St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SCRW BONE CANCELL 6MM/1.9MM/4MM7

Facility

$56.88

Service Code	HCPCS C1713
Hospital Charge Code	64901749
Hospital Revenue Code	278
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.44
Rate for Payer: Hamaspik Choice Inc Medicare	$28.44

SCRW INNER 5.0 SS MOSS MIAMI

Facility

$170.00

Service Code	HCPCS C1781
Hospital Charge Code	40209702
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$102.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: EmblemHealth Commercial	$85.00
Rate for Payer: Fidelis Medicare Advantage	$178.50
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.50

SCRW INNER 5.0 SS MOSS MIAMI

Facility

$170.00

Service Code	HCPCS C1781
Hospital Charge Code	40209702
Hospital Revenue Code	278
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$85.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

SCRW LCKING 4.0X 95MM

Facility

$3,306.00

Hospital Charge Code	40200285
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.10
Max. Negotiated Rate	$3,471.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,818.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,653.00
Rate for Payer: Aetna Government	$1,653.00
Rate for Payer: Brighton Health Commercial	$1,983.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,653.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,900.95
Rate for Payer: EmblemHealth Commercial	$1,653.00
Rate for Payer: Fidelis Medicare Advantage	$3,471.30
Rate for Payer: Group Health Inc Commercial	$1,653.00
Rate for Payer: Group Health Inc Medicare	$1,157.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,653.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,653.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,148.90

SCRW LCKING 4.0X 95MM

Facility

$3,306.00

Hospital Charge Code	40200285
Hospital Revenue Code	278
Min. Negotiated Rate	$1,653.00
Max. Negotiated Rate	$1,653.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,653.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,653.00

SCRW REST GAP PLATE 6.5X

Facility

$360.00

Service Code	HCPCS C1776
Hospital Charge Code	40205016
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00

SCRW REST GAP PLATE 6.5X

Facility

$360.00

Service Code	HCPCS C1776
Hospital Charge Code	40205016
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$378.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$198.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$216.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.00
Rate for Payer: EmblemHealth Commercial	$180.00
Rate for Payer: Fidelis Medicare Advantage	$378.00
Rate for Payer: Group Health Inc Commercial	$180.00
Rate for Payer: Group Health Inc Medicare	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$234.00

SC THER INFUSION, RESET PUMP

Facility

$183.15

Service Code	HCPCS 96371
Hospital Charge Code	40509900
Hospital Revenue Code	269
Rate for Payer: Cash Price	$81.46

SC THER INFUSION, RESET PUMP

Facility

$183.15

Service Code	HCPCS 96371
Hospital Charge Code	40509900
Hospital Revenue Code	269
Min. Negotiated Rate	$57.02
Max. Negotiated Rate	$146.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.46
Rate for Payer: Aetna Government	$81.46
Rate for Payer: Affinity Essential Plan 1&2	$57.02
Rate for Payer: Affinity Essential Plan 3&4	$57.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$57.02
Rate for Payer: Brighton Health Commercial	$137.36
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$81.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.54
Rate for Payer: Elderplan Medicare Advantage	$81.46
Rate for Payer: EmblemHealth Commercial	$81.46
Rate for Payer: Fidelis Essential Plan Aliesa	$69.24
Rate for Payer: Fidelis Essential Plan QHP	$72.50
Rate for Payer: Fidelis Medicare Advantage	$81.46
Rate for Payer: Fidelis Qualified Health Plan	$72.50
Rate for Payer: Group Health Inc Commercial	$81.46
Rate for Payer: Group Health Inc Medicare	$81.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.58
Rate for Payer: Hamaspik Choice Inc Medicare	$81.46
Rate for Payer: Healthfirst Medicare Advantage	$69.24
Rate for Payer: Healthfirst QHP	$81.46
Rate for Payer: Humana Medicare	$83.09
Rate for Payer: Senior Whole Health Medicare Advantage	$81.46
Rate for Payer: United Healthcare Commercial	$76.00
Rate for Payer: United Healthcare Medicare Advantage	$81.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65.17
Rate for Payer: Wellcare Medicare	$77.39

SCTHER INFUSION, RESET PUMP

Facility

$183.15

Service Code	HCPCS 96371
Hospital Charge Code	30306649
Hospital Revenue Code	510
Rate for Payer: Cash Price	$81.46

SCTHER INFUSION, RESET PUMP

Facility

$183.15

Service Code	HCPCS 96371
Hospital Charge Code	30306649
Hospital Revenue Code	510
Min. Negotiated Rate	$57.02
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.46
Rate for Payer: Aetna Government	$81.46
Rate for Payer: Affinity Essential Plan 1&2	$57.02
Rate for Payer: Affinity Essential Plan 3&4	$57.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$57.02
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$81.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Elderplan Medicare Advantage	$81.46
Rate for Payer: Fidelis Essential Plan Aliesa	$69.24
Rate for Payer: Fidelis Essential Plan QHP	$72.50
Rate for Payer: Fidelis Medicare Advantage	$81.46
Rate for Payer: Fidelis Qualified Health Plan	$72.50
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	$91.58
Rate for Payer: Hamaspik Choice Inc Medicare	$81.46
Rate for Payer: Healthfirst Medicare Advantage	$69.24
Rate for Payer: Healthfirst QHP	$81.46
Rate for Payer: Humana Medicare	$83.09
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$81.46
Rate for Payer: Senior Whole Health Medicare Advantage	$81.46
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$81.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65.17
Rate for Payer: Wellcare Medicare	$77.39

