St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GENERATOR,NEUROSTIM, RECHG, SYS

Facility

$36,000.00

Service Code	HCPCS C1820
Hospital Charge Code	40202500
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

GENERATOR REUSABLE

Facility

$2,750.00

Hospital Charge Code	64907068
Hospital Revenue Code	270
Min. Negotiated Rate	$962.50
Max. Negotiated Rate	$2,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,512.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,375.00
Rate for Payer: Aetna Government	$1,375.00
Rate for Payer: Brighton Health Commercial	$2,062.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,870.00
Rate for Payer: Group Health Inc Commercial	$1,375.00
Rate for Payer: Group Health Inc Medicare	$962.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,375.00

GENERIC MED/SURG SUPPLY

Facility

$0.01

Hospital Charge Code	64901001
Hospital Revenue Code	270
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

GENESIS TROCAR PINS 5IN

Facility

$229.20

Service Code	HCPCS C1713
Hospital Charge Code	64905962
Hospital Revenue Code	278
Min. Negotiated Rate	$80.22
Max. Negotiated Rate	$240.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$137.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.79
Rate for Payer: EmblemHealth Commercial	$114.60
Rate for Payer: Fidelis Medicare Advantage	$240.66
Rate for Payer: Group Health Inc Commercial	$114.60
Rate for Payer: Group Health Inc Medicare	$80.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.60
Rate for Payer: Hamaspik Choice Inc Medicare	$114.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.98

GENESIS TROCAR PINS 5IN

Facility

$229.20

Service Code	HCPCS C1713
Hospital Charge Code	64905962
Hospital Revenue Code	278
Min. Negotiated Rate	$114.60
Max. Negotiated Rate	$114.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.60
Rate for Payer: Hamaspik Choice Inc Medicare	$114.60

GENETIC TEST SPE ANALYSIS

Facility

$150.00

Service Code	HCPCS D0423
Hospital Charge Code	42303462
Hospital Revenue Code	361
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Brighton Health Commercial	$112.50
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: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

GEN II 7.5MM RES PAT 29MM

Facility

$1,885.88

Service Code	HCPCS C1776
Hospital Charge Code	64905343
Hospital Revenue Code	278
Min. Negotiated Rate	$942.94
Max. Negotiated Rate	$942.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$942.94
Rate for Payer: Hamaspik Choice Inc Medicare	$942.94

GEN II 7.5MM RES PAT 29MM

Facility

$1,885.88

Service Code	HCPCS C1776
Hospital Charge Code	64905343
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,980.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,037.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,131.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$942.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,084.38
Rate for Payer: EmblemHealth Commercial	$942.94
Rate for Payer: Fidelis Medicare Advantage	$1,980.17
Rate for Payer: Group Health Inc Commercial	$942.94
Rate for Payer: Group Health Inc Medicare	$660.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$942.94
Rate for Payer: Hamaspik Choice Inc Medicare	$942.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,225.82

GEN II 7.5MM RESUR PAT 32MM

Facility

$1,885.88

Service Code	HCPCS C1776
Hospital Charge Code	64902971
Hospital Revenue Code	278
Min. Negotiated Rate	$942.94
Max. Negotiated Rate	$942.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$942.94
Rate for Payer: Hamaspik Choice Inc Medicare	$942.94

GEN II 7.5MM RESUR PAT 32MM

Facility

$1,885.88

Service Code	HCPCS C1776
Hospital Charge Code	64902971
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,980.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,037.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,131.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$942.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,084.38
Rate for Payer: EmblemHealth Commercial	$942.94
Rate for Payer: Fidelis Medicare Advantage	$1,980.17
Rate for Payer: Group Health Inc Commercial	$942.94
Rate for Payer: Group Health Inc Medicare	$660.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$942.94
Rate for Payer: Hamaspik Choice Inc Medicare	$942.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,225.82

GEN II 7.5MM RESUR PAT 35MM

Facility

$1,885.88

Service Code	HCPCS C1776
Hospital Charge Code	64905349
Hospital Revenue Code	278
Min. Negotiated Rate	$942.94
Max. Negotiated Rate	$942.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$942.94
Rate for Payer: Hamaspik Choice Inc Medicare	$942.94

GEN II 7.5MM RESUR PAT 35MM

Facility

$1,885.88

Service Code	HCPCS C1776
Hospital Charge Code	64905349
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,980.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,037.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,131.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$942.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,084.38
Rate for Payer: EmblemHealth Commercial	$942.94
Rate for Payer: Fidelis Medicare Advantage	$1,980.17
Rate for Payer: Group Health Inc Commercial	$942.94
Rate for Payer: Group Health Inc Medicare	$660.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$942.94
Rate for Payer: Hamaspik Choice Inc Medicare	$942.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,225.82

