St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEGIONELLA PNEUMOPHILA ABS.

Facility

$38.25

Service Code	HCPCS 86713
Hospital Charge Code	40619172
Hospital Revenue Code	300
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$28.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.30
Rate for Payer: Aetna Government	$15.30
Rate for Payer: Affinity Essential Plan 1&2	$10.71
Rate for Payer: Affinity Essential Plan 3&4	$10.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.71
Rate for Payer: Brighton Health Commercial	$28.69
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.57
Rate for Payer: Elderplan Medicare Advantage	$15.30
Rate for Payer: EmblemHealth Commercial	$15.30
Rate for Payer: Fidelis Essential Plan Aliesa	$13.00
Rate for Payer: Fidelis Essential Plan QHP	$13.62
Rate for Payer: Fidelis Medicare Advantage	$15.30
Rate for Payer: Fidelis Qualified Health Plan	$13.62
Rate for Payer: Group Health Inc Commercial	$15.30
Rate for Payer: Group Health Inc Medicare	$15.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.12
Rate for Payer: Hamaspik Choice Inc Medicare	$15.30
Rate for Payer: Healthfirst Medicare Advantage	$15.30
Rate for Payer: Healthfirst QHP	$15.30
Rate for Payer: Humana Medicare	$15.61
Rate for Payer: Senior Whole Health Medicare Advantage	$15.30
Rate for Payer: United Healthcare Commercial	$19.38
Rate for Payer: United Healthcare Medicare Advantage	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.24
Rate for Payer: Wellcare Medicare	$13.77

LEGIONELLA PNEUMOPHILA ABS.

Facility

$38.25

Service Code	HCPCS 86713
Hospital Charge Code	40619172
Hospital Revenue Code	300
Rate for Payer: Cash Price	$15.30

LEGIONELLA SPECIES CULTURE

Facility

$21.55

Service Code	HCPCS 87070
Hospital Charge Code	40619184
Hospital Revenue Code	300
Rate for Payer: Cash Price	$8.62

LEGIONELLA SPECIES CULTURE

Facility

$21.55

Service Code	HCPCS 87070
Hospital Charge Code	40619184
Hospital Revenue Code	300
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$16.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.62
Rate for Payer: Aetna Government	$8.62
Rate for Payer: Affinity Essential Plan 1&2	$6.03
Rate for Payer: Affinity Essential Plan 3&4	$6.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.03
Rate for Payer: Brighton Health Commercial	$16.16
Rate for Payer: Cash Price	$8.62
Rate for Payer: Cash Price	$8.62
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.59
Rate for Payer: Elderplan Medicare Advantage	$8.62
Rate for Payer: EmblemHealth Commercial	$8.62
Rate for Payer: Fidelis Essential Plan Aliesa	$7.33
Rate for Payer: Fidelis Essential Plan QHP	$7.67
Rate for Payer: Fidelis Medicare Advantage	$8.62
Rate for Payer: Fidelis Qualified Health Plan	$7.67
Rate for Payer: Group Health Inc Commercial	$8.62
Rate for Payer: Group Health Inc Medicare	$8.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.78
Rate for Payer: Hamaspik Choice Inc Medicare	$8.62
Rate for Payer: Healthfirst Medicare Advantage	$8.62
Rate for Payer: Healthfirst QHP	$8.62
Rate for Payer: Humana Medicare	$8.79
Rate for Payer: Senior Whole Health Medicare Advantage	$8.62
Rate for Payer: United Healthcare Commercial	$10.91
Rate for Payer: United Healthcare Medicare Advantage	$8.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.90
Rate for Payer: Wellcare Medicare	$7.76

LEGION PS NP FEM SZ 5

Facility

$6,744.25

Service Code	HCPCS C1776
Hospital Charge Code	64902969
Hospital Revenue Code	278
Min. Negotiated Rate	$3,372.12
Max. Negotiated Rate	$3,372.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,372.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3,372.12

LEGION PS NP FEM SZ 5

Facility

$6,744.25

Service Code	HCPCS C1776
Hospital Charge Code	64902969
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,081.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,709.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,046.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,372.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,877.94
Rate for Payer: EmblemHealth Commercial	$3,372.12
Rate for Payer: Fidelis Medicare Advantage	$7,081.46
Rate for Payer: Group Health Inc Commercial	$3,372.12
Rate for Payer: Group Health Inc Medicare	$2,360.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,372.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3,372.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,383.76

