St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$30,301.16

Service Code	MSDRG 512
Min. Negotiated Rate	$13,813.76
Max. Negotiated Rate	$30,301.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23,795.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29,707.02
Rate for Payer: Aetna Government	$29,707.02
Rate for Payer: Brighton Health Commercial	$23,400.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30,301.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27,868.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,998.46
Rate for Payer: Elderplan Medicare Advantage	$28,221.67
Rate for Payer: EmblemHealth Commercial	$13,838.30
Rate for Payer: Fidelis Medicare Advantage	$29,707.02
Rate for Payer: Group Health Inc Commercial	$29,707.02
Rate for Payer: Group Health Inc Medicare	$29,707.02
Rate for Payer: Hamaspik Choice Inc Medicare	$29,707.02
Rate for Payer: Healthfirst Medicare Advantage	$13,813.76
Rate for Payer: Senior Whole Health Medicare Advantage	$29,707.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29,707.02
Rate for Payer: Wellcare Medicare	$28,221.67

SHOULDER HUM TRY =0 40MM STD

Facility

$2,715.00

Service Code	HCPCS C1776
Hospital Charge Code	64906970
Hospital Revenue Code	278
Min. Negotiated Rate	$1,357.50
Max. Negotiated Rate	$1,357.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,357.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,357.50

SHOULDER HUM TRY =0 40MM STD

Facility

$2,715.00

Service Code	HCPCS C1776
Hospital Charge Code	64906970
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,850.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,493.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,629.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,357.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,561.12
Rate for Payer: EmblemHealth Commercial	$1,357.50
Rate for Payer: Fidelis Medicare Advantage	$2,850.75
Rate for Payer: Group Health Inc Commercial	$1,357.50
Rate for Payer: Group Health Inc Medicare	$950.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,357.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,357.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,764.75

Shoulder Immobilizer

Facility

$99.94

Hospital Charge Code	40205717
Hospital Revenue Code	270
Min. Negotiated Rate	$34.98
Max. Negotiated Rate	$79.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.97
Rate for Payer: Aetna Government	$49.97
Rate for Payer: Brighton Health Commercial	$74.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.96
Rate for Payer: Group Health Inc Commercial	$49.97
Rate for Payer: Group Health Inc Medicare	$34.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.97
Rate for Payer: Hamaspik Choice Inc Medicare	$49.97

SHOULDER IMPLANT

Facility

$4,775.00

Service Code	HCPCS C1776
Hospital Charge Code	64907359
Hospital Revenue Code	278
Min. Negotiated Rate	$2,387.50
Max. Negotiated Rate	$2,387.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,387.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,387.50

SHOULDER IMPLANT

Facility

$4,775.00

Service Code	HCPCS C1776
Hospital Charge Code	64907359
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,013.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,626.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,865.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,387.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,745.62
Rate for Payer: EmblemHealth Commercial	$2,387.50
Rate for Payer: Fidelis Medicare Advantage	$5,013.75
Rate for Payer: Group Health Inc Commercial	$2,387.50
Rate for Payer: Group Health Inc Medicare	$1,671.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,387.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,387.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,103.75

SHOULDER REPL

Facility

$5,187.06

Service Code	HCPCS 23472
Hospital Charge Code	40000530
Hospital Revenue Code	360
Rate for Payer: Cash Price	$21,551.15

SHOULDER REPL

Facility

$5,187.06

Service Code	HCPCS 23472
Hospital Charge Code	40000530
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$22,108.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,108.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21,551.15
Rate for Payer: Aetna Government	$21,551.15
Rate for Payer: Brighton Health Commercial	$3,890.30
Rate for Payer: Cash Price	$21,551.15
Rate for Payer: Cash Price	$21,551.15
Rate for Payer: Cash Price	$21,551.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21,551.15
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	$21,551.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$18,318.48
Rate for Payer: Fidelis Essential Plan QHP	$19,180.52
Rate for Payer: Fidelis Medicare Advantage	$21,551.15
Rate for Payer: Fidelis Qualified Health Plan	$19,180.52
Rate for Payer: Group Health Inc Commercial	$21,551.15
Rate for Payer: Group Health Inc Medicare	$21,551.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,593.53
Rate for Payer: Hamaspik Choice Inc Medicare	$21,551.15
Rate for Payer: Healthfirst Medicare Advantage	$18,318.48
Rate for Payer: Healthfirst QHP	$21,551.15
Rate for Payer: Senior Whole Health Medicare Advantage	$21,551.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,551.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,240.92
Rate for Payer: Wellcare Medicare	$20,473.59

