St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MOMETASONE FUROATE 110 MCG/INH IN AEPB [91877]

Facility

$111.65

Service Code	NDC 78206011501
Hospital Charge Code	78206011501
Hospital Revenue Code	250
Min. Negotiated Rate	$39.08
Max. Negotiated Rate	$89.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.82
Rate for Payer: Aetna Government	$55.82
Rate for Payer: Brighton Health Commercial	$83.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.92
Rate for Payer: Group Health Inc Commercial	$55.82
Rate for Payer: Group Health Inc Medicare	$39.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.82
Rate for Payer: Hamaspik Choice Inc Medicare	$55.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.57

MOMETASONE FUROATE 220 MCG/ACT IN AEPB [188324]

Facility

$46.56

Service Code	NDC 78206011403
Hospital Charge Code	78206011403
Hospital Revenue Code	250
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$37.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.28
Rate for Payer: Aetna Government	$23.28
Rate for Payer: Brighton Health Commercial	$34.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.66
Rate for Payer: Group Health Inc Commercial	$23.28
Rate for Payer: Group Health Inc Medicare	$16.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.28
Rate for Payer: Hamaspik Choice Inc Medicare	$23.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.26

MOMETASONE FUROATE 220 MCG/INH IN AEPB [41828]

Facility

$46.56

Service Code	NDC 78206011403
Hospital Charge Code	78206011403
Hospital Revenue Code	250
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$37.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.28
Rate for Payer: Aetna Government	$23.28
Rate for Payer: Brighton Health Commercial	$34.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.66
Rate for Payer: Group Health Inc Commercial	$23.28
Rate for Payer: Group Health Inc Medicare	$16.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.28
Rate for Payer: Hamaspik Choice Inc Medicare	$23.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.26

MONARCH III C. CARTRIDGES

Facility

$25.00

Hospital Charge Code	64905394
Hospital Revenue Code	270
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$20.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$18.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.00
Rate for Payer: Group Health Inc Commercial	$12.50
Rate for Payer: Group Health Inc Medicare	$8.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50

MONITOR 9529 REVEAL XT USA

Facility

$8,600.00

Service Code	HCPCS C1764
Hospital Charge Code	66524667
Hospital Revenue Code	278
Min. Negotiated Rate	$3,010.00
Max. Negotiated Rate	$9,030.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,730.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,126.13
Rate for Payer: Aetna Government	$4,126.13
Rate for Payer: Brighton Health Commercial	$5,160.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,945.00
Rate for Payer: EmblemHealth Commercial	$4,300.00
Rate for Payer: Fidelis Medicare Advantage	$9,030.00
Rate for Payer: Group Health Inc Commercial	$4,300.00
Rate for Payer: Group Health Inc Medicare	$3,010.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,590.00

MONITOR 9529 REVEAL XT USA

Facility

$8,600.00

Service Code	HCPCS C1764
Hospital Charge Code	66524667
Hospital Revenue Code	278
Min. Negotiated Rate	$4,300.00
Max. Negotiated Rate	$4,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,300.00

MONITOR ABVISER INTRA ABDOM PRESS

Facility

$192.50

Hospital Charge Code	64903270
Hospital Revenue Code	270
Min. Negotiated Rate	$67.38
Max. Negotiated Rate	$154.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.25
Rate for Payer: Aetna Government	$96.25
Rate for Payer: Brighton Health Commercial	$144.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.90
Rate for Payer: Group Health Inc Commercial	$96.25
Rate for Payer: Group Health Inc Medicare	$67.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.25
Rate for Payer: Hamaspik Choice Inc Medicare	$96.25

MONITORING OF FLUID PRESSURE

Facility

$1,847.58

Service Code	HCPCS 20950
Hospital Charge Code	30106623
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$813.63
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
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	$813.63
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
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	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$813.63
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

MONITORING OF FLUID PRESSURE

Facility

$1,847.58

Service Code	HCPCS 20950
Hospital Charge Code	30106623
Hospital Revenue Code	450
Rate for Payer: Cash Price	$813.63

MONKEYPOX (ORTHOPOXVIRUS),DNA,PCR

Facility

$192.50

Hospital Charge Code	40601402
Hospital Revenue Code	300
Min. Negotiated Rate	$67.38
Max. Negotiated Rate	$154.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.25
Rate for Payer: Aetna Government	$96.25
Rate for Payer: Brighton Health Commercial	$144.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.90
Rate for Payer: Group Health Inc Commercial	$96.25
Rate for Payer: Group Health Inc Medicare	$67.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.25
Rate for Payer: Hamaspik Choice Inc Medicare	$96.25

MONOBLK NEXGEN FEM SZ4, C/H 14MM

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40202114
Hospital Revenue Code	278
Min. Negotiated Rate	$3,884.00
Max. Negotiated Rate	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00

MONOBLK NEXGEN FEM SZ4, C/H 14MM

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40202114
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,156.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,272.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,660.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,884.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,466.60
Rate for Payer: EmblemHealth Commercial	$3,884.00
Rate for Payer: Fidelis Medicare Advantage	$8,156.40
Rate for Payer: Group Health Inc Commercial	$3,884.00
Rate for Payer: Group Health Inc Medicare	$2,718.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,049.20

MONOBLK NEXGEN SZ3,C/D 10MM

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40009106
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,156.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,272.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,660.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,884.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,466.60
Rate for Payer: EmblemHealth Commercial	$3,884.00
Rate for Payer: Fidelis Medicare Advantage	$8,156.40
Rate for Payer: Group Health Inc Commercial	$3,884.00
Rate for Payer: Group Health Inc Medicare	$2,718.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,049.20

