St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ELECTRODE ENDOSCOP 24FR 30

Facility

$250.74

Hospital Charge Code	64903914
Hospital Revenue Code	270
Min. Negotiated Rate	$87.76
Max. Negotiated Rate	$200.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.37
Rate for Payer: Aetna Government	$125.37
Rate for Payer: Brighton Health Commercial	$188.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.50
Rate for Payer: Group Health Inc Commercial	$125.37
Rate for Payer: Group Health Inc Medicare	$87.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.37
Rate for Payer: Hamaspik Choice Inc Medicare	$125.37

ELECTRODE ENDOSCOPIC CA 24FR

Facility

$266.58

Hospital Charge Code	64904805
Hospital Revenue Code	270
Min. Negotiated Rate	$93.30
Max. Negotiated Rate	$213.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$133.29
Rate for Payer: Aetna Government	$133.29
Rate for Payer: Brighton Health Commercial	$199.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$213.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$181.27
Rate for Payer: Group Health Inc Commercial	$133.29
Rate for Payer: Group Health Inc Medicare	$93.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.29
Rate for Payer: Hamaspik Choice Inc Medicare	$133.29

ELECTRODE FETAL SPIRAL

Facility

$6.50

Hospital Charge Code	64902366
Hospital Revenue Code	270
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.25
Rate for Payer: Aetna Government	$3.25
Rate for Payer: Brighton Health Commercial	$4.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.42
Rate for Payer: Group Health Inc Commercial	$3.25
Rate for Payer: Group Health Inc Medicare	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3.25

ELECTRODE FOAM 133 CHILD

Facility

$0.23

Hospital Charge Code	64902421
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12

ELECTRODE,FOAM,PRE-WIRED KITY

Facility

$1.36

Hospital Charge Code	64902388
Hospital Revenue Code	270
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.92
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68

ELECTRODE INSERT

Facility

$910.00

Hospital Charge Code	64902783
Hospital Revenue Code	270
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$728.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$500.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$455.00
Rate for Payer: Aetna Government	$455.00
Rate for Payer: Brighton Health Commercial	$682.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$728.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$618.80
Rate for Payer: Group Health Inc Commercial	$455.00
Rate for Payer: Group Health Inc Medicare	$318.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$455.00
Rate for Payer: Hamaspik Choice Inc Medicare	$455.00

ELECTRODE J-HOOK IRR/ASP 33C/5M

Facility

$118.71

Hospital Charge Code	64904382
Hospital Revenue Code	270
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$94.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.36
Rate for Payer: Aetna Government	$59.36
Rate for Payer: Brighton Health Commercial	$89.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.72
Rate for Payer: Group Health Inc Commercial	$59.36
Rate for Payer: Group Health Inc Medicare	$41.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.36
Rate for Payer: Hamaspik Choice Inc Medicare	$59.36

ELECTRODE LHOOK 5MMX33CM ADVANT

Facility

$118.71

Hospital Charge Code	64904380
Hospital Revenue Code	270
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$94.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.36
Rate for Payer: Aetna Government	$59.36
Rate for Payer: Brighton Health Commercial	$89.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.72
Rate for Payer: Group Health Inc Commercial	$59.36
Rate for Payer: Group Health Inc Medicare	$41.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.36
Rate for Payer: Hamaspik Choice Inc Medicare	$59.36

ELECTRODE LOOP WALLACH 10X10MM

Facility

$32.99

Hospital Charge Code	64902983
Hospital Revenue Code	270
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$26.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.50
Rate for Payer: Aetna Government	$16.50
Rate for Payer: Brighton Health Commercial	$24.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.43
Rate for Payer: Group Health Inc Commercial	$16.50
Rate for Payer: Group Health Inc Medicare	$11.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.50
Rate for Payer: Hamaspik Choice Inc Medicare	$16.50

ELECTRODE LOOP WALLACH 20X15MM

Facility

$33.90

Hospital Charge Code	64902982
Hospital Revenue Code	270
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$27.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.95
Rate for Payer: Aetna Government	$16.95
Rate for Payer: Brighton Health Commercial	$25.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.05
Rate for Payer: Group Health Inc Commercial	$16.95
Rate for Payer: Group Health Inc Medicare	$11.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.95
Rate for Payer: Hamaspik Choice Inc Medicare	$16.95