SHUNT BYPASS CAROTID 12FR ST 13CM

Facility

$361.00

Hospital Charge Code	40200983
Hospital Revenue Code	270
Min. Negotiated Rate	$126.35
Max. Negotiated Rate	$288.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$198.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.50
Rate for Payer: Aetna Government	$180.50
Rate for Payer: Brighton Health Commercial	$270.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$288.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$245.48
Rate for Payer: Group Health Inc Commercial	$180.50
Rate for Payer: Group Health Inc Medicare	$126.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.50
Rate for Payer: Hamaspik Choice Inc Medicare	$180.50

SHUNT CAROTID

Facility

$1,346.63

Hospital Charge Code	64907142
Hospital Revenue Code	270
Min. Negotiated Rate	$471.32
Max. Negotiated Rate	$1,077.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$740.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$673.32
Rate for Payer: Aetna Government	$673.32
Rate for Payer: Brighton Health Commercial	$1,009.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,077.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$915.71
Rate for Payer: Group Health Inc Commercial	$673.32
Rate for Payer: Group Health Inc Medicare	$471.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$673.32
Rate for Payer: Hamaspik Choice Inc Medicare	$673.32

SHUTTLE SHEATH 90CM

Facility

$250.00

Hospital Charge Code	64905928
Hospital Revenue Code	270
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.00
Rate for Payer: Aetna Government	$125.00
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.00
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

SIALODOCHOPLASTY

Facility

$2,065.00

Service Code	HCPCS D7982
Hospital Charge Code	42302145
Hospital Revenue Code	361
Min. Negotiated Rate	$547.61
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,135.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$547.61
Rate for Payer: Aetna Government	$547.61
Rate for Payer: Brighton Health Commercial	$1,548.75
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	$1,032.50
Rate for Payer: Group Health Inc Medicare	$722.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,032.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,032.50

SIALOGRAPHY

Facility

$102.50

Service Code	HCPCS D0310
Hospital Charge Code	42300165
Hospital Revenue Code	361
Min. Negotiated Rate	$51.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Brighton Health Commercial	$76.88
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
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	$283.37
Rate for Payer: EmblemHealth Commercial	$283.37
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$283.37
Rate for Payer: Group Health Inc Medicare	$283.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.25
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst Medicare Advantage	$240.86
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

SIALOGRAPHY

Facility

$102.50

Service Code	HCPCS D0310
Hospital Charge Code	42300165
Hospital Revenue Code	361
Rate for Payer: Cash Price	$283.37

SIALOLITHOTOMY

Facility

$725.00

Service Code	HCPCS D7980
Hospital Charge Code	42302135
Hospital Revenue Code	361
Min. Negotiated Rate	$231.13
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$398.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.13
Rate for Payer: Aetna Government	$231.13
Rate for Payer: Brighton Health Commercial	$543.75
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	$362.50
Rate for Payer: Group Health Inc Medicare	$253.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$362.50
Rate for Payer: Hamaspik Choice Inc Medicare	$362.50

SICKLE CELL SC FEE

Facility

$32.18

Service Code	HCPCS 83020
Hospital Charge Code	40701196
Hospital Revenue Code	301
Rate for Payer: Cash Price	$12.87

SICKLE CELL SC FEE

Facility

$32.18

Service Code	HCPCS 83020
Hospital Charge Code	40701196
Hospital Revenue Code	301
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$24.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.87
Rate for Payer: Aetna Government	$12.87
Rate for Payer: Brighton Health Commercial	$24.14
Rate for Payer: Cash Price	$12.87
Rate for Payer: Cash Price	$12.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.32
Rate for Payer: Elderplan Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Fidelis Essential Plan Aliesa	$10.94
Rate for Payer: Fidelis Essential Plan QHP	$11.45
Rate for Payer: Fidelis Medicare Advantage	$12.87
Rate for Payer: Fidelis Qualified Health Plan	$11.45
Rate for Payer: Group Health Inc Commercial	$12.87
Rate for Payer: Group Health Inc Medicare	$12.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.09
Rate for Payer: Hamaspik Choice Inc Medicare	$12.87
Rate for Payer: Healthfirst Medicare Advantage	$12.87
Rate for Payer: Healthfirst QHP	$12.87
Rate for Payer: Senior Whole Health Medicare Advantage	$12.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.30
Rate for Payer: Wellcare Medicare	$11.58

SICKLE CELL SCREEN

Facility

$13.78

Service Code	HCPCS 85660
Hospital Charge Code	40621555
Hospital Revenue Code	305
Rate for Payer: Cash Price	$5.51

