St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RALTEGRAVIR POTASSIUM 600 MG PO TABS

Facility

$39.94

Service Code	NDC 0006308001
Hospital Charge Code	0006308001
Hospital Revenue Code	250
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$19.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.97

RALTEGRAVIR POTASSIUM 600 MG PO TABS

Facility

$39.94

Service Code	NDC 0006308001
Hospital Charge Code	0006308001
Hospital Revenue Code	250
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$31.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.97
Rate for Payer: Aetna Government	$19.97
Rate for Payer: Brighton Health Commercial	$29.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.16
Rate for Payer: EmblemHealth Commercial	$19.97
Rate for Payer: Group Health Inc Commercial	$19.97
Rate for Payer: Group Health Inc Medicare	$13.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.97
Rate for Payer: Hamaspik Choice Inc Medicare	$19.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.96

RAMUCIRUMAB 100 MG/10ML IV SOLN

Facility

$171.39

Service Code	HCPCS J9308
Hospital Charge Code	0002766901
Hospital Revenue Code	258
Min. Negotiated Rate	$85.69
Max. Negotiated Rate	$85.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.69

RAMUCIRUMAB 100 MG/10ML IV SOLN

Facility

$171.39

Service Code	HCPCS J9308
Hospital Charge Code	0002766901
Hospital Revenue Code	258
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$137.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.36
Rate for Payer: Aetna Government	$74.36
Rate for Payer: Affinity Essential Plan 1&2	$52.05
Rate for Payer: Affinity Essential Plan 3&4	$52.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$52.05
Rate for Payer: Brighton Health Commercial	$128.54
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$74.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$116.54
Rate for Payer: Elderplan Medicare Advantage	$74.36
Rate for Payer: EmblemHealth Commercial	$74.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$66.92
Rate for Payer: Fidelis Essential Plan Aliesa	$63.21
Rate for Payer: Fidelis Essential Plan QHP	$66.18
Rate for Payer: Fidelis Medicare Advantage	$74.36
Rate for Payer: Fidelis Qualified Health Plan	$66.18
Rate for Payer: Group Health Inc Commercial	$74.36
Rate for Payer: Group Health Inc Medicare	$74.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.36
Rate for Payer: Hamaspik Choice Inc Medicare	$74.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$74.36
Rate for Payer: Healthfirst Medicare Advantage	$63.21
Rate for Payer: Healthfirst QHP	$74.36
Rate for Payer: Humana Medicare	$75.85
Rate for Payer: Senior Whole Health Medicare Advantage	$74.36
Rate for Payer: United Healthcare Medicare Advantage	$74.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70.64
Rate for Payer: Wellcare Medicare	$70.64

RAMUCIRUMAB 500 MG/50ML IV SOLN

Facility

$171.39

Service Code	HCPCS J9308
Hospital Charge Code	0002767801
Hospital Revenue Code	258
Min. Negotiated Rate	$85.69
Max. Negotiated Rate	$85.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.69

RAMUCIRUMAB 500 MG/50ML IV SOLN

Facility

$171.39

Service Code	HCPCS J9308
Hospital Charge Code	0002767801
Hospital Revenue Code	258
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$137.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.36
Rate for Payer: Aetna Government	$74.36
Rate for Payer: Affinity Essential Plan 1&2	$52.05
Rate for Payer: Affinity Essential Plan 3&4	$52.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$52.05
Rate for Payer: Brighton Health Commercial	$128.54
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$74.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$116.54
Rate for Payer: Elderplan Medicare Advantage	$74.36
Rate for Payer: EmblemHealth Commercial	$74.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$66.92
Rate for Payer: Fidelis Essential Plan Aliesa	$63.21
Rate for Payer: Fidelis Essential Plan QHP	$66.18
Rate for Payer: Fidelis Medicare Advantage	$74.36
Rate for Payer: Fidelis Qualified Health Plan	$66.18
Rate for Payer: Group Health Inc Commercial	$74.36
Rate for Payer: Group Health Inc Medicare	$74.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.36
Rate for Payer: Hamaspik Choice Inc Medicare	$74.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$74.36
Rate for Payer: Healthfirst Medicare Advantage	$63.21
Rate for Payer: Healthfirst QHP	$74.36
Rate for Payer: Humana Medicare	$75.85
Rate for Payer: Senior Whole Health Medicare Advantage	$74.36
Rate for Payer: United Healthcare Medicare Advantage	$74.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70.64
Rate for Payer: Wellcare Medicare	$70.64

