St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IGNITE POWERMIX PROC KIT

Facility

$9,287.50

Hospital Charge Code	64905864
Hospital Revenue Code	270
Min. Negotiated Rate	$3,250.62
Max. Negotiated Rate	$7,430.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,108.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,643.75
Rate for Payer: Aetna Government	$4,643.75
Rate for Payer: Brighton Health Commercial	$6,965.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,315.50
Rate for Payer: Group Health Inc Commercial	$4,643.75
Rate for Payer: Group Health Inc Medicare	$3,250.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,643.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,643.75

ILEOSTOMY-JEJUNOSTOMY

Facility

$3,442.35

Service Code	HCPCS 44310
Hospital Charge Code	40019878
Hospital Revenue Code	360
Min. Negotiated Rate	$1,204.82
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,893.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,233.13
Rate for Payer: Aetna Government	$1,233.13
Rate for Payer: Brighton Health Commercial	$2,581.76
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	$1,721.18
Rate for Payer: Group Health Inc Medicare	$1,204.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,721.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1,721.18
Rate for Payer: United Healthcare Commercial	$1,496.00

ILIAC CREST WEDGE

Facility

$2,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64902905
Hospital Revenue Code	278
Min. Negotiated Rate	$1,006.25
Max. Negotiated Rate	$1,006.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,006.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,006.25

ILIAC CREST WEDGE

Facility

$2,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64902905
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,113.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,106.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,207.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,006.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,157.19
Rate for Payer: EmblemHealth Commercial	$1,006.25
Rate for Payer: Fidelis Medicare Advantage	$2,113.12
Rate for Payer: Group Health Inc Commercial	$1,006.25
Rate for Payer: Group Health Inc Medicare	$704.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,006.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,006.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,308.12

ILIAC LIMB 12 X 120MM

Facility

$10,000.00

Service Code	HCPCS C1876
Hospital Charge Code	64904128
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$10,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,500.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$6,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,750.00
Rate for Payer: EmblemHealth Commercial	$5,000.00
Rate for Payer: Fidelis Medicare Advantage	$10,500.00
Rate for Payer: Group Health Inc Commercial	$5,000.00
Rate for Payer: Group Health Inc Medicare	$3,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,500.00

ILIAC LIMB 12 X 120MM

Facility

$10,000.00

Service Code	HCPCS C1876
Hospital Charge Code	64904128
Hospital Revenue Code	278
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00

ILIAC LIMB 14X140MM

Facility

$7,500.00

Service Code	HCPCS C1876
Hospital Charge Code	64903895
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00

ILIAC LIMB 14X140MM

Facility

$7,500.00

Service Code	HCPCS C1876
Hospital Charge Code	64903895
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$7,875.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,125.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$4,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,312.50
Rate for Payer: EmblemHealth Commercial	$3,750.00
Rate for Payer: Fidelis Medicare Advantage	$7,875.00
Rate for Payer: Group Health Inc Commercial	$3,750.00
Rate for Payer: Group Health Inc Medicare	$2,625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,875.00

ILIAC LIMB 18X140MM

Facility

$7,500.00

Service Code	HCPCS C1876
Hospital Charge Code	64903893
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00

ILIAC LIMB 18X140MM

Facility

$7,500.00

Service Code	HCPCS C1876
Hospital Charge Code	64903893
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$7,875.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,125.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$4,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,312.50
Rate for Payer: EmblemHealth Commercial	$3,750.00
Rate for Payer: Fidelis Medicare Advantage	$7,875.00
Rate for Payer: Group Health Inc Commercial	$3,750.00
Rate for Payer: Group Health Inc Medicare	$2,625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,875.00

ILIOFEMORAL ANGIOGRAM

Facility

$8,393.53

Service Code	HCPCS 75630 TC
Hospital Charge Code	66524450
Hospital Revenue Code	320
Rate for Payer: Cash Price	$3,686.08

ILIOFEMORAL ANGIOGRAM

Facility

$8,393.53

Service Code	HCPCS 75630 TC
Hospital Charge Code	66524450
Hospital Revenue Code	320
Min. Negotiated Rate	$2,580.26
Max. Negotiated Rate	$4,616.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
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	$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	$4,056.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,432.09
Rate for Payer: Elderplan Medicare Advantage	$3,686.08
Rate for Payer: EmblemHealth Commercial	$2,580.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,133.17
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	$3,317.47
Rate for Payer: Group Health Inc Medicare	$3,317.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,317.47
Rate for Payer: Healthfirst Medicare Advantage	$3,686.08
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 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

ILIUM CREST WEDGE 24-26MMX31MM

Facility

$2,212.20

Service Code	HCPCS C1713
Hospital Charge Code	40200252
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.10
Max. Negotiated Rate	$1,106.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,106.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1,106.10

