St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZOLPIDEM TARTRATE 5 MG PO TABS [11701]

Facility

$4.63

Service Code	NDC 13668000701
Hospital Charge Code	13668000701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.31
Rate for Payer: Aetna Government	$2.31
Rate for Payer: Brighton Health Commercial	$3.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.14
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.01

ZOLPIDEM TARTRATE 5 MG PO TABS [11701]

Facility

$0.10

Service Code	NDC 00904608261
Hospital Charge Code	00904608261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

ZOLPIDEM TARTRATE 5 MG PO TABS [11701]

Facility

$1.76

Service Code	NDC 68084018911
Hospital Charge Code	68084018911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.88
Rate for Payer: Aetna Government	$0.88
Rate for Payer: Brighton Health Commercial	$1.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
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

ZONAIR BED

Facility

$86.47

Hospital Charge Code	40209110
Hospital Revenue Code	270
Min. Negotiated Rate	$30.26
Max. Negotiated Rate	$69.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.24
Rate for Payer: Aetna Government	$43.24
Rate for Payer: Brighton Health Commercial	$64.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.80
Rate for Payer: Group Health Inc Commercial	$43.24
Rate for Payer: Group Health Inc Medicare	$30.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.24
Rate for Payer: Hamaspik Choice Inc Medicare	$43.24

ZONEAIRE 1155 W/OPT

Facility

$99.23

Hospital Charge Code	40209115
Hospital Revenue Code	270
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$79.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.62
Rate for Payer: Aetna Government	$49.62
Rate for Payer: Brighton Health Commercial	$74.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.48
Rate for Payer: Group Health Inc Commercial	$49.62
Rate for Payer: Group Health Inc Medicare	$34.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.62
Rate for Payer: Hamaspik Choice Inc Medicare	$49.62

ZONISAMIDE 100 MG CAP

Facility

$1.09

Hospital Charge Code	41654538
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

ZONISAMIDE 100 MG CAP

Facility

$1.09

Hospital Charge Code	41644538
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.74
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.71

ZONISAMIDE 100 MG PO CAPS [27780]

Facility

$1.72

Service Code	NDC 50268081611
Hospital Charge Code	50268081611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.17
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.12

ZONISAMIDE 100 MG PO CAPS [27780]

Facility

$2.19

Service Code	NDC 69097086107
Hospital Charge Code	69097086107
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.10
Rate for Payer: Aetna Government	$1.10
Rate for Payer: Brighton Health Commercial	$1.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.49
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.42

ZONISAMIDE 100 MG PO CAPS [27780]

Facility

$0.90

Service Code	NDC 60687023001
Hospital Charge Code	60687023001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

ZONISAMIDE 100 MG PO CAPS [27780]

Facility

$1.72

Service Code	NDC 50268081615
Hospital Charge Code	50268081615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.17
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.12

ZONISAMIDE 10 MG/ML SUSP

Facility

$1.00

Hospital Charge Code	41654540
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

ZONISAMIDE 10 MG/ML SUSP

Facility

$1.00

Hospital Charge Code	41644540
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

ZONISAMIDE 25 MG CAP

Facility

$1.00

Hospital Charge Code	41655500
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

ZONISAMIDE 25 MG CAP

Facility

$1.00

Hospital Charge Code	41645500
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

ZONISAMIDE 25 MG PO CAPS [36987]

Facility

$0.55

Service Code	NDC 62756025802
Hospital Charge Code	62756025802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

ZONISAMIDE 25 MG PO CAPS [36987]

Facility

$0.55

Service Code	NDC 68462012801
Hospital Charge Code	68462012801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR [150819]

Facility

$237.47

Service Code	HCPCS 90750
Hospital Charge Code	58160082311
Hospital Revenue Code	250
Min. Negotiated Rate	$83.12
Max. Negotiated Rate	$14,140.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.25
Rate for Payer: Aetna Government	$165.25
Rate for Payer: Amida Care Medicaid	$141.40
Rate for Payer: Brighton Health Commercial	$178.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$189.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14,140.00
Rate for Payer: Fidelis Essential Plan Aliesa	$141.40
Rate for Payer: Fidelis Essential Plan QHP	$141.40
Rate for Payer: Fidelis Qualified Health Plan	$148.47
Rate for Payer: Group Health Inc Commercial	$118.74
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.40
Rate for Payer: Hamaspik Choice Inc Medicare	$118.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$141.40
Rate for Payer: Healthfirst Essential Plan	$318.15
Rate for Payer: Healthfirst QHP	$141.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.40
Rate for Payer: SOMOS Essential	$141.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$141.40

ZR ELVOW 1 VIEW

Facility

$766.16

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107502
Hospital Revenue Code	320
Rate for Payer: Cash Price	$105.08

ZR ELVOW 1 VIEW

Facility

$766.16

Service Code	HCPCS 76499 TC
Hospital Charge Code	41107502
Hospital Revenue Code	320
Min. Negotiated Rate	$268.16
Max. Negotiated Rate	$612.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$383.08
Rate for Payer: Aetna Government	$383.08
Rate for Payer: Brighton Health Commercial	$574.62
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.99
Rate for Payer: Group Health Inc Commercial	$383.08
Rate for Payer: Group Health Inc Medicare	$268.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.08
Rate for Payer: Hamaspik Choice Inc Medicare	$383.08

Z SCARF GUIDE

Facility

$250.00

Hospital Charge Code	64905959
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

ZZ 14 F X 24CM SPLIT CATH III SET

Facility

$860.00

Service Code	HCPCS C1725
Hospital Charge Code	41561878
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ 14 F X 24CM SPLIT CATH III SET

Facility

$860.00

Service Code	HCPCS C1725
Hospital Charge Code	41561878
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$903.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$516.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: EmblemHealth Commercial	$430.00
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

ZZ 14 F X24CM SPLIT CATH III SET

Facility

$860.00

Hospital Charge Code	41501878
Hospital Revenue Code	278
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00

ZZ 14 F X24CM SPLIT CATH III SET

Facility

$860.00

Hospital Charge Code	41501878
Hospital Revenue Code	278
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$903.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$473.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$430.00
Rate for Payer: Aetna Government	$430.00
Rate for Payer: Brighton Health Commercial	$516.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$430.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$494.50
Rate for Payer: EmblemHealth Commercial	$430.00
Rate for Payer: Fidelis Medicare Advantage	$903.00
Rate for Payer: Group Health Inc Commercial	$430.00
Rate for Payer: Group Health Inc Medicare	$301.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$430.00
Rate for Payer: Hamaspik Choice Inc Medicare	$430.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$559.00

Know your out-of-pocket cost for care.

All Charges