St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SGOT,SGPT

Facility

$12.95

Service Code	HCPCS 84450
Hospital Charge Code	40602125
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$9.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.18
Rate for Payer: Aetna Government	$5.18
Rate for Payer: Brighton Health Commercial	$9.71
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cash Price	$5.18
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.96
Rate for Payer: Elderplan Medicare Advantage	$5.18
Rate for Payer: EmblemHealth Commercial	$5.18
Rate for Payer: Fidelis Essential Plan Aliesa	$4.40
Rate for Payer: Fidelis Essential Plan QHP	$4.61
Rate for Payer: Fidelis Medicare Advantage	$5.18
Rate for Payer: Fidelis Qualified Health Plan	$4.61
Rate for Payer: Group Health Inc Commercial	$5.18
Rate for Payer: Group Health Inc Medicare	$5.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.18
Rate for Payer: Healthfirst Medicare Advantage	$5.18
Rate for Payer: Healthfirst QHP	$5.18
Rate for Payer: Senior Whole Health Medicare Advantage	$5.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.14
Rate for Payer: Wellcare Medicare	$4.66

SGOT,SGPT

Facility

$12.95

Service Code	HCPCS 84450
Hospital Charge Code	40602125
Hospital Revenue Code	301
Rate for Payer: Cash Price	$5.18

SGPT

Facility

$13.25

Service Code	HCPCS 84460
Hospital Charge Code	40602135
Hospital Revenue Code	301
Rate for Payer: Cash Price	$5.30

SGPT

Facility

$13.25

Service Code	HCPCS 84460
Hospital Charge Code	40602135
Hospital Revenue Code	301
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$9.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.30
Rate for Payer: Aetna Government	$5.30
Rate for Payer: Brighton Health Commercial	$9.94
Rate for Payer: Cash Price	$5.30
Rate for Payer: Cash Price	$5.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.12
Rate for Payer: Elderplan Medicare Advantage	$5.30
Rate for Payer: EmblemHealth Commercial	$5.30
Rate for Payer: Fidelis Essential Plan Aliesa	$4.50
Rate for Payer: Fidelis Essential Plan QHP	$4.72
Rate for Payer: Fidelis Medicare Advantage	$5.30
Rate for Payer: Fidelis Qualified Health Plan	$4.72
Rate for Payer: Group Health Inc Commercial	$5.30
Rate for Payer: Group Health Inc Medicare	$5.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5.30
Rate for Payer: Healthfirst Medicare Advantage	$5.30
Rate for Payer: Healthfirst QHP	$5.30
Rate for Payer: Senior Whole Health Medicare Advantage	$5.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.24
Rate for Payer: Wellcare Medicare	$4.77

SGTRY SER POLYAX 6.5X45MM

Facility

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008314
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,898.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,566.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,799.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,332.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,682.71
Rate for Payer: EmblemHealth Commercial	$2,332.79
Rate for Payer: Fidelis Medicare Advantage	$4,898.86
Rate for Payer: Group Health Inc Commercial	$2,332.79
Rate for Payer: Group Health Inc Medicare	$1,632.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,032.63

SGTRY SER POLYAX 6.5X45MM

Facility

$4,665.58

Service Code	HCPCS C1713
Hospital Charge Code	40008314
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.79
Max. Negotiated Rate	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,332.79

SHAFT STIFF ANGLED .035 180CM

Facility

$127.50

Service Code	HCPCS C1713
Hospital Charge Code	64902794
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.75
Rate for Payer: Hamaspik Choice Inc Medicare	$63.75

SHAFT STIFF ANGLED .035 180CM

Facility

$127.50

Service Code	HCPCS C1713
Hospital Charge Code	64902794
Hospital Revenue Code	278
Min. Negotiated Rate	$44.62
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.31
Rate for Payer: EmblemHealth Commercial	$63.75
Rate for Payer: Fidelis Medicare Advantage	$133.88
Rate for Payer: Group Health Inc Commercial	$63.75
Rate for Payer: Group Health Inc Medicare	$44.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.75
Rate for Payer: Hamaspik Choice Inc Medicare	$63.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.88

SHANK, SCREW RELINE 6.5X45MM 2

Facility

$2,282.00

Service Code	HCPCS C1713
Hospital Charge Code	64905584
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,396.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,255.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,369.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,312.15
Rate for Payer: EmblemHealth Commercial	$1,141.00
Rate for Payer: Fidelis Medicare Advantage	$2,396.10
Rate for Payer: Group Health Inc Commercial	$1,141.00
Rate for Payer: Group Health Inc Medicare	$798.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,141.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,483.30

SHANK, SCREW RELINE 6.5X45MM 2

Facility

$2,282.00

Service Code	HCPCS C1713
Hospital Charge Code	64905584
Hospital Revenue Code	278
Min. Negotiated Rate	$1,141.00
Max. Negotiated Rate	$1,141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,141.00

