St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SREP S/N/A/G/TR/E, OVER 30CM

Facility

$529.23

Service Code	HCPCS 12007
Hospital Charge Code	30103258
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$231.52
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$231.52
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	$525.00
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	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
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

SREW 2.0X6MM SQ-FIT

Facility

$61.00

Service Code	HCPCS C1713
Hospital Charge Code	40202377
Hospital Revenue Code	278
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$36.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.08
Rate for Payer: EmblemHealth Commercial	$30.50
Rate for Payer: Fidelis Medicare Advantage	$64.05
Rate for Payer: Group Health Inc Commercial	$30.50
Rate for Payer: Group Health Inc Medicare	$21.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.65

SREW 2.0X6MM SQ-FIT

Facility

$61.00

Service Code	HCPCS C1713
Hospital Charge Code	40202377
Hospital Revenue Code	278
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$30.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50

SREW 2.0X8MM SQ-FIT

Facility

$90.00

Service Code	HCPCS C1713
Hospital Charge Code	40202378
Hospital Revenue Code	278
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.00
Rate for Payer: Hamaspik Choice Inc Medicare	$45.00

SREW 2.0X8MM SQ-FIT

Facility

$90.00

Service Code	HCPCS C1713
Hospital Charge Code	40202378
Hospital Revenue Code	278
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$54.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$45.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.75
Rate for Payer: EmblemHealth Commercial	$45.00
Rate for Payer: Fidelis Medicare Advantage	$94.50
Rate for Payer: Group Health Inc Commercial	$45.00
Rate for Payer: Group Health Inc Medicare	$31.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.00
Rate for Payer: Hamaspik Choice Inc Medicare	$45.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.50

SREW 2.3X18 HEX ST COMMAND

Facility

$113.00

Service Code	HCPCS C1713
Hospital Charge Code	40202382
Hospital Revenue Code	278
Min. Negotiated Rate	$56.50
Max. Negotiated Rate	$56.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.50
Rate for Payer: Hamaspik Choice Inc Medicare	$56.50

SREW 2.3X18 HEX ST COMMAND

Facility

$113.00

Service Code	HCPCS C1713
Hospital Charge Code	40202382
Hospital Revenue Code	278
Min. Negotiated Rate	$39.55
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$67.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.98
Rate for Payer: EmblemHealth Commercial	$56.50
Rate for Payer: Fidelis Medicare Advantage	$118.65
Rate for Payer: Group Health Inc Commercial	$56.50
Rate for Payer: Group Health Inc Medicare	$39.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.50
Rate for Payer: Hamaspik Choice Inc Medicare	$56.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.45

SRS BODY TX MGMT

Facility

$2,516.85

Service Code	HCPCS 77435
Hospital Charge Code	66542953
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$2,013.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,384.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$788.10
Rate for Payer: Aetna Government	$788.10
Rate for Payer: Brighton Health Commercial	$1,887.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,013.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,711.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$1,258.42
Rate for Payer: Group Health Inc Medicare	$880.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,258.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1,258.42

SRS LINEAR BASED COMP CRAN,1SESS

Facility

$24,055.58

Service Code	HCPCS 77372
Hospital Charge Code	66542947
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$19,244.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13,230.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,005.37
Rate for Payer: Aetna Government	$9,005.37
Rate for Payer: Brighton Health Commercial	$18,041.68
Rate for Payer: Cash Price	$9,005.37
Rate for Payer: Cash Price	$9,005.37
Rate for Payer: Cash Price	$9,005.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9,005.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,244.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$16,357.79
Rate for Payer: Elderplan Medicare Advantage	$9,005.37
Rate for Payer: EmblemHealth Commercial	$9,005.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Medicare Advantage	$9,005.37
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$9,005.37
Rate for Payer: Group Health Inc Medicare	$9,005.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,027.79
Rate for Payer: Hamaspik Choice Inc Medicare	$9,005.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8,104.83
Rate for Payer: Healthfirst Medicare Advantage	$9,005.37
Rate for Payer: Healthfirst QHP	$9,005.37
Rate for Payer: Senior Whole Health Medicare Advantage	$9,005.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9,005.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7,204.30
Rate for Payer: Wellcare Medicare	$8,555.10

SRS LINEAR BASED COMP CRAN,1SESS

Facility

$24,055.58

Service Code	HCPCS 77372
Hospital Charge Code	66542947
Hospital Revenue Code	333
Rate for Payer: Cash Price	$9,005.37

SRS TX MGMT CEREBRAL LESION

Facility

$1,664.08

Service Code	HCPCS 77432
Hospital Charge Code	66542952
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$1,331.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$915.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$522.60
Rate for Payer: Aetna Government	$522.60
Rate for Payer: Brighton Health Commercial	$1,248.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,331.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,131.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$832.04
Rate for Payer: Group Health Inc Medicare	$582.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$832.04
Rate for Payer: Hamaspik Choice Inc Medicare	$832.04

SS 8.0X9.0MM 25MM

Facility

$441.00

Service Code	HCPCS C1776
Hospital Charge Code	40207054
Hospital Revenue Code	278
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$463.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$264.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.58
Rate for Payer: EmblemHealth Commercial	$220.50
Rate for Payer: Fidelis Medicare Advantage	$463.05
Rate for Payer: Group Health Inc Commercial	$220.50
Rate for Payer: Group Health Inc Medicare	$154.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.50
Rate for Payer: Hamaspik Choice Inc Medicare	$220.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$286.65

