St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ENDOLOGIX AORTIC GRFT 25-25-75RL

Facility

$5,590.00

Service Code	HCPCS C1768
Hospital Charge Code	40205780
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$5,869.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,074.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$3,354.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,795.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,214.25
Rate for Payer: EmblemHealth Commercial	$2,795.00
Rate for Payer: Fidelis Medicare Advantage	$5,869.50
Rate for Payer: Group Health Inc Commercial	$2,795.00
Rate for Payer: Group Health Inc Medicare	$1,956.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,795.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,633.50

ENDOLOGIX AORTIC GRFT 25-25-75RL

Facility

$5,590.00

Service Code	HCPCS C1768
Hospital Charge Code	40205780
Hospital Revenue Code	278
Min. Negotiated Rate	$2,795.00
Max. Negotiated Rate	$2,795.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,795.00

ENDOLOGIX POWER LINK

Facility

$21,590.00

Hospital Charge Code	40205662
Hospital Revenue Code	279
Min. Negotiated Rate	$7,556.50
Max. Negotiated Rate	$17,272.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,874.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10,795.00
Rate for Payer: Aetna Government	$10,795.00
Rate for Payer: Brighton Health Commercial	$16,192.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17,272.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,681.20
Rate for Payer: Group Health Inc Commercial	$10,795.00
Rate for Payer: Group Health Inc Medicare	$7,556.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10,795.00

ENDOLOGIX POWER LINK SYSTEM

Facility

$6,790.00

Hospital Charge Code	40205649
Hospital Revenue Code	279
Min. Negotiated Rate	$2,376.50
Max. Negotiated Rate	$5,432.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,734.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,395.00
Rate for Payer: Aetna Government	$3,395.00
Rate for Payer: Brighton Health Commercial	$5,092.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,432.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,617.20
Rate for Payer: Group Health Inc Commercial	$3,395.00
Rate for Payer: Group Health Inc Medicare	$2,376.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,395.00

ENDOLOGIX P/S W/D/S 55M

Facility

$4,690.00

Service Code	HCPCS C1768
Hospital Charge Code	40205652
Hospital Revenue Code	278
Min. Negotiated Rate	$2,345.00
Max. Negotiated Rate	$2,345.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,345.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,345.00

ENDOLOGIX P/S W/D/S 55M

Facility

$4,690.00

Service Code	HCPCS C1768
Hospital Charge Code	40205652
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$4,924.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,579.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$2,814.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,345.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,696.75
Rate for Payer: EmblemHealth Commercial	$2,345.00
Rate for Payer: Fidelis Medicare Advantage	$4,924.50
Rate for Payer: Group Health Inc Commercial	$2,345.00
Rate for Payer: Group Health Inc Medicare	$1,641.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,345.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,345.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,048.50

ENDOLOGIX SHEATH AFX S17-45

Facility

$650.00

Hospital Charge Code	40205785
Hospital Revenue Code	270
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$325.00
Rate for Payer: Aetna Government	$325.00
Rate for Payer: Brighton Health Commercial	$487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$442.00
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

ENDOLOOP SUTURE #EJ10G

Facility

$280.14

Hospital Charge Code	40206057
Hospital Revenue Code	270
Min. Negotiated Rate	$98.05
Max. Negotiated Rate	$224.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.07
Rate for Payer: Aetna Government	$140.07
Rate for Payer: Brighton Health Commercial	$210.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$190.50
Rate for Payer: Group Health Inc Commercial	$140.07
Rate for Payer: Group Health Inc Medicare	$98.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.07
Rate for Payer: Hamaspik Choice Inc Medicare	$140.07

ENDOLOOP SUTURE VICRYL 18

Facility

$101.93

Hospital Charge Code	64902993
Hospital Revenue Code	270
Min. Negotiated Rate	$35.68
Max. Negotiated Rate	$81.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.96
Rate for Payer: Aetna Government	$50.96
Rate for Payer: Brighton Health Commercial	$76.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.31
Rate for Payer: Group Health Inc Commercial	$50.96
Rate for Payer: Group Health Inc Medicare	$35.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.96
Rate for Payer: Hamaspik Choice Inc Medicare	$50.96

Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (List separately in addition to code for primary procedure)

Facility

$6,937.00

Service Code	CPT 92978
Hospital Revenue Code	481
Min. Negotiated Rate	$256.73
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$256.73
Rate for Payer: Aetna Government	$256.73
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,215.78
Rate for Payer: United Healthcare Commercial	$1,113.00

