St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IBUPROFEN LYSINE 10 MG/ML IV SOLN [76780]

Facility

$206.25

Service Code	NDC 39822103001
Hospital Charge Code	39822103001
Hospital Revenue Code	278
Min. Negotiated Rate	$72.19
Max. Negotiated Rate	$216.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$113.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$103.12
Rate for Payer: Aetna Government	$103.12
Rate for Payer: Brighton Health Commercial	$123.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.59
Rate for Payer: EmblemHealth Commercial	$103.12
Rate for Payer: Fidelis Medicare Advantage	$216.56
Rate for Payer: Group Health Inc Commercial	$103.12
Rate for Payer: Group Health Inc Medicare	$72.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.12
Rate for Payer: Hamaspik Choice Inc Medicare	$103.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$134.06

IBUPROFEN LYSINE 10 MG/ML IV SOLN [76780]

Facility

$206.25

Service Code	NDC 39822103001
Hospital Charge Code	39822103001
Hospital Revenue Code	278
Min. Negotiated Rate	$103.12
Max. Negotiated Rate	$103.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.12
Rate for Payer: Hamaspik Choice Inc Medicare	$103.12

IBUPROFEN LYSINE 10 MG/ML IV SOLN [76780]

Facility

$206.25

Service Code	NDC 39822103002
Hospital Charge Code	39822103002
Hospital Revenue Code	278
Min. Negotiated Rate	$103.12
Max. Negotiated Rate	$103.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.12
Rate for Payer: Hamaspik Choice Inc Medicare	$103.12

IBUPROFEN LYSINE 10 MG/ML IV SOLN [76780]

Facility

$273.74

Service Code	NDC 66993049036
Hospital Charge Code	66993049036
Hospital Revenue Code	278
Min. Negotiated Rate	$95.81
Max. Negotiated Rate	$287.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$136.87
Rate for Payer: Aetna Government	$136.87
Rate for Payer: Brighton Health Commercial	$164.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.40
Rate for Payer: EmblemHealth Commercial	$136.87
Rate for Payer: Fidelis Medicare Advantage	$287.43
Rate for Payer: Group Health Inc Commercial	$136.87
Rate for Payer: Group Health Inc Medicare	$95.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.87
Rate for Payer: Hamaspik Choice Inc Medicare	$136.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$177.93

IBUPROFEN LYSINE 10 MG/ML IV SOLN [76780]

Facility

$206.25

Service Code	NDC 39822103002
Hospital Charge Code	39822103002
Hospital Revenue Code	278
Min. Negotiated Rate	$72.19
Max. Negotiated Rate	$216.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$113.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$103.12
Rate for Payer: Aetna Government	$103.12
Rate for Payer: Brighton Health Commercial	$123.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.59
Rate for Payer: EmblemHealth Commercial	$103.12
Rate for Payer: Fidelis Medicare Advantage	$216.56
Rate for Payer: Group Health Inc Commercial	$103.12
Rate for Payer: Group Health Inc Medicare	$72.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.12
Rate for Payer: Hamaspik Choice Inc Medicare	$103.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$134.06

IBUPROFEN LYSINE 10 MG/ML IV SOLN [76780]

Facility

$273.74

Service Code	NDC 66993049036
Hospital Charge Code	66993049036
Hospital Revenue Code	278
Min. Negotiated Rate	$136.87
Max. Negotiated Rate	$136.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.87
Rate for Payer: Hamaspik Choice Inc Medicare	$136.87

IBUPROFEN ORAL SYRINGE 100MG/5ML

Facility

$2.79

Hospital Charge Code	41656565
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$2.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.40
Rate for Payer: Aetna Government	$1.40
Rate for Payer: Brighton Health Commercial	$2.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.90
Rate for Payer: Group Health Inc Commercial	$1.40
Rate for Payer: Group Health Inc Medicare	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.81

IBUPROFEN ORAL SYRINGE 100MG/5ML

Facility

$2.79

Hospital Charge Code	41646565
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$2.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.40
Rate for Payer: Aetna Government	$1.40
Rate for Payer: Brighton Health Commercial	$2.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.90
Rate for Payer: Group Health Inc Commercial	$1.40
Rate for Payer: Group Health Inc Medicare	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.81

IBUPROFEN/PLACEBO SUSPENSION

Facility

$1.68

Hospital Charge Code	41657203
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

IBUPROFEN/PLACEBO SUSPENSION

Facility

$1.68

Hospital Charge Code	41647203
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

