St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PLATE Y 5H W/4MM BAR MDFC LOCK

Facility

$470.30

Service Code	HCPCS C1713
Hospital Charge Code	64901586
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$493.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$282.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.42
Rate for Payer: EmblemHealth Commercial	$235.15
Rate for Payer: Fidelis Medicare Advantage	$493.82
Rate for Payer: Group Health Inc Commercial	$235.15
Rate for Payer: Group Health Inc Medicare	$164.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.15
Rate for Payer: Hamaspik Choice Inc Medicare	$235.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.70

PLATE Y 5H W/8MM BAR MDFC LOCK

Facility

$470.30

Service Code	HCPCS C1713
Hospital Charge Code	64901588
Hospital Revenue Code	278
Min. Negotiated Rate	$235.15
Max. Negotiated Rate	$235.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.15
Rate for Payer: Hamaspik Choice Inc Medicare	$235.15

PLATE Y 5H W/8MM BAR MDFC LOCK

Facility

$470.30

Service Code	HCPCS C1713
Hospital Charge Code	64901588
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$493.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$258.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$282.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$270.42
Rate for Payer: EmblemHealth Commercial	$235.15
Rate for Payer: Fidelis Medicare Advantage	$493.82
Rate for Payer: Group Health Inc Commercial	$235.15
Rate for Payer: Group Health Inc Medicare	$164.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$235.15
Rate for Payer: Hamaspik Choice Inc Medicare	$235.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$305.70

PLATE Y 8-HOLE

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Charge Code	64906274
Hospital Revenue Code	278
Min. Negotiated Rate	$762.00
Max. Negotiated Rate	$762.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$762.00
Rate for Payer: Hamaspik Choice Inc Medicare	$762.00

PLATE Y 8-HOLE

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Charge Code	64906274
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,600.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$838.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$914.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$762.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$876.30
Rate for Payer: EmblemHealth Commercial	$762.00
Rate for Payer: Fidelis Medicare Advantage	$1,600.20
Rate for Payer: Group Health Inc Commercial	$762.00
Rate for Payer: Group Health Inc Medicare	$533.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$762.00
Rate for Payer: Hamaspik Choice Inc Medicare	$762.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$990.60

PLATE Y BROAD 4 HOLE T10

Facility

$3,578.00

Service Code	HCPCS C1713
Hospital Charge Code	64906860
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,756.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,967.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,146.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,789.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,057.35
Rate for Payer: EmblemHealth Commercial	$1,789.00
Rate for Payer: Fidelis Medicare Advantage	$3,756.90
Rate for Payer: Group Health Inc Commercial	$1,789.00
Rate for Payer: Group Health Inc Medicare	$1,252.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,789.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,789.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,325.70

PLATE Y BROAD 4 HOLE T10

Facility

$3,578.00

Service Code	HCPCS C1713
Hospital Charge Code	64906860
Hospital Revenue Code	278
Min. Negotiated Rate	$1,789.00
Max. Negotiated Rate	$1,789.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,789.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,789.00

PLATE, Y- SLIM

Facility

$3,810.00

Service Code	HCPCS C1713
Hospital Charge Code	64907414
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,000.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,095.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,286.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,905.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,190.75
Rate for Payer: EmblemHealth Commercial	$1,905.00
Rate for Payer: Fidelis Medicare Advantage	$4,000.50
Rate for Payer: Group Health Inc Commercial	$1,905.00
Rate for Payer: Group Health Inc Medicare	$1,333.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,905.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,905.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,476.50

PLATE, Y- SLIM

Facility

$3,810.00

Service Code	HCPCS C1713
Hospital Charge Code	64907414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,905.00
Max. Negotiated Rate	$1,905.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,905.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,905.00

PLATE, ZERO 6MM

Facility

$6,575.00

Service Code	HCPCS C1713
Hospital Charge Code	64904763
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,903.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,616.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,945.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,287.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,780.62
Rate for Payer: EmblemHealth Commercial	$3,287.50
Rate for Payer: Fidelis Medicare Advantage	$6,903.75
Rate for Payer: Group Health Inc Commercial	$3,287.50
Rate for Payer: Group Health Inc Medicare	$2,301.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,287.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,287.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,273.75

PLATE, ZERO 6MM

Facility

$6,575.00

Service Code	HCPCS C1713
Hospital Charge Code	64904763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,287.50
Max. Negotiated Rate	$3,287.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,287.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,287.50

