St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INTERFERON BETA 1A (AVONEX) 30 MCG INJ

Facility

$69.42

Service Code	HCPCS Q3027
Hospital Charge Code	41655070
Hospital Revenue Code	636
Min. Negotiated Rate	$34.71
Max. Negotiated Rate	$34.71
Rate for Payer: Cash Price	$53.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.71
Rate for Payer: Hamaspik Choice Inc Medicare	$34.71

INTERFERON BETA 1A (AVONEX) 30 MCG INJ

Facility

$69.42

Service Code	HCPCS Q3027
Hospital Charge Code	41655070
Hospital Revenue Code	636
Min. Negotiated Rate	$34.71
Max. Negotiated Rate	$57.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.69
Rate for Payer: Aetna Government	$53.69
Rate for Payer: Affinity Essential Plan 1&2	$37.58
Rate for Payer: Affinity Essential Plan 3&4	$37.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$37.58
Rate for Payer: Brighton Health Commercial	$41.65
Rate for Payer: Cash Price	$53.69
Rate for Payer: Cash Price	$53.69
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$53.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.92
Rate for Payer: Elderplan Medicare Advantage	$53.69
Rate for Payer: EmblemHealth Commercial	$53.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53.69
Rate for Payer: Fidelis Essential Plan Aliesa	$53.69
Rate for Payer: Fidelis Essential Plan QHP	$56.38
Rate for Payer: Fidelis Medicare Advantage	$53.69
Rate for Payer: Fidelis Qualified Health Plan	$56.38
Rate for Payer: Group Health Inc Commercial	$53.69
Rate for Payer: Group Health Inc Medicare	$53.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.71
Rate for Payer: Hamaspik Choice Inc Medicare	$34.71
Rate for Payer: Healthfirst Medicare Advantage	$45.64
Rate for Payer: Healthfirst QHP	$53.69
Rate for Payer: Humana Medicare	$54.76
Rate for Payer: Senior Whole Health Medicare Advantage	$53.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$57.54
Rate for Payer: SOMOS Essential	$57.54
Rate for Payer: United Healthcare Commercial	$54.42
Rate for Payer: United Healthcare Medicare Advantage	$53.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42.95
Rate for Payer: Wellcare Medicare	$51.01

INTERFERON BETA 1B 0.3 MG INJ

Facility

$157.00

Service Code	HCPCS J1830
Hospital Charge Code	41653444
Hospital Revenue Code	636
Min. Negotiated Rate	$78.50
Max. Negotiated Rate	$78.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.50
Rate for Payer: Hamaspik Choice Inc Medicare	$78.50

INTERFERON BETA 1B 0.3 MG INJ

Facility

$157.00

Service Code	HCPCS J1830
Hospital Charge Code	41643444
Hospital Revenue Code	636
Min. Negotiated Rate	$54.95
Max. Negotiated Rate	$368.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$368.87
Rate for Payer: Aetna Government	$368.87
Rate for Payer: Brighton Health Commercial	$94.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.28
Rate for Payer: Group Health Inc Commercial	$78.50
Rate for Payer: Group Health Inc Medicare	$54.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.50
Rate for Payer: Hamaspik Choice Inc Medicare	$78.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.05

INTERFERON BETA 1B 0.3 MG INJ

Facility

$157.00

Service Code	HCPCS J1830
Hospital Charge Code	41653444
Hospital Revenue Code	636
Min. Negotiated Rate	$54.95
Max. Negotiated Rate	$368.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$368.87
Rate for Payer: Aetna Government	$368.87
Rate for Payer: Brighton Health Commercial	$94.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.28
Rate for Payer: Group Health Inc Commercial	$78.50
Rate for Payer: Group Health Inc Medicare	$54.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.50
Rate for Payer: Hamaspik Choice Inc Medicare	$78.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.05

INTERFERON BETA 1B 0.3 MG INJ

Facility

$157.00

Service Code	HCPCS J1830
Hospital Charge Code	41643444
Hospital Revenue Code	636
Min. Negotiated Rate	$78.50
Max. Negotiated Rate	$78.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.50
Rate for Payer: Hamaspik Choice Inc Medicare	$78.50

INTERGRO DBM PASTE 5CC (DBM005)

Facility

$1,920.00

Service Code	HCPCS C1713
Hospital Charge Code	64906582
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,016.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,056.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,152.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.00
Rate for Payer: EmblemHealth Commercial	$960.00
Rate for Payer: Fidelis Medicare Advantage	$2,016.00
Rate for Payer: Group Health Inc Commercial	$960.00
Rate for Payer: Group Health Inc Medicare	$672.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$960.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,248.00

INTERGRO DBM PASTE 5CC (DBM005)

Facility

$1,920.00

Service Code	HCPCS C1713
Hospital Charge Code	64906582
Hospital Revenue Code	278
Min. Negotiated Rate	$960.00
Max. Negotiated Rate	$960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$960.00

