St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TRIM SKIN LESION

Facility

$502.69

Service Code	HCPCS 11055
Hospital Charge Code	30301100
Hospital Revenue Code	510
Rate for Payer: Cash Price	$231.52

TRIM SKIN LESION

Facility

$502.69

Service Code	HCPCS 11055
Hospital Charge Code	30301100
Hospital Revenue Code	510
Min. Negotiated Rate	$185.22
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
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	$251.34
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

TRIM SKIN LESIONS 2-4

Facility

$529.23

Service Code	HCPCS 11056
Hospital Charge Code	30305439
Hospital Revenue Code	510
Rate for Payer: Cash Price	$231.52

TRIM SKIN LESIONS 2-4

Facility

$529.23

Service Code	HCPCS 11056
Hospital Charge Code	30305439
Hospital Revenue Code	510
Min. Negotiated Rate	$185.22
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
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	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

TRIM SKIN LESIONS >4

Facility

$529.23

Service Code	HCPCS 11057
Hospital Charge Code	30305440
Hospital Revenue Code	510
Min. Negotiated Rate	$185.22
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
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	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

TRIM SKIN LESIONS >4

Facility

$529.23

Service Code	HCPCS 11057
Hospital Charge Code	30305440
Hospital Revenue Code	510
Rate for Payer: Cash Price	$231.52

TRINICA PLATE 20MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	64905359
Hospital Revenue Code	278
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00

TRINICA PLATE 20MM

Facility

$4,940.00

Service Code	HCPCS C1713
Hospital Charge Code	64905359
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,187.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,964.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,470.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,840.50
Rate for Payer: EmblemHealth Commercial	$2,470.00
Rate for Payer: Fidelis Medicare Advantage	$5,187.00
Rate for Payer: Group Health Inc Commercial	$2,470.00
Rate for Payer: Group Health Inc Medicare	$1,729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,211.00

TRIPLE DYE EX SWAB [87825]

Facility

$6.31

Service Code	NDC 66689071006
Hospital Charge Code	66689071006
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$5.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.16
Rate for Payer: Aetna Government	$3.16
Rate for Payer: Brighton Health Commercial	$4.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.29
Rate for Payer: Group Health Inc Commercial	$3.16
Rate for Payer: Group Health Inc Medicare	$2.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.16
Rate for Payer: Hamaspik Choice Inc Medicare	$3.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.10

TRIPLE DYE STICK

Facility

$1.00

Hospital Charge Code	41651417
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

TRIPLE DYE STICK

Facility

$1.00

Hospital Charge Code	41641417
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

Triple Lumen Cath.

Facility

$88.60

Hospital Charge Code	40206025
Hospital Revenue Code	270
Min. Negotiated Rate	$31.01
Max. Negotiated Rate	$70.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.30
Rate for Payer: Aetna Government	$44.30
Rate for Payer: Brighton Health Commercial	$66.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.25
Rate for Payer: Group Health Inc Commercial	$44.30
Rate for Payer: Group Health Inc Medicare	$31.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.30
Rate for Payer: Hamaspik Choice Inc Medicare	$44.30

TRISMUS APPLIANCE (NOT FOR TMD TR

Facility

$362.50

Service Code	HCPCS D5937
Hospital Charge Code	42301320
Hospital Revenue Code	361
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$199.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.43
Rate for Payer: Aetna Government	$242.43
Rate for Payer: Brighton Health Commercial	$271.88
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: Group Health Inc Commercial	$181.25
Rate for Payer: Group Health Inc Medicare	$126.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.25
Rate for Payer: Hamaspik Choice Inc Medicare	$181.25

TRI-STAPLER 2.0 45 MED THICK

Facility

$9,278.40

Hospital Charge Code	40008319
Hospital Revenue Code	272
Min. Negotiated Rate	$3,247.44
Max. Negotiated Rate	$7,422.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,103.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,639.20
Rate for Payer: Aetna Government	$4,639.20
Rate for Payer: Brighton Health Commercial	$6,958.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,422.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,309.31
Rate for Payer: Group Health Inc Commercial	$4,639.20
Rate for Payer: Group Health Inc Medicare	$3,247.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,639.20
Rate for Payer: Hamaspik Choice Inc Medicare	$4,639.20

TRIVANTAGE TUBE

Facility

$822.50

Hospital Charge Code	64905130
Hospital Revenue Code	270
Min. Negotiated Rate	$287.88
Max. Negotiated Rate	$658.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$411.25
Rate for Payer: Aetna Government	$411.25
Rate for Payer: Brighton Health Commercial	$616.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$658.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$559.30
Rate for Payer: Group Health Inc Commercial	$411.25
Rate for Payer: Group Health Inc Medicare	$287.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.25
Rate for Payer: Hamaspik Choice Inc Medicare	$411.25

TRLUML PERIP ATHRC BRCHIOCPH

Facility

$48,278.18

Service Code	HCPCS 0238T
Hospital Charge Code	40034271
Hospital Revenue Code	360
Rate for Payer: Cash Price	$20,278.00