PLEURAL EFFUSION WITH CC

Facility

$29,072.86

Service Code	MSDRG 187
Min. Negotiated Rate	$8,543.27
Max. Negotiated Rate	$29,072.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,690.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21,143.90
Rate for Payer: Aetna Government	$21,143.90
Rate for Payer: Brighton Health Commercial	$14,446.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21,566.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17,205.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,198.39
Rate for Payer: Elderplan Medicare Advantage	$20,086.70
Rate for Payer: EmblemHealth Commercial	$8,543.27
Rate for Payer: Fidelis Medicare Advantage	$21,143.90
Rate for Payer: Group Health Inc Commercial	$21,143.90
Rate for Payer: Group Health Inc Medicare	$21,143.90
Rate for Payer: Hamaspik Choice Inc Medicare	$21,143.90
Rate for Payer: Healthfirst Medicare Advantage	$9,831.91
Rate for Payer: Humana Medicare	$29,072.86
Rate for Payer: Senior Whole Health Medicare Advantage	$21,143.90
Rate for Payer: United Healthcare Commercial	$19,813.42
Rate for Payer: United Healthcare Medicare Advantage	$21,143.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,143.90
Rate for Payer: Wellcare Medicare	$20,086.70

PLEURAL EFFUSION WITH MCC

Facility

$39,670.68

Service Code	MSDRG 186
Min. Negotiated Rate	$13,309.30
Max. Negotiated Rate	$39,670.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,885.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28,851.40
Rate for Payer: Aetna Government	$28,851.40
Rate for Payer: Brighton Health Commercial	$22,505.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29,428.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26,803.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,119.16
Rate for Payer: Elderplan Medicare Advantage	$27,408.83
Rate for Payer: EmblemHealth Commercial	$13,309.30
Rate for Payer: Fidelis Medicare Advantage	$28,851.40
Rate for Payer: Group Health Inc Commercial	$28,851.40
Rate for Payer: Group Health Inc Medicare	$28,851.40
Rate for Payer: Hamaspik Choice Inc Medicare	$28,851.40
Rate for Payer: Healthfirst Medicare Advantage	$13,415.90
Rate for Payer: Humana Medicare	$39,670.68
Rate for Payer: Senior Whole Health Medicare Advantage	$28,851.40
Rate for Payer: United Healthcare Commercial	$30,866.61
Rate for Payer: United Healthcare Medicare Advantage	$28,851.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28,851.40
Rate for Payer: Wellcare Medicare	$27,408.83

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$24,309.77

Service Code	MSDRG 188
Min. Negotiated Rate	$6,401.24
Max. Negotiated Rate	$24,309.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,007.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17,679.83
Rate for Payer: Aetna Government	$17,679.83
Rate for Payer: Brighton Health Commercial	$10,824.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18,033.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12,891.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,638.46
Rate for Payer: Elderplan Medicare Advantage	$16,795.84
Rate for Payer: EmblemHealth Commercial	$6,401.24
Rate for Payer: Fidelis Medicare Advantage	$17,679.83
Rate for Payer: Group Health Inc Commercial	$17,679.83
Rate for Payer: Group Health Inc Medicare	$17,679.83
Rate for Payer: Hamaspik Choice Inc Medicare	$17,679.83
Rate for Payer: Healthfirst Medicare Advantage	$8,221.12
Rate for Payer: Humana Medicare	$24,309.77
Rate for Payer: Senior Whole Health Medicare Advantage	$17,679.83
Rate for Payer: United Healthcare Commercial	$14,845.65
Rate for Payer: United Healthcare Medicare Advantage	$17,679.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17,679.83
Rate for Payer: Wellcare Medicare	$16,795.84

PLEUR-EVAC

Facility

$1,909.65

Service Code	HCPCS 32554
Hospital Charge Code	40000300
Hospital Revenue Code	360
Min. Negotiated Rate	$508.53
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$726.47
Rate for Payer: Aetna Government	$726.47
Rate for Payer: Affinity Essential Plan 1&2	$508.53
Rate for Payer: Affinity Essential Plan 3&4	$508.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$508.53
Rate for Payer: Brighton Health Commercial	$1,432.24
Rate for Payer: Cash Price	$726.47
Rate for Payer: Cash Price	$726.47
Rate for Payer: Cash Price	$726.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$726.47
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	$726.47
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$617.50
Rate for Payer: Fidelis Essential Plan QHP	$646.56
Rate for Payer: Fidelis Medicare Advantage	$726.47
Rate for Payer: Fidelis Qualified Health Plan	$646.56
Rate for Payer: Group Health Inc Commercial	$726.47
Rate for Payer: Group Health Inc Medicare	$726.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.82
Rate for Payer: Hamaspik Choice Inc Medicare	$726.47
Rate for Payer: Healthfirst Medicare Advantage	$617.50
Rate for Payer: Healthfirst QHP	$726.47
Rate for Payer: Humana Medicare	$741.00
Rate for Payer: Senior Whole Health Medicare Advantage	$726.47
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$726.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$726.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$581.18
Rate for Payer: Wellcare Medicare	$690.15

