St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA [10434]

Facility

$0.60

Service Code	NDC 00168035730
Hospital Charge Code	00168035730
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

LIDOCAINE-PRILOCAINE 2.5-2.5 % EX KIT [11934]

Facility

$49.58

Service Code	NDC 00168035756
Hospital Charge Code	00168035756
Hospital Revenue Code	250
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$39.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.79
Rate for Payer: Aetna Government	$24.79
Rate for Payer: Brighton Health Commercial	$37.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.71
Rate for Payer: Group Health Inc Commercial	$24.79
Rate for Payer: Group Health Inc Medicare	$17.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.79
Rate for Payer: Hamaspik Choice Inc Medicare	$24.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.23

LIDOCAINE + PRILOCAINE CREAM 30 GRAMS

Facility

$73.00

Hospital Charge Code	41643144
Hospital Revenue Code	250
Min. Negotiated Rate	$25.55
Max. Negotiated Rate	$58.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.50
Rate for Payer: Aetna Government	$36.50
Rate for Payer: Brighton Health Commercial	$54.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.64
Rate for Payer: Group Health Inc Commercial	$36.50
Rate for Payer: Group Health Inc Medicare	$25.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.50
Rate for Payer: Hamaspik Choice Inc Medicare	$36.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.45

LIDOCAINE + PRILOCAINE CREAM 30 GRAMS

Facility

$73.00

Hospital Charge Code	41653144
Hospital Revenue Code	250
Min. Negotiated Rate	$25.55
Max. Negotiated Rate	$58.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.50
Rate for Payer: Aetna Government	$36.50
Rate for Payer: Brighton Health Commercial	$54.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.64
Rate for Payer: Group Health Inc Commercial	$36.50
Rate for Payer: Group Health Inc Medicare	$25.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.50
Rate for Payer: Hamaspik Choice Inc Medicare	$36.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.45

LIDOCAINE + PRILOCAINE CREAM 5 GRAMS

Facility

$1.71

Hospital Charge Code	41653732
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.16
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.11

LIDOCAINE + PRILOCAINE CREAM 5 GRAMS

Facility

$1.71

Hospital Charge Code	41643732
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.16
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.11

LIDOCAINE TOPICAL 4% 50ML

Facility

$5.00

Hospital Charge Code	41645903
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

LIDOCAINE TOPICAL 4% 50ML

Facility

$5.00

Hospital Charge Code	41655903
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

LIDOCAINE VISCOUS HCL 2 % MT SOLN [27898]

Facility

$0.13

Service Code	NDC 00054350049
Hospital Charge Code	00054350049
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

LIDOCAINE VISCOUS HCL 2 % MT SOLN [27898]

Facility

$0.13

Service Code	NDC 60432046400
Hospital Charge Code	60432046400
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

LIDOCAINE VISCOUS HCL 2 % MT SOLN [27898]

Facility

$0.31

Service Code	NDC 00121090340
Hospital Charge Code	00121090340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

LIDOCAINE VISCOUS HCL 2 % MT SOLN [27898]

Facility

$0.31

Service Code	NDC 00121090315
Hospital Charge Code	00121090315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

LIDOCAINE (XYLOCAINE) SERUM

Facility

$36.73

Service Code	HCPCS 80176
Hospital Charge Code	40609712
Hospital Revenue Code	301
Min. Negotiated Rate	$10.28
Max. Negotiated Rate	$27.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.69
Rate for Payer: Aetna Government	$14.69
Rate for Payer: Affinity Essential Plan 1&2	$10.28
Rate for Payer: Affinity Essential Plan 3&4	$10.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.28
Rate for Payer: Brighton Health Commercial	$27.55
Rate for Payer: Cash Price	$14.69
Rate for Payer: Cash Price	$14.69
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.77
Rate for Payer: Elderplan Medicare Advantage	$14.69
Rate for Payer: EmblemHealth Commercial	$14.69
Rate for Payer: Fidelis Essential Plan Aliesa	$12.49
Rate for Payer: Fidelis Essential Plan QHP	$13.07
Rate for Payer: Fidelis Medicare Advantage	$14.69
Rate for Payer: Fidelis Qualified Health Plan	$13.07
Rate for Payer: Group Health Inc Commercial	$14.69
Rate for Payer: Group Health Inc Medicare	$14.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.36
Rate for Payer: Hamaspik Choice Inc Medicare	$14.69
Rate for Payer: Healthfirst Medicare Advantage	$14.69
Rate for Payer: Healthfirst QHP	$14.69
Rate for Payer: Humana Medicare	$14.98
Rate for Payer: Senior Whole Health Medicare Advantage	$14.69
Rate for Payer: United Healthcare Commercial	$18.60
Rate for Payer: United Healthcare Medicare Advantage	$14.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.75
Rate for Payer: Wellcare Medicare	$13.22

