St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BUDESONIDE + FORMOTEROL 160 MCG/4.5 MCG

Facility

$136.76

Hospital Charge Code	41655595
Hospital Revenue Code	250
Min. Negotiated Rate	$47.87
Max. Negotiated Rate	$109.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.38
Rate for Payer: Aetna Government	$68.38
Rate for Payer: Brighton Health Commercial	$102.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.00
Rate for Payer: Group Health Inc Commercial	$68.38
Rate for Payer: Group Health Inc Medicare	$47.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.38
Rate for Payer: Hamaspik Choice Inc Medicare	$68.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.89

BUDESONIDE + FORMOTEROL 160 MCG/4.5 MCG

Facility

$136.76

Hospital Charge Code	41645595
Hospital Revenue Code	250
Min. Negotiated Rate	$47.87
Max. Negotiated Rate	$109.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.38
Rate for Payer: Aetna Government	$68.38
Rate for Payer: Brighton Health Commercial	$102.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.00
Rate for Payer: Group Health Inc Commercial	$68.38
Rate for Payer: Group Health Inc Medicare	$47.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.38
Rate for Payer: Hamaspik Choice Inc Medicare	$68.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.89

BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO [81454]

Facility

$39.51

Service Code	NDC 00310737020
Hospital Charge Code	00310737020
Hospital Revenue Code	250
Min. Negotiated Rate	$13.83
Max. Negotiated Rate	$31.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.75
Rate for Payer: Aetna Government	$19.75
Rate for Payer: Brighton Health Commercial	$29.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.86
Rate for Payer: Group Health Inc Commercial	$19.75
Rate for Payer: Group Health Inc Medicare	$13.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.75
Rate for Payer: Hamaspik Choice Inc Medicare	$19.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.68

BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO [81454]

Facility

$27.56

Service Code	NDC 00186037020
Hospital Charge Code	00186037020
Hospital Revenue Code	250
Min. Negotiated Rate	$9.65
Max. Negotiated Rate	$22.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.78
Rate for Payer: Aetna Government	$13.78
Rate for Payer: Brighton Health Commercial	$20.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.74
Rate for Payer: Group Health Inc Commercial	$13.78
Rate for Payer: Group Health Inc Medicare	$9.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.78
Rate for Payer: Hamaspik Choice Inc Medicare	$13.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.92

BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO [81454]

Facility

$31.84

Service Code	NDC 00186037028
Hospital Charge Code	00186037028
Hospital Revenue Code	250
Min. Negotiated Rate	$11.14
Max. Negotiated Rate	$25.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.92
Rate for Payer: Aetna Government	$15.92
Rate for Payer: Brighton Health Commercial	$23.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.65
Rate for Payer: Group Health Inc Commercial	$15.92
Rate for Payer: Group Health Inc Medicare	$11.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.92
Rate for Payer: Hamaspik Choice Inc Medicare	$15.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.70

BUFFALO FILTER

Facility

$1,465.68

Hospital Charge Code	64907349
Hospital Revenue Code	279
Min. Negotiated Rate	$512.99
Max. Negotiated Rate	$1,172.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$806.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$732.84
Rate for Payer: Aetna Government	$732.84
Rate for Payer: Brighton Health Commercial	$1,099.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,172.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$996.66
Rate for Payer: Group Health Inc Commercial	$732.84
Rate for Payer: Group Health Inc Medicare	$512.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$732.84
Rate for Payer: Hamaspik Choice Inc Medicare	$732.84

BUILD UP BLOCK 13/15

Facility

$1,094.52

Service Code	HCPCS C1713
Hospital Charge Code	64907457
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,149.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$601.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$656.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$547.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$629.35
Rate for Payer: EmblemHealth Commercial	$547.26
Rate for Payer: Fidelis Medicare Advantage	$1,149.25
Rate for Payer: Group Health Inc Commercial	$547.26
Rate for Payer: Group Health Inc Medicare	$383.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$547.26
Rate for Payer: Hamaspik Choice Inc Medicare	$547.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$711.44

