St. Barnabas Hospital

All Charges

Charge

Type

Price

SPACER SPINE 10X22X28 8DEG

Facility IP

$17,040.20

Service Code	HCPCS C1776
Hospital Charge Code	64904643
Hospital Revenue Code	278
Min. Negotiated Rate	$8,520.10
Max. Negotiated Rate	$8,520.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,520.10
Rate for Payer: Hamaspik Choice Inc Medicare	$8,520.10

SPACER SPINE 10X22X28 8DEG

Facility OP

$17,040.20

Service Code	HCPCS C1776
Hospital Charge Code	64904643
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$17,892.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,372.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,520.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,798.12
Rate for Payer: Fidelis Medicare Advantage	$17,892.21
Rate for Payer: Group Health Inc Commercial	$8,520.10
Rate for Payer: Group Health Inc Medicare	$5,964.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,520.10
Rate for Payer: Hamaspik Choice Inc Medicare	$8,520.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,076.13

SPACER SPINE 8X25X10 PEEK

Facility OP

$15,724.95

Service Code	HCPCS C1776
Hospital Charge Code	64904802
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$16,511.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,648.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,862.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,041.85
Rate for Payer: Fidelis Medicare Advantage	$16,511.20
Rate for Payer: Group Health Inc Commercial	$7,862.48
Rate for Payer: Group Health Inc Medicare	$5,503.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,862.48
Rate for Payer: Hamaspik Choice Inc Medicare	$7,862.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,221.22

SPACER SPINE 8X25X10 PEEK

Facility IP

$15,724.95

Service Code	HCPCS C1776
Hospital Charge Code	64904802
Hospital Revenue Code	278
Min. Negotiated Rate	$7,862.48
Max. Negotiated Rate	$7,862.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,862.48
Rate for Payer: Hamaspik Choice Inc Medicare	$7,862.48

SPACER VERTEBRAL 14X25X35X12D

Facility IP

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905309
Hospital Revenue Code	278
Min. Negotiated Rate	$11,610.00
Max. Negotiated Rate	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00

SPACER VERTEBRAL 14X25X35X12D

Facility OP

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905309
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$24,381.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,771.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,610.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,351.50
Rate for Payer: Fidelis Medicare Advantage	$24,381.00
Rate for Payer: Group Health Inc Commercial	$11,610.00
Rate for Payer: Group Health Inc Medicare	$8,127.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,093.00

SPACER VERTEBRAL 14X25X35X4D

Facility IP

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905310
Hospital Revenue Code	278
Min. Negotiated Rate	$11,610.00
Max. Negotiated Rate	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00

SPACER VERTEBRAL 14X25X35X4D

Facility OP

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905310
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$24,381.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,771.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,610.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,351.50
Rate for Payer: Fidelis Medicare Advantage	$24,381.00
Rate for Payer: Group Health Inc Commercial	$11,610.00
Rate for Payer: Group Health Inc Medicare	$8,127.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,093.00

SP ACTIVATED CLOTTING TIME

Facility OP

$10.70

Service Code	HCPCS 85347 TC
Hospital Charge Code	41546011
Hospital Revenue Code	300
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$8.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.35
Rate for Payer: Aetna Government	$5.35
Rate for Payer: Cash Price	$4.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.28
Rate for Payer: Group Health Inc Commercial	$5.35
Rate for Payer: Group Health Inc Medicare	$3.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.35
Rate for Payer: Hamaspik Choice Inc Medicare	$5.35

SPANAIDS

Facility OP

$51.39

Service Code	HCPCS C1713
Hospital Charge Code	40205726
Hospital Revenue Code	270
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.95
Rate for Payer: Group Health Inc Commercial	$25.70
Rate for Payer: Group Health Inc Medicare	$17.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.70
Rate for Payer: Hamaspik Choice Inc Medicare	$25.70