IBUPROFEN, SERUM/PLASMA

Facility

$107.50

Service Code	HCPCS 80329
Hospital Charge Code	40609886
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$86.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$80.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.10
Rate for Payer: Group Health Inc Commercial	$53.75
Rate for Payer: Group Health Inc Medicare	$37.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.75
Rate for Payer: Hamaspik Choice Inc Medicare	$53.75
Rate for Payer: United Healthcare Commercial	$24.79

ICD ACTICOR

Facility

$32,500.00

Service Code	HCPCS C1722
Hospital Charge Code	64907356
Hospital Revenue Code	278
Min. Negotiated Rate	$16,250.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16,250.00

ICD ACTICOR

Facility

$32,500.00

Service Code	HCPCS C1722
Hospital Charge Code	64907356
Hospital Revenue Code	278
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$34,125.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17,875.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$19,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$18,687.50
Rate for Payer: EmblemHealth Commercial	$16,250.00
Rate for Payer: Fidelis Medicare Advantage	$34,125.00
Rate for Payer: Group Health Inc Commercial	$16,250.00
Rate for Payer: Group Health Inc Medicare	$11,375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,125.00

ICD ENERGEN (E140)

Facility

$45,000.00

Service Code	HCPCS C1722
Hospital Charge Code	64901003
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$47,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$27,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$25,875.00
Rate for Payer: EmblemHealth Commercial	$22,500.00
Rate for Payer: Fidelis Medicare Advantage	$47,250.00
Rate for Payer: Group Health Inc Commercial	$22,500.00
Rate for Payer: Group Health Inc Medicare	$15,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29,250.00

ICE BAG

Facility

$25.52

Hospital Charge Code	40202712
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

ICU HD CATHETER PLACEMENT

Facility

$8,811.82

Service Code	HCPCS 36556 TC
Hospital Charge Code	41308063
Hospital Revenue Code	361
Min. Negotiated Rate	$1,188.00
Max. Negotiated Rate	$6,608.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Affinity Essential Plan 1&2	$2,580.26
Rate for Payer: Affinity Essential Plan 3&4	$2,580.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,580.26
Rate for Payer: Brighton Health Commercial	$6,608.86
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,686.08
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	$3,686.08
Rate for Payer: EmblemHealth Commercial	$3,686.08
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$3,686.08
Rate for Payer: Group Health Inc Medicare	$3,686.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,405.91
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst Medicare Advantage	$3,133.17
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Humana Medicare	$3,759.80
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

ICU HD CATHETER PLACEMENT

Facility

$8,811.82

Service Code	HCPCS 36556 TC
Hospital Charge Code	41308063
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,686.08

ICU PARACENTESIS

Facility

$2,490.74

Service Code	HCPCS 49082 TC
Hospital Charge Code	41308058
Hospital Revenue Code	361
Min. Negotiated Rate	$733.80
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,048.28
Rate for Payer: Aetna Government	$1,048.28
Rate for Payer: Affinity Essential Plan 1&2	$733.80
Rate for Payer: Affinity Essential Plan 3&4	$733.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$733.80
Rate for Payer: Brighton Health Commercial	$1,868.06
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,048.28
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	$1,048.28
Rate for Payer: EmblemHealth Commercial	$1,048.28
Rate for Payer: Fidelis Essential Plan Aliesa	$891.04
Rate for Payer: Fidelis Essential Plan QHP	$932.97
Rate for Payer: Fidelis Medicare Advantage	$1,048.28
Rate for Payer: Fidelis Qualified Health Plan	$932.97
Rate for Payer: Group Health Inc Commercial	$1,048.28
Rate for Payer: Group Health Inc Medicare	$1,048.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,245.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1,048.28
Rate for Payer: Healthfirst Medicare Advantage	$891.04
Rate for Payer: Healthfirst QHP	$1,048.28
Rate for Payer: Humana Medicare	$1,069.25
Rate for Payer: Senior Whole Health Medicare Advantage	$1,048.28
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,048.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,048.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$838.62
Rate for Payer: Wellcare Medicare	$995.87

ICU PARACENTESIS

Facility

$2,490.74

Service Code	HCPCS 49082 TC
Hospital Charge Code	41308058
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,048.28

