St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CORAIL2 STD SZ 13

Facility

$21,435.00

Service Code	HCPCS C1776
Hospital Charge Code	64903614
Hospital Revenue Code	278
Min. Negotiated Rate	$10,717.50
Max. Negotiated Rate	$10,717.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,717.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10,717.50

CORAIL AMT COLLAR SZ 16

Facility

$17,406.00

Service Code	HCPCS C1776
Hospital Charge Code	40005147
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$18,276.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,573.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$10,443.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,703.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,008.45
Rate for Payer: EmblemHealth Commercial	$8,703.00
Rate for Payer: Fidelis Medicare Advantage	$18,276.30
Rate for Payer: Group Health Inc Commercial	$8,703.00
Rate for Payer: Group Health Inc Medicare	$6,092.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,703.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,703.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,313.90

CORAIL AMT COLLAR SZ 16

Facility

$21,757.50

Service Code	HCPCS C1776
Hospital Charge Code	64905207
Hospital Revenue Code	278
Min. Negotiated Rate	$10,878.75
Max. Negotiated Rate	$10,878.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,878.75
Rate for Payer: Hamaspik Choice Inc Medicare	$10,878.75

CORAIL AMT COLLAR SZ 16

Facility

$17,406.00

Service Code	HCPCS C1776
Hospital Charge Code	40005147
Hospital Revenue Code	278
Min. Negotiated Rate	$8,703.00
Max. Negotiated Rate	$8,703.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,703.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,703.00

CORAIL AMT COLLAR SZ 16

Facility

$21,757.50

Service Code	HCPCS C1776
Hospital Charge Code	64905207
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$22,845.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,966.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$13,054.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,878.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,510.56
Rate for Payer: EmblemHealth Commercial	$10,878.75
Rate for Payer: Fidelis Medicare Advantage	$22,845.38
Rate for Payer: Group Health Inc Commercial	$10,878.75
Rate for Payer: Group Health Inc Medicare	$7,615.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,878.75
Rate for Payer: Hamaspik Choice Inc Medicare	$10,878.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,142.38

CORD BLOOD

Facility

$330.23

Service Code	HCPCS 86900
Hospital Charge Code	40711115
Hospital Revenue Code	300
Rate for Payer: Cash Price	$147.72

CORD BLOOD

Facility

$330.23

Service Code	HCPCS 86900
Hospital Charge Code	40711115
Hospital Revenue Code	300
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$247.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
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: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.02
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	$147.72
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 Commercial	$3.78
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

CORD BLOOD GAS,ARTERIAL

Facility

$65.18

Service Code	HCPCS 82803
Hospital Charge Code	40602312
Hospital Revenue Code	301
Rate for Payer: Cash Price	$26.07

CORD BLOOD GAS,ARTERIAL

Facility

$65.18

Service Code	HCPCS 82803
Hospital Charge Code	40602312
Hospital Revenue Code	301
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$48.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.07
Rate for Payer: Aetna Government	$26.07
Rate for Payer: Affinity Essential Plan 1&2	$18.25
Rate for Payer: Affinity Essential Plan 3&4	$18.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$18.25
Rate for Payer: Brighton Health Commercial	$48.88
Rate for Payer: Cash Price	$26.07
Rate for Payer: Cash Price	$26.07
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$26.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.02
Rate for Payer: Elderplan Medicare Advantage	$26.07
Rate for Payer: EmblemHealth Commercial	$26.07
Rate for Payer: Fidelis Essential Plan Aliesa	$22.16
Rate for Payer: Fidelis Essential Plan QHP	$23.20
Rate for Payer: Fidelis Medicare Advantage	$26.07
Rate for Payer: Fidelis Qualified Health Plan	$23.20
Rate for Payer: Group Health Inc Commercial	$26.07
Rate for Payer: Group Health Inc Medicare	$26.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.59
Rate for Payer: Hamaspik Choice Inc Medicare	$26.07
Rate for Payer: Healthfirst Medicare Advantage	$26.07
Rate for Payer: Healthfirst QHP	$26.07
Rate for Payer: Humana Medicare	$26.59
Rate for Payer: Senior Whole Health Medicare Advantage	$26.07
Rate for Payer: United Healthcare Commercial	$24.50
Rate for Payer: United Healthcare Medicare Advantage	$26.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.86
Rate for Payer: Wellcare Medicare	$23.46

CORD BLOOD GAS, VENOUS

Facility

$65.18

Service Code	HCPCS 82803
Hospital Charge Code	40602313
Hospital Revenue Code	301
Rate for Payer: Cash Price	$26.07