SP ANKLE ARTHROGRAM

Facility OP

$447.40

Service Code	HCPCS 27648 TC
Hospital Charge Code	41547464
Hospital Revenue Code	361
Min. Negotiated Rate	$156.59
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$246.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.70
Rate for Payer: Aetna Government	$223.70
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: Group Health Inc Commercial	$223.70
Rate for Payer: Group Health Inc Medicare	$156.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.70
Rate for Payer: Hamaspik Choice Inc Medicare	$223.70

SP AORTA CATHETER

Facility OP

$1,965.63

Service Code	HCPCS 36200 TC
Hospital Charge Code	41542689
Hospital Revenue Code	361
Min. Negotiated Rate	$687.97
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,081.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$982.82
Rate for Payer: Aetna Government	$982.82
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: Group Health Inc Commercial	$982.82
Rate for Payer: Group Health Inc Medicare	$687.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$982.82
Rate for Payer: Hamaspik Choice Inc Medicare	$982.82

SP AORTA/IVC/ILIA COMP

Facility OP

$705.83

Service Code	HCPCS 93978 TC
Hospital Charge Code	41201174
Hospital Revenue Code	920
Min. Negotiated Rate	$159.91
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$159.91
Rate for Payer: Group Health Inc Commercial	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$177.68

SP AORTA/IVC/ILIA LTD

Facility OP

$339.45

Service Code	HCPCS 93979 TC
Hospital Charge Code	41201175
Hospital Revenue Code	920
Min. Negotiated Rate	$105.27
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$105.27
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$116.97

SP AORTA TRANSLUMBAR

Facility OP

$30,010.30

Service Code	HCPCS 0236T
Hospital Charge Code	41542766
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$15,005.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12,721.98
Rate for Payer: Aetna Government	$12,721.98
Rate for Payer: Cash Price	$12,721.98
Rate for Payer: Cash Price	$12,721.98
Rate for Payer: Cash Price	$12,721.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12,721.98
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	$12,721.98
Rate for Payer: EmblemHealth Commercial	$12,721.98
Rate for Payer: Fidelis Essential Plan Aliesa	$10,813.68
Rate for Payer: Fidelis Essential Plan QHP	$11,322.56
Rate for Payer: Fidelis Medicare Advantage	$12,721.98
Rate for Payer: Fidelis Qualified Health Plan	$11,322.56
Rate for Payer: Group Health Inc Commercial	$12,721.98
Rate for Payer: Group Health Inc Medicare	$12,721.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.15
Rate for Payer: Hamaspik Choice Inc Medicare	$12,721.98
Rate for Payer: Healthfirst Medicare Advantage	$10,813.68
Rate for Payer: Healthfirst QHP	$12,721.98
Rate for Payer: Senior Whole Health Medicare Advantage	$12,721.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,721.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10,177.58
Rate for Payer: Wellcare Medicare	$12,085.88

SP ARTER. ABOVE DIAPH. 1S

Facility OP

$3,471.23

Service Code	HCPCS 36215 TC
Hospital Charge Code	41542678
Hospital Revenue Code	361
Min. Negotiated Rate	$1,214.93
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,909.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,735.62
Rate for Payer: Aetna Government	$1,735.62
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: Group Health Inc Commercial	$1,735.62
Rate for Payer: Group Health Inc Medicare	$1,214.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,735.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,735.62

SP ARTER. ABOVE DIAPH. 2N

Facility OP

$3,790.55

Service Code	HCPCS 36216 TC
Hospital Charge Code	41542679
Hospital Revenue Code	361
Min. Negotiated Rate	$1,326.69
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,084.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,895.28
Rate for Payer: Aetna Government	$1,895.28
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: Group Health Inc Commercial	$1,895.28
Rate for Payer: Group Health Inc Medicare	$1,326.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,895.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1,895.28

