St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GANCICLOVIR 500 MG INJ

Facility

$129.00

Service Code	HCPCS J1570
Hospital Charge Code	41650436
Hospital Revenue Code	636
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$83.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.40
Rate for Payer: Aetna Government	$49.40
Rate for Payer: Brighton Health Commercial	$77.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.18
Rate for Payer: Group Health Inc Commercial	$64.50
Rate for Payer: Group Health Inc Medicare	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46.74
Rate for Payer: SOMOS Essential	$46.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.85

GANCICLOVIR 500 MG INJ

Facility

$129.00

Service Code	HCPCS J1570
Hospital Charge Code	41650436
Hospital Revenue Code	636
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$64.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50

GANCICLOVIR 500 MG INJ

Facility

$129.00

Service Code	HCPCS J1570
Hospital Charge Code	41640436
Hospital Revenue Code	636
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$83.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.40
Rate for Payer: Aetna Government	$49.40
Rate for Payer: Brighton Health Commercial	$77.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.18
Rate for Payer: Group Health Inc Commercial	$64.50
Rate for Payer: Group Health Inc Medicare	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46.74
Rate for Payer: SOMOS Essential	$46.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.85

GANCICLOVIR 500 MG INJ

Facility

$129.00

Service Code	HCPCS J1570
Hospital Charge Code	41640436
Hospital Revenue Code	636
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$64.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50

GANCICLOVIR SODIUM 500 MG IV SOLR [10101]

Facility

$101.57

Service Code	HCPCS J1570
Hospital Charge Code	70436008955
Hospital Revenue Code	278
Min. Negotiated Rate	$50.78
Max. Negotiated Rate	$50.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.78
Rate for Payer: Hamaspik Choice Inc Medicare	$50.78

GANCICLOVIR SODIUM 500 MG IV SOLR [10101]

Facility

$101.57

Service Code	HCPCS J1570
Hospital Charge Code	70436008955
Hospital Revenue Code	278
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$106.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.40
Rate for Payer: Aetna Government	$49.40
Rate for Payer: Brighton Health Commercial	$60.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.40
Rate for Payer: EmblemHealth Commercial	$50.78
Rate for Payer: Fidelis Medicare Advantage	$106.65
Rate for Payer: Group Health Inc Commercial	$50.78
Rate for Payer: Group Health Inc Medicare	$35.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.78
Rate for Payer: Hamaspik Choice Inc Medicare	$50.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.02

GANGL CYST

Facility

$4,105.13

Service Code	HCPCS 25111
Hospital Charge Code	40021735
Hospital Revenue Code	360
Min. Negotiated Rate	$1,301.03
Max. Negotiated Rate	$3,078.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,858.61
Rate for Payer: Aetna Government	$1,858.61
Rate for Payer: Affinity Essential Plan 1&2	$1,301.03
Rate for Payer: Affinity Essential Plan 3&4	$1,301.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,301.03
Rate for Payer: Brighton Health Commercial	$3,078.85
Rate for Payer: Cash Price	$1,858.61
Rate for Payer: Cash Price	$1,858.61
Rate for Payer: Cash Price	$1,858.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,858.61
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	$1,858.61
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,579.82
Rate for Payer: Fidelis Essential Plan QHP	$1,654.16
Rate for Payer: Fidelis Medicare Advantage	$1,858.61
Rate for Payer: Fidelis Qualified Health Plan	$1,654.16
Rate for Payer: Group Health Inc Commercial	$1,858.61
Rate for Payer: Group Health Inc Medicare	$1,858.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,052.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1,858.61
Rate for Payer: Healthfirst Medicare Advantage	$1,579.82
Rate for Payer: Healthfirst QHP	$1,858.61
Rate for Payer: Humana Medicare	$1,895.78
Rate for Payer: Senior Whole Health Medicare Advantage	$1,858.61
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$1,858.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,858.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,486.89
Rate for Payer: Wellcare Medicare	$1,765.68

GANGL CYST

Facility

$4,105.13

Service Code	HCPCS 25111
Hospital Charge Code	40021735
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,858.61