GENOTYPE DNA HIV OTHER REG

Facility

$321.83

Service Code	HCPCS 87906
Hospital Charge Code	30305719
Hospital Revenue Code	306
Min. Negotiated Rate	$90.11
Max. Negotiated Rate	$241.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$128.73
Rate for Payer: Aetna Government	$128.73
Rate for Payer: Affinity Essential Plan 1&2	$90.11
Rate for Payer: Affinity Essential Plan 3&4	$90.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$90.11
Rate for Payer: Brighton Health Commercial	$241.37
Rate for Payer: Cash Price	$128.73
Rate for Payer: Cash Price	$128.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$128.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.13
Rate for Payer: Elderplan Medicare Advantage	$128.73
Rate for Payer: EmblemHealth Commercial	$128.73
Rate for Payer: Fidelis Essential Plan Aliesa	$109.42
Rate for Payer: Fidelis Essential Plan QHP	$114.57
Rate for Payer: Fidelis Medicare Advantage	$128.73
Rate for Payer: Fidelis Qualified Health Plan	$114.57
Rate for Payer: Group Health Inc Commercial	$128.73
Rate for Payer: Group Health Inc Medicare	$128.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.92
Rate for Payer: Hamaspik Choice Inc Medicare	$128.73
Rate for Payer: Healthfirst Medicare Advantage	$128.73
Rate for Payer: Healthfirst QHP	$128.73
Rate for Payer: Humana Medicare	$131.30
Rate for Payer: Senior Whole Health Medicare Advantage	$128.73
Rate for Payer: United Healthcare Commercial	$163.03
Rate for Payer: United Healthcare Medicare Advantage	$128.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$128.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$102.98
Rate for Payer: Wellcare Medicare	$115.86

GENOTYPE DNA HIV OTHER REG

Facility

$321.83

Service Code	HCPCS 87906
Hospital Charge Code	30305719
Hospital Revenue Code	306
Rate for Payer: Cash Price	$128.73

GENOTYPE DNA HIV REVERSE

Facility

$643.63

Service Code	HCPCS 87901
Hospital Charge Code	40609634
Hospital Revenue Code	300
Min. Negotiated Rate	$180.22
Max. Negotiated Rate	$482.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$354.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$257.45
Rate for Payer: Aetna Government	$257.45
Rate for Payer: Affinity Essential Plan 1&2	$180.22
Rate for Payer: Affinity Essential Plan 3&4	$180.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$180.22
Rate for Payer: Brighton Health Commercial	$482.72
Rate for Payer: Cash Price	$257.45
Rate for Payer: Cash Price	$257.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$257.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$409.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$346.26
Rate for Payer: Elderplan Medicare Advantage	$257.45
Rate for Payer: EmblemHealth Commercial	$257.45
Rate for Payer: Fidelis Essential Plan Aliesa	$218.83
Rate for Payer: Fidelis Essential Plan QHP	$229.13
Rate for Payer: Fidelis Medicare Advantage	$257.45
Rate for Payer: Fidelis Qualified Health Plan	$229.13
Rate for Payer: Group Health Inc Commercial	$257.45
Rate for Payer: Group Health Inc Medicare	$257.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.82
Rate for Payer: Hamaspik Choice Inc Medicare	$257.45
Rate for Payer: Healthfirst Medicare Advantage	$257.45
Rate for Payer: Healthfirst QHP	$257.45
Rate for Payer: Humana Medicare	$262.60
Rate for Payer: Senior Whole Health Medicare Advantage	$257.45
Rate for Payer: United Healthcare Commercial	$326.05
Rate for Payer: United Healthcare Medicare Advantage	$257.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$205.96
Rate for Payer: Wellcare Medicare	$231.70

GENOTYPE DNA HIV REVERSE

Facility

$643.63

Service Code	HCPCS 87901
Hospital Charge Code	40609634
Hospital Revenue Code	300
Rate for Payer: Cash Price	$257.45

GENOTYPE DNA HIV REVERSE T

Facility

$643.63

Service Code	HCPCS 87901
Hospital Charge Code	40609610
Hospital Revenue Code	300
Min. Negotiated Rate	$180.22
Max. Negotiated Rate	$482.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$354.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$257.45
Rate for Payer: Aetna Government	$257.45
Rate for Payer: Affinity Essential Plan 1&2	$180.22
Rate for Payer: Affinity Essential Plan 3&4	$180.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$180.22
Rate for Payer: Brighton Health Commercial	$482.72
Rate for Payer: Cash Price	$257.45
Rate for Payer: Cash Price	$257.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$257.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$409.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$346.26
Rate for Payer: Elderplan Medicare Advantage	$257.45
Rate for Payer: EmblemHealth Commercial	$257.45
Rate for Payer: Fidelis Essential Plan Aliesa	$218.83
Rate for Payer: Fidelis Essential Plan QHP	$229.13
Rate for Payer: Fidelis Medicare Advantage	$257.45
Rate for Payer: Fidelis Qualified Health Plan	$229.13
Rate for Payer: Group Health Inc Commercial	$257.45
Rate for Payer: Group Health Inc Medicare	$257.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.82
Rate for Payer: Hamaspik Choice Inc Medicare	$257.45
Rate for Payer: Healthfirst Medicare Advantage	$257.45
Rate for Payer: Healthfirst QHP	$257.45
Rate for Payer: Humana Medicare	$262.60
Rate for Payer: Senior Whole Health Medicare Advantage	$257.45
Rate for Payer: United Healthcare Commercial	$326.05
Rate for Payer: United Healthcare Medicare Advantage	$257.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$205.96
Rate for Payer: Wellcare Medicare	$231.70

