St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RASBURICASE 7.5 MG IV SOLR

Facility

$6.00

Service Code	HCPCS J2783
Hospital Charge Code	0024515175
Hospital Revenue Code	258
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00

REFRESH LACRI-LUBE OP OINT

Facility

$3.35

Service Code	NDC 0023031204
Hospital Charge Code	0023031204
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$1.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.67

REFRESH LACRI-LUBE OP OINT

Facility

$3.35

Service Code	NDC 0023031204
Hospital Charge Code	0023031204
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.67
Rate for Payer: Aetna Government	$1.67
Rate for Payer: Brighton Health Commercial	$2.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.28
Rate for Payer: EmblemHealth Commercial	$1.67
Rate for Payer: Group Health Inc Commercial	$1.67
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.67
Rate for Payer: Hamaspik Choice Inc Medicare	$1.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$42.04

Service Code	HCPCS J2785
Hospital Charge Code	0409140105
Hospital Revenue Code	258
Min. Negotiated Rate	$21.02
Max. Negotiated Rate	$21.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.02

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$60.06

Service Code	HCPCS J2785
Hospital Charge Code	6050561160
Hospital Revenue Code	258
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$30.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.03

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$60.06

Service Code	HCPCS J2785
Hospital Charge Code	6050561160
Hospital Revenue Code	258
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$59.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.70
Rate for Payer: Aetna Government	$59.70
Rate for Payer: Brighton Health Commercial	$45.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.84
Rate for Payer: EmblemHealth Commercial	$30.03
Rate for Payer: Group Health Inc Commercial	$30.03
Rate for Payer: Group Health Inc Medicare	$21.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.03
Rate for Payer: Hamaspik Choice Inc Medicare	$30.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.04

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$61.86

Service Code	HCPCS J2785
Hospital Charge Code	0469650189
Hospital Revenue Code	258
Min. Negotiated Rate	$30.93
Max. Negotiated Rate	$30.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.93

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$61.86

Service Code	HCPCS J2785
Hospital Charge Code	0469650189
Hospital Revenue Code	258
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$59.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.70
Rate for Payer: Aetna Government	$59.70
Rate for Payer: Brighton Health Commercial	$46.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.07
Rate for Payer: EmblemHealth Commercial	$30.93
Rate for Payer: Group Health Inc Commercial	$30.93
Rate for Payer: Group Health Inc Medicare	$21.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.93
Rate for Payer: Hamaspik Choice Inc Medicare	$30.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.21

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$42.04

Service Code	HCPCS J2785
Hospital Charge Code	0409140105
Hospital Revenue Code	258
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$59.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.70
Rate for Payer: Aetna Government	$59.70
Rate for Payer: Brighton Health Commercial	$31.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.59
Rate for Payer: EmblemHealth Commercial	$21.02
Rate for Payer: Group Health Inc Commercial	$21.02
Rate for Payer: Group Health Inc Medicare	$14.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.02
Rate for Payer: Hamaspik Choice Inc Medicare	$21.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.33

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$4.80

Service Code	HCPCS J2785
Hospital Charge Code	7128820185
Hospital Revenue Code	258
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$59.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.70
Rate for Payer: Aetna Government	$59.70
Rate for Payer: Brighton Health Commercial	$3.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.26
Rate for Payer: EmblemHealth Commercial	$2.40
Rate for Payer: Group Health Inc Commercial	$2.40
Rate for Payer: Group Health Inc Medicare	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40
Rate for Payer: Hamaspik Choice Inc Medicare	$2.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.12

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$7.20

Service Code	HCPCS J2785
Hospital Charge Code	7632933210
Hospital Revenue Code	258
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$59.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.70
Rate for Payer: Aetna Government	$59.70
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.90
Rate for Payer: EmblemHealth Commercial	$3.60
Rate for Payer: Group Health Inc Commercial	$3.60
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$7.20