ENDOMETR ABLATE THERMAL

Facility

$12,937.43

Service Code	HCPCS 58353
Hospital Charge Code	40059672
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,751.94

ENDOMETR ABLATE THERMAL

Facility

$12,937.43

Service Code	HCPCS 58353
Hospital Charge Code	40059672
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$9,703.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,751.94
Rate for Payer: Aetna Government	$5,751.94
Rate for Payer: Affinity Essential Plan 1&2	$4,026.36
Rate for Payer: Affinity Essential Plan 3&4	$4,026.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,026.36
Rate for Payer: Brighton Health Commercial	$9,703.07
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5,751.94
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	$5,751.94
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$4,889.15
Rate for Payer: Fidelis Essential Plan QHP	$5,119.23
Rate for Payer: Fidelis Medicare Advantage	$5,751.94
Rate for Payer: Fidelis Qualified Health Plan	$5,119.23
Rate for Payer: Group Health Inc Commercial	$5,751.94
Rate for Payer: Group Health Inc Medicare	$5,751.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,468.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5,751.94
Rate for Payer: Healthfirst Medicare Advantage	$4,889.15
Rate for Payer: Healthfirst QHP	$5,751.94
Rate for Payer: Humana Medicare	$5,866.98
Rate for Payer: Senior Whole Health Medicare Advantage	$5,751.94
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$5,751.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,751.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,601.55
Rate for Payer: Wellcare Medicare	$5,464.34

ENDOMETRIAL BIOPSY

Facility

$502.93

Service Code	HCPCS 58100
Hospital Charge Code	40129539
Hospital Revenue Code	360
Min. Negotiated Rate	$161.31
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.44
Rate for Payer: Aetna Government	$230.44
Rate for Payer: Affinity Essential Plan 1&2	$161.31
Rate for Payer: Affinity Essential Plan 3&4	$161.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$161.31
Rate for Payer: Brighton Health Commercial	$377.20
Rate for Payer: Cash Price	$230.44
Rate for Payer: Cash Price	$230.44
Rate for Payer: Cash Price	$230.44
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$230.44
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	$230.44
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$195.87
Rate for Payer: Fidelis Essential Plan QHP	$205.09
Rate for Payer: Fidelis Medicare Advantage	$230.44
Rate for Payer: Fidelis Qualified Health Plan	$205.09
Rate for Payer: Group Health Inc Commercial	$230.44
Rate for Payer: Group Health Inc Medicare	$230.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.46
Rate for Payer: Hamaspik Choice Inc Medicare	$230.44
Rate for Payer: Healthfirst Medicare Advantage	$195.87
Rate for Payer: Healthfirst QHP	$230.44
Rate for Payer: Humana Medicare	$235.05
Rate for Payer: Senior Whole Health Medicare Advantage	$230.44
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$230.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$184.35
Rate for Payer: Wellcare Medicare	$218.92

ENDOMETRIAL BIOPSY

Facility

$502.93

Service Code	HCPCS 58100
Hospital Charge Code	40129539
Hospital Revenue Code	360
Rate for Payer: Cash Price	$230.44

ENDOMETRIAL CURRETAGE

Facility

$12,937.43

Service Code	HCPCS 58356
Hospital Charge Code	40129538
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$9,703.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,751.94
Rate for Payer: Aetna Government	$5,751.94
Rate for Payer: Affinity Essential Plan 1&2	$4,026.36
Rate for Payer: Affinity Essential Plan 3&4	$4,026.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,026.36
Rate for Payer: Brighton Health Commercial	$9,703.07
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Cash Price	$5,751.94
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5,751.94
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	$5,751.94
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$4,889.15
Rate for Payer: Fidelis Essential Plan QHP	$5,119.23
Rate for Payer: Fidelis Medicare Advantage	$5,751.94
Rate for Payer: Fidelis Qualified Health Plan	$5,119.23
Rate for Payer: Group Health Inc Commercial	$5,751.94
Rate for Payer: Group Health Inc Medicare	$5,751.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,468.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5,751.94
Rate for Payer: Healthfirst Medicare Advantage	$4,889.15
Rate for Payer: Healthfirst QHP	$5,751.94
Rate for Payer: Humana Medicare	$5,866.98
Rate for Payer: Senior Whole Health Medicare Advantage	$5,751.94
Rate for Payer: United Healthcare Commercial	$2,683.00
Rate for Payer: United Healthcare Medicare Advantage	$5,751.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,751.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,601.55
Rate for Payer: Wellcare Medicare	$5,464.34

