St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ESTAB PT WELL CHILD CARE <1 YEAR

Facility

$358.69

Service Code	HCPCS 99391
Hospital Charge Code	30301280
Hospital Revenue Code	510
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.50
Rate for Payer: Aetna Government	$59.50
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.34
Rate for Payer: Hamaspik Choice Inc Medicare	$179.34
Rate for Payer: United Healthcare Commercial	$222.00

ESTAB PT WELL CHILD CARE 5-11YEAR

Facility

$358.69

Service Code	HCPCS 99393
Hospital Charge Code	30301282
Hospital Revenue Code	510
Min. Negotiated Rate	$62.88
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.88
Rate for Payer: Aetna Government	$62.88
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.34
Rate for Payer: Hamaspik Choice Inc Medicare	$179.34
Rate for Payer: United Healthcare Commercial	$222.00

EST PT PRE AGE 12-17

Facility

$358.63

Service Code	HCPCS 99394
Hospital Charge Code	30400225
Hospital Revenue Code	510
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.44
Rate for Payer: Aetna Government	$71.44
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

EST PT PRE AGE 18-39 YR

Facility

$358.63

Service Code	HCPCS 99395
Hospital Charge Code	30400227
Hospital Revenue Code	510
Min. Negotiated Rate	$66.27
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$66.27
Rate for Payer: Aetna Government	$66.27
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

EST PT PRE AGE 40-64 YRS

Facility

$358.63

Service Code	HCPCS 99396
Hospital Charge Code	30400228
Hospital Revenue Code	510
Min. Negotiated Rate	$72.08
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.08
Rate for Payer: Aetna Government	$72.08
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

EST PT PRE AGE 65 - OLDER

Facility

$358.63

Service Code	HCPCS 99397
Hospital Charge Code	30400229
Hospital Revenue Code	510
Min. Negotiated Rate	$75.81
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.81
Rate for Payer: Aetna Government	$75.81
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

EST PT WELL CHILD CARE 5-11 YEAR

Facility

$358.63

Service Code	HCPCS 99393
Hospital Charge Code	30400224
Hospital Revenue Code	510
Min. Negotiated Rate	$62.88
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.88
Rate for Payer: Aetna Government	$62.88
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

ESTRAMUSTINE 140 MG CAP

Facility

$7.00

Hospital Charge Code	41641227
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

ESTRAMUSTINE 140 MG CAP

Facility

$7.00

Hospital Charge Code	41651227
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

ESTROGENS CONJUGATED 0.625 MG/GM VA CREA [187009]

Facility

$18.00

Service Code	NDC 00046087221
Hospital Charge Code	00046087221
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$14.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.00
Rate for Payer: Aetna Government	$9.00
Rate for Payer: Brighton Health Commercial	$13.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.24
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70

ESTROGENS CONJUGATED 1.25 MG PO TABS [2938]

Facility

$8.29

Service Code	NDC 00046110481
Hospital Charge Code	00046110481
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$6.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.14
Rate for Payer: Aetna Government	$4.14
Rate for Payer: Brighton Health Commercial	$6.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.64
Rate for Payer: Group Health Inc Commercial	$4.14
Rate for Payer: Group Health Inc Medicare	$2.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.14
Rate for Payer: Hamaspik Choice Inc Medicare	$4.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.39

ESTROGENS CONJUGATED 25 MG IJ SOLR [9972]

Facility

$441.66

Service Code	HCPCS J1410
Hospital Charge Code	00046074905
Hospital Revenue Code	250
Min. Negotiated Rate	$220.83
Max. Negotiated Rate	$394.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$372.15
Rate for Payer: Aetna Government	$372.15
Rate for Payer: Affinity Essential Plan 1&2	$260.50
Rate for Payer: Affinity Essential Plan 3&4	$260.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$260.50
Rate for Payer: Brighton Health Commercial	$331.24
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$372.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$353.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$300.33
Rate for Payer: Elderplan Medicare Advantage	$372.15
Rate for Payer: EmblemHealth Commercial	$372.15
Rate for Payer: Fidelis Essential Plan Aliesa	$316.32
Rate for Payer: Fidelis Essential Plan QHP	$331.21
Rate for Payer: Fidelis Medicare Advantage	$372.15
Rate for Payer: Fidelis Qualified Health Plan	$331.21
Rate for Payer: Group Health Inc Commercial	$372.15
Rate for Payer: Group Health Inc Medicare	$372.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.83
Rate for Payer: Hamaspik Choice Inc Medicare	$372.15
Rate for Payer: Healthfirst Medicare Advantage	$316.32
Rate for Payer: Healthfirst QHP	$372.15
Rate for Payer: Humana Medicare	$379.59
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$372.37
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$394.71
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$394.71
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$394.71
Rate for Payer: Senior Whole Health Medicare Advantage	$372.15
Rate for Payer: United Healthcare Medicare Advantage	$372.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$287.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$297.72
Rate for Payer: Wellcare Medicare	$353.54

