St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

UPPR GI ENDOSCOPY/ REMOV FOR BODY

Facility

$2,380.35

Service Code	HCPCS 43247
Hospital Charge Code	41114210
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,048.28

UPPR GI ENDOSCOPY, W BALLOON DILA

Facility

$4,716.98

Service Code	HCPCS 43249
Hospital Charge Code	41114211
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,200.46

UPPR GI ENDOSCOPY, W BALLOON DILA

Facility

$4,716.98

Service Code	HCPCS 43249
Hospital Charge Code	41114211
Hospital Revenue Code	360
Min. Negotiated Rate	$955.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,200.46
Rate for Payer: Aetna Government	$2,200.46
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Cash Price	$2,200.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,200.46
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	$2,200.46
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,870.39
Rate for Payer: Fidelis Essential Plan QHP	$1,958.41
Rate for Payer: Fidelis Medicare Advantage	$2,200.46
Rate for Payer: Fidelis Qualified Health Plan	$1,958.41
Rate for Payer: Group Health Inc Commercial	$2,200.46
Rate for Payer: Group Health Inc Medicare	$2,200.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,358.49
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.46
Rate for Payer: Healthfirst Medicare Advantage	$1,870.39
Rate for Payer: Healthfirst QHP	$2,200.46
Rate for Payer: Senior Whole Health Medicare Advantage	$2,200.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,200.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,760.37
Rate for Payer: Wellcare Medicare	$2,090.44

UPPR GI ENDOSCOPY, W BIOPSY

Facility

$2,380.35

Service Code	HCPCS 43239
Hospital Charge Code	41114209
Hospital Revenue Code	360
Min. Negotiated Rate	$838.62
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,048.28
Rate for Payer: Aetna Government	$1,048.28
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Cash Price	$1,048.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,048.28
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	$1,048.28
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$891.04
Rate for Payer: Fidelis Essential Plan QHP	$932.97
Rate for Payer: Fidelis Medicare Advantage	$1,048.28
Rate for Payer: Fidelis Qualified Health Plan	$932.97
Rate for Payer: Group Health Inc Commercial	$1,048.28
Rate for Payer: Group Health Inc Medicare	$1,048.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,190.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1,048.28
Rate for Payer: Healthfirst Medicare Advantage	$891.04
Rate for Payer: Healthfirst QHP	$1,048.28
Rate for Payer: Senior Whole Health Medicare Advantage	$1,048.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,048.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$838.62
Rate for Payer: Wellcare Medicare	$995.87

UPPR GI ENDOSCOPY, W BIOPSY

Facility

$2,380.35

Service Code	HCPCS 43239
Hospital Charge Code	41114209
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,048.28

UPR/L XTREMITY ART 2 LEVELS

Facility

$330.23

Service Code	HCPCS 93922 TC
Hospital Charge Code	41301524
Hospital Revenue Code	921
Rate for Payer: Cash Price	$147.72

UPR/L XTREMITY ART 2 LEVELS

Facility

$330.23

Service Code	HCPCS 93922 TC
Hospital Charge Code	41301524
Hospital Revenue Code	921
Min. Negotiated Rate	$115.58
Max. Negotiated Rate	$264.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.12
Rate for Payer: Aetna Government	$165.12
Rate for Payer: Brighton Health Commercial	$247.67
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$264.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.56
Rate for Payer: Group Health Inc Commercial	$165.12
Rate for Payer: Group Health Inc Medicare	$115.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$165.12

UREA 20 % EX CREA [19776]

Facility

$0.17

Service Code	NDC 00536110945
Hospital Charge Code	00536110945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

UREA NITROGEN-BF.

Facility

$9.88

Service Code	HCPCS 84520
Hospital Charge Code	40602678
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$7.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.95
Rate for Payer: Aetna Government	$3.95
Rate for Payer: Brighton Health Commercial	$7.41
Rate for Payer: Cash Price	$3.95
Rate for Payer: Cash Price	$3.95
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.30
Rate for Payer: Elderplan Medicare Advantage	$3.95
Rate for Payer: EmblemHealth Commercial	$3.95
Rate for Payer: Fidelis Essential Plan Aliesa	$3.36
Rate for Payer: Fidelis Essential Plan QHP	$3.52
Rate for Payer: Fidelis Medicare Advantage	$3.95
Rate for Payer: Fidelis Qualified Health Plan	$3.52
Rate for Payer: Group Health Inc Commercial	$3.95
Rate for Payer: Group Health Inc Medicare	$3.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.94
Rate for Payer: Hamaspik Choice Inc Medicare	$3.95
Rate for Payer: Healthfirst Medicare Advantage	$3.95
Rate for Payer: Healthfirst QHP	$3.95
Rate for Payer: Senior Whole Health Medicare Advantage	$3.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.16
Rate for Payer: Wellcare Medicare	$3.56

UREA NITROGEN-BF.

