
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
Rate for Payer: Group Health Inc Commercial	$231.52
Rate for Payer: Group Health Inc Medicare	$231.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: Humana Medicare	$236.15
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

DRESS/DEBRID P THICK BURN S

Facility

$529.23

Service Code	HCPCS 16020
Hospital Charge Code	42500455
Hospital Revenue Code	361
Rate for Payer: Cash Price	$231.52

DRESSING ABTHERA OPEN AB

Facility

$920.00

Hospital Charge Code	64901133
Hospital Revenue Code	270
Min. Negotiated Rate	$322.00
Max. Negotiated Rate	$736.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$506.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$460.00
Rate for Payer: Aetna Government	$460.00
Rate for Payer: Brighton Health Commercial	$690.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$736.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$625.60
Rate for Payer: Group Health Inc Commercial	$460.00
Rate for Payer: Group Health Inc Medicare	$322.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$460.00

DRESSING ABTHERA OPEN ABDOMINAL

Facility

$901.60

Hospital Charge Code	40201961
Hospital Revenue Code	272
Min. Negotiated Rate	$315.56
Max. Negotiated Rate	$721.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.80
Rate for Payer: Aetna Government	$450.80
Rate for Payer: Brighton Health Commercial	$676.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$721.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$613.09
Rate for Payer: Group Health Inc Commercial	$450.80
Rate for Payer: Group Health Inc Medicare	$315.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.80
Rate for Payer: Hamaspik Choice Inc Medicare	$450.80

DRESSING ALGINATE MAXORB 4X4

Facility

$6.90

Hospital Charge Code	40201962
Hospital Revenue Code	272
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$5.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.45
Rate for Payer: Aetna Government	$3.45
Rate for Payer: Brighton Health Commercial	$5.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.69
Rate for Payer: Group Health Inc Commercial	$3.45
Rate for Payer: Group Health Inc Medicare	$2.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.45
Rate for Payer: Hamaspik Choice Inc Medicare	$3.45

DRESSING FOAM

Facility

$50.70

Hospital Charge Code	41809544
Hospital Revenue Code	270
Min. Negotiated Rate	$17.74
Max. Negotiated Rate	$40.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.35
Rate for Payer: Aetna Government	$25.35
Rate for Payer: Brighton Health Commercial	$38.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.48
Rate for Payer: Group Health Inc Commercial	$25.35
Rate for Payer: Group Health Inc Medicare	$17.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.35
Rate for Payer: Hamaspik Choice Inc Medicare	$25.35

DRESSING FOAM 4X4

Facility

$50.70

Hospital Charge Code	41709544
Hospital Revenue Code	270
Min. Negotiated Rate	$17.74
Max. Negotiated Rate	$40.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.35
Rate for Payer: Aetna Government	$25.35
Rate for Payer: Brighton Health Commercial	$38.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.48
Rate for Payer: Group Health Inc Commercial	$25.35
Rate for Payer: Group Health Inc Medicare	$17.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.35
Rate for Payer: Hamaspik Choice Inc Medicare	$25.35

DRESSING,GEL,SILVASORB,ANTIMICROB

Facility

$66.48

Hospital Charge Code	40201967
Hospital Revenue Code	270
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$53.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33.24
Rate for Payer: Aetna Government	$33.24
Rate for Payer: Brighton Health Commercial	$49.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$45.21
Rate for Payer: Group Health Inc Commercial	$33.24
Rate for Payer: Group Health Inc Medicare	$23.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.24
Rate for Payer: Hamaspik Choice Inc Medicare	$33.24

Know your out-of-pocket cost for care.

All Charges