SP ARTER. ABOVE DIAPH. 3R

Facility OP

$6,223.85

Service Code	HCPCS 36217 TC
Hospital Charge Code	41542680
Hospital Revenue Code	361
Min. Negotiated Rate	$2,178.35
Max. Negotiated Rate	$3,423.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,423.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,111.92
Rate for Payer: Aetna Government	$3,111.92
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: Group Health Inc Commercial	$3,111.92
Rate for Payer: Group Health Inc Medicare	$2,178.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,111.92
Rate for Payer: Hamaspik Choice Inc Medicare	$3,111.92

SP ARTER. ABOVE DIAPH. >3RD

Facility OP

$577.70

Service Code	HCPCS 36218 TC
Hospital Charge Code	41542681
Hospital Revenue Code	361
Min. Negotiated Rate	$202.20
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$317.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$288.85
Rate for Payer: Aetna Government	$288.85
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: Group Health Inc Commercial	$288.85
Rate for Payer: Group Health Inc Medicare	$202.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$288.85
Rate for Payer: Hamaspik Choice Inc Medicare	$288.85

SP ARTER. BELOW DIAPH. 1ST

Facility OP

$3,839.45

Service Code	HCPCS 36245 TC
Hospital Charge Code	41542026
Hospital Revenue Code	361
Min. Negotiated Rate	$1,343.81
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,111.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,919.72
Rate for Payer: Aetna Government	$1,919.72
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: Group Health Inc Commercial	$1,919.72
Rate for Payer: Group Health Inc Medicare	$1,343.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,919.72
Rate for Payer: Hamaspik Choice Inc Medicare	$1,919.72

SP ARTER. BELOW DIAPH. 2N

Facility OP

$3,759.98

Service Code	HCPCS 36246 TC
Hospital Charge Code	41542052
Hospital Revenue Code	361
Min. Negotiated Rate	$1,315.99
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,067.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.99
Rate for Payer: Aetna Government	$1,879.99
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: Group Health Inc Commercial	$1,879.99
Rate for Payer: Group Health Inc Medicare	$1,315.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,879.99
Rate for Payer: Hamaspik Choice Inc Medicare	$1,879.99

SP ARTER. BELOW DIAPH. >3

Facility OP

$494.03

Service Code	HCPCS 36248 TC
Hospital Charge Code	41542683
Hospital Revenue Code	361
Min. Negotiated Rate	$172.91
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$271.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$247.02
Rate for Payer: Aetna Government	$247.02
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: Group Health Inc Commercial	$247.02
Rate for Payer: Group Health Inc Medicare	$172.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$247.02
Rate for Payer: Hamaspik Choice Inc Medicare	$247.02

SP ARTER. BELOW DIAPH. 3R

Facility OP

$5,942.45

Service Code	HCPCS 36247 TC
Hospital Charge Code	41542682
Hospital Revenue Code	361
Min. Negotiated Rate	$2,079.86
Max. Negotiated Rate	$3,268.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,268.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,971.22
Rate for Payer: Aetna Government	$2,971.22
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: Group Health Inc Commercial	$2,971.22
Rate for Payer: Group Health Inc Medicare	$2,079.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,971.22
Rate for Payer: Hamaspik Choice Inc Medicare	$2,971.22

SP ARTHROCENTESIS LARGE JOINT

Facility OP

$786.00

Service Code	HCPCS 20610 TC
Hospital Charge Code	41548512
Hospital Revenue Code	361
Min. Negotiated Rate	$275.10
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$432.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$393.00
Rate for Payer: Aetna Government	$393.00
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
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: Group Health Inc Commercial	$393.00
Rate for Payer: Group Health Inc Medicare	$275.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$393.00
Rate for Payer: Hamaspik Choice Inc Medicare	$393.00

SP ARTHROCENTESIS LARGE JOINT

Facility OP

$1,229.75

Service Code	HCPCS 20610
Hospital Charge Code	30102473
Hospital Revenue Code	450
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$342.51
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
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	$342.51
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$49.78
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
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	$614.88
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$342.51
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

Price Transparency.

All Charges