St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEP B PED 10MCG/0.5ML SYR

Facility

$28.15

Service Code	HCPCS 90744
Hospital Charge Code	41649579
Hospital Revenue Code	636
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$14.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.08
Rate for Payer: Hamaspik Choice Inc Medicare	$14.08

HEP B SURFACE AB

Facility

$26.85

Service Code	HCPCS 86706
Hospital Charge Code	40729706
Hospital Revenue Code	302
Rate for Payer: Cash Price	$10.74

HEP B SURFACE AB

Facility

$26.85

Service Code	HCPCS 86706
Hospital Charge Code	40729706
Hospital Revenue Code	302
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$20.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.74
Rate for Payer: Aetna Government	$10.74
Rate for Payer: Affinity Essential Plan 1&2	$7.52
Rate for Payer: Affinity Essential Plan 3&4	$7.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.52
Rate for Payer: Brighton Health Commercial	$20.14
Rate for Payer: Cash Price	$10.74
Rate for Payer: Cash Price	$10.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.45
Rate for Payer: Elderplan Medicare Advantage	$10.74
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Fidelis Essential Plan Aliesa	$9.13
Rate for Payer: Fidelis Essential Plan QHP	$9.56
Rate for Payer: Fidelis Medicare Advantage	$10.74
Rate for Payer: Fidelis Qualified Health Plan	$9.56
Rate for Payer: Group Health Inc Commercial	$10.74
Rate for Payer: Group Health Inc Medicare	$10.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.42
Rate for Payer: Hamaspik Choice Inc Medicare	$10.74
Rate for Payer: Healthfirst Medicare Advantage	$10.74
Rate for Payer: Healthfirst QHP	$10.74
Rate for Payer: Humana Medicare	$10.95
Rate for Payer: Senior Whole Health Medicare Advantage	$10.74
Rate for Payer: United Healthcare Commercial	$13.61
Rate for Payer: United Healthcare Medicare Advantage	$10.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.59
Rate for Payer: Wellcare Medicare	$9.67

HEP B VACCINE (ADULT), IM

Facility

$94.85

Service Code	HCPCS 90746
Hospital Charge Code	30300147
Hospital Revenue Code	636
Min. Negotiated Rate	$33.20
Max. Negotiated Rate	$74.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.65
Rate for Payer: Aetna Government	$69.65
Rate for Payer: Brighton Health Commercial	$56.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.54
Rate for Payer: Group Health Inc Commercial	$47.42
Rate for Payer: Group Health Inc Medicare	$33.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.42
Rate for Payer: Hamaspik Choice Inc Medicare	$47.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$74.60
Rate for Payer: SOMOS Essential	$74.60
Rate for Payer: United Healthcare Commercial	$70.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.65

HEP B VACCINE (ADULT), IM

Facility

$94.85

Service Code	HCPCS 90746
Hospital Charge Code	30300147
Hospital Revenue Code	636
Min. Negotiated Rate	$47.42
Max. Negotiated Rate	$47.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.42
Rate for Payer: Hamaspik Choice Inc Medicare	$47.42

HEP B VACCINE ILL PAT 3 DOSE IM

Facility

$208.13

Service Code	HCPCS 90740
Hospital Charge Code	30303058
Hospital Revenue Code	636
Min. Negotiated Rate	$72.85
Max. Negotiated Rate	$167.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.76
Rate for Payer: Aetna Government	$140.76
Rate for Payer: Brighton Health Commercial	$124.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.67
Rate for Payer: Group Health Inc Commercial	$104.06
Rate for Payer: Group Health Inc Medicare	$72.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.06
Rate for Payer: Hamaspik Choice Inc Medicare	$104.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.64
Rate for Payer: SOMOS Essential	$167.64
Rate for Payer: United Healthcare Commercial	$146.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$135.28

HEP B VACCINE ILL PAT 3 DOSE IM

Facility

$208.13

Service Code	HCPCS 90740
Hospital Charge Code	30303058
Hospital Revenue Code	636
Min. Negotiated Rate	$104.06
Max. Negotiated Rate	$104.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.06
Rate for Payer: Hamaspik Choice Inc Medicare	$104.06

HEP B (VFC) 10 MCG/0.5ML SYR

Facility

$0.01

Service Code	HCPCS 90744
Hospital Charge Code	41659557
Hospital Revenue Code	636
Max. Negotiated Rate	$32.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.22
Rate for Payer: Aetna Government	$28.22
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: SOMOS CHP/HARP/Medicaid	$32.62
Rate for Payer: SOMOS Essential	$32.62
Rate for Payer: United Healthcare Commercial	$29.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

HEP B (VFC) 10 MCG/0.5ML SYR

Facility

$0.01

Service Code	HCPCS 90744
Hospital Charge Code	41659557
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

HEP B (VFC) 10MCG/0.5M SYR

Facility

$0.01

Service Code	HCPCS 90744
Hospital Charge Code	41649557
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