Facility

$9.88

Service Code	HCPCS 84520
Hospital Charge Code	40602678
Hospital Revenue Code	301
Rate for Payer: Cash Price	$3.95

UREA NITROGEN (UREA) (BUN)

Facility

$9.88

Service Code	HCPCS 84520
Hospital Charge Code	40602080
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$7.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.95
Rate for Payer: Aetna Government	$3.95
Rate for Payer: Brighton Health Commercial	$7.41
Rate for Payer: Cash Price	$3.95
Rate for Payer: Cash Price	$3.95
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.30
Rate for Payer: Elderplan Medicare Advantage	$3.95
Rate for Payer: EmblemHealth Commercial	$3.95
Rate for Payer: Fidelis Essential Plan Aliesa	$3.36
Rate for Payer: Fidelis Essential Plan QHP	$3.52
Rate for Payer: Fidelis Medicare Advantage	$3.95
Rate for Payer: Fidelis Qualified Health Plan	$3.52
Rate for Payer: Group Health Inc Commercial	$3.95
Rate for Payer: Group Health Inc Medicare	$3.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.94
Rate for Payer: Hamaspik Choice Inc Medicare	$3.95
Rate for Payer: Healthfirst Medicare Advantage	$3.95
Rate for Payer: Healthfirst QHP	$3.95
Rate for Payer: Senior Whole Health Medicare Advantage	$3.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.16
Rate for Payer: Wellcare Medicare	$3.56

UREA NITROGEN (UREA) (BUN)

Facility

$9.88

Service Code	HCPCS 84520
Hospital Charge Code	40602080
Hospital Revenue Code	301
Rate for Payer: Cash Price	$3.95

UREAPLASMA/MYCOPLASMA HOMINIS

Facility

$38.48

Service Code	HCPCS 87109
Hospital Charge Code	40619187
Hospital Revenue Code	300
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$28.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.39
Rate for Payer: Aetna Government	$15.39
Rate for Payer: Brighton Health Commercial	$28.86
Rate for Payer: Cash Price	$15.39
Rate for Payer: Cash Price	$15.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.68
Rate for Payer: Elderplan Medicare Advantage	$15.39
Rate for Payer: EmblemHealth Commercial	$15.39
Rate for Payer: Fidelis Essential Plan Aliesa	$13.08
Rate for Payer: Fidelis Essential Plan QHP	$13.70
Rate for Payer: Fidelis Medicare Advantage	$15.39
Rate for Payer: Fidelis Qualified Health Plan	$13.70
Rate for Payer: Group Health Inc Commercial	$15.39
Rate for Payer: Group Health Inc Medicare	$15.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.24
Rate for Payer: Hamaspik Choice Inc Medicare	$15.39
Rate for Payer: Healthfirst Medicare Advantage	$15.39
Rate for Payer: Healthfirst QHP	$15.39
Rate for Payer: Senior Whole Health Medicare Advantage	$15.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.31
Rate for Payer: Wellcare Medicare	$13.85

UREAPLASMA/MYCOPLASMA HOMINIS

Facility

$38.48

Service Code	HCPCS 87109
Hospital Charge Code	40619187
Hospital Revenue Code	300
Rate for Payer: Cash Price	$15.39

UREA-SKIN EMOLLIENT 20% CREAM

Facility

$15.00

Hospital Charge Code	41643975
Hospital Revenue Code	250
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$12.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.50
Rate for Payer: Aetna Government	$7.50
Rate for Payer: Brighton Health Commercial	$11.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.20
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

UREA-SKIN EMOLLIENT 20% CREAM

Facility

$15.00

Hospital Charge Code	41653975
Hospital Revenue Code	250
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$12.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.50
Rate for Payer: Aetna Government	$7.50
Rate for Payer: Brighton Health Commercial	$11.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.20
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

UR-EOSINOPHIL

Facility

$11.80

Service Code	HCPCS 89050
Hospital Charge Code	40626005
Hospital Revenue Code	300
Rate for Payer: Cash Price	$4.72

