St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SHELL METAL TRABECULAR

Facility

$9,739.88

Service Code	HCPCS C1776
Hospital Charge Code	64907178
Hospital Revenue Code	278
Min. Negotiated Rate	$4,869.94
Max. Negotiated Rate	$4,869.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,869.94
Rate for Payer: Hamaspik Choice Inc Medicare	$4,869.94

SHELL METAL TRABECULAR

Facility

$9,739.88

Service Code	HCPCS C1776
Hospital Charge Code	64907178
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,226.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,356.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,843.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,869.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,600.43
Rate for Payer: EmblemHealth Commercial	$4,869.94
Rate for Payer: Fidelis Medicare Advantage	$10,226.87
Rate for Payer: Group Health Inc Commercial	$4,869.94
Rate for Payer: Group Health Inc Medicare	$3,408.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,869.94
Rate for Payer: Hamaspik Choice Inc Medicare	$4,869.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,330.92

SHELL OSSEO 3HOLE 52MM SZE E

Facility

$3,800.00

Hospital Charge Code	64906837
Hospital Revenue Code	279
Min. Negotiated Rate	$1,330.00
Max. Negotiated Rate	$3,040.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,900.00
Rate for Payer: Aetna Government	$1,900.00
Rate for Payer: Brighton Health Commercial	$2,850.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,040.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,584.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

SHELL OSSEO 4HOLE 56MM SZ F

Facility

$3,800.00

Hospital Charge Code	64906849
Hospital Revenue Code	279
Min. Negotiated Rate	$1,330.00
Max. Negotiated Rate	$3,040.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,900.00
Rate for Payer: Aetna Government	$1,900.00
Rate for Payer: Brighton Health Commercial	$2,850.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,040.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,584.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

SHELL OSSEO 4HOLE 58MM G

Facility

$3,800.00

Hospital Charge Code	64906852
Hospital Revenue Code	279
Min. Negotiated Rate	$1,330.00
Max. Negotiated Rate	$3,040.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,900.00
Rate for Payer: Aetna Government	$1,900.00
Rate for Payer: Brighton Health Commercial	$2,850.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,040.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,584.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

SHELL OSSEO G7 54MM COMP

Facility

$3,800.00

Service Code	HCPCS C1776
Hospital Charge Code	64906896
Hospital Revenue Code	278
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

SHELL OSSEO G7 54MM COMP

Facility

$3,800.00

Service Code	HCPCS C1776
Hospital Charge Code	64906896
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,280.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,185.00
Rate for Payer: EmblemHealth Commercial	$1,900.00
Rate for Payer: Fidelis Medicare Advantage	$3,990.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,470.00

SHELL R-HOLE SHELL 58 LL

Facility

$3,800.00

Service Code	HCPCS C1776
Hospital Charge Code	64906546
Hospital Revenue Code	278
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

SHELL R-HOLE SHELL 58 LL

Facility

$3,800.00

Service Code	HCPCS C1776
Hospital Charge Code	64906546
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,280.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,185.00
Rate for Payer: EmblemHealth Commercial	$1,900.00
Rate for Payer: Fidelis Medicare Advantage	$3,990.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,470.00

SHIELD SPLASH

Facility

$2.78

Hospital Charge Code	40200623
Hospital Revenue Code	270
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.39
Rate for Payer: Aetna Government	$1.39
Rate for Payer: Brighton Health Commercial	$2.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.89
Rate for Payer: Group Health Inc Commercial	$1.39
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.39
Rate for Payer: Hamaspik Choice Inc Medicare	$1.39

SHIELD, SPLASH ZEROWET

Facility

$347.65

Hospital Charge Code	64903186
Hospital Revenue Code	270
Min. Negotiated Rate	$121.68
Max. Negotiated Rate	$278.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$191.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.82
Rate for Payer: Aetna Government	$173.82
Rate for Payer: Brighton Health Commercial	$260.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$278.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$236.40
Rate for Payer: Group Health Inc Commercial	$173.82
Rate for Payer: Group Health Inc Medicare	$121.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.82
Rate for Payer: Hamaspik Choice Inc Medicare	$173.82

