St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BOSTON SCI EMBLEM MRI S-ICD A219

Facility

$45,400.00

Service Code	HCPCS C1722
Hospital Charge Code	66573276
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$47,670.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24,970.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$27,240.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$26,105.00
Rate for Payer: EmblemHealth Commercial	$22,700.00
Rate for Payer: Fidelis Medicare Advantage	$47,670.00
Rate for Payer: Group Health Inc Commercial	$22,700.00
Rate for Payer: Group Health Inc Medicare	$15,890.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$22,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29,510.00

BOSTON SCI EMBLEM SICD LEAD 3501

Facility

$10,000.00

Service Code	HCPCS C1896
Hospital Charge Code	66573277
Hospital Revenue Code	278
Min. Negotiated Rate	$3,139.11
Max. Negotiated Rate	$10,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,500.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,139.11
Rate for Payer: Aetna Government	$3,139.11
Rate for Payer: Brighton Health Commercial	$6,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,750.00
Rate for Payer: EmblemHealth Commercial	$5,000.00
Rate for Payer: Fidelis Medicare Advantage	$10,500.00
Rate for Payer: Group Health Inc Commercial	$5,000.00
Rate for Payer: Group Health Inc Medicare	$3,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,500.00

BOSTON SCI EMBLEM SICD LEAD 3501

Facility

$10,000.00

Service Code	HCPCS C1896
Hospital Charge Code	66573277
Hospital Revenue Code	278
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00

BOSTON SCI ENERGEN ICD- E142

Facility

$39,000.00

Service Code	HCPCS C1721
Hospital Charge Code	66573505
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$40,950.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,450.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Brighton Health Commercial	$23,400.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,425.00
Rate for Payer: EmblemHealth Commercial	$19,500.00
Rate for Payer: Fidelis Medicare Advantage	$40,950.00
Rate for Payer: Group Health Inc Commercial	$19,500.00
Rate for Payer: Group Health Inc Medicare	$13,650.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,350.00

BOSTON SCIENTIFIC DIAL WIRE BLLN

Facility

$598.00

Hospital Charge Code	40205612
Hospital Revenue Code	270
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$478.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$328.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$299.00
Rate for Payer: Aetna Government	$299.00
Rate for Payer: Brighton Health Commercial	$448.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$478.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.64
Rate for Payer: Group Health Inc Commercial	$299.00
Rate for Payer: Group Health Inc Medicare	$209.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$299.00
Rate for Payer: Hamaspik Choice Inc Medicare	$299.00

BOSTON SCIENTIFIC INCEPTA ICDE160

Facility

$36,220.00

Service Code	HCPCS C1722
Hospital Charge Code	66573201
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$38,031.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19,921.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$21,732.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18,110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20,826.50
Rate for Payer: EmblemHealth Commercial	$18,110.00
Rate for Payer: Fidelis Medicare Advantage	$38,031.00
Rate for Payer: Group Health Inc Commercial	$18,110.00
Rate for Payer: Group Health Inc Medicare	$12,677.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18,110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23,543.00

BOSTON SCIENTIFIC PERIVAC- 4305

Facility

$300.00

Hospital Charge Code	66526607
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

BOSTON SCIENTIFIC UROMAX 20

Facility

$473.62

Hospital Charge Code	40009320
Hospital Revenue Code	272
Min. Negotiated Rate	$165.77
Max. Negotiated Rate	$378.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$260.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$236.81
Rate for Payer: Aetna Government	$236.81
Rate for Payer: Brighton Health Commercial	$355.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$378.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.06
Rate for Payer: Group Health Inc Commercial	$236.81
Rate for Payer: Group Health Inc Medicare	$165.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.81
Rate for Payer: Hamaspik Choice Inc Medicare	$236.81

BOSTON SCIENTIFIC UROMAX 20

Facility

$473.62

Hospital Charge Code	40203338
Hospital Revenue Code	272
Min. Negotiated Rate	$165.77
Max. Negotiated Rate	$378.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$260.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$236.81
Rate for Payer: Aetna Government	$236.81
Rate for Payer: Brighton Health Commercial	$355.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$378.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.06
Rate for Payer: Group Health Inc Commercial	$236.81
Rate for Payer: Group Health Inc Medicare	$165.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.81
Rate for Payer: Hamaspik Choice Inc Medicare	$236.81

