St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INTRLOK 75MM FXD CRUCIATE TIB PLT

Facility

$3,178.00

Service Code	HCPCS C1713
Hospital Charge Code	40200875
Hospital Revenue Code	278
Min. Negotiated Rate	$1,589.00
Max. Negotiated Rate	$1,589.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,589.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,589.00

INTRO CATH DIALYSIS CIRCUIT

Facility

$4,940.28

Service Code	HCPCS 36901
Hospital Charge Code	40034503
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,852.05

INTRO CATH DIALYSIS CIRCUIT

Facility

$4,940.28

Service Code	HCPCS 36901
Hospital Charge Code	40034503
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$3,705.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
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	$3,705.21
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	$2,470.14
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	$1,409.00
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

INTROD SET ANSEL II 7FR 55CM

Facility

$197.03

Hospital Charge Code	41569677
Hospital Revenue Code	270
Min. Negotiated Rate	$68.96
Max. Negotiated Rate	$157.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.52
Rate for Payer: Aetna Government	$98.52
Rate for Payer: Brighton Health Commercial	$147.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$133.98
Rate for Payer: Group Health Inc Commercial	$98.52
Rate for Payer: Group Health Inc Medicare	$68.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.52
Rate for Payer: Hamaspik Choice Inc Medicare	$98.52

INTRODUCER BOUGIE 15FR CVD

Facility

$9.49

Hospital Charge Code	64903249
Hospital Revenue Code	270
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$7.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.74
Rate for Payer: Aetna Government	$4.74
Rate for Payer: Brighton Health Commercial	$7.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.45
Rate for Payer: Group Health Inc Commercial	$4.74
Rate for Payer: Group Health Inc Medicare	$3.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.74
Rate for Payer: Hamaspik Choice Inc Medicare	$4.74

INTRODUCER BOUGIE 15FR CVD

Facility

$112.00

Hospital Charge Code	40200851
Hospital Revenue Code	270
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$89.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.00
Rate for Payer: Aetna Government	$56.00
Rate for Payer: Brighton Health Commercial	$84.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.16
Rate for Payer: Group Health Inc Commercial	$56.00
Rate for Payer: Group Health Inc Medicare	$39.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00

INTRODUCER CHECKFLO 6.0 18

Facility

$192.00

Hospital Charge Code	64906847
Hospital Revenue Code	270
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$153.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.00
Rate for Payer: Aetna Government	$96.00
Rate for Payer: Brighton Health Commercial	$144.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$153.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.56
Rate for Payer: Group Health Inc Commercial	$96.00
Rate for Payer: Group Health Inc Medicare	$67.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.00
Rate for Payer: Hamaspik Choice Inc Medicare	$96.00

INTRODUCER SHEATH .035IN HI-FL

Facility

$160.00

Hospital Charge Code	64905508
Hospital Revenue Code	270
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$128.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.00
Rate for Payer: Aetna Government	$80.00
Rate for Payer: Brighton Health Commercial	$120.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$128.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.80
Rate for Payer: Group Health Inc Commercial	$80.00
Rate for Payer: Group Health Inc Medicare	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.00
Rate for Payer: Hamaspik Choice Inc Medicare	$80.00

INTRODUCER SHEATH/DRYSEAL FLEX

Facility

$1,657.50

Service Code	HCPCS C1894
Hospital Charge Code	64907417
Hospital Revenue Code	278
Min. Negotiated Rate	$828.75
Max. Negotiated Rate	$828.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$828.75
Rate for Payer: Hamaspik Choice Inc Medicare	$828.75

INTRODUCER SHEATH/DRYSEAL FLEX

Facility

$1,657.50

Service Code	HCPCS C1894
Hospital Charge Code	64907417
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1,740.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$911.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$994.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$828.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$953.06
Rate for Payer: EmblemHealth Commercial	$828.75
Rate for Payer: Fidelis Medicare Advantage	$1,740.38
Rate for Payer: Group Health Inc Commercial	$828.75
Rate for Payer: Group Health Inc Medicare	$580.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$828.75
Rate for Payer: Hamaspik Choice Inc Medicare	$828.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,077.38