SHILEY CATHETER

Facility

$80.44

Hospital Charge Code	40207001
Hospital Revenue Code	270
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$64.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.22
Rate for Payer: Aetna Government	$40.22
Rate for Payer: Brighton Health Commercial	$60.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.70
Rate for Payer: Group Health Inc Commercial	$40.22
Rate for Payer: Group Health Inc Medicare	$28.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.22
Rate for Payer: Hamaspik Choice Inc Medicare	$40.22

Shiley Tracheotomy Tube

Facility

$297.68

Hospital Charge Code	40205718
Hospital Revenue Code	270
Min. Negotiated Rate	$104.19
Max. Negotiated Rate	$238.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$163.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$148.84
Rate for Payer: Aetna Government	$148.84
Rate for Payer: Brighton Health Commercial	$223.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$238.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$202.42
Rate for Payer: Group Health Inc Commercial	$148.84
Rate for Payer: Group Health Inc Medicare	$104.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.84
Rate for Payer: Hamaspik Choice Inc Medicare	$148.84

SHILEY TUBE TRACH 4LPC CUFF LOW P

Facility

$55.20

Hospital Charge Code	40205146
Hospital Revenue Code	272
Min. Negotiated Rate	$19.32
Max. Negotiated Rate	$44.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.60
Rate for Payer: Aetna Government	$27.60
Rate for Payer: Brighton Health Commercial	$41.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.54
Rate for Payer: Group Health Inc Commercial	$27.60
Rate for Payer: Group Health Inc Medicare	$19.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.60
Rate for Payer: Hamaspik Choice Inc Medicare	$27.60

SHIRT LNG SLEEVE NAVY STYLE 101

Facility

$49.97

Hospital Charge Code	64902978
Hospital Revenue Code	270
Min. Negotiated Rate	$17.49
Max. Negotiated Rate	$39.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.98
Rate for Payer: Aetna Government	$24.98
Rate for Payer: Brighton Health Commercial	$37.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.98
Rate for Payer: Group Health Inc Commercial	$24.98
Rate for Payer: Group Health Inc Medicare	$17.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.98
Rate for Payer: Hamaspik Choice Inc Medicare	$24.98

SHO ARTHRS SRG CAPSULORPAPHY

Facility

$18,117.83

Service Code	HCPCS 29806
Hospital Charge Code	40029937
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

SHO ARTHRS SRG CAPSULORPAPHY

Facility

$18,117.83

Service Code	HCPCS 29806
Hospital Charge Code	40029937
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$13,588.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Brighton Health Commercial	$13,588.37
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
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	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

SHO ARTHRS SRG COMPL SYNVCT

Facility

$8,291.05

Service Code	HCPCS 29821
Hospital Charge Code	40029913
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
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: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
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 Medicaid	$4,145.52
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: Senior Whole Health 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

SHO ARTHRS SRG COMPL SYNVCT

Facility

$8,291.05

Service Code	HCPCS 29821
Hospital Charge Code	40029913
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

SHO ARTHRS SRG DECOMPRESSION

Facility

$2,065.55

Service Code	HCPCS 29826
Hospital Charge Code	40024213
Hospital Revenue Code	360
Min. Negotiated Rate	$182.32
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.32
Rate for Payer: Aetna Government	$182.32
Rate for Payer: Brighton Health Commercial	$1,549.16
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	$1,032.78
Rate for Payer: Group Health Inc Medicare	$722.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,032.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1,032.78

SHO ARTHRS SRG DSTL CLAVICLC

Facility

$8,291.05

Service Code	HCPCS 29824
Hospital Charge Code	40024268
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
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 Medicaid	$4,145.52
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: Senior Whole Health 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

SHO ARTHRS SRG DSTL CLAVICLC

Facility

$8,291.05

Service Code	HCPCS 29824
Hospital Charge Code	40024268
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

SHO ARTHRS SRG LMTD DBRDMT

Facility

$8,291.05

Service Code	HCPCS 29822
Hospital Charge Code	40029938
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

SHO ARTHRS SRG LMTD DBRDMT

Facility

$8,291.05

Service Code	HCPCS 29822
Hospital Charge Code	40029938
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
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: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
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 Medicaid	$4,145.52
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: Senior Whole Health 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

SHO ARTHRS SRG LSS&RESCJ ADS

Facility

$8,291.05

Service Code	HCPCS 29825
Hospital Charge Code	40029914
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

Know your out-of-pocket cost for care.

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