ESTRONE LC/MS/MS

Facility

$62.38

Service Code	HCPCS 82679
Hospital Charge Code	30303359
Hospital Revenue Code	301
Min. Negotiated Rate	$17.46
Max. Negotiated Rate	$46.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.95
Rate for Payer: Aetna Government	$24.95
Rate for Payer: Affinity Essential Plan 1&2	$17.46
Rate for Payer: Affinity Essential Plan 3&4	$17.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$17.46
Rate for Payer: Brighton Health Commercial	$46.78
Rate for Payer: Cash Price	$24.95
Rate for Payer: Cash Price	$24.95
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$24.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.57
Rate for Payer: Elderplan Medicare Advantage	$24.95
Rate for Payer: EmblemHealth Commercial	$24.95
Rate for Payer: Fidelis Essential Plan Aliesa	$21.21
Rate for Payer: Fidelis Essential Plan QHP	$22.21
Rate for Payer: Fidelis Medicare Advantage	$24.95
Rate for Payer: Fidelis Qualified Health Plan	$22.21
Rate for Payer: Group Health Inc Commercial	$24.95
Rate for Payer: Group Health Inc Medicare	$24.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.19
Rate for Payer: Hamaspik Choice Inc Medicare	$24.95
Rate for Payer: Healthfirst Medicare Advantage	$24.95
Rate for Payer: Healthfirst QHP	$24.95
Rate for Payer: Humana Medicare	$25.45
Rate for Payer: Senior Whole Health Medicare Advantage	$24.95
Rate for Payer: United Healthcare Commercial	$31.61
Rate for Payer: United Healthcare Medicare Advantage	$24.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.96
Rate for Payer: Wellcare Medicare	$22.46

ESTRONE LC/MS/MS

Facility

$62.38

Service Code	HCPCS 82679
Hospital Charge Code	30303359
Hospital Revenue Code	301
Rate for Payer: Cash Price	$24.95

ESTRONE, SERUM

Facility

$62.38

Service Code	HCPCS 82679
Hospital Charge Code	40609070
Hospital Revenue Code	300
Min. Negotiated Rate	$17.46
Max. Negotiated Rate	$46.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.95
Rate for Payer: Aetna Government	$24.95
Rate for Payer: Affinity Essential Plan 1&2	$17.46
Rate for Payer: Affinity Essential Plan 3&4	$17.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$17.46
Rate for Payer: Brighton Health Commercial	$46.78
Rate for Payer: Cash Price	$24.95
Rate for Payer: Cash Price	$24.95
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$24.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.57
Rate for Payer: Elderplan Medicare Advantage	$24.95
Rate for Payer: EmblemHealth Commercial	$24.95
Rate for Payer: Fidelis Essential Plan Aliesa	$21.21
Rate for Payer: Fidelis Essential Plan QHP	$22.21
Rate for Payer: Fidelis Medicare Advantage	$24.95
Rate for Payer: Fidelis Qualified Health Plan	$22.21
Rate for Payer: Group Health Inc Commercial	$24.95
Rate for Payer: Group Health Inc Medicare	$24.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.19
Rate for Payer: Hamaspik Choice Inc Medicare	$24.95
Rate for Payer: Healthfirst Medicare Advantage	$24.95
Rate for Payer: Healthfirst QHP	$24.95
Rate for Payer: Humana Medicare	$25.45
Rate for Payer: Senior Whole Health Medicare Advantage	$24.95
Rate for Payer: United Healthcare Commercial	$31.61
Rate for Payer: United Healthcare Medicare Advantage	$24.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.96
Rate for Payer: Wellcare Medicare	$22.46

