St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ETHYL ALCOHOL 100 % SOLN [21960]

Facility

$0.30

Service Code	NDC 62991253702
Hospital Charge Code	62991253702
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

ETHYL ALCOHOL 100 % SOLN [21960]

Facility

$0.00

Service Code	NDC 50483200004
Hospital Charge Code	50483200004
Hospital Revenue Code	250
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

ETHYL ALCOHOL 100 % SOLN [21960]

Facility

$0.00

Service Code	NDC 50483300004
Hospital Charge Code	50483300004
Hospital Revenue Code	250
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

ETHYL ALCOHOL 98% INJ 1 ML

Facility

$20.00

Hospital Charge Code	41651116
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$16.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.00
Rate for Payer: Aetna Government	$10.00
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.60
Rate for Payer: Group Health Inc Commercial	$10.00
Rate for Payer: Group Health Inc Medicare	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.00

ETHYL ALCOHOL 98% INJ 1 ML

Facility

$20.00

Hospital Charge Code	41641116
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$16.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.00
Rate for Payer: Aetna Government	$10.00
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.60
Rate for Payer: Group Health Inc Commercial	$10.00
Rate for Payer: Group Health Inc Medicare	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.00

ETHYL ALCOHOL 98% INJ 5 ML

Facility

$50.00

Hospital Charge Code	41653367
Hospital Revenue Code	250
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.50

ETHYL ALCOHOL 98% INJ 5 ML

Facility

$50.00

Hospital Charge Code	41643367
Hospital Revenue Code	250
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.50

ETHYL CHLORIDE EX AERO [2951]

Facility

$0.29

Service Code	NDC 00386000102
Hospital Charge Code	00386000102
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

ETHYL CHLORIDE EX AERO [2951]

Facility

$0.28

Service Code	NDC 00386000111
Hospital Charge Code	00386000111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.19
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

ETHYL CHLORIDE TOPICAL AEROSOL

Facility

$49.00

Hospital Charge Code	41650439
Hospital Revenue Code	250
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.50
Rate for Payer: Aetna Government	$24.50
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.85

ETHYL CHLORIDE TOPICAL AEROSOL

Facility

$49.00

Hospital Charge Code	41640439
Hospital Revenue Code	250
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.50
Rate for Payer: Aetna Government	$24.50
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.85

ETHYLENE GLYCOL, SERUM

Facility

$37.25

Service Code	HCPCS 82693
Hospital Charge Code	40609071
Hospital Revenue Code	300
Min. Negotiated Rate	$10.43
Max. Negotiated Rate	$27.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.90
Rate for Payer: Aetna Government	$14.90
Rate for Payer: Affinity Essential Plan 1&2	$10.43
Rate for Payer: Affinity Essential Plan 3&4	$10.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.43
Rate for Payer: Brighton Health Commercial	$27.94
Rate for Payer: Cash Price	$14.90
Rate for Payer: Cash Price	$14.90
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.02
Rate for Payer: Elderplan Medicare Advantage	$14.90
Rate for Payer: EmblemHealth Commercial	$14.90
Rate for Payer: Fidelis Essential Plan Aliesa	$12.66
Rate for Payer: Fidelis Essential Plan QHP	$13.26
Rate for Payer: Fidelis Medicare Advantage	$14.90
Rate for Payer: Fidelis Qualified Health Plan	$13.26
Rate for Payer: Group Health Inc Commercial	$14.90
Rate for Payer: Group Health Inc Medicare	$14.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.62
Rate for Payer: Hamaspik Choice Inc Medicare	$14.90
Rate for Payer: Healthfirst Medicare Advantage	$14.90
Rate for Payer: Healthfirst QHP	$14.90
Rate for Payer: Humana Medicare	$15.20
Rate for Payer: Senior Whole Health Medicare Advantage	$14.90
Rate for Payer: United Healthcare Commercial	$18.86
Rate for Payer: United Healthcare Medicare Advantage	$14.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.92
Rate for Payer: Wellcare Medicare	$13.41

ETHYLENE GLYCOL, SERUM

Facility

$37.25

Service Code	HCPCS 82693
Hospital Charge Code	40609071
Hospital Revenue Code	300
Rate for Payer: Cash Price	$14.90

ETOMIDATE 2 MG/ML INJ

Facility

$19.78

Hospital Charge Code	41644280
Hospital Revenue Code	250
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$15.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.89
Rate for Payer: Aetna Government	$9.89
Rate for Payer: Brighton Health Commercial	$14.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.45
Rate for Payer: Group Health Inc Commercial	$9.89
Rate for Payer: Group Health Inc Medicare	$6.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.89
Rate for Payer: Hamaspik Choice Inc Medicare	$9.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.86

ETOMIDATE 2 MG/ML INJ

Facility

$19.78

Hospital Charge Code	41654280
Hospital Revenue Code	250
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$15.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.89
Rate for Payer: Aetna Government	$9.89
Rate for Payer: Brighton Health Commercial	$14.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.45
Rate for Payer: Group Health Inc Commercial	$9.89
Rate for Payer: Group Health Inc Medicare	$6.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.89
Rate for Payer: Hamaspik Choice Inc Medicare	$9.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.86

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.29

Service Code	NDC 72266014701
Hospital Charge Code	72266014701
Hospital Revenue Code	278
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.53

Service Code	NDC 72266014610
Hospital Charge Code	72266014610
Hospital Revenue Code	278
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Fidelis Medicare Advantage	$0.56
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.35

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$1.18

Service Code	NDC 67457090210
Hospital Charge Code	67457090210
Hospital Revenue Code	278
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$1.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.59
Rate for Payer: Fidelis Medicare Advantage	$1.24
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.29

Service Code	NDC 72266014701
Hospital Charge Code	72266014701
Hospital Revenue Code	278
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Fidelis Medicare Advantage	$0.30
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$1.18

Service Code	NDC 67457090200
Hospital Charge Code	67457090200
Hospital Revenue Code	278
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$1.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.59
Rate for Payer: Fidelis Medicare Advantage	$1.24
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$1.18

Service Code	NDC 67457090200
Hospital Charge Code	67457090200
Hospital Revenue Code	278
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.56

Service Code	NDC 55150022220
Hospital Charge Code	55150022220
Hospital Revenue Code	278
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.68

Service Code	NDC 00409669511
Hospital Charge Code	00409669511
Hospital Revenue Code	278
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.65

Service Code	NDC 67457090320
Hospital Charge Code	67457090320
Hospital Revenue Code	278
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Fidelis Medicare Advantage	$0.69
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

ETOMIDATE 2 MG/ML IV SOLN [20472]

Facility

$0.56

Service Code	NDC 55150022220
Hospital Charge Code	55150022220
Hospital Revenue Code	278
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.32
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Fidelis Medicare Advantage	$0.58
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

Know your out-of-pocket cost for care.

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