St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BLADES TONGUE

Facility

$0.07

Hospital Charge Code	64901268
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04

BLADE SURGICAL 12 STERILE S/S

Facility

$174.80

Hospital Charge Code	64902175
Hospital Revenue Code	270
Min. Negotiated Rate	$61.18
Max. Negotiated Rate	$139.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$87.40
Rate for Payer: Aetna Government	$87.40
Rate for Payer: Brighton Health Commercial	$131.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.86
Rate for Payer: Group Health Inc Commercial	$87.40
Rate for Payer: Group Health Inc Medicare	$61.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.40
Rate for Payer: Hamaspik Choice Inc Medicare	$87.40

BLADE SURGICAL 20 STERILE S/S

Facility

$0.88

Hospital Charge Code	64901554
Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44

BLADE,SURG,STAINLESS,10 STERIL

Facility

$0.62

Hospital Charge Code	64902170
Hospital Revenue Code	270
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.42
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31

BLADE,SURG,STAINLESS,11 STERIL

Facility

$0.62

Hospital Charge Code	64902173
Hospital Revenue Code	270
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.42
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31

BLADE,SURG,STAINLESS,15,STERIL

Facility

$0.62

Hospital Charge Code	64901556
Hospital Revenue Code	270
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.42
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31

BLAKE DRAIN 15FR ROUND

Facility

$112.12

Hospital Charge Code	64905255
Hospital Revenue Code	270
Min. Negotiated Rate	$39.24
Max. Negotiated Rate	$89.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.06
Rate for Payer: Aetna Government	$56.06
Rate for Payer: Brighton Health Commercial	$84.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.24
Rate for Payer: Group Health Inc Commercial	$56.06
Rate for Payer: Group Health Inc Medicare	$39.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.06
Rate for Payer: Hamaspik Choice Inc Medicare	$56.06

BLAKE DRAN 10MM FLAT FULL

Facility

$149.46

Hospital Charge Code	64905494
Hospital Revenue Code	270
Min. Negotiated Rate	$52.31
Max. Negotiated Rate	$119.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.73
Rate for Payer: Aetna Government	$74.73
Rate for Payer: Brighton Health Commercial	$112.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$101.63
Rate for Payer: Group Health Inc Commercial	$74.73
Rate for Payer: Group Health Inc Medicare	$52.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.73
Rate for Payer: Hamaspik Choice Inc Medicare	$74.73

BLAKEMORE CATHETERS

Facility

$287.05

Hospital Charge Code	40207633
Hospital Revenue Code	270
Min. Negotiated Rate	$100.47
Max. Negotiated Rate	$229.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$143.52
Rate for Payer: Aetna Government	$143.52
Rate for Payer: Brighton Health Commercial	$215.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$229.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$195.19
Rate for Payer: Group Health Inc Commercial	$143.52
Rate for Payer: Group Health Inc Medicare	$100.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.52
Rate for Payer: Hamaspik Choice Inc Medicare	$143.52

BLAKEMORE TRAY

Facility

$63.43

Hospital Charge Code	40200620
Hospital Revenue Code	270
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$50.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.72
Rate for Payer: Aetna Government	$31.72
Rate for Payer: Brighton Health Commercial	$47.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.13
Rate for Payer: Group Health Inc Commercial	$31.72
Rate for Payer: Group Health Inc Medicare	$22.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.72
Rate for Payer: Hamaspik Choice Inc Medicare	$31.72

BLAKEMORE TUBE

Facility

$214.04

Hospital Charge Code	40200080
Hospital Revenue Code	270
Min. Negotiated Rate	$74.91
Max. Negotiated Rate	$171.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.02
Rate for Payer: Aetna Government	$107.02
Rate for Payer: Brighton Health Commercial	$160.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$171.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$145.55
Rate for Payer: Group Health Inc Commercial	$107.02
Rate for Payer: Group Health Inc Medicare	$74.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.02
Rate for Payer: Hamaspik Choice Inc Medicare	$107.02

BLD DRW CENT PERIPHERALCATHVENOUS

Facility

$330.23

Service Code	HCPCS 36592
Hospital Charge Code	40500011
Hospital Revenue Code	300
Rate for Payer: Cash Price	$147.72

BLD DRW CENT PERIPHERALCATHVENOUS

Facility

$330.23

Service Code	HCPCS 36592
Hospital Charge Code	40500011
Hospital Revenue Code	300
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.72
Rate for Payer: Aetna Government	$147.72
Rate for Payer: Affinity Essential Plan 1&2	$103.40
Rate for Payer: Affinity Essential Plan 3&4	$103.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$103.40
Rate for Payer: Brighton Health Commercial	$247.67
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$147.72
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	$147.72
Rate for Payer: EmblemHealth Commercial	$147.72
Rate for Payer: Fidelis Essential Plan Aliesa	$125.56
Rate for Payer: Fidelis Essential Plan QHP	$131.47
Rate for Payer: Fidelis Medicare Advantage	$147.72
Rate for Payer: Fidelis Qualified Health Plan	$131.47
Rate for Payer: Group Health Inc Commercial	$147.72
Rate for Payer: Group Health Inc Medicare	$147.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$147.72
Rate for Payer: Healthfirst Medicare Advantage	$125.56
Rate for Payer: Healthfirst QHP	$147.72
Rate for Payer: Humana Medicare	$150.67
Rate for Payer: Senior Whole Health Medicare Advantage	$147.72
Rate for Payer: United Healthcare Medicare Advantage	$147.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.18
Rate for Payer: Wellcare Medicare	$132.95