ESTRONE, SERUM

Facility

$62.38

Service Code	HCPCS 82679
Hospital Charge Code	40609070
Hospital Revenue Code	300
Rate for Payer: Cash Price	$24.95

ESWL LITHOTRIPSY BILE DUCT

Facility

$14,479.95

Service Code	HCPCS 43265
Hospital Charge Code	40019526
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,590.73

ESWL LITHOTRIPSY BILE DUCT

Facility

$14,479.95

Service Code	HCPCS 43265
Hospital Charge Code	40019526
Hospital Revenue Code	360
Min. Negotiated Rate	$955.00
Max. Negotiated Rate	$7,239.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,590.73
Rate for Payer: Aetna Government	$6,590.73
Rate for Payer: Affinity Essential Plan 1&2	$4,613.51
Rate for Payer: Affinity Essential Plan 3&4	$4,613.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,613.51
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$6,590.73
Rate for Payer: Cash Price	$6,590.73
Rate for Payer: Cash Price	$6,590.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,590.73
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	$6,590.73
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$5,602.12
Rate for Payer: Fidelis Essential Plan QHP	$5,865.75
Rate for Payer: Fidelis Medicare Advantage	$6,590.73
Rate for Payer: Fidelis Qualified Health Plan	$5,865.75
Rate for Payer: Group Health Inc Commercial	$6,590.73
Rate for Payer: Group Health Inc Medicare	$6,590.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,239.98
Rate for Payer: Hamaspik Choice Inc Medicare	$6,590.73
Rate for Payer: Healthfirst Medicare Advantage	$5,602.12
Rate for Payer: Healthfirst QHP	$6,590.73
Rate for Payer: Humana Medicare	$6,722.54
Rate for Payer: Senior Whole Health Medicare Advantage	$6,590.73
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$6,590.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,590.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,272.58
Rate for Payer: Wellcare Medicare	$6,261.19

ETESEVIMAB

Facility

$0.01

Service Code	HCPCS Q0245
Hospital Charge Code	41650247
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

ETESEVIMAB

Facility

$0.01

Service Code	HCPCS Q0245
Hospital Charge Code	41640247
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
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	$0.01
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	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ETESEVIMAB

Facility

$0.01

Service Code	HCPCS Q0245
Hospital Charge Code	41640247
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

ETESEVIMAB

Facility

$0.01

Service Code	HCPCS Q0245
Hospital Charge Code	41650247
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
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	$0.01
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	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ETHACRYNATE SODIUM 50MG INJ

Facility

$1,314.46

Hospital Charge Code	41654944
Hospital Revenue Code	250
Min. Negotiated Rate	$460.06
Max. Negotiated Rate	$1,051.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$722.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$657.23
Rate for Payer: Aetna Government	$657.23
Rate for Payer: Brighton Health Commercial	$985.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,051.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$893.83
Rate for Payer: Group Health Inc Commercial	$657.23
Rate for Payer: Group Health Inc Medicare	$460.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$657.23
Rate for Payer: Hamaspik Choice Inc Medicare	$657.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$854.40

ETHACRYNATE SODIUM 50MG INJ

Facility

$1,314.46

Hospital Charge Code	41644944
Hospital Revenue Code	250
Min. Negotiated Rate	$460.06
Max. Negotiated Rate	$1,051.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$722.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$657.23
Rate for Payer: Aetna Government	$657.23
Rate for Payer: Brighton Health Commercial	$985.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,051.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$893.83
Rate for Payer: Group Health Inc Commercial	$657.23
Rate for Payer: Group Health Inc Medicare	$460.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$657.23
Rate for Payer: Hamaspik Choice Inc Medicare	$657.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$854.40

ETHACRYNATE SODIUM 50 MG IV SOLR [9979]

Facility

$4,560.00

Service Code	NDC 42023015701
Hospital Charge Code	42023015701
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$4,788.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,508.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,280.00
Rate for Payer: Aetna Government	$2,280.00
Rate for Payer: Brighton Health Commercial	$2,736.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,622.00
Rate for Payer: EmblemHealth Commercial	$2,280.00
Rate for Payer: Fidelis Medicare Advantage	$4,788.00
Rate for Payer: Group Health Inc Commercial	$2,280.00
Rate for Payer: Group Health Inc Medicare	$1,596.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,280.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,280.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,964.00

Know your out-of-pocket cost for care.

All Charges