ILIUM CREST WEDGE 24-26MMX31MM

Facility

$2,212.20

Service Code	HCPCS C1713
Hospital Charge Code	40200252
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,322.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,216.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,327.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,106.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,272.02
Rate for Payer: EmblemHealth Commercial	$1,106.10
Rate for Payer: Fidelis Medicare Advantage	$2,322.81
Rate for Payer: Group Health Inc Commercial	$1,106.10
Rate for Payer: Group Health Inc Medicare	$774.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,106.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1,106.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,437.93

ILR DEVICE EVAL PROG

Facility

$109.80

Service Code	HCPCS 93285 TC
Hospital Charge Code	30306648
Hospital Revenue Code	480
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.61
Rate for Payer: Aetna Government	$43.61
Rate for Payer: Affinity Essential Plan 1&2	$30.53
Rate for Payer: Affinity Essential Plan 3&4	$30.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$30.53
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Elderplan Medicare Advantage	$43.61
Rate for Payer: EmblemHealth Commercial	$43.61
Rate for Payer: Fidelis Essential Plan Aliesa	$37.07
Rate for Payer: Fidelis Essential Plan QHP	$38.81
Rate for Payer: Fidelis Medicare Advantage	$43.61
Rate for Payer: Fidelis Qualified Health Plan	$38.81
Rate for Payer: Group Health Inc Commercial	$43.61
Rate for Payer: Group Health Inc Medicare	$43.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$43.61
Rate for Payer: Healthfirst Medicare Advantage	$37.07
Rate for Payer: Healthfirst QHP	$43.61
Rate for Payer: Humana Medicare	$44.48
Rate for Payer: Senior Whole Health Medicare Advantage	$43.61
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$43.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.89
Rate for Payer: Wellcare Medicare	$41.43

ILR DEVICE EVAL PROG

Facility

$109.80

Service Code	HCPCS 93285 TC
Hospital Charge Code	30306648
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

IMADM ANY ROUTE 1ST VAC/TOX

Facility

$35.25

Service Code	HCPCS 90460
Hospital Charge Code	30301455
Hospital Revenue Code	771
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.00
Rate for Payer: Aetna Government	$10.00
Rate for Payer: Brighton Health Commercial	$26.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.97
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.62
Rate for Payer: Hamaspik Choice Inc Medicare	$17.62
Rate for Payer: United Healthcare Commercial	$44.00

IMADM ANY ROUTE 1ST VAC/TOX

Facility

$35.25

Service Code	HCPCS 90460
Hospital Charge Code	30301230
Hospital Revenue Code	771
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.00
Rate for Payer: Aetna Government	$10.00
Rate for Payer: Brighton Health Commercial	$26.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.97
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.62
Rate for Payer: Hamaspik Choice Inc Medicare	$17.62
Rate for Payer: United Healthcare Commercial	$44.00

IMAGE-GUIDE FLUID COLL&DRAIN CATH

Facility

$1,847.58

Service Code	HCPCS 10030
Hospital Charge Code	30107823
Hospital Revenue Code	450
Rate for Payer: Cash Price	$813.63

IMAGE-GUIDE FLUID COLL&DRAIN CATH

Facility

$1,847.58

Service Code	HCPCS 10030
Hospital Charge Code	30107823
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$813.63
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
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	$813.63
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
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	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$813.63
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

IMBIBE BEVELED

Facility

$438.13

Hospital Charge Code	64906013
Hospital Revenue Code	270
Min. Negotiated Rate	$153.35
Max. Negotiated Rate	$350.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$219.06
Rate for Payer: Aetna Government	$219.06
Rate for Payer: Brighton Health Commercial	$328.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$297.93
Rate for Payer: Group Health Inc Commercial	$219.06
Rate for Payer: Group Health Inc Medicare	$153.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.06
Rate for Payer: Hamaspik Choice Inc Medicare	$219.06

IMBIBO NEEDLE 6 INCH

Facility

$438.13

Hospital Charge Code	64906025
Hospital Revenue Code	270
Min. Negotiated Rate	$153.35
Max. Negotiated Rate	$350.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$219.06
Rate for Payer: Aetna Government	$219.06
Rate for Payer: Brighton Health Commercial	$328.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$297.93
Rate for Payer: Group Health Inc Commercial	$219.06
Rate for Payer: Group Health Inc Medicare	$153.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.06
Rate for Payer: Hamaspik Choice Inc Medicare	$219.06

IMDEVIMAB

Facility

$0.01

Service Code	HCPCS Q0244
Hospital Charge Code	41640233
Hospital Revenue Code	636
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
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

IMDEVIMAB

Facility

$0.01

Service Code	HCPCS Q0244
Hospital Charge Code	41640233
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

IMDEVIMAB

Facility

$0.01

Service Code	HCPCS Q0244
Hospital Charge Code	41650233
Hospital Revenue Code	636
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
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

Know your out-of-pocket cost for care.

All Charges