SICKLE CELL SCREEN

Facility

$13.78

Service Code	HCPCS 85660
Hospital Charge Code	40621555
Hospital Revenue Code	305
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$10.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.51
Rate for Payer: Aetna Government	$5.51
Rate for Payer: Brighton Health Commercial	$10.34
Rate for Payer: Cash Price	$5.51
Rate for Payer: Cash Price	$5.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.41
Rate for Payer: Elderplan Medicare Advantage	$5.51
Rate for Payer: EmblemHealth Commercial	$5.51
Rate for Payer: Fidelis Essential Plan Aliesa	$4.68
Rate for Payer: Fidelis Essential Plan QHP	$4.90
Rate for Payer: Fidelis Medicare Advantage	$5.51
Rate for Payer: Fidelis Qualified Health Plan	$4.90
Rate for Payer: Group Health Inc Commercial	$5.51
Rate for Payer: Group Health Inc Medicare	$5.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.89
Rate for Payer: Hamaspik Choice Inc Medicare	$5.51
Rate for Payer: Healthfirst Medicare Advantage	$5.51
Rate for Payer: Healthfirst QHP	$5.51
Rate for Payer: Senior Whole Health Medicare Advantage	$5.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.41
Rate for Payer: Wellcare Medicare	$4.96

SIENTRA BREAST EXPANDER

Facility

$2,590.00

Service Code	HCPCS C1789
Hospital Charge Code	40005328
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,719.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,424.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,554.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,295.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,489.25
Rate for Payer: EmblemHealth Commercial	$1,295.00
Rate for Payer: Fidelis Medicare Advantage	$2,719.50
Rate for Payer: Group Health Inc Commercial	$1,295.00
Rate for Payer: Group Health Inc Medicare	$906.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,295.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,683.50

SIENTRA BREAST EXPANDER

Facility

$2,590.00

Service Code	HCPCS C1789
Hospital Charge Code	40005328
Hospital Revenue Code	278
Min. Negotiated Rate	$1,295.00
Max. Negotiated Rate	$1,295.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,295.00

SIGMOIDOSCOPE DISPO KLEENSPEC

Facility

$17.93

Hospital Charge Code	64903014
Hospital Revenue Code	270
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$14.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.96
Rate for Payer: Aetna Government	$8.96
Rate for Payer: Brighton Health Commercial	$13.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.19
Rate for Payer: Group Health Inc Commercial	$8.96
Rate for Payer: Group Health Inc Medicare	$6.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.96
Rate for Payer: Hamaspik Choice Inc Medicare	$8.96

SIGMOIDOSCOPE DISPOSABLE KLEENSPE

Facility

$6.70

Hospital Charge Code	40200624
Hospital Revenue Code	270
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$5.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.35
Rate for Payer: Aetna Government	$3.35
Rate for Payer: Brighton Health Commercial	$5.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.56
Rate for Payer: Group Health Inc Commercial	$3.35
Rate for Payer: Group Health Inc Medicare	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.35
Rate for Payer: Hamaspik Choice Inc Medicare	$3.35

SIGMOIDOSCOPY

Facility

$2,313.60

Service Code	HCPCS 45330
Hospital Charge Code	41118120
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,056.92

SIGMOIDOSCOPY

Facility

$2,313.60

Service Code	HCPCS 45330
Hospital Charge Code	41118120
Hospital Revenue Code	360
Min. Negotiated Rate	$845.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,056.92
Rate for Payer: Aetna Government	$1,056.92
Rate for Payer: Brighton Health Commercial	$1,735.20
Rate for Payer: Cash Price	$1,056.92
Rate for Payer: Cash Price	$1,056.92
Rate for Payer: Cash Price	$1,056.92
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,056.92
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: Elderplan Medicare Advantage	$1,056.92
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$898.38
Rate for Payer: Fidelis Essential Plan QHP	$940.66
Rate for Payer: Fidelis Medicare Advantage	$1,056.92
Rate for Payer: Fidelis Qualified Health Plan	$940.66
Rate for Payer: Group Health Inc Commercial	$1,056.92
Rate for Payer: Group Health Inc Medicare	$1,056.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,156.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1,056.92
Rate for Payer: Healthfirst Medicare Advantage	$898.38
Rate for Payer: Healthfirst QHP	$1,056.92
Rate for Payer: Senior Whole Health Medicare Advantage	$1,056.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,056.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$845.54
Rate for Payer: Wellcare Medicare	$1,004.07

Know your out-of-pocket cost for care.

All Charges