St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ENDOTRACHEL TUBE 5.0

Facility

$12.10

Hospital Charge Code	40201521
Hospital Revenue Code	270
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$9.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.05
Rate for Payer: Aetna Government	$6.05
Rate for Payer: Brighton Health Commercial	$9.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.23
Rate for Payer: Group Health Inc Commercial	$6.05
Rate for Payer: Group Health Inc Medicare	$4.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.05
Rate for Payer: Hamaspik Choice Inc Medicare	$6.05

ENDOTRACHEL TUBE 5.5

Facility

$9.57

Hospital Charge Code	40201522
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

ENDOTRACHEL TUBE 6.0

Facility

$9.57

Hospital Charge Code	40201523
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

ENDOTRACHEL TUBE 6.5

Facility

$9.57

Hospital Charge Code	40201524
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

ENDOTRACHEL TUBE 7.0

Facility

$9.57

Hospital Charge Code	40201525
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

ENDOTRACHEL TUBE 7.5

Facility

$9.57

Hospital Charge Code	40201526
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

ENDOTRACHEL TUBE 8.0

Facility

$9.57

Hospital Charge Code	40201527
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

ENDOTRACHEL TUBE 8.5

Facility

$9.57

Hospital Charge Code	40201528
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

ENDOTRACHEL TUBE 9.0

Facility

$6.38

Hospital Charge Code	40201529
Hospital Revenue Code	270
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$5.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.19
Rate for Payer: Aetna Government	$3.19
Rate for Payer: Brighton Health Commercial	$4.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.34
Rate for Payer: Group Health Inc Commercial	$3.19
Rate for Payer: Group Health Inc Medicare	$2.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.19
Rate for Payer: Hamaspik Choice Inc Medicare	$3.19

ENDOTRACHEL TUBE 9.5

Facility

$7.38

Hospital Charge Code	40201530
Hospital Revenue Code	270
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$5.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.69
Rate for Payer: Aetna Government	$3.69
Rate for Payer: Brighton Health Commercial	$5.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.02
Rate for Payer: Group Health Inc Commercial	$3.69
Rate for Payer: Group Health Inc Medicare	$2.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.69
Rate for Payer: Hamaspik Choice Inc Medicare	$3.69

ENDOTRACH TUBE

Facility

$17.00

Hospital Charge Code	40207620
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Brighton Health Commercial	$12.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$129,174.25

Service Code	MSDRG 266
Min. Negotiated Rate	$43,684.38
Max. Negotiated Rate	$129,174.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92,098.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$93,944.91
Rate for Payer: Aetna Government	$93,944.91
Rate for Payer: Brighton Health Commercial	$90,568.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$95,823.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107,863.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$89,013.92
Rate for Payer: Elderplan Medicare Advantage	$89,247.66
Rate for Payer: EmblemHealth Commercial	$53,560.30
Rate for Payer: Fidelis Medicare Advantage	$93,944.91
Rate for Payer: Group Health Inc Commercial	$93,944.91
Rate for Payer: Group Health Inc Medicare	$93,944.91
Rate for Payer: Hamaspik Choice Inc Medicare	$93,944.91
Rate for Payer: Healthfirst Medicare Advantage	$43,684.38
Rate for Payer: Humana Medicare	$129,174.25
Rate for Payer: Senior Whole Health Medicare Advantage	$93,944.91
Rate for Payer: United Healthcare Commercial	$124,216.19
Rate for Payer: United Healthcare Medicare Advantage	$93,944.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93,944.91
Rate for Payer: Wellcare Medicare	$89,247.66

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$103,129.74

Service Code	MSDRG 267
Min. Negotiated Rate	$34,876.60
Max. Negotiated Rate	$103,129.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71,958.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75,003.45
Rate for Payer: Aetna Government	$75,003.45
Rate for Payer: Brighton Health Commercial	$70,762.90
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$76,503.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84,276.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$69,548.32
Rate for Payer: Elderplan Medicare Advantage	$71,253.28
Rate for Payer: EmblemHealth Commercial	$41,847.70
Rate for Payer: Fidelis Medicare Advantage	$75,003.45
Rate for Payer: Group Health Inc Commercial	$75,003.45
Rate for Payer: Group Health Inc Medicare	$75,003.45
Rate for Payer: Hamaspik Choice Inc Medicare	$75,003.45
Rate for Payer: Healthfirst Medicare Advantage	$34,876.60
Rate for Payer: Humana Medicare	$103,129.74
Rate for Payer: Senior Whole Health Medicare Advantage	$75,003.45
Rate for Payer: United Healthcare Commercial	$97,052.54
Rate for Payer: United Healthcare Medicare Advantage	$75,003.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75,003.45
Rate for Payer: Wellcare Medicare	$71,253.28