INTRODUCTION OF HEMOSTATIC AGENT

Facility

$502.93

Service Code	HCPCS 57180
Hospital Charge Code	30301198
Hospital Revenue Code	510
Min. Negotiated Rate	$161.31
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$230.44
Rate for Payer: Aetna Government	$230.44
Rate for Payer: Affinity Essential Plan 1&2	$161.31
Rate for Payer: Affinity Essential Plan 3&4	$161.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$161.31
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$230.44
Rate for Payer: Cash Price	$230.44
Rate for Payer: Cash Price	$230.44
Rate for Payer: Cash Price	$230.44
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$230.44
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	$230.44
Rate for Payer: Fidelis Essential Plan Aliesa	$195.87
Rate for Payer: Fidelis Essential Plan QHP	$205.09
Rate for Payer: Fidelis Medicare Advantage	$230.44
Rate for Payer: Fidelis Qualified Health Plan	$205.09
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	$251.46
Rate for Payer: Hamaspik Choice Inc Medicare	$230.44
Rate for Payer: Healthfirst Medicare Advantage	$195.87
Rate for Payer: Healthfirst QHP	$230.44
Rate for Payer: Humana Medicare	$235.05
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$230.44
Rate for Payer: Senior Whole Health Medicare Advantage	$230.44
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$230.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$184.35
Rate for Payer: Wellcare Medicare	$218.92

INTRODUCTION OF HEMOSTATIC AGENT

Facility

$502.93

Service Code	HCPCS 57180
Hospital Charge Code	30301198
Hospital Revenue Code	510
Rate for Payer: Cash Price	$230.44

INTRODUCTION OF NEEDLE IN VEIN

Facility

$285.27

Service Code	HCPCS 36000
Hospital Charge Code	30100011
Hospital Revenue Code	450
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.98
Rate for Payer: Aetna Government	$9.98
Rate for Payer: Brighton Health Commercial	$874.00
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	$525.00
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	$142.64
Rate for Payer: Hamaspik Choice Inc Medicare	$142.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: United Healthcare Commercial	$569.00

INTRODUCTION OF NEEDLE IN VEIN

Facility

$285.27

Service Code	HCPCS 36000
Hospital Charge Code	30103222
Hospital Revenue Code	450
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.98
Rate for Payer: Aetna Government	$9.98
Rate for Payer: Brighton Health Commercial	$874.00
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	$525.00
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	$142.64
Rate for Payer: Hamaspik Choice Inc Medicare	$142.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: United Healthcare Commercial	$569.00

Introduction of needle or intracatheter, upper or lower extremity artery

Facility

$2,915.00

Service Code	CPT 36140
Hospital Revenue Code	360
Min. Negotiated Rate	$114.72
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.72
Rate for Payer: Aetna Government	$114.72
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: United Healthcare Commercial	$1,113.00

Introduction of needle or intracatheter, upper or lower extremity artery

Facility

$2,915.00

Service Code	CPT 36140
Hospital Revenue Code	361
Min. Negotiated Rate	$114.72
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.72
Rate for Payer: Aetna Government	$114.72
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: United Healthcare Commercial	$1,113.00

Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

Facility

$6,741.91

Service Code	CPT 36902
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,741.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,609.72
Rate for Payer: Aetna Government	$6,609.72
Rate for Payer: Affinity Essential Plan 1&2	$4,626.80
Rate for Payer: Affinity Essential Plan 3&4	$4,626.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,626.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,609.72
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	$6,609.72
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$5,618.26
Rate for Payer: Fidelis Essential Plan QHP	$5,882.65
Rate for Payer: Fidelis Medicare Advantage	$6,609.72
Rate for Payer: Fidelis Qualified Health Plan	$5,882.65
Rate for Payer: Group Health Inc Commercial	$6,609.72
Rate for Payer: Group Health Inc Medicare	$6,609.72
Rate for Payer: Hamaspik Choice Inc Medicare	$6,609.72
Rate for Payer: Healthfirst Medicare Advantage	$5,618.26
Rate for Payer: Healthfirst QHP	$6,609.72
Rate for Payer: Humana Medicare	$6,741.91
Rate for Payer: Senior Whole Health Medicare Advantage	$6,609.72
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$6,609.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,609.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,287.78
Rate for Payer: Wellcare Medicare	$6,279.23

INT. ROOT REPAIR OF PERF. DEFECTS

Facility

$276.41

Service Code	HCPCS D3333
Hospital Charge Code	42303305
Hospital Revenue Code	361
Min. Negotiated Rate	$138.20
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$207.31
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

INT. ROOT REPAIR OF PERF. DEFECTS

Facility

$276.41

Service Code	HCPCS D3333
Hospital Charge Code	42303305
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

INTRPRE GRFT BNE PRO OSTEON

Facility

$1,986.00

Service Code	HCPCS C1768
Hospital Charge Code	40209725
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$2,085.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,092.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$1,191.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$993.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,141.95
Rate for Payer: EmblemHealth Commercial	$993.00
Rate for Payer: Fidelis Medicare Advantage	$2,085.30
Rate for Payer: Group Health Inc Commercial	$993.00
Rate for Payer: Group Health Inc Medicare	$695.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$993.00
Rate for Payer: Hamaspik Choice Inc Medicare	$993.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,290.90

INTRPRE GRFT BNE PRO OSTEON

Facility

$1,986.00

Service Code	HCPCS C1768
Hospital Charge Code	40209725
Hospital Revenue Code	278
Min. Negotiated Rate	$993.00
Max. Negotiated Rate	$993.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$993.00
Rate for Payer: Hamaspik Choice Inc Medicare	$993.00

INVENTRA VR-T ICD MODEL 399436

Facility

$26,600.00

Service Code	HCPCS C1722
Hospital Charge Code	66576684
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$27,930.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,630.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$15,960.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15,295.00
Rate for Payer: EmblemHealth Commercial	$13,300.00
Rate for Payer: Fidelis Medicare Advantage	$27,930.00
Rate for Payer: Group Health Inc Commercial	$13,300.00
Rate for Payer: Group Health Inc Medicare	$9,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$13,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17,290.00

INVERTED PIN TO ROD COUP 4-5/8MM

Facility

$1,026.20

Service Code	HCPCS C1713
Hospital Charge Code	40200521
Hospital Revenue Code	278
Min. Negotiated Rate	$513.10
Max. Negotiated Rate	$513.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$513.10
Rate for Payer: Hamaspik Choice Inc Medicare	$513.10

INVERTED PIN TO ROD COUP 4-5/8MM

Facility

$1,026.20

Service Code	HCPCS C1713
Hospital Charge Code	40200521
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,077.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$564.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$615.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$513.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$590.06
Rate for Payer: EmblemHealth Commercial	$513.10
Rate for Payer: Fidelis Medicare Advantage	$1,077.51
Rate for Payer: Group Health Inc Commercial	$513.10
Rate for Payer: Group Health Inc Medicare	$359.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$513.10
Rate for Payer: Hamaspik Choice Inc Medicare	$513.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$667.03

INVERTED V TIP

Facility

$840.00

Hospital Charge Code	64907304
Hospital Revenue Code	270
Min. Negotiated Rate	$294.00
Max. Negotiated Rate	$672.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$462.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$420.00
Rate for Payer: Aetna Government	$420.00
Rate for Payer: Brighton Health Commercial	$630.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$672.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$571.20
Rate for Payer: Group Health Inc Commercial	$420.00
Rate for Payer: Group Health Inc Medicare	$294.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$420.00

Know your out-of-pocket cost for care.

All Charges