St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

D&C LEEP CONE BIOPSY

Facility

$7,566.13

Service Code	HCPCS 57460
Hospital Charge Code	30302440
Hospital Revenue Code	510
Rate for Payer: Cash Price	$3,615.39

D&C LEEP CONE BIOPSY

Facility

$7,566.13

Service Code	HCPCS 57460
Hospital Charge Code	30302440
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$3,783.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,615.39
Rate for Payer: Aetna Government	$3,615.39
Rate for Payer: Affinity Essential Plan 1&2	$2,530.77
Rate for Payer: Affinity Essential Plan 3&4	$2,530.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,530.77
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,615.39
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	$3,615.39
Rate for Payer: Fidelis Essential Plan Aliesa	$3,073.08
Rate for Payer: Fidelis Essential Plan QHP	$3,217.70
Rate for Payer: Fidelis Medicare Advantage	$3,615.39
Rate for Payer: Fidelis Qualified Health Plan	$3,217.70
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	$3,783.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3,615.39
Rate for Payer: Healthfirst Medicare Advantage	$3,073.08
Rate for Payer: Healthfirst QHP	$3,615.39
Rate for Payer: Humana Medicare	$3,687.70
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$3,615.39
Rate for Payer: Senior Whole Health Medicare Advantage	$3,615.39
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$3,615.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,615.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,892.31
Rate for Payer: Wellcare Medicare	$3,434.62

D&C LEEP CONE BIOPSY

Facility

$7,566.13

Service Code	HCPCS 57460
Hospital Charge Code	40053258
Hospital Revenue Code	360
Min. Negotiated Rate	$1,412.00
Max. Negotiated Rate	$5,674.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,615.39
Rate for Payer: Aetna Government	$3,615.39
Rate for Payer: Affinity Essential Plan 1&2	$2,530.77
Rate for Payer: Affinity Essential Plan 3&4	$2,530.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,530.77
Rate for Payer: Brighton Health Commercial	$5,674.60
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,615.39
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	$3,615.39
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,073.08
Rate for Payer: Fidelis Essential Plan QHP	$3,217.70
Rate for Payer: Fidelis Medicare Advantage	$3,615.39
Rate for Payer: Fidelis Qualified Health Plan	$3,217.70
Rate for Payer: Group Health Inc Commercial	$3,615.39
Rate for Payer: Group Health Inc Medicare	$3,615.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,783.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3,615.39
Rate for Payer: Healthfirst Medicare Advantage	$3,073.08
Rate for Payer: Healthfirst QHP	$3,615.39
Rate for Payer: Humana Medicare	$3,687.70
Rate for Payer: Senior Whole Health Medicare Advantage	$3,615.39
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,615.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,615.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,892.31
Rate for Payer: Wellcare Medicare	$3,434.62

DCM CR TIBIAL BEARING 12MMX63/67M

Facility

$2,208.00

Service Code	HCPCS C1776
Hospital Charge Code	40209936
Hospital Revenue Code	278
Min. Negotiated Rate	$1,104.00
Max. Negotiated Rate	$1,104.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,104.00

DCM CR TIBIAL BEARING 12MMX63/67M

Facility

$2,208.00

Service Code	HCPCS C1776
Hospital Charge Code	40209936
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,318.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,214.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,324.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,269.60
Rate for Payer: EmblemHealth Commercial	$1,104.00
Rate for Payer: Fidelis Medicare Advantage	$2,318.40
Rate for Payer: Group Health Inc Commercial	$1,104.00
Rate for Payer: Group Health Inc Medicare	$772.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,104.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,435.20

DCM CR TIBIAL BEARING 18MMX71/75M

Facility

$4,640.00

Service Code	HCPCS C1776
Hospital Charge Code	40209907
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,872.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,552.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,784.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,668.00
Rate for Payer: EmblemHealth Commercial	$2,320.00
Rate for Payer: Fidelis Medicare Advantage	$4,872.00
Rate for Payer: Group Health Inc Commercial	$2,320.00
Rate for Payer: Group Health Inc Medicare	$1,624.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,320.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,016.00

DCM CR TIBIAL BEARING 18MMX71/75M

Facility

$4,640.00

Service Code	HCPCS C1776
Hospital Charge Code	40209907
Hospital Revenue Code	278
Min. Negotiated Rate	$2,320.00
Max. Negotiated Rate	$2,320.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,320.00

D&C MISSED ABORT 2ND TRIMESTER

Facility

$7,566.13

Service Code	HCPCS 59821
Hospital Charge Code	40059638
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,615.39

D&C MISSED ABORT 2ND TRIMESTER

Facility

$7,566.13

Service Code	HCPCS 59821
Hospital Charge Code	30102505
Hospital Revenue Code	450
Rate for Payer: Cash Price	$3,615.39