LEGION PS NP NARR FEM SZ4 LT

Facility

$6,742.50

Service Code	HCPCS C1776
Hospital Charge Code	64905340
Hospital Revenue Code	278
Min. Negotiated Rate	$3,371.25
Max. Negotiated Rate	$3,371.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,371.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3,371.25

LEGION PS NP NARR FEM SZ4 LT

Facility

$6,742.50

Service Code	HCPCS C1776
Hospital Charge Code	64905340
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,079.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,708.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,045.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,371.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,876.94
Rate for Payer: EmblemHealth Commercial	$3,371.25
Rate for Payer: Fidelis Medicare Advantage	$7,079.62
Rate for Payer: Group Health Inc Commercial	$3,371.25
Rate for Payer: Group Health Inc Medicare	$2,359.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,371.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3,371.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,382.62

LEGION PS OXIN FEM SZ4 RT

Facility

$9,705.00

Service Code	HCPCS C1776
Hospital Charge Code	64904949
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,190.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,337.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,823.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,852.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,580.38
Rate for Payer: EmblemHealth Commercial	$4,852.50
Rate for Payer: Fidelis Medicare Advantage	$10,190.25
Rate for Payer: Group Health Inc Commercial	$4,852.50
Rate for Payer: Group Health Inc Medicare	$3,396.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,308.25

LEGION PS OXIN FEM SZ4 RT

Facility

$9,705.00

Service Code	HCPCS C1776
Hospital Charge Code	64904949
Hospital Revenue Code	278
Min. Negotiated Rate	$4,852.50
Max. Negotiated Rate	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50

LEGION PS OXIN FEM SZ5 LT

Facility

$9,705.00

Service Code	HCPCS C1776
Hospital Charge Code	64905346
Hospital Revenue Code	278
Min. Negotiated Rate	$4,852.50
Max. Negotiated Rate	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50

LEGION PS OXIN FEM SZ5 LT

Facility

$9,705.00

Service Code	HCPCS C1776
Hospital Charge Code	64905346
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,190.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,337.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,823.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,852.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,580.38
Rate for Payer: EmblemHealth Commercial	$4,852.50
Rate for Payer: Fidelis Medicare Advantage	$10,190.25
Rate for Payer: Group Health Inc Commercial	$4,852.50
Rate for Payer: Group Health Inc Medicare	$3,396.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,308.25

LEG SCREW SUPER 95MM

Facility

$810.88

Service Code	HCPCS C1713
Hospital Charge Code	64903821
Hospital Revenue Code	278
Min. Negotiated Rate	$405.44
Max. Negotiated Rate	$405.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$405.44
Rate for Payer: Hamaspik Choice Inc Medicare	$405.44

LEG SCREW SUPER 95MM

Facility

$810.88

Service Code	HCPCS C1713
Hospital Charge Code	64903821
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$851.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$445.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$486.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$405.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$466.26
Rate for Payer: EmblemHealth Commercial	$405.44
Rate for Payer: Fidelis Medicare Advantage	$851.42
Rate for Payer: Group Health Inc Commercial	$405.44
Rate for Payer: Group Health Inc Medicare	$283.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$405.44
Rate for Payer: Hamaspik Choice Inc Medicare	$405.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$527.07

LEIBINGER MDFC MIC SCRW 1.2MMX8MM

Facility

$92.00

Service Code	HCPCS C1713
Hospital Charge Code	40200715
Hospital Revenue Code	278
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$55.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$52.90
Rate for Payer: EmblemHealth Commercial	$46.00
Rate for Payer: Fidelis Medicare Advantage	$96.60
Rate for Payer: Group Health Inc Commercial	$46.00
Rate for Payer: Group Health Inc Medicare	$32.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.00
Rate for Payer: Hamaspik Choice Inc Medicare	$46.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59.80

LEIBINGER MDFC MIC SCRW 1.2MMX8MM

Facility

$92.00

Service Code	HCPCS C1713
Hospital Charge Code	40200715
Hospital Revenue Code	278
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$46.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.00
Rate for Payer: Hamaspik Choice Inc Medicare	$46.00