CORD BLOOD GAS, VENOUS

Facility

$65.18

Service Code	HCPCS 82803
Hospital Charge Code	40602313
Hospital Revenue Code	301
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$48.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.07
Rate for Payer: Aetna Government	$26.07
Rate for Payer: Affinity Essential Plan 1&2	$18.25
Rate for Payer: Affinity Essential Plan 3&4	$18.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$18.25
Rate for Payer: Brighton Health Commercial	$48.88
Rate for Payer: Cash Price	$26.07
Rate for Payer: Cash Price	$26.07
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$26.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.02
Rate for Payer: Elderplan Medicare Advantage	$26.07
Rate for Payer: EmblemHealth Commercial	$26.07
Rate for Payer: Fidelis Essential Plan Aliesa	$22.16
Rate for Payer: Fidelis Essential Plan QHP	$23.20
Rate for Payer: Fidelis Medicare Advantage	$26.07
Rate for Payer: Fidelis Qualified Health Plan	$23.20
Rate for Payer: Group Health Inc Commercial	$26.07
Rate for Payer: Group Health Inc Medicare	$26.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.59
Rate for Payer: Hamaspik Choice Inc Medicare	$26.07
Rate for Payer: Healthfirst Medicare Advantage	$26.07
Rate for Payer: Healthfirst QHP	$26.07
Rate for Payer: Humana Medicare	$26.59
Rate for Payer: Senior Whole Health Medicare Advantage	$26.07
Rate for Payer: United Healthcare Commercial	$24.50
Rate for Payer: United Healthcare Medicare Advantage	$26.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.86
Rate for Payer: Wellcare Medicare	$23.46

CORD BLOOD RPR

Facility

$10.68

Service Code	HCPCS 86592
Hospital Charge Code	40721423
Hospital Revenue Code	302
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$8.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.27
Rate for Payer: Aetna Government	$4.27
Rate for Payer: Affinity Essential Plan 1&2	$2.99
Rate for Payer: Affinity Essential Plan 3&4	$2.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.99
Rate for Payer: Brighton Health Commercial	$8.01
Rate for Payer: Cash Price	$4.27
Rate for Payer: Cash Price	$4.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.74
Rate for Payer: Elderplan Medicare Advantage	$4.27
Rate for Payer: EmblemHealth Commercial	$4.27
Rate for Payer: Fidelis Essential Plan Aliesa	$3.63
Rate for Payer: Fidelis Essential Plan QHP	$3.80
Rate for Payer: Fidelis Medicare Advantage	$4.27
Rate for Payer: Fidelis Qualified Health Plan	$3.80
Rate for Payer: Group Health Inc Commercial	$4.27
Rate for Payer: Group Health Inc Medicare	$4.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.34
Rate for Payer: Hamaspik Choice Inc Medicare	$4.27
Rate for Payer: Healthfirst Medicare Advantage	$4.27
Rate for Payer: Healthfirst QHP	$4.27
Rate for Payer: Humana Medicare	$4.36
Rate for Payer: Senior Whole Health Medicare Advantage	$4.27
Rate for Payer: United Healthcare Commercial	$5.41
Rate for Payer: United Healthcare Medicare Advantage	$4.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.42
Rate for Payer: Wellcare Medicare	$3.84

CORD BLOOD RPR

Facility

$10.68

Service Code	HCPCS 86592
Hospital Charge Code	40721423
Hospital Revenue Code	302
Rate for Payer: Cash Price	$4.27

CORD BUCKS TRACTION

Facility

$232.50

Hospital Charge Code	64904101
Hospital Revenue Code	270
Min. Negotiated Rate	$81.38
Max. Negotiated Rate	$186.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$116.25
Rate for Payer: Aetna Government	$116.25
Rate for Payer: Brighton Health Commercial	$174.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$186.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$158.10
Rate for Payer: Group Health Inc Commercial	$116.25
Rate for Payer: Group Health Inc Medicare	$81.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.25
Rate for Payer: Hamaspik Choice Inc Medicare	$116.25

CORDIS FILTER VENA CAVA PRM TRAPE

Facility

$2,400.00

Service Code	HCPCS C1880
Hospital Charge Code	40209930
Hospital Revenue Code	278
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$2,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.08
Rate for Payer: Aetna Government	$57.08
Rate for Payer: Brighton Health Commercial	$1,440.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,380.00
Rate for Payer: EmblemHealth Commercial	$1,200.00
Rate for Payer: Fidelis Medicare Advantage	$2,520.00
Rate for Payer: Group Health Inc Commercial	$1,200.00
Rate for Payer: Group Health Inc Medicare	$840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,560.00