LIDOCAINE (XYLOCAINE) SERUM

Facility

$36.73

Service Code	HCPCS 80176
Hospital Charge Code	40609712
Hospital Revenue Code	301
Rate for Payer: Cash Price	$14.69

LIDO/EPI/BICARD INJ 500ML

Facility

$33.45

Service Code	HCPCS J3490
Hospital Charge Code	41647890
Hospital Revenue Code	636
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$21.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.72
Rate for Payer: Aetna Government	$16.72
Rate for Payer: Brighton Health Commercial	$20.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.23
Rate for Payer: Group Health Inc Commercial	$16.72
Rate for Payer: Group Health Inc Medicare	$11.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.72
Rate for Payer: Hamaspik Choice Inc Medicare	$16.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.74

LIDO/EPI/BICARD INJ 500ML

Facility

$33.45

Service Code	HCPCS J3490
Hospital Charge Code	41647890
Hospital Revenue Code	636
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$16.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.72
Rate for Payer: Hamaspik Choice Inc Medicare	$16.72

LIDO/EPI/BICARD INJ 500ML

Facility

$33.45

Service Code	HCPCS J3490
Hospital Charge Code	41657890
Hospital Revenue Code	636
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$21.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.72
Rate for Payer: Aetna Government	$16.72
Rate for Payer: Brighton Health Commercial	$20.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.23
Rate for Payer: Group Health Inc Commercial	$16.72
Rate for Payer: Group Health Inc Medicare	$11.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.72
Rate for Payer: Hamaspik Choice Inc Medicare	$16.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.74

LIDO/EPI/BICARD INJ 500ML

Facility

$33.45

Service Code	HCPCS J3490
Hospital Charge Code	41657890
Hospital Revenue Code	636
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$16.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.72
Rate for Payer: Hamaspik Choice Inc Medicare	$16.72

LID,ORAL,DISP,10ML,NICU,ONLY

Facility

$35.00

Hospital Charge Code	64903722
Hospital Revenue Code	270
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$28.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.50
Rate for Payer: Aetna Government	$17.50
Rate for Payer: Brighton Health Commercial	$26.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.80
Rate for Payer: Group Health Inc Commercial	$17.50
Rate for Payer: Group Health Inc Medicare	$12.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50

LID,ORAL,DISP,30ML,NICU,ONLY

Facility

$35.00

Hospital Charge Code	64903725
Hospital Revenue Code	270
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$28.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.50
Rate for Payer: Aetna Government	$17.50
Rate for Payer: Brighton Health Commercial	$26.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.80
Rate for Payer: Group Health Inc Commercial	$17.50
Rate for Payer: Group Health Inc Medicare	$12.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50

LIFEPORT LPS-7513

Facility

$737.50

Hospital Charge Code	64902618
Hospital Revenue Code	270
Min. Negotiated Rate	$258.12
Max. Negotiated Rate	$590.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$405.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$368.75
Rate for Payer: Aetna Government	$368.75
Rate for Payer: Brighton Health Commercial	$553.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$590.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$501.50
Rate for Payer: Group Health Inc Commercial	$368.75
Rate for Payer: Group Health Inc Medicare	$258.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.75
Rate for Payer: Hamaspik Choice Inc Medicare	$368.75

LIFESTENT 5MMX100MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004790
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

LIFESTENT 5MMX100MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004790
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

LIFESTENT 5MMX40MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004787
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

LIFESTENT 5MMX40MMX80CM

Facility

$3,200.00

Service Code	HCPCS C1876
Hospital Charge Code	40004787
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

Know your out-of-pocket cost for care.

All Charges