D&C MISSED ABORT 2ND TRIMESTER

Facility

$7,566.13

Service Code	HCPCS 59821
Hospital Charge Code	40059638
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$5,674.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,615.39
Rate for Payer: Aetna Government	$3,615.39
Rate for Payer: Affinity Essential Plan 1&2	$2,530.77
Rate for Payer: Affinity Essential Plan 3&4	$2,530.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,530.77
Rate for Payer: Brighton Health Commercial	$5,674.60
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,615.39
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	$3,615.39
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,073.08
Rate for Payer: Fidelis Essential Plan QHP	$3,217.70
Rate for Payer: Fidelis Medicare Advantage	$3,615.39
Rate for Payer: Fidelis Qualified Health Plan	$3,217.70
Rate for Payer: Group Health Inc Commercial	$3,615.39
Rate for Payer: Group Health Inc Medicare	$3,615.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,783.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3,615.39
Rate for Payer: Healthfirst Medicare Advantage	$3,073.08
Rate for Payer: Healthfirst QHP	$3,615.39
Rate for Payer: Humana Medicare	$3,687.70
Rate for Payer: Senior Whole Health Medicare Advantage	$3,615.39
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,615.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,615.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,892.31
Rate for Payer: Wellcare Medicare	$3,434.62

D&C MISSED ABORT 2ND TRIMESTER

Facility

$7,566.13

Service Code	HCPCS 59821
Hospital Charge Code	30102505
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$3,783.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,615.39
Rate for Payer: Aetna Government	$3,615.39
Rate for Payer: Affinity Essential Plan 1&2	$2,530.77
Rate for Payer: Affinity Essential Plan 3&4	$2,530.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,530.77
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$3,615.39
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,615.39
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	$3,615.39
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,073.08
Rate for Payer: Fidelis Essential Plan QHP	$3,217.70
Rate for Payer: Fidelis Medicare Advantage	$3,615.39
Rate for Payer: Fidelis Qualified Health Plan	$3,217.70
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	$3,783.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3,615.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$3,615.39
Rate for Payer: Humana Medicare	$3,687.70
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$3,615.39
Rate for Payer: Senior Whole Health Medicare Advantage	$3,615.39
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$3,615.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,615.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,892.31
Rate for Payer: Wellcare Medicare	$3,434.62

D&C MISSED ABORT FIRST TRIMESTER

Facility

$7,566.13

Service Code	HCPCS 59820
Hospital Charge Code	40059637
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$5,674.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,615.39
Rate for Payer: Aetna Government	$3,615.39
Rate for Payer: Affinity Essential Plan 1&2	$2,530.77
Rate for Payer: Affinity Essential Plan 3&4	$2,530.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,530.77
Rate for Payer: Brighton Health Commercial	$5,674.60
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,615.39
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	$3,615.39
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,073.08
Rate for Payer: Fidelis Essential Plan QHP	$3,217.70
Rate for Payer: Fidelis Medicare Advantage	$3,615.39
Rate for Payer: Fidelis Qualified Health Plan	$3,217.70
Rate for Payer: Group Health Inc Commercial	$3,615.39
Rate for Payer: Group Health Inc Medicare	$3,615.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,783.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3,615.39
Rate for Payer: Healthfirst Medicare Advantage	$3,073.08
Rate for Payer: Healthfirst QHP	$3,615.39
Rate for Payer: Humana Medicare	$3,687.70
Rate for Payer: Senior Whole Health Medicare Advantage	$3,615.39
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,615.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,615.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,892.31
Rate for Payer: Wellcare Medicare	$3,434.62

D&C MISSED ABORT FIRST TRIMESTER

Facility

$7,566.13

Service Code	HCPCS 59820
Hospital Charge Code	40059637
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,615.39

D & C PACKS

Facility

$12.76

Hospital Charge Code	40000175
Hospital Revenue Code	272
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$10.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.38
Rate for Payer: Aetna Government	$6.38
Rate for Payer: Brighton Health Commercial	$9.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.68
Rate for Payer: Group Health Inc Commercial	$6.38
Rate for Payer: Group Health Inc Medicare	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.38
Rate for Payer: Hamaspik Choice Inc Medicare	$6.38

D&C-POLYPECTOMY

Facility

$7,566.13

Service Code	HCPCS 58558
Hospital Charge Code	40052205
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,615.39

D&C-POLYPECTOMY

Facility

$7,566.13

Service Code	HCPCS 58558
Hospital Charge Code	40052205
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$5,674.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,615.39
Rate for Payer: Aetna Government	$3,615.39
Rate for Payer: Affinity Essential Plan 1&2	$2,530.77
Rate for Payer: Affinity Essential Plan 3&4	$2,530.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,530.77
Rate for Payer: Brighton Health Commercial	$5,674.60
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,615.39
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	$3,615.39
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,073.08
Rate for Payer: Fidelis Essential Plan QHP	$3,217.70
Rate for Payer: Fidelis Medicare Advantage	$3,615.39
Rate for Payer: Fidelis Qualified Health Plan	$3,217.70
Rate for Payer: Group Health Inc Commercial	$3,615.39
Rate for Payer: Group Health Inc Medicare	$3,615.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,783.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3,615.39
Rate for Payer: Healthfirst Medicare Advantage	$3,073.08
Rate for Payer: Healthfirst QHP	$3,615.39
Rate for Payer: Humana Medicare	$3,687.70
Rate for Payer: Senior Whole Health Medicare Advantage	$3,615.39
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,615.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,615.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,892.31
Rate for Payer: Wellcare Medicare	$3,434.62