INTERIM CARIES MED APP

Facility

$40.00

Service Code	HCPCS D1354
Hospital Charge Code	42303463
Hospital Revenue Code	361
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.74
Rate for Payer: Aetna Government	$34.74
Rate for Payer: Affinity Essential Plan 1&2	$34.09
Rate for Payer: Affinity Essential Plan 3&4	$34.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.15
Rate for Payer: Amida Care Medicaid	$15.15
Rate for Payer: Brighton Health Commercial	$30.00
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: Fidelis CHP/HARP/Medicaid	$1,515.00
Rate for Payer: Fidelis Essential Plan Aliesa	$15.15
Rate for Payer: Fidelis Essential Plan QHP	$15.15
Rate for Payer: Fidelis Qualified Health Plan	$15.91
Rate for Payer: Group Health Inc Commercial	$20.00
Rate for Payer: Group Health Inc Medicare	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.15
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.15
Rate for Payer: Healthfirst Essential Plan	$34.09
Rate for Payer: Healthfirst QHP	$15.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.15
Rate for Payer: SOMOS Essential	$15.15
Rate for Payer: United Healthcare Essential Plan 1&2	$34.09
Rate for Payer: United Healthcare Essential Plan 3&4	$16.66
Rate for Payer: United Healthcare Medicaid	$15.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.15

INTERIM COMPLETE DENTURE (LOWER)

Facility

$642.00

Service Code	HCPCS D5811
Hospital Charge Code	42301170
Hospital Revenue Code	361
Min. Negotiated Rate	$209.32
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$353.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.32
Rate for Payer: Aetna Government	$209.32
Rate for Payer: Brighton Health Commercial	$481.50
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	$321.00
Rate for Payer: Group Health Inc Medicare	$224.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.00
Rate for Payer: Hamaspik Choice Inc Medicare	$321.00

INTERIM COMPLETE DENTURE (UPPER)

Facility

$642.00

Service Code	HCPCS D5810
Hospital Charge Code	42301165
Hospital Revenue Code	361
Min. Negotiated Rate	$194.84
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$353.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$194.84
Rate for Payer: Aetna Government	$194.84
Rate for Payer: Brighton Health Commercial	$481.50
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	$321.00
Rate for Payer: Group Health Inc Medicare	$224.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.00
Rate for Payer: Hamaspik Choice Inc Medicare	$321.00

INTERIM PARTIAL DENTURE (LOWER)

Facility

$435.00

Service Code	HCPCS D5821
Hospital Charge Code	42301180
Hospital Revenue Code	361
Min. Negotiated Rate	$152.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$159.72
Rate for Payer: Aetna Government	$159.72
Rate for Payer: Brighton Health Commercial	$326.25
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	$217.50
Rate for Payer: Group Health Inc Medicare	$152.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.50
Rate for Payer: Hamaspik Choice Inc Medicare	$217.50

INTERIM PARTIAL DENTURE (UPPER)

Facility

$435.00

Service Code	HCPCS D5820
Hospital Charge Code	42301175
Hospital Revenue Code	361
Min. Negotiated Rate	$150.46
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.46
Rate for Payer: Aetna Government	$150.46
Rate for Payer: Brighton Health Commercial	$326.25
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	$217.50
Rate for Payer: Group Health Inc Medicare	$152.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.50
Rate for Payer: Hamaspik Choice Inc Medicare	$217.50

INTERJECT

Facility

$572.00

Hospital Charge Code	40209766
Hospital Revenue Code	270
Min. Negotiated Rate	$200.20
Max. Negotiated Rate	$457.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$314.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$286.00
Rate for Payer: Aetna Government	$286.00
Rate for Payer: Brighton Health Commercial	$429.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$457.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$388.96
Rate for Payer: Group Health Inc Commercial	$286.00
Rate for Payer: Group Health Inc Medicare	$200.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$286.00
Rate for Payer: Hamaspik Choice Inc Medicare	$286.00

INTERLEUKIN-6, SERUM

Facility

$43.18

Service Code	HCPCS 83520
Hospital Charge Code	40611964
Hospital Revenue Code	301
Rate for Payer: Cash Price	$17.27

INTERLEUKIN-6, SERUM

Facility

$43.18

Service Code	HCPCS 83520
Hospital Charge Code	40611964
Hospital Revenue Code	301
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$32.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.27
Rate for Payer: Aetna Government	$17.27
Rate for Payer: Affinity Essential Plan 1&2	$12.09
Rate for Payer: Affinity Essential Plan 3&4	$12.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.09
Rate for Payer: Brighton Health Commercial	$32.38
Rate for Payer: Cash Price	$17.27
Rate for Payer: Cash Price	$17.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.41
Rate for Payer: Elderplan Medicare Advantage	$17.27
Rate for Payer: EmblemHealth Commercial	$17.27
Rate for Payer: Fidelis Essential Plan Aliesa	$14.68
Rate for Payer: Fidelis Essential Plan QHP	$15.37
Rate for Payer: Fidelis Medicare Advantage	$17.27
Rate for Payer: Fidelis Qualified Health Plan	$15.37
Rate for Payer: Group Health Inc Commercial	$17.27
Rate for Payer: Group Health Inc Medicare	$17.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.59
Rate for Payer: Hamaspik Choice Inc Medicare	$17.27
Rate for Payer: Healthfirst Medicare Advantage	$17.27
Rate for Payer: Healthfirst QHP	$17.27
Rate for Payer: Humana Medicare	$17.62
Rate for Payer: Senior Whole Health Medicare Advantage	$17.27
Rate for Payer: United Healthcare Commercial	$16.40
Rate for Payer: United Healthcare Medicare Advantage	$17.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.82
Rate for Payer: Wellcare Medicare	$15.54