Service Code	HCPCS J2785
Hospital Charge Code	7632933210
Hospital Revenue Code	258
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60

REGADENOSON 0.4 MG/5ML IV SOLN

Facility

$4.80

Service Code	HCPCS J2785
Hospital Charge Code	7128820185
Hospital Revenue Code	258
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.40

Rehabilitation

Facility

$73,737.65

Service Code	APR-DRG 8604
Min. Negotiated Rate	$17,221.00
Max. Negotiated Rate	$73,737.65
Rate for Payer: Affinity Essential Plan 1&2	$73,737.65
Rate for Payer: Affinity Essential Plan 3&4	$73,737.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,772.29
Rate for Payer: Amida Care Medicaid	$32,772.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$73,737.65
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,772.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,772.29
Rate for Payer: Fidelis Qualified Health Plan	$39,326.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,772.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,772.29
Rate for Payer: Healthfirst Commercial	$39,229.00
Rate for Payer: Healthfirst Essential Plan	$73,737.65
Rate for Payer: Healthfirst QHP	$17,221.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,772.29
Rate for Payer: SOMOS Essential	$73,737.65
Rate for Payer: United Healthcare Essential Plan 1&2	$73,737.65
Rate for Payer: United Healthcare Essential Plan 3&4	$73,737.65
Rate for Payer: United Healthcare Medicaid	$32,772.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,772.29

Rehabilitation

Facility

$63,566.82

Service Code	APR-DRG 8602
Min. Negotiated Rate	$14,770.00
Max. Negotiated Rate	$63,566.82
Rate for Payer: Affinity Essential Plan 1&2	$63,566.82
Rate for Payer: Affinity Essential Plan 3&4	$63,566.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,251.92
Rate for Payer: Amida Care Medicaid	$28,251.92
Rate for Payer: EmblemHealth Essential Plan 1&2	$63,566.82
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,251.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,251.92
Rate for Payer: Fidelis Qualified Health Plan	$33,902.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,251.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,251.92
Rate for Payer: Healthfirst Commercial	$21,778.00
Rate for Payer: Healthfirst Essential Plan	$63,566.82
Rate for Payer: Healthfirst QHP	$14,770.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,251.92
Rate for Payer: SOMOS Essential	$63,566.82
Rate for Payer: United Healthcare Essential Plan 1&2	$63,566.82
Rate for Payer: United Healthcare Essential Plan 3&4	$63,566.82
Rate for Payer: United Healthcare Medicaid	$28,251.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,251.92

Rehabilitation

Facility

$73,737.65

Service Code	APR-DRG 8603
Min. Negotiated Rate	$16,704.00
Max. Negotiated Rate	$73,737.65
Rate for Payer: Affinity Essential Plan 1&2	$73,737.65
Rate for Payer: Affinity Essential Plan 3&4	$73,737.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,772.29
Rate for Payer: Amida Care Medicaid	$32,772.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$73,737.65
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,772.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,772.29
Rate for Payer: Fidelis Qualified Health Plan	$39,326.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,772.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,772.29
Rate for Payer: Healthfirst Commercial	$36,304.00
Rate for Payer: Healthfirst Essential Plan	$73,737.65
Rate for Payer: Healthfirst QHP	$16,704.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,772.29
Rate for Payer: SOMOS Essential	$73,737.65
Rate for Payer: United Healthcare Essential Plan 1&2	$73,737.65
Rate for Payer: United Healthcare Essential Plan 3&4	$73,737.65
Rate for Payer: United Healthcare Medicaid	$32,772.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,772.29

