St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZIDOVUDINE 10 MG/ML IV SOLN [11691]

Facility

$1.75

Service Code	HCPCS J3485
Hospital Charge Code	49702021326
Hospital Revenue Code	278
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.51
Rate for Payer: Aetna Government	$1.51
Rate for Payer: Brighton Health Commercial	$1.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.01
Rate for Payer: EmblemHealth Commercial	$0.88
Rate for Payer: Fidelis Medicare Advantage	$1.84
Rate for Payer: Group Health Inc Commercial	$0.88
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88
Rate for Payer: Hamaspik Choice Inc Medicare	$0.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.14

ZIDOVUDINE 10 MG/ML IV SOLN [11691]

Facility

$1.75

Service Code	HCPCS J3485
Hospital Charge Code	49702021326
Hospital Revenue Code	278
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.88
Rate for Payer: Hamaspik Choice Inc Medicare	$0.88

ZIDOVUDINE 10 MG/ML PO SYRP [11693]

Facility

$0.32

Service Code	NDC 49702021248
Hospital Charge Code	49702021248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

ZIDOVUDINE 10MG/ML SYRUP

Facility

$0.30

Hospital Charge Code	41641807
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

ZIDOVUDINE 10MG/ML SYRUP

Facility

$0.30

Hospital Charge Code	41651807
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

ZIDOVUDINE 300 MG PO TABS [17961]

Facility

$6.02

Service Code	NDC 31722050960
Hospital Charge Code	31722050960
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.01
Rate for Payer: Aetna Government	$3.01
Rate for Payer: Brighton Health Commercial	$4.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.09
Rate for Payer: Group Health Inc Commercial	$3.01
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.01
Rate for Payer: Hamaspik Choice Inc Medicare	$3.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.91

ZIDOVUDINE 300 MG TAB

Facility

$1.00

Hospital Charge Code	41641812
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ZIDOVUDINE 300 MG TAB

Facility

$1.00

Hospital Charge Code	41651812
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ZIDOVUDINE 4 MG/ML INJ PEDIATRIC

Facility

$53.00

Hospital Charge Code	41653660
Hospital Revenue Code	250
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$42.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.50
Rate for Payer: Aetna Government	$26.50
Rate for Payer: Brighton Health Commercial	$39.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.04
Rate for Payer: Group Health Inc Commercial	$26.50
Rate for Payer: Group Health Inc Medicare	$18.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.50
Rate for Payer: Hamaspik Choice Inc Medicare	$26.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.45

ZIDOVUDINE 4 MG/ML INJ PEDIATRIC

Facility

$53.00

Hospital Charge Code	41643660
Hospital Revenue Code	250
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$42.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.50
Rate for Payer: Aetna Government	$26.50
Rate for Payer: Brighton Health Commercial	$39.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.04
Rate for Payer: Group Health Inc Commercial	$26.50
Rate for Payer: Group Health Inc Medicare	$18.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.50
Rate for Payer: Hamaspik Choice Inc Medicare	$26.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.45

ZIDOVUDINE + LAMIVUDINE 150 MG - 300 MG

Facility

$28.00

Hospital Charge Code	41652197
Hospital Revenue Code	250
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.04
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.20

ZIDOVUDINE + LAMIVUDINE 150 MG - 300 MG

Facility

$28.00

Hospital Charge Code	41642197
Hospital Revenue Code	250
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.04
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.20

ZIDOVUDINE + LAMIVUDINE + ABACAVIR 300

Facility

$48.16

Hospital Charge Code	41642727
Hospital Revenue Code	250
Min. Negotiated Rate	$16.86
Max. Negotiated Rate	$38.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.08
Rate for Payer: Aetna Government	$24.08
Rate for Payer: Brighton Health Commercial	$36.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.75
Rate for Payer: Group Health Inc Commercial	$24.08
Rate for Payer: Group Health Inc Medicare	$16.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.08
Rate for Payer: Hamaspik Choice Inc Medicare	$24.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.30

ZIDOVUDINE + LAMIVUDINE + ABACAVIR 300

Facility

$48.16

Hospital Charge Code	41652727
Hospital Revenue Code	250
Min. Negotiated Rate	$16.86
Max. Negotiated Rate	$38.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.08
Rate for Payer: Aetna Government	$24.08
Rate for Payer: Brighton Health Commercial	$36.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.75
Rate for Payer: Group Health Inc Commercial	$24.08
Rate for Payer: Group Health Inc Medicare	$16.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.08
Rate for Payer: Hamaspik Choice Inc Medicare	$24.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.30

ZIKA VIRUS MAC-ELISA (EUA)