UR-EOSINOPHIL

Facility

$11.80

Service Code	HCPCS 89050
Hospital Charge Code	40626005
Hospital Revenue Code	300
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$8.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.72
Rate for Payer: Aetna Government	$4.72
Rate for Payer: Brighton Health Commercial	$8.85
Rate for Payer: Cash Price	$4.72
Rate for Payer: Cash Price	$4.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.35
Rate for Payer: Elderplan Medicare Advantage	$4.72
Rate for Payer: EmblemHealth Commercial	$4.72
Rate for Payer: Fidelis Essential Plan Aliesa	$4.01
Rate for Payer: Fidelis Essential Plan QHP	$4.20
Rate for Payer: Fidelis Medicare Advantage	$4.72
Rate for Payer: Fidelis Qualified Health Plan	$4.20
Rate for Payer: Group Health Inc Commercial	$4.72
Rate for Payer: Group Health Inc Medicare	$4.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.90
Rate for Payer: Hamaspik Choice Inc Medicare	$4.72
Rate for Payer: Healthfirst Medicare Advantage	$4.72
Rate for Payer: Healthfirst QHP	$4.72
Rate for Payer: Senior Whole Health Medicare Advantage	$4.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.78
Rate for Payer: Wellcare Medicare	$4.25

URETERAL LITHOTOMY

Facility

$12,816.53

Service Code	HCPCS 50561
Hospital Charge Code	40123055
Hospital Revenue Code	360
Min. Negotiated Rate	$1,412.00
Max. Negotiated Rate	$9,612.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,983.74
Rate for Payer: Aetna Government	$5,983.74
Rate for Payer: Brighton Health Commercial	$9,612.40
Rate for Payer: Cash Price	$5,983.74
Rate for Payer: Cash Price	$5,983.74
Rate for Payer: Cash Price	$5,983.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5,983.74
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	$5,983.74
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$5,086.18
Rate for Payer: Fidelis Essential Plan QHP	$5,325.53
Rate for Payer: Fidelis Medicare Advantage	$5,983.74
Rate for Payer: Fidelis Qualified Health Plan	$5,325.53
Rate for Payer: Group Health Inc Commercial	$5,983.74
Rate for Payer: Group Health Inc Medicare	$5,983.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,408.26
Rate for Payer: Hamaspik Choice Inc Medicare	$5,983.74
Rate for Payer: Healthfirst Medicare Advantage	$5,086.18
Rate for Payer: Healthfirst QHP	$5,983.74
Rate for Payer: Senior Whole Health Medicare Advantage	$5,983.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,983.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,786.99
Rate for Payer: Wellcare Medicare	$5,684.55

URETERAL LITHOTOMY

Facility

$12,816.53

Service Code	HCPCS 50561
Hospital Charge Code	40123055
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,983.74

URETERAL STENT

Facility

$326.03

Hospital Charge Code	40207004
Hospital Revenue Code	270
Min. Negotiated Rate	$114.11
Max. Negotiated Rate	$260.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.02
Rate for Payer: Aetna Government	$163.02
Rate for Payer: Brighton Health Commercial	$244.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.70
Rate for Payer: Group Health Inc Commercial	$163.02
Rate for Payer: Group Health Inc Medicare	$114.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.02
Rate for Payer: Hamaspik Choice Inc Medicare	$163.02

URETEROLYSIS-RETROPER FIBROSIS

Facility

$3,153.38

Service Code	HCPCS 50715
Hospital Charge Code	40129505
Hospital Revenue Code	360
Min. Negotiated Rate	$1,103.68
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,734.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,525.26
Rate for Payer: Aetna Government	$1,525.26
Rate for Payer: Brighton Health Commercial	$2,365.04
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	$1,576.69
Rate for Payer: Group Health Inc Medicare	$1,103.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,576.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,576.69

URETEROLYSIS-VAG VEIN

Facility

$2,749.40

Service Code	HCPCS 50722
Hospital Charge Code	40129504
Hospital Revenue Code	360
Min. Negotiated Rate	$962.29
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,512.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,246.67
Rate for Payer: Aetna Government	$1,246.67
Rate for Payer: Brighton Health Commercial	$2,062.05
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	$1,374.70
Rate for Payer: Group Health Inc Medicare	$962.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,374.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1,374.70

URETEROSTOMY

Facility

$419.03

Service Code	HCPCS 50686
Hospital Charge Code	40123115
Hospital Revenue Code	360
Min. Negotiated Rate	$144.51
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.64
Rate for Payer: Aetna Government	$180.64
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$180.64
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	$180.64
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$153.54
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$180.64
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$180.64
Rate for Payer: Group Health Inc Medicare	$180.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$180.64
Rate for Payer: Healthfirst Medicare Advantage	$153.54
Rate for Payer: Healthfirst QHP	$180.64
Rate for Payer: Senior Whole Health Medicare Advantage	$180.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.51
Rate for Payer: Wellcare Medicare	$171.61

URETEROSTOMY

Facility

$419.03

Service Code	HCPCS 50686
Hospital Charge Code	40123115
Hospital Revenue Code	360
Rate for Payer: Cash Price	$180.64

Know your out-of-pocket cost for care.

All Charges