RANOLAZINE ER 500 MG PO TB12

Facility

$7.40

Service Code	NDC 3172266860
Hospital Charge Code	3172266860
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$5.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.70
Rate for Payer: Aetna Government	$3.70
Rate for Payer: Brighton Health Commercial	$5.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.03
Rate for Payer: EmblemHealth Commercial	$3.70
Rate for Payer: Group Health Inc Commercial	$3.70
Rate for Payer: Group Health Inc Medicare	$2.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.70
Rate for Payer: Hamaspik Choice Inc Medicare	$3.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.81

RANOLAZINE ER 500 MG PO TB12

Facility

$6.42

Service Code	NDC 5022842360
Hospital Charge Code	5022842360
Hospital Revenue Code	250
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.21

RANOLAZINE ER 500 MG PO TB12

Facility

$6.42

Service Code	NDC 5022842360
Hospital Charge Code	5022842360
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$5.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$4.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.37
Rate for Payer: EmblemHealth Commercial	$3.21
Rate for Payer: Group Health Inc Commercial	$3.21
Rate for Payer: Group Health Inc Medicare	$2.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.21
Rate for Payer: Hamaspik Choice Inc Medicare	$3.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.17

RANOLAZINE ER 500 MG PO TB12

Facility

$7.11

Service Code	NDC 4596341806
Hospital Charge Code	4596341806
Hospital Revenue Code	250
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$5.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.56
Rate for Payer: Aetna Government	$3.56
Rate for Payer: Brighton Health Commercial	$5.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.84
Rate for Payer: EmblemHealth Commercial	$3.56
Rate for Payer: Group Health Inc Commercial	$3.56
Rate for Payer: Group Health Inc Medicare	$2.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.56
Rate for Payer: Hamaspik Choice Inc Medicare	$3.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.62

RANOLAZINE ER 500 MG PO TB12

Facility

$6.43

Service Code	NDC 6787752560
Hospital Charge Code	6787752560
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$5.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$4.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.37
Rate for Payer: EmblemHealth Commercial	$3.21
Rate for Payer: Group Health Inc Commercial	$3.21
Rate for Payer: Group Health Inc Medicare	$2.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.21
Rate for Payer: Hamaspik Choice Inc Medicare	$3.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.18

RANOLAZINE ER 500 MG PO TB12

Facility

$7.40

Service Code	NDC 3172266860
Hospital Charge Code	3172266860
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$3.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.70

RANOLAZINE ER 500 MG PO TB12

Facility

$6.43

Service Code	NDC 6787752560
Hospital Charge Code	6787752560
Hospital Revenue Code	250
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.21

RANOLAZINE ER 500 MG PO TB12

Facility

$6.42

Service Code	NDC 7075670360
Hospital Charge Code	7075670360
Hospital Revenue Code	250
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.21

RANOLAZINE ER 500 MG PO TB12

Facility

$6.42

Service Code	NDC 7075670360
Hospital Charge Code	7075670360
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$5.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.21
Rate for Payer: Aetna Government	$3.21
Rate for Payer: Brighton Health Commercial	$4.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.37
Rate for Payer: EmblemHealth Commercial	$3.21
Rate for Payer: Group Health Inc Commercial	$3.21
Rate for Payer: Group Health Inc Medicare	$2.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.21
Rate for Payer: Hamaspik Choice Inc Medicare	$3.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.17

RANOLAZINE ER 500 MG PO TB12

Facility

$7.11

Service Code	NDC 4596341806
Hospital Charge Code	4596341806
Hospital Revenue Code	250
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$3.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.56

RASAGILINE MESYLATE 1 MG PO TABS

Facility

$24.98

Service Code	NDC 6787726030
Hospital Charge Code	6787726030
Hospital Revenue Code	250
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$12.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.49

RASAGILINE MESYLATE 1 MG PO TABS

Facility

$24.98

Service Code	NDC 6787726030
Hospital Charge Code	6787726030
Hospital Revenue Code	250
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$19.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.49
Rate for Payer: Aetna Government	$12.49
Rate for Payer: Brighton Health Commercial	$18.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.99
Rate for Payer: EmblemHealth Commercial	$12.49
Rate for Payer: Group Health Inc Commercial	$12.49
Rate for Payer: Group Health Inc Medicare	$8.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.49
Rate for Payer: Hamaspik Choice Inc Medicare	$12.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.24

RASAGILINE MESYLATE 1 MG PO TABS

Facility

$25.00

Service Code	NDC 0093306156
Hospital Charge Code	0093306156
Hospital Revenue Code	250
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$12.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50

RASAGILINE MESYLATE 1 MG PO TABS

Facility

$25.00

Service Code	NDC 0093306156
Hospital Charge Code	0093306156
Hospital Revenue Code	250
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: EmblemHealth Commercial	$12.50
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.25