GARMENT,CALF,LOWER LEG

Facility

$40.00

Hospital Charge Code	64902262
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$32.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.00
Rate for Payer: Aetna Government	$20.00
Rate for Payer: Brighton Health Commercial	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.20
Rate for Payer: Group Health Inc Commercial	$20.00
Rate for Payer: Group Health Inc Medicare	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00

GAS ADULT CIRCUIT

Facility

$28.38

Hospital Charge Code	64901765
Hospital Revenue Code	270
Min. Negotiated Rate	$9.93
Max. Negotiated Rate	$22.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.19
Rate for Payer: Aetna Government	$14.19
Rate for Payer: Brighton Health Commercial	$21.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.30
Rate for Payer: Group Health Inc Commercial	$14.19
Rate for Payer: Group Health Inc Medicare	$9.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.19
Rate for Payer: Hamaspik Choice Inc Medicare	$14.19

GASKET FOR PRESSURE BASE ELEMENT

Facility

$107.25

Hospital Charge Code	64905970
Hospital Revenue Code	270
Min. Negotiated Rate	$37.54
Max. Negotiated Rate	$85.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.62
Rate for Payer: Aetna Government	$53.62
Rate for Payer: Brighton Health Commercial	$80.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.93
Rate for Payer: Group Health Inc Commercial	$53.62
Rate for Payer: Group Health Inc Medicare	$37.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.62
Rate for Payer: Hamaspik Choice Inc Medicare	$53.62

GASTRECTOMY

Facility

$4,621.17

Service Code	HCPCS 43860
Hospital Charge Code	40010935
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$3,465.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,541.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,584.35
Rate for Payer: Aetna Government	$1,584.35
Rate for Payer: Brighton Health Commercial	$3,465.88
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$2,310.58
Rate for Payer: Group Health Inc Medicare	$1,617.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,310.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2,310.58
Rate for Payer: United Healthcare Commercial	$1,496.00

GASTRIC ANALYSIS SET

Facility

$12.05

Hospital Charge Code	40202110
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

GASTRIC INTUB & ASP FOR POISONS

Facility

$766.58

Service Code	HCPCS 43753
Hospital Charge Code	30102461
Hospital Revenue Code	450
Rate for Payer: Cash Price	$362.98

GASTRIC INTUB & ASP FOR POISONS

Facility

$766.58

Service Code	HCPCS 43753
Hospital Charge Code	30102461
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
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	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$362.98
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$362.98
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	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$525.00
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	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$362.98
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$569.00
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

GASTRIC LAVAGE TRAY

Facility

$25.52

Hospital Charge Code	40202120
Hospital Revenue Code	270
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$20.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.76
Rate for Payer: Aetna Government	$12.76
Rate for Payer: Brighton Health Commercial	$19.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.35
Rate for Payer: Group Health Inc Commercial	$12.76
Rate for Payer: Group Health Inc Medicare	$8.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.76
Rate for Payer: Hamaspik Choice Inc Medicare	$12.76

GASTRIN SERUM

Facility

$44.08

Service Code	HCPCS 82941
Hospital Charge Code	40609703
Hospital Revenue Code	301
Rate for Payer: Cash Price	$17.63

GASTRIN SERUM

Facility

$44.08

Service Code	HCPCS 82941
Hospital Charge Code	40609703
Hospital Revenue Code	301
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$33.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.63
Rate for Payer: Aetna Government	$17.63
Rate for Payer: Affinity Essential Plan 1&2	$12.34
Rate for Payer: Affinity Essential Plan 3&4	$12.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.34
Rate for Payer: Brighton Health Commercial	$33.06
Rate for Payer: Cash Price	$17.63
Rate for Payer: Cash Price	$17.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.73
Rate for Payer: Elderplan Medicare Advantage	$17.63
Rate for Payer: EmblemHealth Commercial	$17.63
Rate for Payer: Fidelis Essential Plan Aliesa	$14.99
Rate for Payer: Fidelis Essential Plan QHP	$15.69
Rate for Payer: Fidelis Medicare Advantage	$17.63
Rate for Payer: Fidelis Qualified Health Plan	$15.69
Rate for Payer: Group Health Inc Commercial	$17.63
Rate for Payer: Group Health Inc Medicare	$17.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.04
Rate for Payer: Hamaspik Choice Inc Medicare	$17.63
Rate for Payer: Healthfirst Medicare Advantage	$17.63
Rate for Payer: Healthfirst QHP	$17.63
Rate for Payer: Humana Medicare	$17.98
Rate for Payer: Senior Whole Health Medicare Advantage	$17.63
Rate for Payer: United Healthcare Commercial	$22.34
Rate for Payer: United Healthcare Medicare Advantage	$17.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.10
Rate for Payer: Wellcare Medicare	$15.87

GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$28,834.53

Service Code	MSDRG 378
Min. Negotiated Rate	$8,436.09
Max. Negotiated Rate	$28,834.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,506.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,970.57
Rate for Payer: Aetna Government	$20,970.57
Rate for Payer: Brighton Health Commercial	$14,265.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21,389.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16,989.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,020.25
Rate for Payer: Elderplan Medicare Advantage	$19,922.04
Rate for Payer: EmblemHealth Commercial	$8,436.09
Rate for Payer: Fidelis Medicare Advantage	$20,970.57
Rate for Payer: Group Health Inc Commercial	$20,970.57
Rate for Payer: Group Health Inc Medicare	$20,970.57
Rate for Payer: Hamaspik Choice Inc Medicare	$20,970.57
Rate for Payer: Healthfirst Medicare Advantage	$9,751.32
Rate for Payer: Humana Medicare	$28,834.53
Rate for Payer: Senior Whole Health Medicare Advantage	$20,970.57
Rate for Payer: United Healthcare Commercial	$19,564.83
Rate for Payer: United Healthcare Medicare Advantage	$20,970.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20,970.57
Rate for Payer: Wellcare Medicare	$19,922.04

GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$44,212.62

Service Code	MSDRG 377
Min. Negotiated Rate	$14,951.90
Max. Negotiated Rate	$44,212.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26,397.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32,154.63
Rate for Payer: Aetna Government	$32,154.63
Rate for Payer: Brighton Health Commercial	$25,959.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$32,797.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30,916.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$25,513.78
Rate for Payer: Elderplan Medicare Advantage	$30,546.90
Rate for Payer: EmblemHealth Commercial	$15,351.80
Rate for Payer: Fidelis Medicare Advantage	$32,154.63
Rate for Payer: Group Health Inc Commercial	$32,154.63
Rate for Payer: Group Health Inc Medicare	$32,154.63
Rate for Payer: Hamaspik Choice Inc Medicare	$32,154.63
Rate for Payer: Healthfirst Medicare Advantage	$14,951.90
Rate for Payer: Humana Medicare	$44,212.62
Rate for Payer: Senior Whole Health Medicare Advantage	$32,154.63
Rate for Payer: United Healthcare Commercial	$35,603.70
Rate for Payer: United Healthcare Medicare Advantage	$32,154.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32,154.63
Rate for Payer: Wellcare Medicare	$30,546.90

GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$22,149.42

Service Code	MSDRG 379
Min. Negotiated Rate	$5,429.69
Max. Negotiated Rate	$22,149.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,336.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16,108.67
Rate for Payer: Aetna Government	$16,108.67
Rate for Payer: Brighton Health Commercial	$9,181.40
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16,430.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,934.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,023.81
Rate for Payer: Elderplan Medicare Advantage	$15,303.24
Rate for Payer: EmblemHealth Commercial	$5,429.69
Rate for Payer: Fidelis Medicare Advantage	$16,108.67
Rate for Payer: Group Health Inc Commercial	$16,108.67
Rate for Payer: Group Health Inc Medicare	$16,108.67
Rate for Payer: Hamaspik Choice Inc Medicare	$16,108.67
Rate for Payer: Healthfirst Medicare Advantage	$7,490.53
Rate for Payer: Humana Medicare	$22,149.42
Rate for Payer: Senior Whole Health Medicare Advantage	$16,108.67
Rate for Payer: United Healthcare Commercial	$12,592.45
Rate for Payer: United Healthcare Medicare Advantage	$16,108.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16,108.67
Rate for Payer: Wellcare Medicare	$15,303.24

GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$25,261.28

Service Code	MSDRG 389
Min. Negotiated Rate	$6,829.13
Max. Negotiated Rate	$25,261.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,742.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18,371.84
Rate for Payer: Aetna Government	$18,371.84
Rate for Payer: Brighton Health Commercial	$11,547.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18,739.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13,753.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,349.59
Rate for Payer: Elderplan Medicare Advantage	$17,453.25
Rate for Payer: EmblemHealth Commercial	$6,829.13
Rate for Payer: Fidelis Medicare Advantage	$18,371.84
Rate for Payer: Group Health Inc Commercial	$18,371.84
Rate for Payer: Group Health Inc Medicare	$18,371.84
Rate for Payer: Hamaspik Choice Inc Medicare	$18,371.84
Rate for Payer: Healthfirst Medicare Advantage	$8,542.91
Rate for Payer: Humana Medicare	$25,261.28
Rate for Payer: Senior Whole Health Medicare Advantage	$18,371.84
Rate for Payer: United Healthcare Commercial	$15,838.01
Rate for Payer: United Healthcare Medicare Advantage	$18,371.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18,371.84
Rate for Payer: Wellcare Medicare	$17,453.25

GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$37,790.62

Service Code	MSDRG 388
Min. Negotiated Rate	$12,463.80
Max. Negotiated Rate	$37,790.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,431.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27,484.09
Rate for Payer: Aetna Government	$27,484.09
Rate for Payer: Brighton Health Commercial	$21,075.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$28,033.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25,100.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$20,714.00
Rate for Payer: Elderplan Medicare Advantage	$26,109.89
Rate for Payer: EmblemHealth Commercial	$12,463.80
Rate for Payer: Fidelis Medicare Advantage	$27,484.09
Rate for Payer: Group Health Inc Commercial	$27,484.09
Rate for Payer: Group Health Inc Medicare	$27,484.09
Rate for Payer: Hamaspik Choice Inc Medicare	$27,484.09
Rate for Payer: Healthfirst Medicare Advantage	$12,780.10
Rate for Payer: Humana Medicare	$37,790.62
Rate for Payer: Senior Whole Health Medicare Advantage	$27,484.09
Rate for Payer: United Healthcare Commercial	$28,905.75
Rate for Payer: United Healthcare Medicare Advantage	$27,484.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,484.09
Rate for Payer: Wellcare Medicare	$26,109.89

GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC

Facility

$20,734.60

Service Code	MSDRG 390
Min. Negotiated Rate	$4,793.43
Max. Negotiated Rate	$20,734.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,242.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15,079.71
Rate for Payer: Aetna Government	$15,079.71
Rate for Payer: Brighton Health Commercial	$8,105.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15,381.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,653.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,966.38
Rate for Payer: Elderplan Medicare Advantage	$14,325.72
Rate for Payer: EmblemHealth Commercial	$4,793.43
Rate for Payer: Fidelis Medicare Advantage	$15,079.71
Rate for Payer: Group Health Inc Commercial	$15,079.71
Rate for Payer: Group Health Inc Medicare	$15,079.71
Rate for Payer: Hamaspik Choice Inc Medicare	$15,079.71
Rate for Payer: Healthfirst Medicare Advantage	$7,012.07
Rate for Payer: Humana Medicare	$20,734.60
Rate for Payer: Senior Whole Health Medicare Advantage	$15,079.71
Rate for Payer: United Healthcare Commercial	$11,116.83
Rate for Payer: United Healthcare Medicare Advantage	$15,079.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,079.71
Rate for Payer: Wellcare Medicare	$14,325.72

GASTRO-JEDUCIAL FEEDING TUBE

Facility

$598.37

Hospital Charge Code	64903578
Hospital Revenue Code	270
Min. Negotiated Rate	$209.43
Max. Negotiated Rate	$478.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$329.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$299.18
Rate for Payer: Aetna Government	$299.18
Rate for Payer: Brighton Health Commercial	$448.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$478.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.89
Rate for Payer: Group Health Inc Commercial	$299.18
Rate for Payer: Group Health Inc Medicare	$209.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$299.18
Rate for Payer: Hamaspik Choice Inc Medicare	$299.18

Know your out-of-pocket cost for care.

All Charges