Rehabilitation

Facility

$58,965.93

Service Code	APR-DRG 8601
Min. Negotiated Rate	$14,770.00
Max. Negotiated Rate	$58,965.93
Rate for Payer: Affinity Essential Plan 1&2	$58,965.93
Rate for Payer: Affinity Essential Plan 3&4	$58,965.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,207.08
Rate for Payer: Amida Care Medicaid	$26,207.08
Rate for Payer: EmblemHealth Essential Plan 1&2	$58,965.93
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,207.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,207.08
Rate for Payer: Fidelis Qualified Health Plan	$31,448.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,207.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,207.08
Rate for Payer: Healthfirst Commercial	$21,195.00
Rate for Payer: Healthfirst Essential Plan	$58,965.93
Rate for Payer: Healthfirst QHP	$14,770.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,207.08
Rate for Payer: SOMOS Essential	$58,965.93
Rate for Payer: United Healthcare Essential Plan 1&2	$58,965.93
Rate for Payer: United Healthcare Essential Plan 3&4	$58,965.93
Rate for Payer: United Healthcare Medicaid	$26,207.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,207.08

REHABILITATION

Facility

$197.59

Service Code	EAPG 00870
Min. Negotiated Rate	$143.49
Max. Negotiated Rate	$197.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$143.49
Rate for Payer: Healthfirst Commercial	$197.59

REMDESIVIR 100 MG IV SOLR

Facility

$719.38

Service Code	HCPCS J0248
Hospital Charge Code	6195829012
Hospital Revenue Code	258
Min. Negotiated Rate	$359.69
Max. Negotiated Rate	$359.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.69

REMDESIVIR 100 MG IV SOLR

Facility

$719.38

Service Code	HCPCS J0248
Hospital Charge Code	6195829012
Hospital Revenue Code	258
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$575.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$395.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.73
Rate for Payer: Aetna Government	$6.73
Rate for Payer: Affinity Essential Plan 1&2	$4.71
Rate for Payer: Affinity Essential Plan 3&4	$4.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.71
Rate for Payer: Brighton Health Commercial	$539.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$575.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$489.18
Rate for Payer: Elderplan Medicare Advantage	$6.73
Rate for Payer: EmblemHealth Commercial	$6.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.06
Rate for Payer: Fidelis Essential Plan Aliesa	$5.72
Rate for Payer: Fidelis Essential Plan QHP	$5.99
Rate for Payer: Fidelis Medicare Advantage	$6.73
Rate for Payer: Fidelis Qualified Health Plan	$5.99
Rate for Payer: Group Health Inc Commercial	$6.73
Rate for Payer: Group Health Inc Medicare	$6.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.73
Rate for Payer: Hamaspik Choice Inc Medicare	$6.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.73
Rate for Payer: Healthfirst Medicare Advantage	$5.72
Rate for Payer: Healthfirst QHP	$6.73
Rate for Payer: Humana Medicare	$6.86
Rate for Payer: Senior Whole Health Medicare Advantage	$6.73
Rate for Payer: United Healthcare Medicare Advantage	$6.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$467.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.39
Rate for Payer: Wellcare Medicare	$6.39

REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES

Facility

$3,949.39

Service Code	EAPG 00087
Min. Negotiated Rate	$2,867.42
Max. Negotiated Rate	$3,949.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,867.42
Rate for Payer: Healthfirst Commercial	$3,949.39

Renal dialysis access device procedure only

Facility

$62,740.21

Service Code	APR-DRG 4442
Min. Negotiated Rate	$17,664.00
Max. Negotiated Rate	$62,740.21
Rate for Payer: Affinity Essential Plan 1&2	$62,740.21
Rate for Payer: Affinity Essential Plan 3&4	$62,740.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,884.54
Rate for Payer: Amida Care Medicaid	$27,884.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$62,740.21
Rate for Payer: EmblemHealth Essential Plan 3&4	$27,884.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,884.54
Rate for Payer: Fidelis Qualified Health Plan	$33,461.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,884.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,884.54
Rate for Payer: Healthfirst Commercial	$30,086.00
Rate for Payer: Healthfirst Essential Plan	$62,740.21
Rate for Payer: Healthfirst QHP	$17,664.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,884.54
Rate for Payer: SOMOS Essential	$62,740.21
Rate for Payer: United Healthcare Essential Plan 1&2	$62,740.21
Rate for Payer: United Healthcare Essential Plan 3&4	$62,740.21
Rate for Payer: United Healthcare Medicaid	$27,884.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,884.54