BUILD UP BLOCK 13/15

Facility

$1,094.52

Service Code	HCPCS C1713
Hospital Charge Code	64907457
Hospital Revenue Code	278
Min. Negotiated Rate	$547.26
Max. Negotiated Rate	$547.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$547.26
Rate for Payer: Hamaspik Choice Inc Medicare	$547.26

BULB LARYNGSCOPE 2.5V LARGE

Facility

$17.44

Hospital Charge Code	64902980
Hospital Revenue Code	270
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$13.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Brighton Health Commercial	$13.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.86
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72

BULB LARYNGSCOPE SMALL 2.5V

Facility

$17.45

Hospital Charge Code	64902981
Hospital Revenue Code	270
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$13.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Brighton Health Commercial	$13.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.87
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72

BULKY BANDAGE 4X84

Facility

$3.12

Hospital Charge Code	41809549
Hospital Revenue Code	270
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.12
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

BULKY BANDAGE 4X84

Facility

$3.12

Hospital Charge Code	41709549
Hospital Revenue Code	270
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.12
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

BUMETANIDE 0.25 MG/ML INJ 10 ML

Facility

$4.00

Hospital Charge Code	41655570
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

BUMETANIDE 0.25 MG/ML INJ 10 ML

Facility

$4.00

Hospital Charge Code	41645570
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

BUMETANIDE 0.25 MG/ML INJ 2 ML

Facility

$3.00

Hospital Charge Code	41641071
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BUMETANIDE 0.25 MG/ML INJ 2 ML

Facility

$3.00

Hospital Charge Code	41651071
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BUMETANIDE 0.25 MG/ML INJ 4 ML

Facility

$3.00

Hospital Charge Code	41644542
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BUMETANIDE 0.25 MG/ML INJ 4 ML

Facility

$3.00

Hospital Charge Code	41654542
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BUMPER KRH DURATION

Facility

$2,096.25

Service Code	HCPCS C1776
Hospital Charge Code	64907263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,048.12
Max. Negotiated Rate	$1,048.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,048.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,048.12

BUMPER KRH DURATION

Facility

$2,096.25

Service Code	HCPCS C1776
Hospital Charge Code	64907263
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,201.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,152.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,257.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,048.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,205.34
Rate for Payer: EmblemHealth Commercial	$1,048.12
Rate for Payer: Fidelis Medicare Advantage	$2,201.06
Rate for Payer: Group Health Inc Commercial	$1,048.12
Rate for Payer: Group Health Inc Medicare	$733.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,048.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,048.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,362.56

BUNDLE VSP ORTHOGNATHIC

Facility

$3,237.50

Hospital Charge Code	64906163
Hospital Revenue Code	270
Min. Negotiated Rate	$1,133.12
Max. Negotiated Rate	$2,590.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,780.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,618.75
Rate for Payer: Aetna Government	$1,618.75
Rate for Payer: Brighton Health Commercial	$2,428.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,590.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,201.50
Rate for Payer: Group Health Inc Commercial	$1,618.75
Rate for Payer: Group Health Inc Medicare	$1,133.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,618.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,618.75

BUNIONECTOMY

Facility

$8,291.05

Service Code	HCPCS 28296
Hospital Charge Code	40021430
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

BUNIONECTOMY

Facility

$8,291.05

Service Code	HCPCS 28296
Hospital Charge Code	40021430
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: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
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: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare 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

BUNIONECTOMY CHEVRON

Facility

$8,291.05

Service Code	HCPCS 28296
Hospital Charge Code	40083193
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: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
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: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare 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

BUNIONECTOMY CHEVRON

Facility

$8,291.05

Service Code	HCPCS 28296
Hospital Charge Code	40083193
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

Know your out-of-pocket cost for care.

All Charges