BL DRAW < 3 YRS OTHER VEIN

Facility

$37.52

Service Code	HCPCS 36406
Hospital Charge Code	30105080
Hospital Revenue Code	450
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.59
Rate for Payer: Aetna Government	$17.59
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.76
Rate for Payer: Hamaspik Choice Inc Medicare	$18.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: United Healthcare Commercial	$569.00

BL DRAW < 3 YRS SCALP VEIN

Facility

$66.43

Service Code	HCPCS 36405
Hospital Charge Code	30103314
Hospital Revenue Code	450
Min. Negotiated Rate	$17.30
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.30
Rate for Payer: Aetna Government	$17.30
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.22
Rate for Payer: Hamaspik Choice Inc Medicare	$33.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: United Healthcare Commercial	$569.00

BLEOMYCIN 15 UNITS INJ

Facility

$31.08

Service Code	HCPCS J9040
Hospital Charge Code	41643829
Hospital Revenue Code	636
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$15.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.54
Rate for Payer: Hamaspik Choice Inc Medicare	$15.54

BLEOMYCIN 15 UNITS INJ

Facility

$31.08

Service Code	HCPCS J9040
Hospital Charge Code	41653829
Hospital Revenue Code	636
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$15.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.54
Rate for Payer: Hamaspik Choice Inc Medicare	$15.54

BLEOMYCIN 15 UNITS INJ

Facility

$31.08

Service Code	HCPCS J9040
Hospital Charge Code	41643829
Hospital Revenue Code	636
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$25.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.24
Rate for Payer: Aetna Government	$25.24
Rate for Payer: Brighton Health Commercial	$18.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.87
Rate for Payer: Group Health Inc Commercial	$15.54
Rate for Payer: Group Health Inc Medicare	$10.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.54
Rate for Payer: Hamaspik Choice Inc Medicare	$15.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.51
Rate for Payer: SOMOS Essential	$24.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.20

BLEOMYCIN 15 UNITS INJ

Facility

$31.08

Service Code	HCPCS J9040
Hospital Charge Code	41653829
Hospital Revenue Code	636
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$25.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.24
Rate for Payer: Aetna Government	$25.24
Rate for Payer: Brighton Health Commercial	$18.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.87
Rate for Payer: Group Health Inc Commercial	$15.54
Rate for Payer: Group Health Inc Medicare	$10.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.54
Rate for Payer: Hamaspik Choice Inc Medicare	$15.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.51
Rate for Payer: SOMOS Essential	$24.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.20

BLEOMYCIN SULFATE 15 UNITS IJ SOLR [9289]

Facility

$41.40

Service Code	HCPCS J9040
Hospital Charge Code	63323013610
Hospital Revenue Code	250
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$33.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.24
Rate for Payer: Aetna Government	$25.24
Rate for Payer: Brighton Health Commercial	$31.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.15
Rate for Payer: Group Health Inc Commercial	$20.70
Rate for Payer: Group Health Inc Medicare	$14.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.70
Rate for Payer: Hamaspik Choice Inc Medicare	$20.70
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$23.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$24.51
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$24.51
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$24.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.91

BLEPHARATOMY DRAIN EYELID

Facility

$819.25

Service Code	HCPCS 67700
Hospital Charge Code	30105941
Hospital Revenue Code	450
Rate for Payer: Cash Price	$336.88

BLEPHARATOMY DRAIN EYELID

Facility

$819.25

Service Code	HCPCS 67700
Hospital Charge Code	30105941
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$336.88
Rate for Payer: Aetna Government	$336.88
Rate for Payer: Affinity Essential Plan 1&2	$235.82
Rate for Payer: Affinity Essential Plan 3&4	$235.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$235.82
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$336.88
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$336.88
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: Elderplan Medicare Advantage	$336.88
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$286.35
Rate for Payer: Fidelis Essential Plan QHP	$299.82
Rate for Payer: Fidelis Medicare Advantage	$336.88
Rate for Payer: Fidelis Qualified Health Plan	$299.82
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$409.62
Rate for Payer: Hamaspik Choice Inc Medicare	$336.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$336.88
Rate for Payer: Humana Medicare	$343.62
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$336.88
Rate for Payer: Senior Whole Health Medicare Advantage	$336.88
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$336.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$336.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$269.50
Rate for Payer: Wellcare Medicare	$320.04

BLEPHAROTOMY DRAIN EYELID

Facility

$819.25

Service Code	HCPCS 67700
Hospital Charge Code	30305941
Hospital Revenue Code	450
Rate for Payer: Cash Price	$336.88

BLEPHAROTOMY DRAIN EYELID

Facility

$819.25

Service Code	HCPCS 67700
Hospital Charge Code	30305941
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$336.88
Rate for Payer: Aetna Government	$336.88
Rate for Payer: Affinity Essential Plan 1&2	$235.82
Rate for Payer: Affinity Essential Plan 3&4	$235.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$235.82
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$336.88
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$336.88
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: Elderplan Medicare Advantage	$336.88
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$286.35
Rate for Payer: Fidelis Essential Plan QHP	$299.82
Rate for Payer: Fidelis Medicare Advantage	$336.88
Rate for Payer: Fidelis Qualified Health Plan	$299.82
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$409.62
Rate for Payer: Hamaspik Choice Inc Medicare	$336.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$336.88
Rate for Payer: Humana Medicare	$343.62
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$336.88
Rate for Payer: Senior Whole Health Medicare Advantage	$336.88
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$336.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$336.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$269.50
Rate for Payer: Wellcare Medicare	$320.04

BLEPHEROPLASTY

Facility

$4,914.88

Service Code	HCPCS 15820
Hospital Charge Code	40062310
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,108.87

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