SEALANT DRASEAL 5ML AUTOSUTURE

Facility

$110.00

Hospital Charge Code	64906437
Hospital Revenue Code	270
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$88.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.00
Rate for Payer: Aetna Government	$55.00
Rate for Payer: Brighton Health Commercial	$82.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$88.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.80
Rate for Payer: Group Health Inc Commercial	$55.00
Rate for Payer: Group Health Inc Medicare	$38.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.00
Rate for Payer: Hamaspik Choice Inc Medicare	$55.00

SEALANT HUMAN CROSSEAL 5ML

Facility

$1,150.00

Hospital Charge Code	64904454
Hospital Revenue Code	270
Min. Negotiated Rate	$402.50
Max. Negotiated Rate	$920.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$632.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$575.00
Rate for Payer: Aetna Government	$575.00
Rate for Payer: Brighton Health Commercial	$862.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$920.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$782.00
Rate for Payer: Group Health Inc Commercial	$575.00
Rate for Payer: Group Health Inc Medicare	$402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.00
Rate for Payer: Hamaspik Choice Inc Medicare	$575.00

SEALANT-PER TOOTH

Facility

$87.50

Service Code	HCPCS D1351
Hospital Charge Code	42300285
Hospital Revenue Code	361
Min. Negotiated Rate	$13.97
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.97
Rate for Payer: Aetna Government	$13.97
Rate for Payer: Brighton Health Commercial	$65.62
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: Group Health Inc Commercial	$43.75
Rate for Payer: Group Health Inc Medicare	$30.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$43.75

SEAL CLOSURE DEVICE

Facility

$550.00

Hospital Charge Code	66521496
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

SEALED CONTAINER W/LID MID SIZE

Facility

$1,114.25

Hospital Charge Code	64905546
Hospital Revenue Code	270
Min. Negotiated Rate	$389.99
Max. Negotiated Rate	$891.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$612.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$557.12
Rate for Payer: Aetna Government	$557.12
Rate for Payer: Brighton Health Commercial	$835.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$891.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$757.69
Rate for Payer: Group Health Inc Commercial	$557.12
Rate for Payer: Group Health Inc Medicare	$389.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.12
Rate for Payer: Hamaspik Choice Inc Medicare	$557.12

SEALER LIGASURE LF

Facility

$1,262.55

Hospital Charge Code	64907088
Hospital Revenue Code	270
Min. Negotiated Rate	$441.89
Max. Negotiated Rate	$1,010.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$631.28
Rate for Payer: Aetna Government	$631.28
Rate for Payer: Brighton Health Commercial	$946.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,010.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$858.53
Rate for Payer: Group Health Inc Commercial	$631.28
Rate for Payer: Group Health Inc Medicare	$441.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$631.28
Rate for Payer: Hamaspik Choice Inc Medicare	$631.28

SEALING CAP WITH VENT

Facility

$31.20

Hospital Charge Code	40209538
Hospital Revenue Code	270
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$24.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.60
Rate for Payer: Aetna Government	$15.60
Rate for Payer: Brighton Health Commercial	$23.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.22
Rate for Payer: Group Health Inc Commercial	$15.60
Rate for Payer: Group Health Inc Medicare	$10.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.60
Rate for Payer: Hamaspik Choice Inc Medicare	$15.60

SEAL PULL TIGHT YELLOW

Facility

$0.45

Hospital Charge Code	64902122
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

SEALS CODE CART (YELLOW)

Facility

$0.47

Hospital Charge Code	64901636
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.32
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24

SEAL,TAMPER,EVIDENT,BLUE

Facility

$0.23

Hospital Charge Code	64903439
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12

SEASONAL ALLRGNS, SPRING-TREE

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729323
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

SEASONAL ALLRGNS, SPRING-TREE

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729323
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

SECONDARY IMPLANT

Facility

$5,861.23

Service Code	HCPCS 65125
Hospital Charge Code	40072545
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$4,395.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,702.32
Rate for Payer: Aetna Government	$2,702.32
Rate for Payer: Affinity Essential Plan 1&2	$1,891.62
Rate for Payer: Affinity Essential Plan 3&4	$1,891.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,891.62
Rate for Payer: Brighton Health Commercial	$4,395.92
Rate for Payer: Cash Price	$2,702.32
Rate for Payer: Cash Price	$2,702.32
Rate for Payer: Cash Price	$2,702.32
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,702.32
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	$2,702.32
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,296.97
Rate for Payer: Fidelis Essential Plan QHP	$2,405.06
Rate for Payer: Fidelis Medicare Advantage	$2,702.32
Rate for Payer: Fidelis Qualified Health Plan	$2,405.06
Rate for Payer: Group Health Inc Commercial	$2,702.32
Rate for Payer: Group Health Inc Medicare	$2,702.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,930.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,702.32
Rate for Payer: Healthfirst Medicare Advantage	$2,296.97
Rate for Payer: Healthfirst QHP	$2,702.32
Rate for Payer: Humana Medicare	$2,756.37
Rate for Payer: Senior Whole Health Medicare Advantage	$2,702.32
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$2,702.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,702.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,161.86
Rate for Payer: Wellcare Medicare	$2,567.20

SECONDARY IMPLANT

Facility

$5,861.23

Service Code	HCPCS 65125
Hospital Charge Code	40072545
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,702.32

Know your out-of-pocket cost for care.

All Charges