ENDOVENOUS LASER 1ST VEIN

Facility

$8,393.53

Service Code	HCPCS 36478
Hospital Charge Code	41201184
Hospital Revenue Code	921
Rate for Payer: Cash Price	$3,686.08

ENDOVENOUS LASER 1ST VEIN

Facility

$8,393.53

Service Code	HCPCS 36478
Hospital Charge Code	41201184
Hospital Revenue Code	921
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$6,295.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Affinity Essential Plan 1&2	$2,580.26
Rate for Payer: Affinity Essential Plan 3&4	$2,580.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,580.26
Rate for Payer: Brighton Health Commercial	$6,295.15
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,686.08
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	$3,686.08
Rate for Payer: EmblemHealth Commercial	$3,686.08
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$3,686.08
Rate for Payer: Group Health Inc Medicare	$3,686.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst Medicare Advantage	$3,133.17
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Humana Medicare	$3,759.80
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: United Healthcare Commercial	$4,196.76
Rate for Payer: United Healthcare Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

ENEMA MINERAL OIL RE ENEM [31609]

Facility

$0.02

Service Code	NDC 70000010901
Hospital Charge Code	70000010901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ENEMA SET

Facility

$6.73

Hospital Charge Code	40201510
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

ENERGEN ICD

Facility

$38,500.00

Service Code	HCPCS C1721
Hospital Charge Code	66574084
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$40,425.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,175.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Brighton Health Commercial	$23,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,137.50
Rate for Payer: EmblemHealth Commercial	$19,250.00
Rate for Payer: Fidelis Medicare Advantage	$40,425.00
Rate for Payer: Group Health Inc Commercial	$19,250.00
Rate for Payer: Group Health Inc Medicare	$13,475.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,025.00

ENERGEN ICD-DF4-VR

Facility

$36,000.00

Service Code	HCPCS C1722
Hospital Charge Code	66526904
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$37,800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19,800.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$21,600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20,700.00
Rate for Payer: EmblemHealth Commercial	$18,000.00
Rate for Payer: Fidelis Medicare Advantage	$37,800.00
Rate for Payer: Group Health Inc Commercial	$18,000.00
Rate for Payer: Group Health Inc Medicare	$12,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23,400.00

ENERGEN ICD IS-1DF-1-VR

Facility

$36,000.00

Service Code	HCPCS C1772
Hospital Charge Code	66524665
Hospital Revenue Code	278
Min. Negotiated Rate	$18,000.00
Max. Negotiated Rate	$18,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18,000.00

ENERGEN ICD IS-1DF-1-VR

Facility

$36,000.00

Service Code	HCPCS C1772
Hospital Charge Code	66524665
Hospital Revenue Code	278
Min. Negotiated Rate	$510.46
Max. Negotiated Rate	$37,800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19,800.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$510.46
Rate for Payer: Aetna Government	$510.46
Rate for Payer: Brighton Health Commercial	$21,600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20,700.00
Rate for Payer: EmblemHealth Commercial	$18,000.00
Rate for Payer: Fidelis Medicare Advantage	$37,800.00
Rate for Payer: Group Health Inc Commercial	$18,000.00
Rate for Payer: Group Health Inc Medicare	$12,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23,400.00

ENFAMIL HUMAN MILK FORTIFIER PO PACK [32768]

Facility

$1.28

Service Code	NDC 00087201418
Hospital Charge Code	00087201418
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.64
Rate for Payer: Aetna Government	$0.64
Rate for Payer: Brighton Health Commercial	$0.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.87
Rate for Payer: Group Health Inc Commercial	$0.64
Rate for Payer: Group Health Inc Medicare	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.64
Rate for Payer: Hamaspik Choice Inc Medicare	$0.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.83

ENFAMIL HUMAN MLK FORTIFID .71G

Facility

$0.45

Hospital Charge Code	41640255
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL HUMAN MLK FORTIFID .71G

Facility

$0.45

Hospital Charge Code	41650255
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

ENFAMIL INFANT FORMULA W IRON

Facility

$0.45

Hospital Charge Code	41650252
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

Know your out-of-pocket cost for care.

All Charges