SS 8.0X9.0MM 25MM

Facility

$441.00

Service Code	HCPCS C1776
Hospital Charge Code	40207054
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$220.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.50
Rate for Payer: Hamaspik Choice Inc Medicare	$220.50

SS ROD 300MM

Facility

$1,064.80

Service Code	HCPCS C1713
Hospital Charge Code	40209696
Hospital Revenue Code	278
Min. Negotiated Rate	$532.40
Max. Negotiated Rate	$532.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.40
Rate for Payer: Hamaspik Choice Inc Medicare	$532.40

SS ROD 300MM

Facility

$1,064.80

Service Code	HCPCS C1713
Hospital Charge Code	40209696
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,118.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$585.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$638.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$532.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.26
Rate for Payer: EmblemHealth Commercial	$532.40
Rate for Payer: Fidelis Medicare Advantage	$1,118.04
Rate for Payer: Group Health Inc Commercial	$532.40
Rate for Payer: Group Health Inc Medicare	$372.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.40
Rate for Payer: Hamaspik Choice Inc Medicare	$532.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$692.12

SS ROD 480 MM

Facility

$1,065.00

Service Code	HCPCS C1713
Hospital Charge Code	40209697
Hospital Revenue Code	278
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$532.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.50
Rate for Payer: Hamaspik Choice Inc Medicare	$532.50

SS ROD 480 MM

Facility

$1,065.00

Service Code	HCPCS C1713
Hospital Charge Code	40209697
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,118.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$585.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$639.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$532.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.38
Rate for Payer: EmblemHealth Commercial	$532.50
Rate for Payer: Fidelis Medicare Advantage	$1,118.25
Rate for Payer: Group Health Inc Commercial	$532.50
Rate for Payer: Group Health Inc Medicare	$372.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.50
Rate for Payer: Hamaspik Choice Inc Medicare	$532.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$692.25

STABILIZER EZ

Facility

$42.50

Hospital Charge Code	64904877
Hospital Revenue Code	270
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$34.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.25
Rate for Payer: Aetna Government	$21.25
Rate for Payer: Brighton Health Commercial	$31.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.90
Rate for Payer: Group Health Inc Commercial	$21.25
Rate for Payer: Group Health Inc Medicare	$14.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.25
Rate for Payer: Hamaspik Choice Inc Medicare	$21.25

STABLIZER SHOULDER

Facility

$170.00

Hospital Charge Code	64903497
Hospital Revenue Code	270
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.00
Rate for Payer: Aetna Government	$85.00
Rate for Payer: Brighton Health Commercial	$127.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.60
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

STAGGERED SPONDAIC WORD TEST

Facility

$419.03

Service Code	HCPCS 92572
Hospital Charge Code	42004507
Hospital Revenue Code	471
Rate for Payer: Cash Price	$180.64

STAGGERED SPONDAIC WORD TEST

Facility

$419.03

Service Code	HCPCS 92572
Hospital Charge Code	42004507
Hospital Revenue Code	471
Min. Negotiated Rate	$144.51
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.64
Rate for Payer: Aetna Government	$180.64
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Elderplan Medicare Advantage	$180.64
Rate for Payer: EmblemHealth Commercial	$180.64
Rate for Payer: Fidelis Essential Plan Aliesa	$153.54
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$180.64
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$180.64
Rate for Payer: Group Health Inc Medicare	$180.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$180.64
Rate for Payer: Healthfirst Medicare Advantage	$153.54
Rate for Payer: Healthfirst QHP	$180.64
Rate for Payer: Senior Whole Health Medicare Advantage	$180.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.51
Rate for Payer: Wellcare Medicare	$171.61

STAGING LAPAROTOMY

Facility

$3,077.68

Service Code	HCPCS 58960
Hospital Charge Code	40011060
Hospital Revenue Code	360
Min. Negotiated Rate	$1,077.19
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,692.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,247.93
Rate for Payer: Aetna Government	$1,247.93
Rate for Payer: Brighton Health Commercial	$2,308.26
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$1,538.84
Rate for Payer: Group Health Inc Medicare	$1,077.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,538.84
Rate for Payer: Hamaspik Choice Inc Medicare	$1,538.84

STAGRAFT DBM 10CC PUTTY

Facility

$3,362.50

Service Code	HCPCS C1713
Hospital Charge Code	64902994
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,530.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,849.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,017.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,681.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,933.44
Rate for Payer: EmblemHealth Commercial	$1,681.25
Rate for Payer: Fidelis Medicare Advantage	$3,530.62
Rate for Payer: Group Health Inc Commercial	$1,681.25
Rate for Payer: Group Health Inc Medicare	$1,176.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,681.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,681.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,185.62

STAGRAFT DBM 10CC PUTTY

Facility

$3,362.50

Service Code	HCPCS C1713
Hospital Charge Code	64902994
Hospital Revenue Code	278
Min. Negotiated Rate	$1,681.25
Max. Negotiated Rate	$1,681.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,681.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,681.25

STAMAHESIVE

Facility

$25.52

Hospital Charge Code	40207627
Hospital Revenue Code	270
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$20.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.76
Rate for Payer: Aetna Government	$12.76
Rate for Payer: Brighton Health Commercial	$19.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.35
Rate for Payer: Group Health Inc Commercial	$12.76
Rate for Payer: Group Health Inc Medicare	$8.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.76
Rate for Payer: Hamaspik Choice Inc Medicare	$12.76

Know your out-of-pocket cost for care.

All Charges