SHARP DEBRIDEMENT/ PULSED LAVAGE

Facility

$529.23

Service Code	HCPCS 97597
Hospital Charge Code	41802198
Hospital Revenue Code	430
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$291.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Elderplan Medicare Advantage	$231.52
Rate for Payer: EmblemHealth Commercial	$231.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$231.52
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
Rate for Payer: Group Health Inc Commercial	$231.52
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$55.00

SHARP DEBRIDEMENT/ PULSED LAVAGE

Facility

$529.23

Service Code	HCPCS 97597
Hospital Charge Code	41802198
Hospital Revenue Code	430
Rate for Payer: Cash Price	$231.52

SHAVE LES,S/N/H/F/G,1.1-2.0

Facility

$529.23

Service Code	HCPCS 11307
Hospital Charge Code	42201718
Hospital Revenue Code	510
Min. Negotiated Rate	$185.22
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
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	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

SHAVE LES,S/N/H/F/G,1.1-2.0

Facility

$529.23

Service Code	HCPCS 11307
Hospital Charge Code	42201718
Hospital Revenue Code	510
Rate for Payer: Cash Price	$231.52

SHAVE LES, S/N/H/F/G, > 2.0CM

Facility

$967.73

Service Code	HCPCS 11308
Hospital Charge Code	42201736
Hospital Revenue Code	510
Min. Negotiated Rate	$233.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$461.12
Rate for Payer: Aetna Government	$461.12
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$461.12
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	$461.12
Rate for Payer: Fidelis Essential Plan Aliesa	$391.95
Rate for Payer: Fidelis Essential Plan QHP	$410.40
Rate for Payer: Fidelis Medicare Advantage	$461.12
Rate for Payer: Fidelis Qualified Health Plan	$410.40
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	$483.86
Rate for Payer: Hamaspik Choice Inc Medicare	$461.12
Rate for Payer: Healthfirst Medicare Advantage	$391.95
Rate for Payer: Healthfirst QHP	$461.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$461.12
Rate for Payer: Senior Whole Health Medicare Advantage	$461.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$461.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$368.90
Rate for Payer: Wellcare Medicare	$438.06

SHAVE LES, S/N/H/F/G, > 2.0CM

Facility

$967.73

Service Code	HCPCS 11308
Hospital Charge Code	42201736
Hospital Revenue Code	510
Rate for Payer: Cash Price	$461.12

SHAVE PREP SET

Facility

$12.05

Hospital Charge Code	40204840
Hospital Revenue Code	270
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Brighton Health Commercial	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02

SHAVER 3.5 TOMCAT

Facility

$157.84

Hospital Charge Code	64905726
Hospital Revenue Code	270
Min. Negotiated Rate	$55.24
Max. Negotiated Rate	$126.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$78.92
Rate for Payer: Aetna Government	$78.92
Rate for Payer: Brighton Health Commercial	$118.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.33
Rate for Payer: Group Health Inc Commercial	$78.92
Rate for Payer: Group Health Inc Medicare	$55.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.92
Rate for Payer: Hamaspik Choice Inc Medicare	$78.92

SHAVER 40MM STRYK TOMCAT

Facility

$100.00

Hospital Charge Code	64904989
Hospital Revenue Code	270
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

SHAVER ANGLED 4.0MM STRY TOM

Facility

$100.00

Hospital Charge Code	64904991
Hospital Revenue Code	270
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

SHAVER BUR 6 FLUTE 5.5MM

Facility

$54.35

Hospital Charge Code	64904955
Hospital Revenue Code	270
Min. Negotiated Rate	$19.02
Max. Negotiated Rate	$43.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.18
Rate for Payer: Aetna Government	$27.18
Rate for Payer: Brighton Health Commercial	$40.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.96
Rate for Payer: Group Health Inc Commercial	$27.18
Rate for Payer: Group Health Inc Medicare	$19.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.18
Rate for Payer: Hamaspik Choice Inc Medicare	$27.18

SHAVE SKIN LESION 0.5 CM OR LESS

Facility

$529.23

Service Code	HCPCS 11305
Hospital Charge Code	30302444
Hospital Revenue Code	510
Min. Negotiated Rate	$185.22
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
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	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

SHAVE SKIN LESION 0.5 CM OR LESS

Facility

$529.23

Service Code	HCPCS 11305
Hospital Charge Code	30302444
Hospital Revenue Code	510
Rate for Payer: Cash Price	$231.52

SHAVE SKIN LESION 0.5 CM OR LESS

Facility

$529.23

Service Code	HCPCS 11305
Hospital Charge Code	40019675
Hospital Revenue Code	360
Rate for Payer: Cash Price	$231.52

SHAVE SKIN LESION 0.5 CM OR LESS

Facility

$529.23

Service Code	HCPCS 11305
Hospital Charge Code	40019675
Hospital Revenue Code	360
Min. Negotiated Rate	$185.22
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$396.92
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
Rate for Payer: Group Health Inc Commercial	$231.52
Rate for Payer: Group Health Inc Medicare	$231.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

Know your out-of-pocket cost for care.

All Charges