St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZIPRASIDONE HCL 40 MG PO CAPS [29779]

Facility

$8.96

Service Code	NDC 00904627008
Hospital Charge Code	00904627008
Hospital Revenue Code	250
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$7.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.48
Rate for Payer: Aetna Government	$4.48
Rate for Payer: Brighton Health Commercial	$6.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.10
Rate for Payer: Group Health Inc Commercial	$4.48
Rate for Payer: Group Health Inc Medicare	$3.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.48
Rate for Payer: Hamaspik Choice Inc Medicare	$4.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.83

ZIPRASIDONE HCL 40 MG PO CAPS [29779]

Facility

$3.34

Service Code	NDC 63739000532
Hospital Charge Code	63739000532
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.67
Rate for Payer: Aetna Government	$1.67
Rate for Payer: Brighton Health Commercial	$2.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.27
Rate for Payer: Group Health Inc Commercial	$1.67
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.67
Rate for Payer: Hamaspik Choice Inc Medicare	$1.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.17

ZIPRASIDONE HCL 40 MG PO CAPS [29779]

Facility

$8.00

Service Code	NDC 33342014509
Hospital Charge Code	33342014509
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

ZIPRASIDONE HCL 60 MG PO CAPS [29780]

Facility

$10.76

Service Code	NDC 55111025860
Hospital Charge Code	55111025860
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$8.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.38
Rate for Payer: Aetna Government	$5.38
Rate for Payer: Brighton Health Commercial	$8.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.31
Rate for Payer: Group Health Inc Commercial	$5.38
Rate for Payer: Group Health Inc Medicare	$3.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.38
Rate for Payer: Hamaspik Choice Inc Medicare	$5.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.99

ZIPRASIDONE HCL 60 MG PO CAPS [29780]

Facility

$10.88

Service Code	NDC 00904627108
Hospital Charge Code	00904627108
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$8.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.44
Rate for Payer: Aetna Government	$5.44
Rate for Payer: Brighton Health Commercial	$8.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.40
Rate for Payer: Group Health Inc Commercial	$5.44
Rate for Payer: Group Health Inc Medicare	$3.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.44
Rate for Payer: Hamaspik Choice Inc Medicare	$5.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.07

ZIPRASIDONE HCL 80 MG PO CAPS [29781]

Facility

$3.23

Service Code	NDC 50268081412
Hospital Charge Code	50268081412
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$2.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.61
Rate for Payer: Aetna Government	$1.61
Rate for Payer: Brighton Health Commercial	$2.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.20
Rate for Payer: Group Health Inc Commercial	$1.61
Rate for Payer: Group Health Inc Medicare	$1.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61
Rate for Payer: Hamaspik Choice Inc Medicare	$1.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.10

ZIPRASIDONE HCL 80 MG PO CAPS [29781]

Facility

$3.23

Service Code	NDC 50268081411
Hospital Charge Code	50268081411
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$2.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.61
Rate for Payer: Aetna Government	$1.61
Rate for Payer: Brighton Health Commercial	$2.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.20
Rate for Payer: Group Health Inc Commercial	$1.61
Rate for Payer: Group Health Inc Medicare	$1.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.61
Rate for Payer: Hamaspik Choice Inc Medicare	$1.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.10

ZIPRASIDONE HCL 80 MG PO CAPS [29781]

Facility

$10.76

Service Code	NDC 55111025960
Hospital Charge Code	55111025960
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$8.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.38
Rate for Payer: Aetna Government	$5.38
Rate for Payer: Brighton Health Commercial	$8.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.31
Rate for Payer: Group Health Inc Commercial	$5.38
Rate for Payer: Group Health Inc Medicare	$3.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.38
Rate for Payer: Hamaspik Choice Inc Medicare	$5.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.99

ZIPRASIDONE MESYLATE 20 MG IM SOLR [33175]

