St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OFFICE O/P EST MOD 30-39MIN

Facility

$435.92

Service Code	HCPCS 99214
Hospital Charge Code	42500102
Hospital Revenue Code	510
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.00
Rate for Payer: Aetna Government	$54.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$217.96
Rate for Payer: Hamaspik Choice Inc Medicare	$217.96
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST MOD30-39 MIN

Facility

$435.92

Service Code	HCPCS 99214
Hospital Charge Code	42500162
Hospital Revenue Code	510
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.00
Rate for Payer: Aetna Government	$54.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$217.96
Rate for Payer: Hamaspik Choice Inc Medicare	$217.96
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST MOD30-39 MIN

Facility

$435.92

Service Code	HCPCS 99214
Hospital Charge Code	30300117
Hospital Revenue Code	510
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.00
Rate for Payer: Aetna Government	$54.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$217.96
Rate for Payer: Hamaspik Choice Inc Medicare	$217.96
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST MOD30-39MIN

Facility

$435.92

Service Code	HCPCS 99214
Hospital Charge Code	30300064
Hospital Revenue Code	510
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.00
Rate for Payer: Aetna Government	$54.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$217.96
Rate for Payer: Hamaspik Choice Inc Medicare	$217.96
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST MOD 30-39MIN,MOD25

Facility

$435.92

Service Code	HCPCS 99214 25
Hospital Charge Code	42500103
Hospital Revenue Code	510
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$217.96
Rate for Payer: Hamaspik Choice Inc Medicare	$217.96
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST MOD 30-39MIN,TELEM

Facility

$395.39

Service Code	HCPCS 99214 95
Hospital Charge Code	30300991
Hospital Revenue Code	510
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.00
Rate for Payer: Aetna Government	$75.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$197.70
Rate for Payer: Hamaspik Choice Inc Medicare	$197.70
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST SF 10-19 MIN

Facility

$395.39

Service Code	HCPCS 99212
Hospital Charge Code	42500118
Hospital Revenue Code	510
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.50
Rate for Payer: Aetna Government	$18.50
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$197.70
Rate for Payer: Hamaspik Choice Inc Medicare	$197.70
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST SF 10-19 MIN

Facility

$395.39

Service Code	HCPCS 99212
Hospital Charge Code	30400081
Hospital Revenue Code	510
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.50
Rate for Payer: Aetna Government	$18.50
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$197.70
Rate for Payer: Hamaspik Choice Inc Medicare	$197.70
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST SF 10-19MIN

Facility

$395.39

Service Code	HCPCS 99212
Hospital Charge Code	30400211
Hospital Revenue Code	510
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.50
Rate for Payer: Aetna Government	$18.50
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$197.70
Rate for Payer: Hamaspik Choice Inc Medicare	$197.70
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST SF 10-19MIN,MOD 25

Facility

$395.39

Service Code	HCPCS 99212 25
Hospital Charge Code	42500163
Hospital Revenue Code	510
Min. Negotiated Rate	$32.32
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.32
Rate for Payer: Aetna Government	$32.32
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$197.70
Rate for Payer: Hamaspik Choice Inc Medicare	$197.70
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P EST SF 10-19 MIN,TELEM

Facility

$324.22

Service Code	HCPCS 99212 95
Hospital Charge Code	30300993
Hospital Revenue Code	510
Min. Negotiated Rate	$32.32
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.32
Rate for Payer: Aetna Government	$32.32
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$162.11
Rate for Payer: Hamaspik Choice Inc Medicare	$162.11
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE/OP HIGH COMPLEXITY

Facility

$415.16

Hospital Charge Code	30300116
Hospital Revenue Code	510
Min. Negotiated Rate	$173.89
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$207.58
Rate for Payer: Aetna Government	$207.58
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$207.58
Rate for Payer: Hamaspik Choice Inc Medicare	$207.58
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW HI 60-74 MIN

Facility

$528.66

Service Code	HCPCS 99205
Hospital Charge Code	42500106
Hospital Revenue Code	510
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$290.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.00
Rate for Payer: Aetna Government	$140.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$264.33
Rate for Payer: Hamaspik Choice Inc Medicare	$264.33
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW HI 60-74 MIN

Facility

$528.66

Service Code	HCPCS 99205
Hospital Charge Code	30400209
Hospital Revenue Code	510
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$290.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.00
Rate for Payer: Aetna Government	$140.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$264.33
Rate for Payer: Hamaspik Choice Inc Medicare	$264.33
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW HI 60-74MIN

