St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RETRACTOR ALEXIS

Facility

$681.75

Hospital Charge Code	64907206
Hospital Revenue Code	270
Min. Negotiated Rate	$238.61
Max. Negotiated Rate	$545.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$374.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$340.88
Rate for Payer: Aetna Government	$340.88
Rate for Payer: Brighton Health Commercial	$511.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$545.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$463.59
Rate for Payer: Group Health Inc Commercial	$340.88
Rate for Payer: Group Health Inc Medicare	$238.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$340.88
Rate for Payer: Hamaspik Choice Inc Medicare	$340.88

RETRACTOR ARMY AND NAVY #50-4071

Facility

$147.44

Hospital Charge Code	40200456
Hospital Revenue Code	270
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$117.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.72
Rate for Payer: Aetna Government	$73.72
Rate for Payer: Brighton Health Commercial	$110.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$117.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.26
Rate for Payer: Group Health Inc Commercial	$73.72
Rate for Payer: Group Health Inc Medicare	$51.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.72
Rate for Payer: Hamaspik Choice Inc Medicare	$73.72

RETRACTOR CHEEK 2.0MM

Facility

$550.00

Hospital Charge Code	40201421
Hospital Revenue Code	270
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.00
Rate for Payer: Aetna Government	$275.00
Rate for Payer: Brighton Health Commercial	$412.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.00
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

RETRACTOR KELLY XLARGE

Facility

$51.16

Hospital Charge Code	40200457
Hospital Revenue Code	270
Min. Negotiated Rate	$17.91
Max. Negotiated Rate	$40.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.58
Rate for Payer: Aetna Government	$25.58
Rate for Payer: Brighton Health Commercial	$38.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.79
Rate for Payer: Group Health Inc Commercial	$25.58
Rate for Payer: Group Health Inc Medicare	$17.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.58
Rate for Payer: Hamaspik Choice Inc Medicare	$25.58

RETRACTOR LOVE NERVE ROOT 90DEG

Facility

$112.50

Hospital Charge Code	64904316
Hospital Revenue Code	270
Min. Negotiated Rate	$39.38
Max. Negotiated Rate	$90.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.25
Rate for Payer: Aetna Government	$56.25
Rate for Payer: Brighton Health Commercial	$84.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.50
Rate for Payer: Group Health Inc Commercial	$56.25
Rate for Payer: Group Health Inc Medicare	$39.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$56.25

RETRACTOR, MIDLIF

Facility

$6,250.00

Hospital Charge Code	64905507
Hospital Revenue Code	279
Min. Negotiated Rate	$2,187.50
Max. Negotiated Rate	$5,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,437.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,125.00
Rate for Payer: Aetna Government	$3,125.00
Rate for Payer: Brighton Health Commercial	$4,687.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,250.00
Rate for Payer: Group Health Inc Commercial	$3,125.00
Rate for Payer: Group Health Inc Medicare	$2,187.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,125.00

RETRACTOR VOLKMANN 4-PR BLUNT 9

Facility

$43.60

Hospital Charge Code	40200458
Hospital Revenue Code	270
Min. Negotiated Rate	$15.26
Max. Negotiated Rate	$34.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.80
Rate for Payer: Aetna Government	$21.80
Rate for Payer: Brighton Health Commercial	$32.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.65
Rate for Payer: Group Health Inc Commercial	$21.80
Rate for Payer: Group Health Inc Medicare	$15.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.80
Rate for Payer: Hamaspik Choice Inc Medicare	$21.80

RETREATMENT-ANTERIOR, BY REPORT

Facility

$625.00

Service Code	HCPCS D3346
Hospital Charge Code	42300730
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

RETREATMENT-ANTERIOR, BY REPORT

Facility

$625.00

Service Code	HCPCS D3346
Hospital Charge Code	42300730
Hospital Revenue Code	361
Min. Negotiated Rate	$312.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.75
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	$468.75
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	$312.50
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

RETREATMENT-BICUSPID, BY REPORT

Facility

$750.00

Service Code	HCPCS D3347
Hospital Charge Code	42300735
Hospital Revenue Code	361
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
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	$562.50
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	$375.00
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

RETREATMENT-BICUSPID, BY REPORT

Facility

$750.00

Service Code	HCPCS D3347
Hospital Charge Code	42300735
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

RETREATMENT-MOLAR, BY REPORT

Facility

$1,000.00

Service Code	HCPCS D3348
Hospital Charge Code	42300740
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

RETREATMENT-MOLAR, BY REPORT

Facility

$1,000.00

Service Code	HCPCS D3348
Hospital Charge Code	42300740
Hospital Revenue Code	361
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
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	$750.00
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	$500.00
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

RETRIEVER NET ROTH STND 160CM

Facility

$188.00

Hospital Charge Code	64906825
Hospital Revenue Code	270
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$150.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$94.00
Rate for Payer: Aetna Government	$94.00
Rate for Payer: Brighton Health Commercial	$141.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.84
Rate for Payer: Group Health Inc Commercial	$94.00
Rate for Payer: Group Health Inc Medicare	$65.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.00
Rate for Payer: Hamaspik Choice Inc Medicare	$94.00