Facility

$56.40

Service Code	HCPCS J3486
Hospital Charge Code	43598084858
Hospital Revenue Code	250
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$45.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.85
Rate for Payer: Aetna Government	$14.85
Rate for Payer: Brighton Health Commercial	$42.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$45.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.35
Rate for Payer: Group Health Inc Commercial	$28.20
Rate for Payer: Group Health Inc Medicare	$19.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.20
Rate for Payer: Hamaspik Choice Inc Medicare	$28.20
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$10.22
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$10.83
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$10.83
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$10.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.66

ZIPRASIDONE MESYLATE 20 MG IM SOLR [33175]

Facility

$56.40

Service Code	HCPCS J3486
Hospital Charge Code	43598084811
Hospital Revenue Code	250
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$45.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.85
Rate for Payer: Aetna Government	$14.85
Rate for Payer: Brighton Health Commercial	$42.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$45.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.35
Rate for Payer: Group Health Inc Commercial	$28.20
Rate for Payer: Group Health Inc Medicare	$19.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.20
Rate for Payer: Hamaspik Choice Inc Medicare	$28.20
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$10.22
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$10.83
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$10.83
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$10.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.66

ZIPWIRE .035 ANGLED TIP

Facility

$94.30

Hospital Charge Code	64905400
Hospital Revenue Code	270
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$75.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.15
Rate for Payer: Aetna Government	$47.15
Rate for Payer: Brighton Health Commercial	$70.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.12
Rate for Payer: Group Health Inc Commercial	$47.15
Rate for Payer: Group Health Inc Medicare	$33.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.15
Rate for Payer: Hamaspik Choice Inc Medicare	$47.15

ZIPWIRE .035 STRAIGHT TIP

Facility

$100.05

Hospital Charge Code	64905398
Hospital Revenue Code	270
Min. Negotiated Rate	$35.02
Max. Negotiated Rate	$80.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.02
Rate for Payer: Aetna Government	$50.02
Rate for Payer: Brighton Health Commercial	$75.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.03
Rate for Payer: Group Health Inc Commercial	$50.02
Rate for Payer: Group Health Inc Medicare	$35.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.02
Rate for Payer: Hamaspik Choice Inc Medicare	$50.02

ZIPWIRE .038 ANGLED TIP

Facility

$100.05

Hospital Charge Code	64905404
Hospital Revenue Code	270
Min. Negotiated Rate	$35.02
Max. Negotiated Rate	$80.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.02
Rate for Payer: Aetna Government	$50.02
Rate for Payer: Brighton Health Commercial	$75.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.03
Rate for Payer: Group Health Inc Commercial	$50.02
Rate for Payer: Group Health Inc Medicare	$35.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.02
Rate for Payer: Hamaspik Choice Inc Medicare	$50.02

ZIPWIRE .038 STRAIGHT TIP

Facility

$100.05

Hospital Charge Code	64905402
Hospital Revenue Code	270
Min. Negotiated Rate	$35.02
Max. Negotiated Rate	$80.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.02
Rate for Payer: Aetna Government	$50.02
Rate for Payer: Brighton Health Commercial	$75.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.03
Rate for Payer: Group Health Inc Commercial	$50.02
Rate for Payer: Group Health Inc Medicare	$35.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.02
Rate for Payer: Hamaspik Choice Inc Medicare	$50.02

ZIPWIRE HYDRO .038 X 150CM

Facility

$377.18

Service Code	HCPCS C1713
Hospital Charge Code	64906747
Hospital Revenue Code	278
Min. Negotiated Rate	$132.01
Max. Negotiated Rate	$396.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$207.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$226.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$188.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.88
Rate for Payer: EmblemHealth Commercial	$188.59
Rate for Payer: Fidelis Medicare Advantage	$396.04
Rate for Payer: Group Health Inc Commercial	$188.59
Rate for Payer: Group Health Inc Medicare	$132.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.59
Rate for Payer: Hamaspik Choice Inc Medicare	$188.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$245.17

