St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SURGICLIP PREM II M-11.5 TIT

Facility

$454.05

Hospital Charge Code	64904616
Hospital Revenue Code	270
Min. Negotiated Rate	$158.92
Max. Negotiated Rate	$363.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$249.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$227.02
Rate for Payer: Aetna Government	$227.02
Rate for Payer: Brighton Health Commercial	$340.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$363.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$308.75
Rate for Payer: Group Health Inc Commercial	$227.02
Rate for Payer: Group Health Inc Medicare	$158.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.02
Rate for Payer: Hamaspik Choice Inc Medicare	$227.02

SURGICLIP PREM S 9.0 TITANIUM

Facility

$111.36

Hospital Charge Code	40205968
Hospital Revenue Code	270
Min. Negotiated Rate	$38.98
Max. Negotiated Rate	$89.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.68
Rate for Payer: Aetna Government	$55.68
Rate for Payer: Brighton Health Commercial	$83.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.72
Rate for Payer: Group Health Inc Commercial	$55.68
Rate for Payer: Group Health Inc Medicare	$38.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.68
Rate for Payer: Hamaspik Choice Inc Medicare	$55.68

SURGICLIP PREM S-9.0 TITANIUM

Facility

$438.48

Hospital Charge Code	64904617
Hospital Revenue Code	270
Min. Negotiated Rate	$153.47
Max. Negotiated Rate	$350.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$241.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$219.24
Rate for Payer: Aetna Government	$219.24
Rate for Payer: Brighton Health Commercial	$328.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$298.17
Rate for Payer: Group Health Inc Commercial	$219.24
Rate for Payer: Group Health Inc Medicare	$153.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.24
Rate for Payer: Hamaspik Choice Inc Medicare	$219.24

SURGIMED 2.0 COLLAGEN MATRIX

Facility

$11,050.00

Service Code	HCPCS C9360
Hospital Charge Code	40205000
Hospital Revenue Code	636
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$7,182.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,077.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.32
Rate for Payer: Aetna Government	$13.32
Rate for Payer: Brighton Health Commercial	$6,630.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,525.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,353.75
Rate for Payer: Group Health Inc Commercial	$5,525.00
Rate for Payer: Group Health Inc Medicare	$3,867.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,525.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,525.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,182.50

SURGIMED 2.0 COLLAGEN MATRIX

Facility

$11,050.00

Service Code	HCPCS C9360
Hospital Charge Code	40205000
Hospital Revenue Code	636
Min. Negotiated Rate	$5,525.00
Max. Negotiated Rate	$5,525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,525.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,525.00

SURGIMEND COLLAGEN MTX SFT TISS

Facility

$48.00

Hospital Charge Code	40209552
Hospital Revenue Code	270
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.00
Rate for Payer: Aetna Government	$24.00
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.64
Rate for Payer: Group Health Inc Commercial	$24.00
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00
Rate for Payer: Hamaspik Choice Inc Medicare	$24.00

SURGINEEDLE SGL USE

Facility

$29.65

Hospital Charge Code	64907090
Hospital Revenue Code	270
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$23.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.82
Rate for Payer: Aetna Government	$14.82
Rate for Payer: Brighton Health Commercial	$22.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.16
Rate for Payer: Group Health Inc Commercial	$14.82
Rate for Payer: Group Health Inc Medicare	$10.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.82
Rate for Payer: Hamaspik Choice Inc Medicare	$14.82

SURGISIS IHM INGUINAL HERNIA

Facility

$370.00

Hospital Charge Code	40202011
Hospital Revenue Code	270
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$296.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$185.00
Rate for Payer: Aetna Government	$185.00
Rate for Payer: Brighton Health Commercial	$277.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$296.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$251.60
Rate for Payer: Group Health Inc Commercial	$185.00
Rate for Payer: Group Health Inc Medicare	$129.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.00
Rate for Payer: Hamaspik Choice Inc Medicare	$185.00