PLEUR-EVAC

Facility

$274.64

Hospital Charge Code	40204836
Hospital Revenue Code	270
Min. Negotiated Rate	$96.12
Max. Negotiated Rate	$219.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.32
Rate for Payer: Aetna Government	$137.32
Rate for Payer: Brighton Health Commercial	$205.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$219.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$186.76
Rate for Payer: Group Health Inc Commercial	$137.32
Rate for Payer: Group Health Inc Medicare	$96.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.32
Rate for Payer: Hamaspik Choice Inc Medicare	$137.32

PLEUR-EVAC

Facility

$1,909.65

Service Code	HCPCS 32554
Hospital Charge Code	40000300
Hospital Revenue Code	360
Rate for Payer: Cash Price	$726.47

PLEURX DRAINAGE KIT 1000 ML

Facility

$162.00

Hospital Charge Code	64903513
Hospital Revenue Code	270
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$129.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.00
Rate for Payer: Aetna Government	$81.00
Rate for Payer: Brighton Health Commercial	$121.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.16
Rate for Payer: Group Health Inc Commercial	$81.00
Rate for Payer: Group Health Inc Medicare	$56.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.00
Rate for Payer: Hamaspik Choice Inc Medicare	$81.00

PLEXUR 6000-005

Facility

$1,190.00

Service Code	HCPCS C1768
Hospital Charge Code	40202039
Hospital Revenue Code	278
Min. Negotiated Rate	$595.00
Max. Negotiated Rate	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$595.00
Rate for Payer: Hamaspik Choice Inc Medicare	$595.00

PLEXUR 6000-005

Facility

$1,190.00

Service Code	HCPCS C1768
Hospital Charge Code	40202039
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$1,249.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$654.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$714.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$595.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$684.25
Rate for Payer: EmblemHealth Commercial	$595.00
Rate for Payer: Fidelis Medicare Advantage	$1,249.50
Rate for Payer: Group Health Inc Commercial	$595.00
Rate for Payer: Group Health Inc Medicare	$416.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$595.00
Rate for Payer: Hamaspik Choice Inc Medicare	$595.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$773.50

PLEXUR WEDGE 40MMX15MMX10

Facility

$1,190.00

Service Code	HCPCS C1713
Hospital Charge Code	40202037
Hospital Revenue Code	278
Min. Negotiated Rate	$595.00
Max. Negotiated Rate	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$595.00
Rate for Payer: Hamaspik Choice Inc Medicare	$595.00

PLEXUR WEDGE 40MMX15MMX10

Facility

$1,190.00

Service Code	HCPCS C1713
Hospital Charge Code	40202037
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,249.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$654.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$714.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$595.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$684.25
Rate for Payer: EmblemHealth Commercial	$595.00
Rate for Payer: Fidelis Medicare Advantage	$1,249.50
Rate for Payer: Group Health Inc Commercial	$595.00
Rate for Payer: Group Health Inc Medicare	$416.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$595.00
Rate for Payer: Hamaspik Choice Inc Medicare	$595.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$773.50

PLEXUR WEDGE 40MMX15MMX15

Facility

$1,370.00

Service Code	HCPCS C1713
Hospital Charge Code	40202038
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,438.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$753.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$822.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$685.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.75
Rate for Payer: EmblemHealth Commercial	$685.00
Rate for Payer: Fidelis Medicare Advantage	$1,438.50
Rate for Payer: Group Health Inc Commercial	$685.00
Rate for Payer: Group Health Inc Medicare	$479.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$685.00
Rate for Payer: Hamaspik Choice Inc Medicare	$685.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$890.50

PLEXUR WEDGE 40MMX15MMX15

Facility

$1,370.00

Service Code	HCPCS C1713
Hospital Charge Code	40202038
Hospital Revenue Code	278
Min. Negotiated Rate	$685.00
Max. Negotiated Rate	$685.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$685.00
Rate for Payer: Hamaspik Choice Inc Medicare	$685.00

PLT 3.5MM CURVED RECONSTRUCT 12H

Facility

$913.00

Service Code	HCPCS C1713
Hospital Charge Code	40209890
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$958.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$502.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$547.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$456.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$524.98
Rate for Payer: EmblemHealth Commercial	$456.50
Rate for Payer: Fidelis Medicare Advantage	$958.65
Rate for Payer: Group Health Inc Commercial	$456.50
Rate for Payer: Group Health Inc Medicare	$319.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.50
Rate for Payer: Hamaspik Choice Inc Medicare	$456.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$593.45

Know your out-of-pocket cost for care.

All Charges