BOSTON SCI ESSENT PACEMAKER L100

Facility

$11,600.00

Service Code	HCPCS C1786
Hospital Charge Code	66573210
Hospital Revenue Code	275
Min. Negotiated Rate	$1,116.69
Max. Negotiated Rate	$12,180.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,380.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,116.69
Rate for Payer: Aetna Government	$1,116.69
Rate for Payer: Brighton Health Commercial	$6,960.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,670.00
Rate for Payer: EmblemHealth Commercial	$5,800.00
Rate for Payer: Fidelis Medicare Advantage	$12,180.00
Rate for Payer: Group Health Inc Commercial	$5,800.00
Rate for Payer: Group Health Inc Medicare	$4,060.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,800.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,540.00

BOSTON SCI INGEVITY 7741-52

Facility

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66576696
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

BOSTON SCI INGEVITY 7741-52

Facility

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66576696
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

BOSTON SCI INGEVITY MODEL 7742-59

Facility

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66576693
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

BOSTON SCI INGEVITY MODEL 7742-59

Facility

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66576693
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

BOSTON SCI INGEVITY MRI 45CM 7740

Facility

$1,200.00

Service Code	HCPCS C1785
Hospital Charge Code	66573169
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

BOSTON SCI INGEVITY MRI 52CM 7741

Facility

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66573170
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

BOSTON SCI INGEVITY MRI 52CM 7741

Facility

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66573170
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

BOSTON SCI INGEVITY PPM LEAD 7740

Facility

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66573145
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

BOSTON SCI INGEVITY PPM LEAD 7740

Facility

$1,200.00

Service Code	HCPCS C1898
Hospital Charge Code	66573145
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

BOSTON SCI INOGEN EL ICD #D142

Facility

$42,500.00

Service Code	HCPCS C1721
Hospital Charge Code	66572922
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$44,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Brighton Health Commercial	$25,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$24,437.50
Rate for Payer: EmblemHealth Commercial	$21,250.00
Rate for Payer: Fidelis Medicare Advantage	$44,625.00
Rate for Payer: Group Health Inc Commercial	$21,250.00
Rate for Payer: Group Health Inc Medicare	$14,875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,625.00

BOSTON SCI INTRO SHEATH 11FR

Facility

$100.00

Service Code	HCPCS C1894
Hospital Charge Code	66573278
Hospital Revenue Code	278
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00

BOSTON SCI INTRO SHEATH 11FR

Facility

$100.00

Service Code	HCPCS C1894
Hospital Charge Code	66573278
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$105.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.50
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Fidelis Medicare Advantage	$105.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

BOSTON SCI RELIANCE ICD LEAD 0181

Facility

$10,000.00

Service Code	HCPCS C1777
Hospital Charge Code	66576697
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$10,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,500.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Brighton Health Commercial	$6,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,750.00
Rate for Payer: EmblemHealth Commercial	$5,000.00
Rate for Payer: Fidelis Medicare Advantage	$10,500.00
Rate for Payer: Group Health Inc Commercial	$5,000.00
Rate for Payer: Group Health Inc Medicare	$3,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,500.00

BOSTON SCI RELI SG SINGLE COIL 59

Facility

$11,200.00

Service Code	HCPCS C1777
Hospital Charge Code	66572895
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$11,760.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,160.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Brighton Health Commercial	$6,720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,440.00
Rate for Payer: EmblemHealth Commercial	$5,600.00
Rate for Payer: Fidelis Medicare Advantage	$11,760.00
Rate for Payer: Group Health Inc Commercial	$5,600.00
Rate for Payer: Group Health Inc Medicare	$3,920.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,280.00

BOSTON SCI WALLFLEX BIL STENT

Facility

$5,610.00

Service Code	HCPCS C1874
Hospital Charge Code	40009117
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$5,890.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,085.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$3,366.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,805.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,225.75
Rate for Payer: EmblemHealth Commercial	$2,805.00
Rate for Payer: Fidelis Medicare Advantage	$5,890.50
Rate for Payer: Group Health Inc Commercial	$2,805.00
Rate for Payer: Group Health Inc Medicare	$1,963.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,805.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,805.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,646.50

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