INTERLOCK 35 6X10CM

Facility

$1,273.63

Service Code	HCPCS C1713
Hospital Charge Code	64904920
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,337.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$700.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$764.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$636.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$732.34
Rate for Payer: EmblemHealth Commercial	$636.82
Rate for Payer: Fidelis Medicare Advantage	$1,337.31
Rate for Payer: Group Health Inc Commercial	$636.82
Rate for Payer: Group Health Inc Medicare	$445.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$636.82
Rate for Payer: Hamaspik Choice Inc Medicare	$636.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$827.86

INTERLOCK 35 6X10CM

Facility

$1,273.63

Service Code	HCPCS C1713
Hospital Charge Code	64904920
Hospital Revenue Code	278
Min. Negotiated Rate	$636.82
Max. Negotiated Rate	$636.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$636.82
Rate for Payer: Hamaspik Choice Inc Medicare	$636.82

INTERLOCK 35 6X20CM

Facility

$1,905.35

Service Code	HCPCS C1713
Hospital Charge Code	64904918
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,000.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,047.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,143.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$952.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,095.58
Rate for Payer: EmblemHealth Commercial	$952.68
Rate for Payer: Fidelis Medicare Advantage	$2,000.62
Rate for Payer: Group Health Inc Commercial	$952.68
Rate for Payer: Group Health Inc Medicare	$666.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$952.68
Rate for Payer: Hamaspik Choice Inc Medicare	$952.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,238.48

INTERLOCK 35 6X20CM

Facility

$1,905.35

Service Code	HCPCS C1713
Hospital Charge Code	64904918
Hospital Revenue Code	278
Min. Negotiated Rate	$952.68
Max. Negotiated Rate	$952.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$952.68
Rate for Payer: Hamaspik Choice Inc Medicare	$952.68

INTERLOK 75MM FIXD CRUC TIBI PLT

Facility

$3,178.00

Service Code	HCPCS C1713
Hospital Charge Code	40209916
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,336.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,747.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,906.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,589.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,827.35
Rate for Payer: EmblemHealth Commercial	$1,589.00
Rate for Payer: Fidelis Medicare Advantage	$3,336.90
Rate for Payer: Group Health Inc Commercial	$1,589.00
Rate for Payer: Group Health Inc Medicare	$1,112.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,589.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,589.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,065.70

INTERLOK 75MM FIXD CRUC TIBI PLT

Facility

$3,178.00

Service Code	HCPCS C1713
Hospital Charge Code	40209916
Hospital Revenue Code	278
Min. Negotiated Rate	$1,589.00
Max. Negotiated Rate	$1,589.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,589.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,589.00

INTERMEDIATE EYE EXAM

Facility

$166.60

Service Code	HCPCS 92082 TC
Hospital Charge Code	30301159
Hospital Revenue Code	510
Min. Negotiated Rate	$49.52
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.74
Rate for Payer: Aetna Government	$70.74
Rate for Payer: Affinity Essential Plan 1&2	$49.52
Rate for Payer: Affinity Essential Plan 3&4	$49.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$49.52
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Elderplan Medicare Advantage	$70.74
Rate for Payer: Fidelis Essential Plan Aliesa	$60.13
Rate for Payer: Fidelis Essential Plan QHP	$62.96
Rate for Payer: Fidelis Medicare Advantage	$70.74
Rate for Payer: Fidelis Qualified Health Plan	$62.96
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	$83.30
Rate for Payer: Hamaspik Choice Inc Medicare	$70.74
Rate for Payer: Healthfirst Medicare Advantage	$60.13
Rate for Payer: Healthfirst QHP	$70.74
Rate for Payer: Humana Medicare	$72.15
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$70.74
Rate for Payer: Senior Whole Health Medicare Advantage	$70.74
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$70.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.59
Rate for Payer: Wellcare Medicare	$67.20

INTERMEDIATE EYE EXAM

Facility

$166.60

Service Code	HCPCS 92082 TC
Hospital Charge Code	30301159
Hospital Revenue Code	510
Rate for Payer: Cash Price	$70.74

INTERMED REPAIR OF SCALP > 30CM

Facility

$4,914.88

Service Code	HCPCS 12037
Hospital Charge Code	30105768
Hospital Revenue Code	450
Rate for Payer: Cash Price	$2,108.87

Know your out-of-pocket cost for care.

All Charges