SURG PATH LEVEL I GROSS EXAM

Facility

$69.63

Service Code	HCPCS 88300
Hospital Charge Code	40635401
Hospital Revenue Code	312
Min. Negotiated Rate	$21.44
Max. Negotiated Rate	$38.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.43
Rate for Payer: Aetna Government	$34.43
Rate for Payer: Brighton Health Commercial	$34.43
Rate for Payer: Cash Price	$34.43
Rate for Payer: Cash Price	$34.43
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$34.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.44
Rate for Payer: Elderplan Medicare Advantage	$34.43
Rate for Payer: EmblemHealth Commercial	$34.43
Rate for Payer: Fidelis Essential Plan Aliesa	$29.27
Rate for Payer: Fidelis Essential Plan QHP	$30.64
Rate for Payer: Fidelis Medicare Advantage	$34.43
Rate for Payer: Fidelis Qualified Health Plan	$30.64
Rate for Payer: Group Health Inc Commercial	$34.43
Rate for Payer: Group Health Inc Medicare	$34.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.82
Rate for Payer: Hamaspik Choice Inc Medicare	$34.43
Rate for Payer: Healthfirst Medicare Advantage	$34.43
Rate for Payer: Healthfirst QHP	$34.43
Rate for Payer: Senior Whole Health Medicare Advantage	$34.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.54
Rate for Payer: Wellcare Medicare	$30.99

SURG PATH LEVEL I GROSS EXAM

Facility

$69.63

Service Code	HCPCS 88300
Hospital Charge Code	40635401
Hospital Revenue Code	312
Rate for Payer: Cash Price	$34.43

SURG PATH LEVEL IV GROSS & MICRO

Facility

$149.83

Service Code	HCPCS 88305
Hospital Charge Code	40635418
Hospital Revenue Code	312
Rate for Payer: Cash Price	$62.66

SURG PATH LEVEL IV GROSS & MICRO

Facility

$149.83

Service Code	HCPCS 88305
Hospital Charge Code	40635418
Hospital Revenue Code	312
Min. Negotiated Rate	$50.13
Max. Negotiated Rate	$82.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.66
Rate for Payer: Aetna Government	$62.66
Rate for Payer: Brighton Health Commercial	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$62.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.56
Rate for Payer: Elderplan Medicare Advantage	$62.66
Rate for Payer: EmblemHealth Commercial	$62.66
Rate for Payer: Fidelis Essential Plan Aliesa	$53.26
Rate for Payer: Fidelis Essential Plan QHP	$55.77
Rate for Payer: Fidelis Medicare Advantage	$62.66
Rate for Payer: Fidelis Qualified Health Plan	$55.77
Rate for Payer: Group Health Inc Commercial	$62.66
Rate for Payer: Group Health Inc Medicare	$62.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.92
Rate for Payer: Hamaspik Choice Inc Medicare	$62.66
Rate for Payer: Healthfirst Medicare Advantage	$62.66
Rate for Payer: Healthfirst QHP	$62.66
Rate for Payer: Senior Whole Health Medicare Advantage	$62.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.13
Rate for Payer: Wellcare Medicare	$56.39

SURG PATH LEV II GROSS & MICRO

Facility

$69.63

Service Code	HCPCS 88302
Hospital Charge Code	40635406
Hospital Revenue Code	312
Min. Negotiated Rate	$27.54
Max. Negotiated Rate	$52.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.43
Rate for Payer: Aetna Government	$34.43
Rate for Payer: Brighton Health Commercial	$34.43
Rate for Payer: Cash Price	$34.43
Rate for Payer: Cash Price	$34.43
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$34.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.82
Rate for Payer: Elderplan Medicare Advantage	$34.43
Rate for Payer: EmblemHealth Commercial	$34.43
Rate for Payer: Fidelis Essential Plan Aliesa	$29.27
Rate for Payer: Fidelis Essential Plan QHP	$30.64
Rate for Payer: Fidelis Medicare Advantage	$34.43
Rate for Payer: Fidelis Qualified Health Plan	$30.64
Rate for Payer: Group Health Inc Commercial	$34.43
Rate for Payer: Group Health Inc Medicare	$34.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.82
Rate for Payer: Hamaspik Choice Inc Medicare	$34.43
Rate for Payer: Healthfirst Medicare Advantage	$34.43
Rate for Payer: Healthfirst QHP	$34.43
Rate for Payer: Senior Whole Health Medicare Advantage	$34.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.54
Rate for Payer: Wellcare Medicare	$30.99

