St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TAMOXIFEN 10 MGTAB

Facility

$0.28

Service Code	HCPCS J8999
Hospital Charge Code	41645106
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14

TAMOXIFEN CITRATE 10 MG PO TABS [7711]

Facility

$0.57

Service Code	NDC 63739014310
Hospital Charge Code	63739014310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Brighton Health Commercial	$0.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.39
Rate for Payer: Group Health Inc Commercial	$0.29
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29
Rate for Payer: Hamaspik Choice Inc Medicare	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

TAMSULOSIN 0.4 MG CAP

Facility

$0.78

Hospital Charge Code	41642065
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

TAMSULOSIN 0.4 MG CAP

Facility

$0.78

Hospital Charge Code	41652065
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$4.21

Service Code	NDC 00228299611
Hospital Charge Code	00228299611
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.11
Rate for Payer: Aetna Government	$2.11
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: Group Health Inc Commercial	$2.11
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11
Rate for Payer: Hamaspik Choice Inc Medicare	$2.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$0.48

Service Code	NDC 50268074011
Hospital Charge Code	50268074011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.32
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$4.21

Service Code	NDC 68084029911
Hospital Charge Code	68084029911
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.11
Rate for Payer: Aetna Government	$2.11
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: Group Health Inc Commercial	$2.11
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11
Rate for Payer: Hamaspik Choice Inc Medicare	$2.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$4.22

Service Code	NDC 65862059801
Hospital Charge Code	65862059801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.11
Rate for Payer: Aetna Government	$2.11
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: Group Health Inc Commercial	$2.11
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11
Rate for Payer: Hamaspik Choice Inc Medicare	$2.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$4.21

Service Code	NDC 62756016013
Hospital Charge Code	62756016013
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.10
Rate for Payer: Aetna Government	$2.10
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$4.22

Service Code	NDC 65862059805
Hospital Charge Code	65862059805
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.11
Rate for Payer: Aetna Government	$2.11
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: Group Health Inc Commercial	$2.11
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11
Rate for Payer: Hamaspik Choice Inc Medicare	$2.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$4.21

Service Code	NDC 00904640161
Hospital Charge Code	00904640161
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.10
Rate for Payer: Aetna Government	$2.10
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$0.48

Service Code	NDC 50268074015
Hospital Charge Code	50268074015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.32
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$4.21

Service Code	NDC 68084029901
Hospital Charge Code	68084029901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.11
Rate for Payer: Aetna Government	$2.11
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: Group Health Inc Commercial	$2.11
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11
Rate for Payer: Hamaspik Choice Inc Medicare	$2.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

TAMSULOSIN HCL 0.4 MG PO CAPS [103890]

Facility

$4.22

Service Code	NDC 67877045005
Hospital Charge Code	67877045005
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.11
Rate for Payer: Aetna Government	$2.11
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.87
Rate for Payer: Group Health Inc Commercial	$2.11
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.11
Rate for Payer: Hamaspik Choice Inc Medicare	$2.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.74

TANDEM COCR SHELL 22 42

Facility

$2,085.63

Hospital Charge Code	64905049
Hospital Revenue Code	270
Min. Negotiated Rate	$729.97
Max. Negotiated Rate	$1,668.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,147.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,042.82
Rate for Payer: Aetna Government	$1,042.82
Rate for Payer: Brighton Health Commercial	$1,564.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,668.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,418.23
Rate for Payer: Group Health Inc Commercial	$1,042.82
Rate for Payer: Group Health Inc Medicare	$729.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,042.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,042.82

TANDEM RX CANNULA TAPERED 210CM

Facility

$148.00

Hospital Charge Code	40201004
Hospital Revenue Code	270
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$118.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.00
Rate for Payer: Aetna Government	$74.00
Rate for Payer: Brighton Health Commercial	$111.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.64
Rate for Payer: Group Health Inc Commercial	$74.00
Rate for Payer: Group Health Inc Medicare	$51.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.00
Rate for Payer: Hamaspik Choice Inc Medicare	$74.00

TANDEM SHELL 46MM

Facility

$2,085.63

Hospital Charge Code	64905355
Hospital Revenue Code	270
Min. Negotiated Rate	$729.97
Max. Negotiated Rate	$1,668.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,147.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,042.82
Rate for Payer: Aetna Government	$1,042.82
Rate for Payer: Brighton Health Commercial	$1,564.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,668.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,418.23
Rate for Payer: Group Health Inc Commercial	$1,042.82
Rate for Payer: Group Health Inc Medicare	$729.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,042.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,042.82

TANDEM SHELL OD 28MM 48MM ID

Facility

$2,085.63

Hospital Charge Code	64904004
Hospital Revenue Code	270
Min. Negotiated Rate	$729.97
Max. Negotiated Rate	$1,668.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,147.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,042.82
Rate for Payer: Aetna Government	$1,042.82
Rate for Payer: Brighton Health Commercial	$1,564.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,668.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,418.23
Rate for Payer: Group Health Inc Commercial	$1,042.82
Rate for Payer: Group Health Inc Medicare	$729.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,042.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,042.82

TANGNTL BX SKIN EA SEP/ADDL

Facility

$356.37

Service Code	HCPCS 11103
Hospital Charge Code	42201202
Hospital Revenue Code	510
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.78
Rate for Payer: Aetna Government	$19.78
Rate for Payer: Brighton Health Commercial	$233.00
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	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.18
Rate for Payer: Hamaspik Choice Inc Medicare	$178.18

TANGNTL BX SKIN EA SEP/ADDL

Facility

$356.37

Service Code	HCPCS 11103
Hospital Charge Code	30307937
Hospital Revenue Code	510
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.78
Rate for Payer: Aetna Government	$19.78
Rate for Payer: Brighton Health Commercial	$233.00
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	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.18
Rate for Payer: Hamaspik Choice Inc Medicare	$178.18

TANGNTL BX SKIN EA SEP/ADDL

Facility

$356.37

Service Code	HCPCS 11103
Hospital Charge Code	42501051
Hospital Revenue Code	510
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.78
Rate for Payer: Aetna Government	$19.78
Rate for Payer: Brighton Health Commercial	$233.00
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	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.18
Rate for Payer: Hamaspik Choice Inc Medicare	$178.18

TANGNTL BX SKIN SGL LES

Facility

$529.23

Service Code	HCPCS 11102
Hospital Charge Code	42201201
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

TANGNTL BX SKIN SGL LES

Facility

$529.23

Service Code	HCPCS 11102
Hospital Charge Code	42201201
Hospital Revenue Code	510
Rate for Payer: Cash Price	$231.52

TANGNTL BX SKIN SINGLE LES

Facility

$529.23

Service Code	HCPCS 11102
Hospital Charge Code	30307913
Hospital Revenue Code	510
Rate for Payer: Cash Price	$231.52

TANGNTL BX SKIN SINGLE LES

Facility

$529.23

Service Code	HCPCS 11102
Hospital Charge Code	66543700
Hospital Revenue Code	361
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	$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	$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.

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