Facility

$528.66

Service Code	HCPCS 99205
Hospital Charge Code	30300063
Hospital Revenue Code	510
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$290.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.00
Rate for Payer: Aetna Government	$140.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$264.33
Rate for Payer: Hamaspik Choice Inc Medicare	$264.33
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW HI 60-74MIN,MOD25

Facility

$528.66

Service Code	HCPCS 99205 25
Hospital Charge Code	42500107
Hospital Revenue Code	510
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$290.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.40
Rate for Payer: Aetna Government	$113.40
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$264.33
Rate for Payer: Hamaspik Choice Inc Medicare	$264.33
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW LOW 30-44 MIN

Facility

$479.51

Service Code	HCPCS 99203
Hospital Charge Code	42500120
Hospital Revenue Code	510
Min. Negotiated Rate	$57.06
Max. Negotiated Rate	$263.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$263.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.06
Rate for Payer: Aetna Government	$57.06
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$239.76
Rate for Payer: Hamaspik Choice Inc Medicare	$239.76
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW LOW 30-44MIN

Facility

$479.51

Service Code	HCPCS 99203
Hospital Charge Code	30400204
Hospital Revenue Code	510
Min. Negotiated Rate	$57.06
Max. Negotiated Rate	$263.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$263.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.06
Rate for Payer: Aetna Government	$57.06
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$239.76
Rate for Payer: Hamaspik Choice Inc Medicare	$239.76
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW LOW30-44 MIN

Facility

$479.51

Service Code	HCPCS 99203
Hospital Charge Code	30300056
Hospital Revenue Code	510
Min. Negotiated Rate	$57.06
Max. Negotiated Rate	$263.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$263.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.06
Rate for Payer: Aetna Government	$57.06
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$239.76
Rate for Payer: Hamaspik Choice Inc Medicare	$239.76
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW LOW 30-44MIN,MOD25

Facility

$479.51

Service Code	HCPCS 99203 25
Hospital Charge Code	42500121
Hospital Revenue Code	510
Min. Negotiated Rate	$80.63
Max. Negotiated Rate	$263.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$263.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.63
Rate for Payer: Aetna Government	$80.63
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$239.76
Rate for Payer: Hamaspik Choice Inc Medicare	$239.76
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW LOW 30-44MIN,TELEM

Facility

$415.16

Service Code	HCPCS 99203 95
Hospital Charge Code	30300995
Hospital Revenue Code	510
Min. Negotiated Rate	$80.63
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.63
Rate for Payer: Aetna Government	$80.63
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$207.58
Rate for Payer: Hamaspik Choice Inc Medicare	$207.58
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW MOD 45-59 MIN

Facility

$503.49

Service Code	HCPCS 99204
Hospital Charge Code	42500122
Hospital Revenue Code	510
Min. Negotiated Rate	$92.04
Max. Negotiated Rate	$276.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$92.04
Rate for Payer: Aetna Government	$92.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$251.74
Rate for Payer: Hamaspik Choice Inc Medicare	$251.74
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW MOD 45-59 MIN

Facility

$503.49

Service Code	HCPCS 99204
Hospital Charge Code	30400208
Hospital Revenue Code	510
Min. Negotiated Rate	$92.04
Max. Negotiated Rate	$276.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$92.04
Rate for Payer: Aetna Government	$92.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$251.74
Rate for Payer: Hamaspik Choice Inc Medicare	$251.74
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW MOD 45-59MIN

Facility

$503.49

Service Code	HCPCS 99204
Hospital Charge Code	30301181
Hospital Revenue Code	510
Min. Negotiated Rate	$92.04
Max. Negotiated Rate	$276.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$92.04
Rate for Payer: Aetna Government	$92.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$251.74
Rate for Payer: Hamaspik Choice Inc Medicare	$251.74
Rate for Payer: United Healthcare Commercial	$222.00

OFFICE O/P NEW MOD45-59 MIN

Facility

$503.49

Service Code	HCPCS 99204
Hospital Charge Code	30300062
Hospital Revenue Code	510
Min. Negotiated Rate	$92.04
Max. Negotiated Rate	$276.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$92.04
Rate for Payer: Aetna Government	$92.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$251.74
Rate for Payer: Hamaspik Choice Inc Medicare	$251.74
Rate for Payer: United Healthcare Commercial	$222.00

Know your out-of-pocket cost for care.

All Charges