TRLUML PERIP ATHRC BRCHIOCPH

Facility

$48,278.18

Service Code	HCPCS 0238T
Hospital Charge Code	40034271
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$36,208.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Brighton Health Commercial	$36,208.64
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
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	$20,278.00
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$17,236.30
Rate for Payer: Fidelis Essential Plan QHP	$18,047.42
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Fidelis Qualified Health Plan	$18,047.42
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,139.09
Rate for Payer: Hamaspik Choice Inc Medicare	$20,278.00
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20,278.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40
Rate for Payer: Wellcare Medicare	$19,264.10

TROCAR 10/11MM 100MM LENGTH

Facility

$891.95

Hospital Charge Code	64902723
Hospital Revenue Code	270
Min. Negotiated Rate	$312.18
Max. Negotiated Rate	$713.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$490.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$445.98
Rate for Payer: Aetna Government	$445.98
Rate for Payer: Brighton Health Commercial	$668.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$713.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$606.53
Rate for Payer: Group Health Inc Commercial	$445.98
Rate for Payer: Group Health Inc Medicare	$312.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$445.98
Rate for Payer: Hamaspik Choice Inc Medicare	$445.98

TROCAR ASSEMBLY 4MM LONG

Facility

$226.80

Hospital Charge Code	40200151
Hospital Revenue Code	272
Min. Negotiated Rate	$79.38
Max. Negotiated Rate	$181.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.40
Rate for Payer: Aetna Government	$113.40
Rate for Payer: Brighton Health Commercial	$170.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$181.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$154.22
Rate for Payer: Group Health Inc Commercial	$113.40
Rate for Payer: Group Health Inc Medicare	$79.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.40
Rate for Payer: Hamaspik Choice Inc Medicare	$113.40

TROCAR ASSEMBLY 4MM SHRT

Facility

$606.00

Hospital Charge Code	40200188
Hospital Revenue Code	270
Min. Negotiated Rate	$212.10
Max. Negotiated Rate	$484.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$333.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$303.00
Rate for Payer: Aetna Government	$303.00
Rate for Payer: Brighton Health Commercial	$454.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$484.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$412.08
Rate for Payer: Group Health Inc Commercial	$303.00
Rate for Payer: Group Health Inc Medicare	$212.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$303.00
Rate for Payer: Hamaspik Choice Inc Medicare	$303.00

TROCAR ASSEMBLY 5MM EXTRA SHORT

Facility

$605.38

Hospital Charge Code	40200325
Hospital Revenue Code	272
Min. Negotiated Rate	$211.88
Max. Negotiated Rate	$484.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$332.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$302.69
Rate for Payer: Aetna Government	$302.69
Rate for Payer: Brighton Health Commercial	$454.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$484.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$411.66
Rate for Payer: Group Health Inc Commercial	$302.69
Rate for Payer: Group Health Inc Medicare	$211.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.69
Rate for Payer: Hamaspik Choice Inc Medicare	$302.69

TROCAR ASSEMBLY 5MM SHORT

Facility

$605.38

Hospital Charge Code	40200326
Hospital Revenue Code	272
Min. Negotiated Rate	$211.88
Max. Negotiated Rate	$484.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$332.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$302.69
Rate for Payer: Aetna Government	$302.69
Rate for Payer: Brighton Health Commercial	$454.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$484.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$411.66
Rate for Payer: Group Health Inc Commercial	$302.69
Rate for Payer: Group Health Inc Medicare	$211.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.69
Rate for Payer: Hamaspik Choice Inc Medicare	$302.69

TROCAR ASSEMBLY 6MM LONG

Facility

$605.38

Hospital Charge Code	40200328
Hospital Revenue Code	272
Min. Negotiated Rate	$211.88
Max. Negotiated Rate	$484.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$332.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$302.69
Rate for Payer: Aetna Government	$302.69
Rate for Payer: Brighton Health Commercial	$454.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$484.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$411.66
Rate for Payer: Group Health Inc Commercial	$302.69
Rate for Payer: Group Health Inc Medicare	$211.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.69
Rate for Payer: Hamaspik Choice Inc Medicare	$302.69

TROCAR ASSEMBLY 6MM SHORT

Facility

$605.38

Hospital Charge Code	40200327
Hospital Revenue Code	272
Min. Negotiated Rate	$211.88
Max. Negotiated Rate	$484.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$332.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$302.69
Rate for Payer: Aetna Government	$302.69
Rate for Payer: Brighton Health Commercial	$454.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$484.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$411.66
Rate for Payer: Group Health Inc Commercial	$302.69
Rate for Payer: Group Health Inc Medicare	$211.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$302.69
Rate for Payer: Hamaspik Choice Inc Medicare	$302.69

TROCAR BALLOON&INFLATION BULB

Facility

$531.08

Service Code	HCPCS C1725
Hospital Charge Code	40207000
Hospital Revenue Code	278
Min. Negotiated Rate	$265.54
Max. Negotiated Rate	$265.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.54
Rate for Payer: Hamaspik Choice Inc Medicare	$265.54

Know your out-of-pocket cost for care.

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