GENOTYPE DNA HIV REVERSE T

Facility

$643.63

Service Code	HCPCS 87901
Hospital Charge Code	40609610
Hospital Revenue Code	300
Rate for Payer: Cash Price	$257.45

GENOTYPE DNA/RNA HEP C

Facility

$643.63

Service Code	HCPCS 87902
Hospital Charge Code	40613017
Hospital Revenue Code	300
Rate for Payer: Cash Price	$257.45

GENOTYPE DNA/RNA HEP C

Facility

$643.63

Service Code	HCPCS 87902
Hospital Charge Code	40613017
Hospital Revenue Code	300
Min. Negotiated Rate	$180.22
Max. Negotiated Rate	$482.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$354.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$257.45
Rate for Payer: Aetna Government	$257.45
Rate for Payer: Affinity Essential Plan 1&2	$180.22
Rate for Payer: Affinity Essential Plan 3&4	$180.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$180.22
Rate for Payer: Brighton Health Commercial	$482.72
Rate for Payer: Cash Price	$257.45
Rate for Payer: Cash Price	$257.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$257.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$409.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$346.26
Rate for Payer: Elderplan Medicare Advantage	$257.45
Rate for Payer: EmblemHealth Commercial	$257.45
Rate for Payer: Fidelis Essential Plan Aliesa	$218.83
Rate for Payer: Fidelis Essential Plan QHP	$229.13
Rate for Payer: Fidelis Medicare Advantage	$257.45
Rate for Payer: Fidelis Qualified Health Plan	$229.13
Rate for Payer: Group Health Inc Commercial	$257.45
Rate for Payer: Group Health Inc Medicare	$257.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.82
Rate for Payer: Hamaspik Choice Inc Medicare	$257.45
Rate for Payer: Healthfirst Medicare Advantage	$257.45
Rate for Payer: Healthfirst QHP	$257.45
Rate for Payer: Humana Medicare	$262.60
Rate for Payer: Senior Whole Health Medicare Advantage	$257.45
Rate for Payer: United Healthcare Commercial	$326.05
Rate for Payer: United Healthcare Medicare Advantage	$257.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$257.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$205.96
Rate for Payer: Wellcare Medicare	$231.70

GENTAMICIN

Facility

$40.95

Service Code	HCPCS 80170
Hospital Charge Code	40602005
Hospital Revenue Code	301
Rate for Payer: Cash Price	$16.38

GENTAMICIN

Facility

$40.95

Service Code	HCPCS 80170
Hospital Charge Code	40602005
Hospital Revenue Code	301
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$30.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.38
Rate for Payer: Aetna Government	$16.38
Rate for Payer: Affinity Essential Plan 1&2	$11.47
Rate for Payer: Affinity Essential Plan 3&4	$11.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.47
Rate for Payer: Brighton Health Commercial	$30.71
Rate for Payer: Cash Price	$16.38
Rate for Payer: Cash Price	$16.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.06
Rate for Payer: Elderplan Medicare Advantage	$16.38
Rate for Payer: EmblemHealth Commercial	$16.38
Rate for Payer: Fidelis Essential Plan Aliesa	$13.92
Rate for Payer: Fidelis Essential Plan QHP	$14.58
Rate for Payer: Fidelis Medicare Advantage	$16.38
Rate for Payer: Fidelis Qualified Health Plan	$14.58
Rate for Payer: Group Health Inc Commercial	$16.38
Rate for Payer: Group Health Inc Medicare	$16.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.48
Rate for Payer: Hamaspik Choice Inc Medicare	$16.38
Rate for Payer: Healthfirst Medicare Advantage	$16.38
Rate for Payer: Healthfirst QHP	$16.38
Rate for Payer: Humana Medicare	$16.71
Rate for Payer: Senior Whole Health Medicare Advantage	$16.38
Rate for Payer: United Healthcare Commercial	$20.76
Rate for Payer: United Healthcare Medicare Advantage	$16.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.10
Rate for Payer: Wellcare Medicare	$14.74

GENTAMICIN 0.3% OPHTHALMIC OINT

Facility

$12.00

Hospital Charge Code	41653548
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

GENTAMICIN 0.3% OPHTHALMIC OINT

Facility

$12.00

Hospital Charge Code	41643548
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

GENTAMICIN 0.3% OPHTHALMIC SOLN

Facility

$3.00

Hospital Charge Code	41643234
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

Know your out-of-pocket cost for care.

All Charges