SURG PATH LEV II GROSS & MICRO

Facility

$69.63

Service Code	HCPCS 88302
Hospital Charge Code	40635406
Hospital Revenue Code	312
Rate for Payer: Cash Price	$34.43

SURG PATH LEV III GROSS & MICR

Facility

$149.83

Service Code	HCPCS 88304
Hospital Charge Code	40635409
Hospital Revenue Code	312
Rate for Payer: Cash Price	$62.66

SURG PATH LEV III GROSS & MICR

Facility

$149.83

Service Code	HCPCS 88304
Hospital Charge Code	40635409
Hospital Revenue Code	312
Min. Negotiated Rate	$49.36
Max. Negotiated Rate	$82.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.66
Rate for Payer: Aetna Government	$62.66
Rate for Payer: Brighton Health Commercial	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$62.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.36
Rate for Payer: Elderplan Medicare Advantage	$62.66
Rate for Payer: EmblemHealth Commercial	$62.66
Rate for Payer: Fidelis Essential Plan Aliesa	$53.26
Rate for Payer: Fidelis Essential Plan QHP	$55.77
Rate for Payer: Fidelis Medicare Advantage	$62.66
Rate for Payer: Fidelis Qualified Health Plan	$55.77
Rate for Payer: Group Health Inc Commercial	$62.66
Rate for Payer: Group Health Inc Medicare	$62.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.92
Rate for Payer: Hamaspik Choice Inc Medicare	$62.66
Rate for Payer: Healthfirst Medicare Advantage	$62.66
Rate for Payer: Healthfirst QHP	$62.66
Rate for Payer: Senior Whole Health Medicare Advantage	$62.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.13
Rate for Payer: Wellcare Medicare	$56.39

SURG PATH LEV V GROSS & MICRO

Facility

$858.38

Service Code	HCPCS 88307
Hospital Charge Code	40635421
Hospital Revenue Code	312
Min. Negotiated Rate	$140.29
Max. Negotiated Rate	$472.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$472.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$415.67
Rate for Payer: Aetna Government	$415.67
Rate for Payer: Brighton Health Commercial	$415.67
Rate for Payer: Cash Price	$415.67
Rate for Payer: Cash Price	$415.67
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$415.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$165.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.29
Rate for Payer: Elderplan Medicare Advantage	$415.67
Rate for Payer: EmblemHealth Commercial	$415.67
Rate for Payer: Fidelis Essential Plan Aliesa	$353.32
Rate for Payer: Fidelis Essential Plan QHP	$369.95
Rate for Payer: Fidelis Medicare Advantage	$415.67
Rate for Payer: Fidelis Qualified Health Plan	$369.95
Rate for Payer: Group Health Inc Commercial	$415.67
Rate for Payer: Group Health Inc Medicare	$415.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$429.19
Rate for Payer: Hamaspik Choice Inc Medicare	$415.67
Rate for Payer: Healthfirst Medicare Advantage	$415.67
Rate for Payer: Healthfirst QHP	$415.67
Rate for Payer: Senior Whole Health Medicare Advantage	$415.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$415.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$332.54
Rate for Payer: Wellcare Medicare	$374.10

SURG PATH LEV V GROSS & MICRO

Facility

$858.38

Service Code	HCPCS 88307
Hospital Charge Code	40635421
Hospital Revenue Code	312
Rate for Payer: Cash Price	$415.67