DEB BONE EA ADD 20 SQ CM

Facility

$2,494.35

Service Code	HCPCS 11047
Hospital Charge Code	42500171
Hospital Revenue Code	361
Min. Negotiated Rate	$87.45
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$87.45
Rate for Payer: Aetna Government	$87.45
Rate for Payer: Brighton Health Commercial	$1,870.76
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: Group Health Inc Commercial	$1,247.18
Rate for Payer: Group Health Inc Medicare	$873.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,247.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1,247.18
Rate for Payer: United Healthcare Commercial	$1,113.00

DEB MUSC/FASCIA EA 20 SQ CM

Facility

$821.90

Service Code	HCPCS 11046
Hospital Charge Code	42500172
Hospital Revenue Code	361
Min. Negotiated Rate	$63.49
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.49
Rate for Payer: Aetna Government	$63.49
Rate for Payer: Brighton Health Commercial	$616.42
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	$410.95
Rate for Payer: Group Health Inc Medicare	$287.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$410.95
Rate for Payer: Hamaspik Choice Inc Medicare	$410.95
Rate for Payer: United Healthcare Commercial	$1,113.00

DEB MUSC/FASCIA EA 20 SQ CM

Facility

$821.90

Service Code	HCPCS 11046
Hospital Charge Code	42500179
Hospital Revenue Code	361
Min. Negotiated Rate	$63.49
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.49
Rate for Payer: Aetna Government	$63.49
Rate for Payer: Brighton Health Commercial	$616.42
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	$410.95
Rate for Payer: Group Health Inc Medicare	$287.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$410.95
Rate for Payer: Hamaspik Choice Inc Medicare	$410.95
Rate for Payer: United Healthcare Commercial	$1,113.00

DEBRIDE ABDOM WALL

Facility

$2,109.20

Service Code	HCPCS 11005
Hospital Charge Code	40014337
Hospital Revenue Code	360
Min. Negotiated Rate	$699.67
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,160.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$699.67
Rate for Payer: Aetna Government	$699.67
Rate for Payer: Brighton Health Commercial	$1,581.90
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	$1,054.60
Rate for Payer: Group Health Inc Medicare	$738.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,054.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.60
Rate for Payer: United Healthcare Commercial	$1,496.00

DEBRIDE BPME 20SQ CM/<

Facility

$4,157.25

Service Code	HCPCS 11044
Hospital Charge Code	30105943
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,874.89

DEBRIDE BPME 20SQ CM/<

Facility

$4,157.25

Service Code	HCPCS 11044
Hospital Charge Code	30105943
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,874.89
Rate for Payer: Aetna Government	$1,874.89
Rate for Payer: Affinity Essential Plan 1&2	$1,312.42
Rate for Payer: Affinity Essential Plan 3&4	$1,312.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,312.42
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$1,874.89
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Cash Price	$1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,874.89
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	$1,874.89
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,593.66
Rate for Payer: Fidelis Essential Plan QHP	$1,668.65
Rate for Payer: Fidelis Medicare Advantage	$1,874.89
Rate for Payer: Fidelis Qualified Health Plan	$1,668.65
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	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$1,874.89
Rate for Payer: Humana Medicare	$1,912.39
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage	$1,874.89
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,499.91
Rate for Payer: Wellcare Medicare	$1,781.15

DEBRIDE INFECTED SKIN

Facility

$1,505.35

Service Code	HCPCS 11000
Hospital Charge Code	30300175
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	$726.29
Rate for Payer: Aetna Government	$726.29
Rate for Payer: Affinity Essential Plan 1&2	$508.40
Rate for Payer: Affinity Essential Plan 3&4	$508.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$508.40
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$726.29
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	$726.29
Rate for Payer: Fidelis Essential Plan Aliesa	$617.35
Rate for Payer: Fidelis Essential Plan QHP	$646.40
Rate for Payer: Fidelis Medicare Advantage	$726.29
Rate for Payer: Fidelis Qualified Health Plan	$646.40
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	$752.68
Rate for Payer: Hamaspik Choice Inc Medicare	$726.29
Rate for Payer: Healthfirst Medicare Advantage	$617.35
Rate for Payer: Healthfirst QHP	$726.29
Rate for Payer: Humana Medicare	$740.82
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$726.29
Rate for Payer: Senior Whole Health Medicare Advantage	$726.29
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$726.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$726.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$581.03
Rate for Payer: Wellcare Medicare	$689.98

DEBRIDE INFECTED SKIN

Facility

$1,505.35

Service Code	HCPCS 11000
Hospital Charge Code	30300175
Hospital Revenue Code	510
Rate for Payer: Cash Price	$726.29

DEBRIDE,MASTOID,COMPLEX

Facility

$1,337.85

Service Code	HCPCS 69222
Hospital Charge Code	30305001
Hospital Revenue Code	510
Rate for Payer: Cash Price	$636.27

Know your out-of-pocket cost for care.

All Charges