LEMAITRE XENOSURE BIO PATCH

Facility

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	40206241
Hospital Revenue Code	278
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$199.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$114.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.25
Rate for Payer: EmblemHealth Commercial	$95.00
Rate for Payer: Fidelis Medicare Advantage	$199.50
Rate for Payer: Group Health Inc Commercial	$95.00
Rate for Payer: Group Health Inc Medicare	$66.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.50

LEMAITRE XENOSURE BIO PATCH

Facility

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	40206241
Hospital Revenue Code	278
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$95.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00

LENGTHENING OF PALATE

Facility

$14,691.05

Service Code	HCPCS 42226
Hospital Charge Code	40064151
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$11,018.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,772.21
Rate for Payer: Aetna Government	$6,772.21
Rate for Payer: Affinity Essential Plan 1&2	$4,740.55
Rate for Payer: Affinity Essential Plan 3&4	$4,740.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,740.55
Rate for Payer: Brighton Health Commercial	$11,018.29
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,772.21
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	$6,772.21
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$5,756.38
Rate for Payer: Fidelis Essential Plan QHP	$6,027.27
Rate for Payer: Fidelis Medicare Advantage	$6,772.21
Rate for Payer: Fidelis Qualified Health Plan	$6,027.27
Rate for Payer: Group Health Inc Commercial	$6,772.21
Rate for Payer: Group Health Inc Medicare	$6,772.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,345.52
Rate for Payer: Hamaspik Choice Inc Medicare	$6,772.21
Rate for Payer: Healthfirst Medicare Advantage	$5,756.38
Rate for Payer: Healthfirst QHP	$6,772.21
Rate for Payer: Humana Medicare	$6,907.65
Rate for Payer: Senior Whole Health Medicare Advantage	$6,772.21
Rate for Payer: United Healthcare Commercial	$2,683.00
Rate for Payer: United Healthcare Medicare Advantage	$6,772.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,772.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,417.77
Rate for Payer: Wellcare Medicare	$6,433.60

LENGTHENING OF PALATE

Facility

$14,691.05

Service Code	HCPCS 42226
Hospital Charge Code	40064151
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,772.21

Lengthening or shortening of tendon, leg or ankle; single tendon (separate procedure)

Facility

$3,818.01

Service Code	CPT 27685
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,818.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

LENS 1-PC CLR MONO DCBO

Facility

$325.00

Service Code	HCPCS C1780
Hospital Charge Code	64907382
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$341.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$195.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.00
Rate for Payer: EmblemHealth Commercial	$162.50
Rate for Payer: Fidelis Medicare Advantage	$341.25
Rate for Payer: Group Health Inc Commercial	$162.50
Rate for Payer: Group Health Inc Medicare	$113.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.50
Rate for Payer: Hamaspik Choice Inc Medicare	$162.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.25

LENS 3-PC

Facility

$325.00

Service Code	HCPCS C1780
Hospital Charge Code	64907242
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$341.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$195.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.00
Rate for Payer: EmblemHealth Commercial	$162.50
Rate for Payer: Fidelis Medicare Advantage	$341.25
Rate for Payer: Group Health Inc Commercial	$162.50
Rate for Payer: Group Health Inc Medicare	$113.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.50
Rate for Payer: Hamaspik Choice Inc Medicare	$162.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.25

LENS DIOPTER

Facility

$223.75

Service Code	HCPCS C1780
Hospital Charge Code	40206071
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$234.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$134.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$152.15
Rate for Payer: EmblemHealth Commercial	$111.88
Rate for Payer: Fidelis Medicare Advantage	$234.94
Rate for Payer: Group Health Inc Commercial	$111.88
Rate for Payer: Group Health Inc Medicare	$78.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.88
Rate for Payer: Hamaspik Choice Inc Medicare	$111.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.44

LENS DIOPTER SOFTEC HDO 10.0

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64904229
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$220.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$126.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.80
Rate for Payer: EmblemHealth Commercial	$105.00
Rate for Payer: Fidelis Medicare Advantage	$220.50
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$136.50

Know your out-of-pocket cost for care.

All Charges