RASBURICASE 1.5 MG IV SOLR

Facility

$1.00

Service Code	HCPCS J2783
Hospital Charge Code	0024515010
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$385.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.52
Rate for Payer: Aetna Government	$377.52
Rate for Payer: Affinity Essential Plan 1&2	$264.26
Rate for Payer: Affinity Essential Plan 3&4	$264.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$264.26
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$377.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$377.52
Rate for Payer: EmblemHealth Commercial	$377.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$339.77
Rate for Payer: Fidelis Essential Plan Aliesa	$320.89
Rate for Payer: Fidelis Essential Plan QHP	$335.99
Rate for Payer: Fidelis Medicare Advantage	$377.52
Rate for Payer: Fidelis Qualified Health Plan	$335.99
Rate for Payer: Group Health Inc Commercial	$377.52
Rate for Payer: Group Health Inc Medicare	$377.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.52
Rate for Payer: Hamaspik Choice Inc Medicare	$377.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$377.52
Rate for Payer: Healthfirst Medicare Advantage	$320.89
Rate for Payer: Healthfirst QHP	$377.52
Rate for Payer: Humana Medicare	$385.07
Rate for Payer: Senior Whole Health Medicare Advantage	$377.52
Rate for Payer: United Healthcare Medicare Advantage	$377.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$358.64
Rate for Payer: Wellcare Medicare	$358.64

RASBURICASE 1.5 MG IV SOLR

Facility

$1.00

Service Code	HCPCS J2783
Hospital Charge Code	0024515010
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

RASBURICASE 1.5 MG/ML IV (WET SOLR VIAL)

Facility

$1.00

Service Code	HCPCS J2783
Hospital Charge Code	0024515010
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

RASBURICASE 1.5 MG/ML IV (WET SOLR VIAL)

Facility

$1.00

Service Code	HCPCS J2783
Hospital Charge Code	0024515010
Hospital Revenue Code	258
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$385.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.52
Rate for Payer: Aetna Government	$377.52
Rate for Payer: Affinity Essential Plan 1&2	$264.26
Rate for Payer: Affinity Essential Plan 3&4	$264.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$264.26
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$377.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$377.52
Rate for Payer: EmblemHealth Commercial	$377.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$339.77
Rate for Payer: Fidelis Essential Plan Aliesa	$320.89
Rate for Payer: Fidelis Essential Plan QHP	$335.99
Rate for Payer: Fidelis Medicare Advantage	$377.52
Rate for Payer: Fidelis Qualified Health Plan	$335.99
Rate for Payer: Group Health Inc Commercial	$377.52
Rate for Payer: Group Health Inc Medicare	$377.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.52
Rate for Payer: Hamaspik Choice Inc Medicare	$377.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$377.52
Rate for Payer: Healthfirst Medicare Advantage	$320.89
Rate for Payer: Healthfirst QHP	$377.52
Rate for Payer: Humana Medicare	$385.07
Rate for Payer: Senior Whole Health Medicare Advantage	$377.52
Rate for Payer: United Healthcare Medicare Advantage	$377.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$358.64
Rate for Payer: Wellcare Medicare	$358.64

RASBURICASE 7.5 MG IV SOLR

Facility

$6.00

Service Code	HCPCS J2783
Hospital Charge Code	0024515175
Hospital Revenue Code	258
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$385.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.52
Rate for Payer: Aetna Government	$377.52
Rate for Payer: Affinity Essential Plan 1&2	$264.26
Rate for Payer: Affinity Essential Plan 3&4	$264.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$264.26
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$377.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Elderplan Medicare Advantage	$377.52
Rate for Payer: EmblemHealth Commercial	$377.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$339.77
Rate for Payer: Fidelis Essential Plan Aliesa	$320.89
Rate for Payer: Fidelis Essential Plan QHP	$335.99
Rate for Payer: Fidelis Medicare Advantage	$377.52
Rate for Payer: Fidelis Qualified Health Plan	$335.99
Rate for Payer: Group Health Inc Commercial	$377.52
Rate for Payer: Group Health Inc Medicare	$377.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$377.52
Rate for Payer: Hamaspik Choice Inc Medicare	$377.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$377.52
Rate for Payer: Healthfirst Medicare Advantage	$320.89
Rate for Payer: Healthfirst QHP	$377.52
Rate for Payer: Humana Medicare	$385.07
Rate for Payer: Senior Whole Health Medicare Advantage	$377.52
Rate for Payer: United Healthcare Medicare Advantage	$377.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$358.64
Rate for Payer: Wellcare Medicare	$358.64

Know your out-of-pocket cost for care.

All Charges