HEP B (VFC) 10MCG/0.5M SYR

Facility

$0.01

Service Code	HCPCS 90744
Hospital Charge Code	41649557
Hospital Revenue Code	636
Max. Negotiated Rate	$32.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.22
Rate for Payer: Aetna Government	$28.22
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: SOMOS CHP/HARP/Medicaid	$32.62
Rate for Payer: SOMOS Essential	$32.62
Rate for Payer: United Healthcare Commercial	$29.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

HERED.HEMOCHROMATOSIS, DNA

Facility

$163.40

Service Code	HCPCS 81256
Hospital Charge Code	40609760
Hospital Revenue Code	310
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$130.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.36
Rate for Payer: Aetna Government	$65.36
Rate for Payer: Affinity Essential Plan 1&2	$45.75
Rate for Payer: Affinity Essential Plan 3&4	$45.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$45.75
Rate for Payer: Brighton Health Commercial	$65.36
Rate for Payer: Cash Price	$65.36
Rate for Payer: Cash Price	$65.36
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$65.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$130.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$111.11
Rate for Payer: Elderplan Medicare Advantage	$65.36
Rate for Payer: EmblemHealth Commercial	$65.36
Rate for Payer: Fidelis Essential Plan Aliesa	$55.56
Rate for Payer: Fidelis Essential Plan QHP	$58.17
Rate for Payer: Fidelis Medicare Advantage	$65.36
Rate for Payer: Fidelis Qualified Health Plan	$58.17
Rate for Payer: Group Health Inc Commercial	$65.36
Rate for Payer: Group Health Inc Medicare	$65.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.70
Rate for Payer: Hamaspik Choice Inc Medicare	$65.36
Rate for Payer: Healthfirst Medicare Advantage	$65.36
Rate for Payer: Healthfirst QHP	$65.36
Rate for Payer: Humana Medicare	$66.67
Rate for Payer: Senior Whole Health Medicare Advantage	$65.36
Rate for Payer: United Healthcare Medicare Advantage	$65.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52.29
Rate for Payer: Wellcare Medicare	$58.82

HERED.HEMOCHROMATOSIS, DNA

Facility

$163.40

Service Code	HCPCS 81256
Hospital Charge Code	40609760
Hospital Revenue Code	310
Rate for Payer: Cash Price	$65.36

HEREDITARY HEMOCHROMATOS

Facility

$163.40

Service Code	HCPCS 81256
Hospital Charge Code	30305805
Hospital Revenue Code	310
Rate for Payer: Cash Price	$65.36

HEREDITARY HEMOCHROMATOS

Facility

$163.40

Service Code	HCPCS 81256
Hospital Charge Code	30305805
Hospital Revenue Code	310
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$130.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.36
Rate for Payer: Aetna Government	$65.36
Rate for Payer: Affinity Essential Plan 1&2	$45.75
Rate for Payer: Affinity Essential Plan 3&4	$45.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$45.75
Rate for Payer: Brighton Health Commercial	$65.36
Rate for Payer: Cash Price	$65.36
Rate for Payer: Cash Price	$65.36
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$65.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$130.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$111.11
Rate for Payer: Elderplan Medicare Advantage	$65.36
Rate for Payer: EmblemHealth Commercial	$65.36
Rate for Payer: Fidelis Essential Plan Aliesa	$55.56
Rate for Payer: Fidelis Essential Plan QHP	$58.17
Rate for Payer: Fidelis Medicare Advantage	$65.36
Rate for Payer: Fidelis Qualified Health Plan	$58.17
Rate for Payer: Group Health Inc Commercial	$65.36
Rate for Payer: Group Health Inc Medicare	$65.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.70
Rate for Payer: Hamaspik Choice Inc Medicare	$65.36
Rate for Payer: Healthfirst Medicare Advantage	$65.36
Rate for Payer: Healthfirst QHP	$65.36
Rate for Payer: Humana Medicare	$66.67
Rate for Payer: Senior Whole Health Medicare Advantage	$65.36
Rate for Payer: United Healthcare Medicare Advantage	$65.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52.29
Rate for Payer: Wellcare Medicare	$58.82

HERNIA PATCH

Facility

$3,390.80

Service Code	HCPCS C1781
Hospital Charge Code	40205954
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.40
Max. Negotiated Rate	$1,695.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,695.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,695.40

HERNIA PATCH

Facility

$3,390.80

Service Code	HCPCS C1781
Hospital Charge Code	40205954
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,560.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,864.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,034.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,695.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,949.71
Rate for Payer: EmblemHealth Commercial	$1,695.40
Rate for Payer: Fidelis Medicare Advantage	$3,560.34
Rate for Payer: Group Health Inc Commercial	$1,695.40
Rate for Payer: Group Health Inc Medicare	$1,186.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,695.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,695.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,204.02