ENDOMETRIAL CURRETAGE

Facility

$12,937.43

Service Code	HCPCS 58356
Hospital Charge Code	40129538
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,751.94

ENDOMYSIAL ANTIBODY IGA

Facility

$30.13

Service Code	HCPCS 86255
Hospital Charge Code	40729337
Hospital Revenue Code	300
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$22.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.60
Rate for Payer: Cash Price	$12.05
Rate for Payer: Cash Price	$12.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.20
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.64
Rate for Payer: Wellcare Medicare	$10.84

ENDOMYSIAL ANTIBODY IGA

Facility

$30.13

Service Code	HCPCS 86255
Hospital Charge Code	40729337
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.05

ENDOPROSTHESIS AAA EXCLUDER(CEB23

Facility

$11,576.00

Hospital Charge Code	64906371
Hospital Revenue Code	279
Min. Negotiated Rate	$4,051.60
Max. Negotiated Rate	$9,260.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,366.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,788.00
Rate for Payer: Aetna Government	$5,788.00
Rate for Payer: Brighton Health Commercial	$8,682.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,260.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,871.68
Rate for Payer: Group Health Inc Commercial	$5,788.00
Rate for Payer: Group Health Inc Medicare	$4,051.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,788.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,788.00

ENDOPROSTHESIS CNTLT AAA18M PLC00

Facility

$4,857.00

Hospital Charge Code	64906462
Hospital Revenue Code	279
Min. Negotiated Rate	$1,699.95
Max. Negotiated Rate	$3,885.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,671.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,428.50
Rate for Payer: Aetna Government	$2,428.50
Rate for Payer: Brighton Health Commercial	$3,642.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,885.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,302.76
Rate for Payer: Group Health Inc Commercial	$2,428.50
Rate for Payer: Group Health Inc Medicare	$1,699.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,428.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,428.50

ENDOPROSTHSIS AAA EXCLUDR(RLT2812

Facility

$11,846.00

Hospital Charge Code	64906374
Hospital Revenue Code	279
Min. Negotiated Rate	$4,146.10
Max. Negotiated Rate	$9,476.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,515.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,923.00
Rate for Payer: Aetna Government	$5,923.00
Rate for Payer: Brighton Health Commercial	$8,884.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,476.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,055.28
Rate for Payer: Group Health Inc Commercial	$5,923.00
Rate for Payer: Group Health Inc Medicare	$4,146.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,923.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,923.00

ENDOPROSTSIS AAA EXCLUDR (PLC2712

Facility

$4,857.00

Hospital Charge Code	64906372
Hospital Revenue Code	279
Min. Negotiated Rate	$1,699.95
Max. Negotiated Rate	$3,885.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,671.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,428.50
Rate for Payer: Aetna Government	$2,428.50
Rate for Payer: Brighton Health Commercial	$3,642.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,885.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,302.76
Rate for Payer: Group Health Inc Commercial	$2,428.50
Rate for Payer: Group Health Inc Medicare	$1,699.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,428.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,428.50

ENDOPROSTSIS AAA EXLUDR(HGB161007

Facility

$3,231.00

Hospital Charge Code	64906373
Hospital Revenue Code	279
Min. Negotiated Rate	$1,130.85
Max. Negotiated Rate	$2,584.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,777.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,615.50
Rate for Payer: Aetna Government	$1,615.50
Rate for Payer: Brighton Health Commercial	$2,423.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,584.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,197.08
Rate for Payer: Group Health Inc Commercial	$1,615.50
Rate for Payer: Group Health Inc Medicare	$1,130.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,615.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,615.50

ENDOPROTHS ILC EXT AAA 14.5MM

Facility

$3,418.00

Hospital Charge Code	64906463
Hospital Revenue Code	279
Min. Negotiated Rate	$1,196.30
Max. Negotiated Rate	$2,734.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,879.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,709.00
Rate for Payer: Aetna Government	$1,709.00
Rate for Payer: Brighton Health Commercial	$2,563.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,734.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,324.24
Rate for Payer: Group Health Inc Commercial	$1,709.00
Rate for Payer: Group Health Inc Medicare	$1,196.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,709.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,709.00

ENDO ROTHNET BASKET

Facility

$200.00

Hospital Charge Code	40203657
Hospital Revenue Code	272
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$160.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.00
Rate for Payer: Aetna Government	$100.00
Rate for Payer: Brighton Health Commercial	$150.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

Know your out-of-pocket cost for care.

All Charges