SURG PATH LEV VI GROSS & MICRO

Facility

$1,902.65

Service Code	HCPCS 88309
Hospital Charge Code	40635426
Hospital Revenue Code	312
Rate for Payer: Cash Price	$994.39

SURG PATH LEV VI GROSS & MICRO

Facility

$1,902.65

Service Code	HCPCS 88309
Hospital Charge Code	40635426
Hospital Revenue Code	312
Min. Negotiated Rate	$194.84
Max. Negotiated Rate	$1,046.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,046.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$994.39
Rate for Payer: Aetna Government	$994.39
Rate for Payer: Brighton Health Commercial	$994.39
Rate for Payer: Cash Price	$994.39
Rate for Payer: Cash Price	$994.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$994.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$230.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$194.84
Rate for Payer: Elderplan Medicare Advantage	$994.39
Rate for Payer: EmblemHealth Commercial	$994.39
Rate for Payer: Fidelis Essential Plan Aliesa	$845.23
Rate for Payer: Fidelis Essential Plan QHP	$885.01
Rate for Payer: Fidelis Medicare Advantage	$994.39
Rate for Payer: Fidelis Qualified Health Plan	$885.01
Rate for Payer: Group Health Inc Commercial	$994.39
Rate for Payer: Group Health Inc Medicare	$994.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$951.32
Rate for Payer: Hamaspik Choice Inc Medicare	$994.39
Rate for Payer: Healthfirst Medicare Advantage	$994.39
Rate for Payer: Healthfirst QHP	$994.39
Rate for Payer: Senior Whole Health Medicare Advantage	$994.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$994.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$795.51
Rate for Payer: Wellcare Medicare	$894.95

SURG PREP/H/F/DIGITS/<100SQCM

Facility

$1,505.35

Service Code	HCPCS 15004
Hospital Charge Code	42500192
Hospital Revenue Code	361
Rate for Payer: Cash Price	$726.29

SURG PREP/H/F/DIGITS/<100SQCM

Facility

$1,505.35

Service Code	HCPCS 15004
Hospital Charge Code	42500192
Hospital Revenue Code	361
Min. Negotiated Rate	$581.03
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$726.29
Rate for Payer: Aetna Government	$726.29
Rate for Payer: Brighton Health Commercial	$1,129.01
Rate for Payer: Cash Price	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$726.29
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	$726.29
Rate for Payer: EmblemHealth Commercial	$726.29
Rate for Payer: Fidelis Essential Plan Aliesa	$617.35
Rate for Payer: Fidelis Essential Plan QHP	$646.40
Rate for Payer: Fidelis Medicare Advantage	$726.29
Rate for Payer: Fidelis Qualified Health Plan	$646.40
Rate for Payer: Group Health Inc Commercial	$726.29
Rate for Payer: Group Health Inc Medicare	$726.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$752.68
Rate for Payer: Hamaspik Choice Inc Medicare	$726.29
Rate for Payer: Healthfirst Medicare Advantage	$617.35
Rate for Payer: Healthfirst QHP	$726.29
Rate for Payer: Senior Whole Health Medicare Advantage	$726.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$726.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$581.03
Rate for Payer: Wellcare Medicare	$689.98

SURG PROCEDURE FOR ISOLATION TOOT

Facility

$138.92

Service Code	HCPCS D3910
Hospital Charge Code	42300810
Hospital Revenue Code	361
Min. Negotiated Rate	$69.46
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$76.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$104.19
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	$69.46
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: Senior Whole Health 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

SURG PROCEDURE FOR ISOLATION TOOT

Facility

$138.92

Service Code	HCPCS D3910
Hospital Charge Code	42300810
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

SURG. REDUC. OSSEOUS TUBEROSITY

Facility

$800.00

Service Code	HCPCS D7485
Hospital Charge Code	42303411
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,772.21

Know your out-of-pocket cost for care.

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