ELECTRODE LOOP WALLACH 20X8MM

Facility

$28.27

Hospital Charge Code	64902967
Hospital Revenue Code	270
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$22.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.14
Rate for Payer: Aetna Government	$14.14
Rate for Payer: Brighton Health Commercial	$21.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.22
Rate for Payer: Group Health Inc Commercial	$14.14
Rate for Payer: Group Health Inc Medicare	$9.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.14
Rate for Payer: Hamaspik Choice Inc Medicare	$14.14

ELECTRODE LOOP WALLACH 20X8MM#909

Facility

$137.68

Hospital Charge Code	40200427
Hospital Revenue Code	270
Min. Negotiated Rate	$48.19
Max. Negotiated Rate	$110.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.84
Rate for Payer: Aetna Government	$68.84
Rate for Payer: Brighton Health Commercial	$103.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.62
Rate for Payer: Group Health Inc Commercial	$68.84
Rate for Payer: Group Health Inc Medicare	$48.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.84
Rate for Payer: Hamaspik Choice Inc Medicare	$68.84

ELECTRODE PUPPYDOG

Facility

$1.39

Hospital Charge Code	64902067
Hospital Revenue Code	270
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$1.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.70
Rate for Payer: Aetna Government	$0.70
Rate for Payer: Brighton Health Commercial	$1.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.95
Rate for Payer: Group Health Inc Commercial	$0.70
Rate for Payer: Group Health Inc Medicare	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70
Rate for Payer: Hamaspik Choice Inc Medicare	$0.70

ELECTRODE QCK COMBO PEDMD

Facility

$60.05

Hospital Charge Code	64901559
Hospital Revenue Code	270
Min. Negotiated Rate	$21.02
Max. Negotiated Rate	$48.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.02
Rate for Payer: Aetna Government	$30.02
Rate for Payer: Brighton Health Commercial	$45.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.83
Rate for Payer: Group Health Inc Commercial	$30.02
Rate for Payer: Group Health Inc Medicare	$21.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.02
Rate for Payer: Hamaspik Choice Inc Medicare	$30.02

ELECTRODE RESTING DISP

Facility

$104.08

Hospital Charge Code	64903007
Hospital Revenue Code	270
Min. Negotiated Rate	$36.43
Max. Negotiated Rate	$83.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.04
Rate for Payer: Aetna Government	$52.04
Rate for Payer: Brighton Health Commercial	$78.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.77
Rate for Payer: Group Health Inc Commercial	$52.04
Rate for Payer: Group Health Inc Medicare	$36.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.04
Rate for Payer: Hamaspik Choice Inc Medicare	$52.04

ELECTROENCEPHALOGRAPH

Facility

$766.58

Service Code	HCPCS 95819 TC
Hospital Charge Code	41000001
Hospital Revenue Code	740
Rate for Payer: Cash Price	$362.98

ELECTROENCEPHALOGRAPH

Facility

$766.58

Service Code	HCPCS 95819 TC
Hospital Charge Code	41000001
Hospital Revenue Code	740
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

ELECTROLYTES NA,K+,CHLORIDES

Facility

$17.53

Service Code	HCPCS 80051
Hospital Charge Code	40602395
Hospital Revenue Code	301
Rate for Payer: Cash Price	$7.01

ELECTROLYTES NA,K+,CHLORIDES

Facility

$17.53

Service Code	HCPCS 80051
Hospital Charge Code	40602395
Hospital Revenue Code	301
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$13.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.01
Rate for Payer: Aetna Government	$7.01
Rate for Payer: Affinity Essential Plan 1&2	$4.91
Rate for Payer: Affinity Essential Plan 3&4	$4.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.91
Rate for Payer: Brighton Health Commercial	$13.15
Rate for Payer: Cash Price	$7.01
Rate for Payer: Cash Price	$7.01
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.44
Rate for Payer: Elderplan Medicare Advantage	$7.01
Rate for Payer: EmblemHealth Commercial	$7.01
Rate for Payer: Fidelis Essential Plan Aliesa	$5.96
Rate for Payer: Fidelis Essential Plan QHP	$6.24
Rate for Payer: Fidelis Medicare Advantage	$7.01
Rate for Payer: Fidelis Qualified Health Plan	$6.24
Rate for Payer: Group Health Inc Commercial	$7.01
Rate for Payer: Group Health Inc Medicare	$7.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.76
Rate for Payer: Hamaspik Choice Inc Medicare	$7.01
Rate for Payer: Healthfirst Medicare Advantage	$7.01
Rate for Payer: Healthfirst QHP	$7.01
Rate for Payer: Humana Medicare	$7.15
Rate for Payer: Senior Whole Health Medicare Advantage	$7.01
Rate for Payer: United Healthcare Commercial	$8.88
Rate for Payer: United Healthcare Medicare Advantage	$7.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.61
Rate for Payer: Wellcare Medicare	$6.31