RETRIEVER SUTURE BLITZ

Facility

$180.00

Hospital Charge Code	64903134
Hospital Revenue Code	270
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$144.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$90.00
Rate for Payer: Aetna Government	$90.00
Rate for Payer: Brighton Health Commercial	$135.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.40
Rate for Payer: Group Health Inc Commercial	$90.00
Rate for Payer: Group Health Inc Medicare	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00

RETRIEVER SUTURE BLITZ

Facility

$144.00

Hospital Charge Code	40200824
Hospital Revenue Code	270
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$115.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.00
Rate for Payer: Aetna Government	$72.00
Rate for Payer: Brighton Health Commercial	$108.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.92
Rate for Payer: Group Health Inc Commercial	$72.00
Rate for Payer: Group Health Inc Medicare	$50.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.00
Rate for Payer: Hamaspik Choice Inc Medicare	$72.00

RETRIEVER SUTURE HEWSON

Facility

$235.88

Hospital Charge Code	64905018
Hospital Revenue Code	270
Min. Negotiated Rate	$82.56
Max. Negotiated Rate	$188.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.94
Rate for Payer: Aetna Government	$117.94
Rate for Payer: Brighton Health Commercial	$176.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$188.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$160.40
Rate for Payer: Group Health Inc Commercial	$117.94
Rate for Payer: Group Health Inc Medicare	$82.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$117.94
Rate for Payer: Hamaspik Choice Inc Medicare	$117.94

RETROARC SLING SYSTEM

Facility

$3,275.00

Service Code	HCPCS L8699
Hospital Charge Code	64903328
Hospital Revenue Code	278
Min. Negotiated Rate	$1,637.50
Max. Negotiated Rate	$1,637.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,637.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,637.50

RETROARC SLING SYSTEM

Facility

$3,275.00

Service Code	HCPCS L8699
Hospital Charge Code	64903328
Hospital Revenue Code	278
Min. Negotiated Rate	$1,146.25
Max. Negotiated Rate	$3,438.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,801.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,637.50
Rate for Payer: Aetna Government	$1,637.50
Rate for Payer: Brighton Health Commercial	$1,965.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,637.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,883.12
Rate for Payer: EmblemHealth Commercial	$1,637.50
Rate for Payer: Fidelis Medicare Advantage	$3,438.75
Rate for Payer: Group Health Inc Commercial	$1,637.50
Rate for Payer: Group Health Inc Medicare	$1,146.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,637.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,637.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,128.75

RETROBULBAR INJECTION EYE SOCKET

Facility

$819.25

Service Code	HCPCS 67500
Hospital Charge Code	30303074
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$336.88
Rate for Payer: Aetna Government	$336.88
Rate for Payer: Affinity Essential Plan 1&2	$235.82
Rate for Payer: Affinity Essential Plan 3&4	$235.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$235.82
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$336.88
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	$336.88
Rate for Payer: Fidelis Essential Plan Aliesa	$286.35
Rate for Payer: Fidelis Essential Plan QHP	$299.82
Rate for Payer: Fidelis Medicare Advantage	$336.88
Rate for Payer: Fidelis Qualified Health Plan	$299.82
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	$409.62
Rate for Payer: Hamaspik Choice Inc Medicare	$336.88
Rate for Payer: Healthfirst Medicare Advantage	$286.35
Rate for Payer: Healthfirst QHP	$336.88
Rate for Payer: Humana Medicare	$343.62
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$336.88
Rate for Payer: Senior Whole Health Medicare Advantage	$336.88
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$336.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$336.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$269.50
Rate for Payer: Wellcare Medicare	$320.04

RETROBULBAR INJECTION EYE SOCKET

Facility

$819.25

Service Code	HCPCS 67500
Hospital Charge Code	30303074
Hospital Revenue Code	510
Rate for Payer: Cash Price	$336.88

RETROCUTTER 10MM

Facility

$487.50

Hospital Charge Code	64904931
Hospital Revenue Code	270
Min. Negotiated Rate	$170.62
Max. Negotiated Rate	$390.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$243.75
Rate for Payer: Aetna Government	$243.75
Rate for Payer: Brighton Health Commercial	$365.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$390.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$331.50
Rate for Payer: Group Health Inc Commercial	$243.75
Rate for Payer: Group Health Inc Medicare	$170.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75

RETROGRADE FILLING-PER ROOT

Facility

$125.00

Service Code	HCPCS D3430
Hospital Charge Code	42300790
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

RETROGRADE FILLING-PER ROOT

Facility

$125.00

Service Code	HCPCS D3430
Hospital Charge Code	42300790
Hospital Revenue Code	361
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
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	$93.75
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	$62.50
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

RETROPUBIC PROSTATECTOMY

Facility

$2,193.68

Service Code	HCPCS 55831
Hospital Charge Code	40129535
Hospital Revenue Code	360
Min. Negotiated Rate	$767.79
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,206.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,111.76
Rate for Payer: Aetna Government	$1,111.76
Rate for Payer: Brighton Health Commercial	$1,645.26
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	$1,096.84
Rate for Payer: Group Health Inc Medicare	$767.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,096.84
Rate for Payer: Hamaspik Choice Inc Medicare	$1,096.84
Rate for Payer: United Healthcare Commercial	$1,496.00

Know your out-of-pocket cost for care.

All Charges