Facility

$32.20

Service Code	HCPCS 86790
Hospital Charge Code	40729908
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$24.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.88
Rate for Payer: Aetna Government	$12.88
Rate for Payer: Brighton Health Commercial	$24.15
Rate for Payer: Cash Price	$12.88
Rate for Payer: Cash Price	$12.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.88
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	$12.88
Rate for Payer: EmblemHealth Commercial	$12.88
Rate for Payer: Fidelis Essential Plan Aliesa	$10.95
Rate for Payer: Fidelis Essential Plan QHP	$11.46
Rate for Payer: Fidelis Medicare Advantage	$12.88
Rate for Payer: Fidelis Qualified Health Plan	$11.46
Rate for Payer: Group Health Inc Commercial	$12.88
Rate for Payer: Group Health Inc Medicare	$12.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.10
Rate for Payer: Hamaspik Choice Inc Medicare	$12.88
Rate for Payer: Healthfirst Medicare Advantage	$12.88
Rate for Payer: Healthfirst QHP	$12.88
Rate for Payer: Senior Whole Health Medicare Advantage	$12.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.30
Rate for Payer: Wellcare Medicare	$11.59

ZIKA VIRUS MAC-ELISA (EUA)

Facility

$32.20

Service Code	HCPCS 86790
Hospital Charge Code	40729908
Hospital Revenue Code	302
Rate for Payer: Cash Price	$12.88

ZIKA VIRUS NAA COMPREHENSIVE

Facility

$87.73

Service Code	HCPCS 87798
Hospital Charge Code	40729907
Hospital Revenue Code	306
Rate for Payer: Cash Price	$35.09

ZIKA VIRUS NAA COMPREHENSIVE

Facility

$87.73

Service Code	HCPCS 87798
Hospital Charge Code	40729907
Hospital Revenue Code	306
Min. Negotiated Rate	$28.07
Max. Negotiated Rate	$65.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.09
Rate for Payer: Aetna Government	$35.09
Rate for Payer: Brighton Health Commercial	$65.80
Rate for Payer: Cash Price	$35.09
Rate for Payer: Cash Price	$35.09
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.20
Rate for Payer: Elderplan Medicare Advantage	$35.09
Rate for Payer: EmblemHealth Commercial	$35.09
Rate for Payer: Fidelis Essential Plan Aliesa	$29.83
Rate for Payer: Fidelis Essential Plan QHP	$31.23
Rate for Payer: Fidelis Medicare Advantage	$35.09
Rate for Payer: Fidelis Qualified Health Plan	$31.23
Rate for Payer: Group Health Inc Commercial	$35.09
Rate for Payer: Group Health Inc Medicare	$35.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.86
Rate for Payer: Hamaspik Choice Inc Medicare	$35.09
Rate for Payer: Healthfirst Medicare Advantage	$35.09
Rate for Payer: Healthfirst QHP	$35.09
Rate for Payer: Senior Whole Health Medicare Advantage	$35.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.07
Rate for Payer: Wellcare Medicare	$31.58

ZIM 15X13MM 6MM HEIGHT SPACER

Facility

$4,656.00

Service Code	HCPCS C1776
Hospital Charge Code	40005203
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,888.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,560.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,793.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,328.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,677.20
Rate for Payer: EmblemHealth Commercial	$2,328.00
Rate for Payer: Fidelis Medicare Advantage	$4,888.80
Rate for Payer: Group Health Inc Commercial	$2,328.00
Rate for Payer: Group Health Inc Medicare	$1,629.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,328.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,026.40

ZIM 15X13MM 6MM HEIGHT SPACER

Facility

$4,656.00

Service Code	HCPCS C1776
Hospital Charge Code	40005203
Hospital Revenue Code	278
Min. Negotiated Rate	$2,328.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,328.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,328.00

ZIM 6MM ZERO PLATE

Facility

$890.00

Service Code	HCPCS C1776
Hospital Charge Code	40005204
Hospital Revenue Code	278
Min. Negotiated Rate	$445.00
Max. Negotiated Rate	$445.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$445.00
Rate for Payer: Hamaspik Choice Inc Medicare	$445.00

ZIM 6MM ZERO PLATE

Facility

$890.00

Service Code	HCPCS C1776
Hospital Charge Code	40005204
Hospital Revenue Code	278
Min. Negotiated Rate	$311.50
Max. Negotiated Rate	$934.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$489.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$534.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$445.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$511.75
Rate for Payer: EmblemHealth Commercial	$445.00
Rate for Payer: Fidelis Medicare Advantage	$934.50
Rate for Payer: Group Health Inc Commercial	$445.00
Rate for Payer: Group Health Inc Medicare	$311.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$445.00
Rate for Payer: Hamaspik Choice Inc Medicare	$445.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$578.50

ZIM ACET NEUT LINER 36 MM SZ KK

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204256
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

ZIM ACET NEUT LINER 36 MM SZ KK

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204256
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,040.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: EmblemHealth Commercial	$1,700.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

ZIM ACET NEUT LINER 36MM SZ KK

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204250
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,040.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: EmblemHealth Commercial	$1,700.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

Know your out-of-pocket cost for care.

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