ELECTRONIC NEUROSTIM SIMPL SPINAL

Facility

$343.55

Service Code	HCPCS 95971
Hospital Charge Code	30305905
Hospital Revenue Code	920
Rate for Payer: Cash Price	$111.94

ELECTRONIC NEUROSTIM SIMPL SPINAL

Facility

$343.55

Service Code	HCPCS 95971
Hospital Charge Code	30305905
Hospital Revenue Code	920
Min. Negotiated Rate	$78.36
Max. Negotiated Rate	$274.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$111.94
Rate for Payer: Aetna Government	$111.94
Rate for Payer: Affinity Essential Plan 1&2	$78.36
Rate for Payer: Affinity Essential Plan 3&4	$78.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$78.36
Rate for Payer: Brighton Health Commercial	$257.66
Rate for Payer: Cash Price	$111.94
Rate for Payer: Cash Price	$111.94
Rate for Payer: Cash Price	$111.94
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$111.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$274.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.61
Rate for Payer: Elderplan Medicare Advantage	$111.94
Rate for Payer: EmblemHealth Commercial	$111.94
Rate for Payer: Fidelis Essential Plan Aliesa	$95.15
Rate for Payer: Fidelis Essential Plan QHP	$99.63
Rate for Payer: Fidelis Medicare Advantage	$111.94
Rate for Payer: Fidelis Qualified Health Plan	$99.63
Rate for Payer: Group Health Inc Commercial	$111.94
Rate for Payer: Group Health Inc Medicare	$111.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.78
Rate for Payer: Hamaspik Choice Inc Medicare	$111.94
Rate for Payer: Healthfirst Medicare Advantage	$95.15
Rate for Payer: Healthfirst QHP	$111.94
Rate for Payer: Humana Medicare	$114.18
Rate for Payer: Senior Whole Health Medicare Advantage	$111.94
Rate for Payer: United Healthcare Commercial	$94.00
Rate for Payer: United Healthcare Medicare Advantage	$111.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$89.55
Rate for Payer: Wellcare Medicare	$106.34

ELECTROPHORESIS NES

Facility

$153.75

Service Code	HCPCS 82664
Hospital Charge Code	30305718
Hospital Revenue Code	301
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$115.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.50
Rate for Payer: Aetna Government	$61.50
Rate for Payer: Affinity Essential Plan 1&2	$43.05
Rate for Payer: Affinity Essential Plan 3&4	$43.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.05
Rate for Payer: Brighton Health Commercial	$115.31
Rate for Payer: Cash Price	$61.50
Rate for Payer: Cash Price	$61.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$61.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.22
Rate for Payer: Elderplan Medicare Advantage	$61.50
Rate for Payer: EmblemHealth Commercial	$61.50
Rate for Payer: Fidelis Essential Plan Aliesa	$52.28
Rate for Payer: Fidelis Essential Plan QHP	$54.74
Rate for Payer: Fidelis Medicare Advantage	$61.50
Rate for Payer: Fidelis Qualified Health Plan	$54.74
Rate for Payer: Group Health Inc Commercial	$61.50
Rate for Payer: Group Health Inc Medicare	$61.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.88
Rate for Payer: Hamaspik Choice Inc Medicare	$61.50
Rate for Payer: Healthfirst Medicare Advantage	$61.50
Rate for Payer: Healthfirst QHP	$61.50
Rate for Payer: Humana Medicare	$62.73
Rate for Payer: Senior Whole Health Medicare Advantage	$61.50
Rate for Payer: United Healthcare Commercial	$43.52
Rate for Payer: United Healthcare Medicare Advantage	$61.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$49.20
Rate for Payer: Wellcare Medicare	$55.35

ELECTROPHORESIS NES

Facility

$153.75

Service Code	HCPCS 82664
Hospital Charge Code	30305718
Hospital Revenue Code	301
Rate for Payer: Cash Price	$61.50

ELECTROPLAST 2

Facility

$9.57

Hospital Charge Code	40201462
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

ELECTROPLAST 3

Facility

$12.05

Hospital Charge Code	40201463
Hospital Revenue Code	270
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Brighton Health Commercial	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02

Know your out-of-pocket cost for care.

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