ZIPWIRE HYDRO .038 X 150CM

Facility

$377.18

Service Code	HCPCS C1713
Hospital Charge Code	64906747
Hospital Revenue Code	278
Min. Negotiated Rate	$188.59
Max. Negotiated Rate	$188.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.59
Rate for Payer: Hamaspik Choice Inc Medicare	$188.59

ZM KNEE SYS PLY PTLA 3.8X9.5MM TH

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40008264
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

ZM KNEE SYS PLY PTLA 3.8X9.5MM TH

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40008264
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,320.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: EmblemHealth Commercial	$1,100.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

Z NAIL 4.0X100 CORT SCREW FA

Facility

$415.30

Service Code	HCPCS C1713
Hospital Charge Code	40006452
Hospital Revenue Code	278
Min. Negotiated Rate	$207.65
Max. Negotiated Rate	$207.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.65
Rate for Payer: Hamaspik Choice Inc Medicare	$207.65

Z NAIL 4.0X100 CORT SCREW FA

Facility

$415.30

Service Code	HCPCS C1713
Hospital Charge Code	40006452
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$249.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$207.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.80
Rate for Payer: EmblemHealth Commercial	$207.65
Rate for Payer: Fidelis Medicare Advantage	$436.06
Rate for Payer: Group Health Inc Commercial	$207.65
Rate for Payer: Group Health Inc Medicare	$145.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.65
Rate for Payer: Hamaspik Choice Inc Medicare	$207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$269.94

Z NAIL 4.0X100 CORT SCREW PT

Facility

$415.30

Service Code	HCPCS C1713
Hospital Charge Code	40006379
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$249.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$207.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.80
Rate for Payer: EmblemHealth Commercial	$207.65
Rate for Payer: Fidelis Medicare Advantage	$436.06
Rate for Payer: Group Health Inc Commercial	$207.65
Rate for Payer: Group Health Inc Medicare	$145.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.65
Rate for Payer: Hamaspik Choice Inc Medicare	$207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$269.94

Z NAIL 4.0X100 CORT SCREW PT

Facility

$415.30

Service Code	HCPCS C1713
Hospital Charge Code	40006379
Hospital Revenue Code	278
Min. Negotiated Rate	$207.65
Max. Negotiated Rate	$207.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.65
Rate for Payer: Hamaspik Choice Inc Medicare	$207.65

Z NAIL 4.0X20 CORT SCREW FA

Facility

$415.30

Service Code	HCPCS C1713
Hospital Charge Code	40006390
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$249.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$207.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.80
Rate for Payer: EmblemHealth Commercial	$207.65
Rate for Payer: Fidelis Medicare Advantage	$436.06
Rate for Payer: Group Health Inc Commercial	$207.65
Rate for Payer: Group Health Inc Medicare	$145.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.65
Rate for Payer: Hamaspik Choice Inc Medicare	$207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$269.94

Z NAIL 4.0X20 CORT SCREW FA

Facility

$415.30

Service Code	HCPCS C1713
Hospital Charge Code	40006390
Hospital Revenue Code	278
Min. Negotiated Rate	$207.65
Max. Negotiated Rate	$207.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.65
Rate for Payer: Hamaspik Choice Inc Medicare	$207.65

Z NAIL 4.0X20 CORT SCREW PT

Facility

$415.30

Service Code	HCPCS C1713
Hospital Charge Code	40006299
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$249.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$207.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.80
Rate for Payer: EmblemHealth Commercial	$207.65
Rate for Payer: Fidelis Medicare Advantage	$436.06
Rate for Payer: Group Health Inc Commercial	$207.65
Rate for Payer: Group Health Inc Medicare	$145.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.65
Rate for Payer: Hamaspik Choice Inc Medicare	$207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$269.94

Know your out-of-pocket cost for care.

All Charges