MONOBLK NEXGEN SZ3,C/D 10MM

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40009106
Hospital Revenue Code	278
Min. Negotiated Rate	$3,884.00
Max. Negotiated Rate	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00

MONOBLK NEXGEN SZ3,C/D 10MM

Facility

$9,710.00

Service Code	HCPCS C1776
Hospital Charge Code	40202115
Hospital Revenue Code	278
Min. Negotiated Rate	$4,855.00
Max. Negotiated Rate	$4,855.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,855.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,855.00

MONOBLK NEXGEN SZ3,C/D 10MM

Facility

$9,710.00

Service Code	HCPCS C1776
Hospital Charge Code	40202115
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,195.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,340.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,826.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,855.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,583.25
Rate for Payer: EmblemHealth Commercial	$4,855.00
Rate for Payer: Fidelis Medicare Advantage	$10,195.50
Rate for Payer: Group Health Inc Commercial	$4,855.00
Rate for Payer: Group Health Inc Medicare	$3,398.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,855.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,855.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,311.50

MONOBLOCK TIB COMP SZ5/FEM SZ14MM

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40202113
Hospital Revenue Code	278
Min. Negotiated Rate	$3,884.00
Max. Negotiated Rate	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00

MONOBLOCK TIB COMP SZ5/FEM SZ14MM

Facility

$7,768.00

Service Code	HCPCS C1776
Hospital Charge Code	40202113
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,156.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,272.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,660.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,884.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,466.60
Rate for Payer: EmblemHealth Commercial	$3,884.00
Rate for Payer: Fidelis Medicare Advantage	$8,156.40
Rate for Payer: Group Health Inc Commercial	$3,884.00
Rate for Payer: Group Health Inc Medicare	$2,718.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,049.20

MONOKA MINI

Facility

$162.50

Service Code	HCPCS C1877
Hospital Charge Code	64907165
Hospital Revenue Code	278
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$170.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$97.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.44
Rate for Payer: EmblemHealth Commercial	$81.25
Rate for Payer: Fidelis Medicare Advantage	$170.62
Rate for Payer: Group Health Inc Commercial	$81.25
Rate for Payer: Group Health Inc Medicare	$56.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.62

MONOKA MINI

Facility

$162.50

Service Code	HCPCS C1877
Hospital Charge Code	64907165
Hospital Revenue Code	278
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$81.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.25
Rate for Payer: Hamaspik Choice Inc Medicare	$81.25

MONONUCLEAR CELL ANTIGEN

Facility

$66.95

Service Code	HCPCS 86356
Hospital Charge Code	40729453
Hospital Revenue Code	300
Rate for Payer: Cash Price	$26.78

MONONUCLEAR CELL ANTIGEN

Facility

$66.95

Service Code	HCPCS 86356
Hospital Charge Code	40729453
Hospital Revenue Code	300
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$50.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.78
Rate for Payer: Aetna Government	$26.78
Rate for Payer: Affinity Essential Plan 1&2	$18.75
Rate for Payer: Affinity Essential Plan 3&4	$18.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$18.75
Rate for Payer: Brighton Health Commercial	$50.21
Rate for Payer: Cash Price	$26.78
Rate for Payer: Cash Price	$26.78
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$26.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.01
Rate for Payer: Elderplan Medicare Advantage	$26.78
Rate for Payer: EmblemHealth Commercial	$26.78
Rate for Payer: Fidelis Essential Plan Aliesa	$22.76
Rate for Payer: Fidelis Essential Plan QHP	$23.83
Rate for Payer: Fidelis Medicare Advantage	$26.78
Rate for Payer: Fidelis Qualified Health Plan	$23.83
Rate for Payer: Group Health Inc Commercial	$26.78
Rate for Payer: Group Health Inc Medicare	$26.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.48
Rate for Payer: Hamaspik Choice Inc Medicare	$26.78
Rate for Payer: Healthfirst Medicare Advantage	$26.78
Rate for Payer: Healthfirst QHP	$26.78
Rate for Payer: Humana Medicare	$27.32
Rate for Payer: Senior Whole Health Medicare Advantage	$26.78
Rate for Payer: United Healthcare Commercial	$33.90
Rate for Payer: United Healthcare Medicare Advantage	$26.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21.42
Rate for Payer: Wellcare Medicare	$24.10

MONOSOF BK

Facility

$120.00

Hospital Charge Code	64907071
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.00
Rate for Payer: Aetna Government	$60.00
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

MONOVAL ATTEN HUMAN ROTAVIRUS

Facility

$203.00

Hospital Charge Code	41655058
Hospital Revenue Code	250
Min. Negotiated Rate	$71.05
Max. Negotiated Rate	$162.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$111.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$101.50
Rate for Payer: Aetna Government	$101.50
Rate for Payer: Brighton Health Commercial	$152.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.04
Rate for Payer: Group Health Inc Commercial	$101.50
Rate for Payer: Group Health Inc Medicare	$71.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.50
Rate for Payer: Hamaspik Choice Inc Medicare	$101.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$131.95

MONOVAL ATTEN HUMAN ROTAVIRUS

Facility

$203.00

Hospital Charge Code	41645058
Hospital Revenue Code	250
Min. Negotiated Rate	$71.05
Max. Negotiated Rate	$162.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$111.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$101.50
Rate for Payer: Aetna Government	$101.50
Rate for Payer: Brighton Health Commercial	$152.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.04
Rate for Payer: Group Health Inc Commercial	$101.50
Rate for Payer: Group Health Inc Medicare	$71.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.50
Rate for Payer: Hamaspik Choice Inc Medicare	$101.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$131.95

Know your out-of-pocket cost for care.

All Charges