Renal dialysis access device procedure only

Facility

$88,869.89

Service Code	APR-DRG 4443
Min. Negotiated Rate	$33,511.00
Max. Negotiated Rate	$88,869.89
Rate for Payer: Affinity Essential Plan 1&2	$88,869.89
Rate for Payer: Affinity Essential Plan 3&4	$88,869.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,497.73
Rate for Payer: Amida Care Medicaid	$39,497.73
Rate for Payer: EmblemHealth Essential Plan 1&2	$88,869.89
Rate for Payer: EmblemHealth Essential Plan 3&4	$39,497.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,497.73
Rate for Payer: Fidelis Qualified Health Plan	$47,397.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,497.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,497.73
Rate for Payer: Healthfirst Commercial	$57,702.00
Rate for Payer: Healthfirst Essential Plan	$88,869.89
Rate for Payer: Healthfirst QHP	$33,511.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,497.73
Rate for Payer: SOMOS Essential	$88,869.89
Rate for Payer: United Healthcare Essential Plan 1&2	$88,869.89
Rate for Payer: United Healthcare Essential Plan 3&4	$88,869.89
Rate for Payer: United Healthcare Medicaid	$39,497.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,497.73

Renal dialysis access device procedure only

Facility

$140,810.96

Service Code	APR-DRG 4444
Min. Negotiated Rate	$62,582.65
Max. Negotiated Rate	$140,810.96
Rate for Payer: Affinity Essential Plan 1&2	$140,810.96
Rate for Payer: Affinity Essential Plan 3&4	$140,810.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$62,582.65
Rate for Payer: Amida Care Medicaid	$62,582.65
Rate for Payer: EmblemHealth Essential Plan 1&2	$140,810.96
Rate for Payer: EmblemHealth Essential Plan 3&4	$62,582.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,582.65
Rate for Payer: Fidelis Qualified Health Plan	$75,099.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,582.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,582.65
Rate for Payer: Healthfirst Commercial	$111,996.00
Rate for Payer: Healthfirst Essential Plan	$140,810.96
Rate for Payer: Healthfirst QHP	$74,800.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,582.65
Rate for Payer: SOMOS Essential	$140,810.96
Rate for Payer: United Healthcare Essential Plan 1&2	$140,810.96
Rate for Payer: United Healthcare Essential Plan 3&4	$140,810.96
Rate for Payer: United Healthcare Medicaid	$62,582.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,582.65

Renal dialysis access device procedure only

Facility

$49,294.60

Service Code	APR-DRG 4441
Min. Negotiated Rate	$11,671.00
Max. Negotiated Rate	$49,294.60
Rate for Payer: Affinity Essential Plan 1&2	$49,294.60
Rate for Payer: Affinity Essential Plan 3&4	$49,294.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,908.71
Rate for Payer: Amida Care Medicaid	$21,908.71
Rate for Payer: EmblemHealth Essential Plan 1&2	$49,294.60
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,908.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,908.71
Rate for Payer: Fidelis Qualified Health Plan	$26,290.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,908.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,908.71
Rate for Payer: Healthfirst Commercial	$20,448.00
Rate for Payer: Healthfirst Essential Plan	$49,294.60
Rate for Payer: Healthfirst QHP	$11,671.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,908.71
Rate for Payer: SOMOS Essential	$49,294.60
Rate for Payer: United Healthcare Essential Plan 1&2	$49,294.60
Rate for Payer: United Healthcare Essential Plan 3&4	$49,294.60
Rate for Payer: United Healthcare Medicaid	$21,908.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,908.71

Know your out-of-pocket cost for care.

All Charges