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$42,830.19

Service Code	MSDRG 354
Min. Negotiated Rate	$14,484.39
Max. Negotiated Rate	$42,830.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25,328.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31,149.23
Rate for Payer: Aetna Government	$31,149.23
Rate for Payer: Brighton Health Commercial	$24,908.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$31,772.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29,664.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$24,480.57
Rate for Payer: Elderplan Medicare Advantage	$29,591.77
Rate for Payer: EmblemHealth Commercial	$14,730.10
Rate for Payer: Fidelis Medicare Advantage	$31,149.23
Rate for Payer: Group Health Inc Commercial	$31,149.23
Rate for Payer: Group Health Inc Medicare	$31,149.23
Rate for Payer: Hamaspik Choice Inc Medicare	$31,149.23
Rate for Payer: Healthfirst Medicare Advantage	$14,484.39
Rate for Payer: Humana Medicare	$42,830.19
Rate for Payer: Senior Whole Health Medicare Advantage	$31,149.23
Rate for Payer: United Healthcare Commercial	$34,161.89
Rate for Payer: United Healthcare Medicare Advantage	$31,149.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31,149.23
Rate for Payer: Wellcare Medicare	$29,591.77

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$65,835.30

Service Code	MSDRG 353
Min. Negotiated Rate	$22,264.30
Max. Negotiated Rate	$65,835.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43,118.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47,880.22
Rate for Payer: Aetna Government	$47,880.22
Rate for Payer: Brighton Health Commercial	$42,402.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$48,837.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50,499.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$41,674.55
Rate for Payer: Elderplan Medicare Advantage	$45,486.21
Rate for Payer: EmblemHealth Commercial	$25,075.90
Rate for Payer: Fidelis Medicare Advantage	$47,880.22
Rate for Payer: Group Health Inc Commercial	$47,880.22
Rate for Payer: Group Health Inc Medicare	$47,880.22
Rate for Payer: Hamaspik Choice Inc Medicare	$47,880.22
Rate for Payer: Healthfirst Medicare Advantage	$22,264.30
Rate for Payer: Humana Medicare	$65,835.30
Rate for Payer: Senior Whole Health Medicare Advantage	$47,880.22
Rate for Payer: United Healthcare Commercial	$58,155.55
Rate for Payer: United Healthcare Medicare Advantage	$47,880.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47,880.22
Rate for Payer: Wellcare Medicare	$45,486.21

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$36,057.35

Service Code	MSDRG 355
Min. Negotiated Rate	$11,684.30
Max. Negotiated Rate	$36,057.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20,091.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26,223.53
Rate for Payer: Aetna Government	$26,223.53
Rate for Payer: Brighton Health Commercial	$19,757.70
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$26,748.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23,530.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$19,418.58
Rate for Payer: Elderplan Medicare Advantage	$24,912.35
Rate for Payer: EmblemHealth Commercial	$11,684.30
Rate for Payer: Fidelis Medicare Advantage	$26,223.53
Rate for Payer: Group Health Inc Commercial	$26,223.53
Rate for Payer: Group Health Inc Medicare	$26,223.53
Rate for Payer: Hamaspik Choice Inc Medicare	$26,223.53
Rate for Payer: Healthfirst Medicare Advantage	$12,193.94
Rate for Payer: Humana Medicare	$36,057.35
Rate for Payer: Senior Whole Health Medicare Advantage	$26,223.53
Rate for Payer: United Healthcare Commercial	$27,098.03
Rate for Payer: United Healthcare Medicare Advantage	$26,223.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,223.53
Rate for Payer: Wellcare Medicare	$24,912.35

HERNIA REPAIR W/MESH

Facility

$1,086.91

Service Code	HCPCS 49568
Hospital Charge Code	40014065
Hospital Revenue Code	360
Min. Negotiated Rate	$318.47
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$597.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$318.47
Rate for Payer: Aetna Government	$318.47
Rate for Payer: Brighton Health Commercial	$815.18
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	$543.46
Rate for Payer: Group Health Inc Medicare	$380.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$543.46
Rate for Payer: Hamaspik Choice Inc Medicare	$543.46
Rate for Payer: United Healthcare Commercial	$1,113.00

HETASTARCH 6% IN SODIUM CHLORIDE INFUSIO

Facility

$33.88

Hospital Charge Code	41654142
Hospital Revenue Code	250
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$27.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.94
Rate for Payer: Aetna Government	$16.94
Rate for Payer: Brighton Health Commercial	$25.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.04
Rate for Payer: Group Health Inc Commercial	$16.94
Rate for Payer: Group Health Inc Medicare	$11.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.94
Rate for Payer: Hamaspik Choice Inc Medicare	$16.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.02

HETASTARCH 6% IN SODIUM CHLORIDE INFUSIO

Facility

$33.88

Hospital Charge Code	41644142
Hospital Revenue Code	250
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$27.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.94
Rate for Payer: Aetna Government	$16.94
Rate for Payer: Brighton Health Commercial	$25.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.04
Rate for Payer: Group Health Inc Commercial	$16.94
Rate for Payer: Group Health Inc Medicare	$11.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.94
Rate for Payer: Hamaspik Choice Inc Medicare	$16.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.02

HETASTARCH-NACL 6-0.9 % IV SOLN [25174]

Facility

$0.05

Service Code	NDC 00409724803
Hospital Charge Code	00409724803
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

HETASTARCH-NACL 6-0.9 % IV SOLN [25174]

Facility

$0.05

Service Code	NDC 00409724803
Hospital Charge Code	00409724803
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

Know your out-of-pocket cost for care.

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