CORDIS FILTER VENA CAVA PRM TRAPE

Facility

$2,400.00

Service Code	HCPCS C1880
Hospital Charge Code	40209930
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00

COR DISPOSABLE SET SZ 6MM

Facility

$1,890.00

Hospital Charge Code	40209620
Hospital Revenue Code	270
Min. Negotiated Rate	$661.50
Max. Negotiated Rate	$1,512.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,039.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$945.00
Rate for Payer: Aetna Government	$945.00
Rate for Payer: Brighton Health Commercial	$1,417.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,512.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,285.20
Rate for Payer: Group Health Inc Commercial	$945.00
Rate for Payer: Group Health Inc Medicare	$661.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$945.00
Rate for Payer: Hamaspik Choice Inc Medicare	$945.00

COR DISPOSABLE SET SZ 8MM

Facility

$1,576.00

Hospital Charge Code	40209621
Hospital Revenue Code	270
Min. Negotiated Rate	$551.60
Max. Negotiated Rate	$1,260.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$866.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$788.00
Rate for Payer: Aetna Government	$788.00
Rate for Payer: Brighton Health Commercial	$1,182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,260.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,071.68
Rate for Payer: Group Health Inc Commercial	$788.00
Rate for Payer: Group Health Inc Medicare	$551.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$788.00
Rate for Payer: Hamaspik Choice Inc Medicare	$788.00

CORD MONOPOLAR W/8MM PLUG

Facility

$68.50

Hospital Charge Code	64905020
Hospital Revenue Code	270
Min. Negotiated Rate	$23.98
Max. Negotiated Rate	$54.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.25
Rate for Payer: Aetna Government	$34.25
Rate for Payer: Brighton Health Commercial	$51.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.58
Rate for Payer: Group Health Inc Commercial	$34.25
Rate for Payer: Group Health Inc Medicare	$23.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.25
Rate for Payer: Hamaspik Choice Inc Medicare	$34.25

CORE BUILD-UP, INCLUDING ANY PINS

Facility

$354.38

Service Code	HCPCS D2950
Hospital Charge Code	42300645
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

CORE BUILD-UP, INCLUDING ANY PINS

Facility

$354.38

Service Code	HCPCS D2950
Hospital Charge Code	42300645
Hospital Revenue Code	361
Min. Negotiated Rate	$177.19
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$265.78
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	$177.19
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: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare 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

CORNEA IMPLANT

Facility

$2,354.08

Hospital Charge Code	40202050
Hospital Revenue Code	270
Min. Negotiated Rate	$823.93
Max. Negotiated Rate	$1,883.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,294.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,177.04
Rate for Payer: Aetna Government	$1,177.04
Rate for Payer: Brighton Health Commercial	$1,765.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,883.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,600.77
Rate for Payer: Group Health Inc Commercial	$1,177.04
Rate for Payer: Group Health Inc Medicare	$823.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,177.04
Rate for Payer: Hamaspik Choice Inc Medicare	$1,177.04

CORNEAL FB,REMOVAL W/O SLIT LAMP

Facility

$1,101.23

Service Code	HCPCS 65220
Hospital Charge Code	30301991
Hospital Revenue Code	510
Rate for Payer: Cash Price	$460.76

CORNEAL FB,REMOVAL W/O SLIT LAMP

Facility

$1,101.23

Service Code	HCPCS 65220
Hospital Charge Code	30301991
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$460.76
Rate for Payer: Aetna Government	$460.76
Rate for Payer: Affinity Essential Plan 1&2	$322.53
Rate for Payer: Affinity Essential Plan 3&4	$322.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$322.53
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Cash Price	$460.76
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$460.76
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	$460.76
Rate for Payer: Fidelis Essential Plan Aliesa	$391.65
Rate for Payer: Fidelis Essential Plan QHP	$410.08
Rate for Payer: Fidelis Medicare Advantage	$460.76
Rate for Payer: Fidelis Qualified Health Plan	$410.08
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	$550.62
Rate for Payer: Hamaspik Choice Inc Medicare	$460.76
Rate for Payer: Healthfirst Medicare Advantage	$391.65
Rate for Payer: Healthfirst QHP	$460.76
Rate for Payer: Humana Medicare	$469.98
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$460.76
Rate for Payer: Senior Whole Health Medicare Advantage	$460.76
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$460.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$460.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$368.61
Rate for Payer: Wellcare Medicare	$437.72

CORNEAL FB, REMOVAL W/SLIT LAMP

Facility

$330.23

Service Code	HCPCS 65222
Hospital Charge Code	30301998
Hospital Revenue Code	510
Rate for Payer: Cash Price	$147.72

Know your out-of-pocket cost for care.

All Charges