ICU PICC INS > 5 YRS OLD

Facility

$4,328.59

Service Code	HCPCS 36569 TC
Hospital Charge Code	41308068
Hospital Revenue Code	361
Min. Negotiated Rate	$1,188.00
Max. Negotiated Rate	$3,246.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,852.05
Rate for Payer: Aetna Government	$1,852.05
Rate for Payer: Affinity Essential Plan 1&2	$1,296.44
Rate for Payer: Affinity Essential Plan 3&4	$1,296.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,296.44
Rate for Payer: Brighton Health Commercial	$3,246.44
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,852.05
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	$1,852.05
Rate for Payer: EmblemHealth Commercial	$1,852.05
Rate for Payer: Fidelis Essential Plan Aliesa	$1,574.24
Rate for Payer: Fidelis Essential Plan QHP	$1,648.32
Rate for Payer: Fidelis Medicare Advantage	$1,852.05
Rate for Payer: Fidelis Qualified Health Plan	$1,648.32
Rate for Payer: Group Health Inc Commercial	$1,852.05
Rate for Payer: Group Health Inc Medicare	$1,852.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1,852.05
Rate for Payer: Healthfirst Medicare Advantage	$1,574.24
Rate for Payer: Healthfirst QHP	$1,852.05
Rate for Payer: Humana Medicare	$1,889.09
Rate for Payer: Senior Whole Health Medicare Advantage	$1,852.05
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$1,852.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,852.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,481.64
Rate for Payer: Wellcare Medicare	$1,759.45

ICU PICC INS > 5 YRS OLD

Facility

$4,328.59

Service Code	HCPCS 36569 TC
Hospital Charge Code	41308068
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,852.05

ICU PIGTAIL PLACEMENT

Facility

$4,999.65

Service Code	HCPCS 32556 TC
Hospital Charge Code	41308059
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,200.46

ICU PIGTAIL PLACEMENT

Facility

$4,999.65

Service Code	HCPCS 32556 TC
Hospital Charge Code	41308059
Hospital Revenue Code	361
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$3,749.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,200.46
Rate for Payer: Aetna Government	$2,200.46
Rate for Payer: Affinity Essential Plan 1&2	$1,540.32
Rate for Payer: Affinity Essential Plan 3&4	$1,540.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,540.32
Rate for Payer: Brighton Health Commercial	$3,749.74
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,200.46
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	$2,200.46
Rate for Payer: EmblemHealth Commercial	$2,200.46
Rate for Payer: Fidelis Essential Plan Aliesa	$1,870.39
Rate for Payer: Fidelis Essential Plan QHP	$1,958.41
Rate for Payer: Fidelis Medicare Advantage	$2,200.46
Rate for Payer: Fidelis Qualified Health Plan	$1,958.41
Rate for Payer: Group Health Inc Commercial	$2,200.46
Rate for Payer: Group Health Inc Medicare	$2,200.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,499.82
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.46
Rate for Payer: Healthfirst Medicare Advantage	$1,870.39
Rate for Payer: Healthfirst QHP	$2,200.46
Rate for Payer: Humana Medicare	$2,244.47
Rate for Payer: Senior Whole Health Medicare Advantage	$2,200.46
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$2,200.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,200.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,760.37
Rate for Payer: Wellcare Medicare	$2,090.44

ICU PIGTAIL PLCMNT DRAIN FLD

Facility

$4,328.59

Service Code	HCPCS 32557 TC
Hospital Charge Code	41308069
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,852.05

ICU PIGTAIL PLCMNT DRAIN FLD

Facility

$4,328.59

Service Code	HCPCS 32557 TC
Hospital Charge Code	41308069
Hospital Revenue Code	350
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,852.05
Rate for Payer: Aetna Government	$1,852.05
Rate for Payer: Affinity Essential Plan 1&2	$1,296.44
Rate for Payer: Affinity Essential Plan 3&4	$1,296.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,296.44
Rate for Payer: Brighton Health Commercial	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,852.05
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	$1,852.05
Rate for Payer: EmblemHealth Commercial	$1,296.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,574.24
Rate for Payer: Fidelis Essential Plan Aliesa	$1,574.24
Rate for Payer: Fidelis Essential Plan QHP	$1,648.32
Rate for Payer: Fidelis Medicare Advantage	$1,852.05
Rate for Payer: Fidelis Qualified Health Plan	$1,648.32
Rate for Payer: Group Health Inc Commercial	$1,666.84
Rate for Payer: Group Health Inc Medicare	$1,666.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1,852.05
Rate for Payer: Healthfirst Medicare Advantage	$1,574.24
Rate for Payer: Healthfirst QHP	$1,852.05
Rate for Payer: Humana Medicare	$1,889.09
Rate for Payer: Senior Whole Health Medicare Advantage	$1,852.05
Rate for Payer: United Healthcare Medicare Advantage	$1,852.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,852.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,481.64
Rate for Payer: Wellcare Medicare	$1,759.45

Know your out-of-pocket cost for care.

All Charges