St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR [128163]

Facility

$474.70

Service Code	HCPCS J0714
Hospital Charge Code	00456270010
Hospital Revenue Code	278
Min. Negotiated Rate	$76.36
Max. Negotiated Rate	$308.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$261.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.45
Rate for Payer: Aetna Government	$95.45
Rate for Payer: Brighton Health Commercial	$284.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$95.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$237.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.95
Rate for Payer: Elderplan Medicare Advantage	$95.45
Rate for Payer: EmblemHealth Commercial	$237.35
Rate for Payer: Fidelis Medicare Advantage	$95.45
Rate for Payer: Group Health Inc Commercial	$95.45
Rate for Payer: Group Health Inc Medicare	$95.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.35
Rate for Payer: Hamaspik Choice Inc Medicare	$237.35
Rate for Payer: Healthfirst Medicare Advantage	$81.13
Rate for Payer: Healthfirst QHP	$95.45
Rate for Payer: Humana Medicare	$97.36
Rate for Payer: Senior Whole Health Medicare Advantage	$95.45
Rate for Payer: United Healthcare Medicare Advantage	$95.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$308.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.36

CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR [128163]

Facility

$474.70

Service Code	HCPCS J0714
Hospital Charge Code	00456270010
Hospital Revenue Code	278
Min. Negotiated Rate	$237.35
Max. Negotiated Rate	$237.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.35
Rate for Payer: Hamaspik Choice Inc Medicare	$237.35

CEFTOLOZANE/TAZOBACTAM 1500MG

Facility

$13.18

Service Code	HCPCS J0695
Hospital Charge Code	41657842
Hospital Revenue Code	636
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$8.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.37
Rate for Payer: Aetna Government	$7.37
Rate for Payer: Affinity Essential Plan 1&2	$5.16
Rate for Payer: Affinity Essential Plan 3&4	$5.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.16
Rate for Payer: Brighton Health Commercial	$7.91
Rate for Payer: Cash Price	$7.37
Rate for Payer: Cash Price	$7.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.58
Rate for Payer: Elderplan Medicare Advantage	$7.37
Rate for Payer: EmblemHealth Commercial	$7.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.37
Rate for Payer: Fidelis Essential Plan Aliesa	$7.37
Rate for Payer: Fidelis Essential Plan QHP	$7.74
Rate for Payer: Fidelis Medicare Advantage	$7.37
Rate for Payer: Fidelis Qualified Health Plan	$7.74
Rate for Payer: Group Health Inc Commercial	$7.37
Rate for Payer: Group Health Inc Medicare	$7.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.59
Rate for Payer: Hamaspik Choice Inc Medicare	$6.59
Rate for Payer: Healthfirst Medicare Advantage	$6.26
Rate for Payer: Healthfirst QHP	$7.37
Rate for Payer: Humana Medicare	$7.52
Rate for Payer: Senior Whole Health Medicare Advantage	$7.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.73
Rate for Payer: SOMOS Essential	$7.73
Rate for Payer: United Healthcare Commercial	$6.56
Rate for Payer: United Healthcare Medicare Advantage	$7.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.90
Rate for Payer: Wellcare Medicare	$7.00

CEFTOLOZANE/TAZOBACTAM 1500MG

Facility

$13.18

Service Code	HCPCS J0695
Hospital Charge Code	41657842
Hospital Revenue Code	636
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$6.59
Rate for Payer: Cash Price	$7.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.59
Rate for Payer: Hamaspik Choice Inc Medicare	$6.59

CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR [127841]

Facility

$190.38

Service Code	HCPCS J0695
Hospital Charge Code	67919003001
Hospital Revenue Code	278
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$123.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.37
Rate for Payer: Aetna Government	$7.37
Rate for Payer: Brighton Health Commercial	$114.23
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.47
Rate for Payer: Elderplan Medicare Advantage	$7.37
Rate for Payer: EmblemHealth Commercial	$95.19
Rate for Payer: Fidelis Medicare Advantage	$7.37
Rate for Payer: Group Health Inc Commercial	$7.37
Rate for Payer: Group Health Inc Medicare	$7.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.19
Rate for Payer: Hamaspik Choice Inc Medicare	$95.19
Rate for Payer: Healthfirst Medicare Advantage	$6.26
Rate for Payer: Healthfirst QHP	$7.37
Rate for Payer: Humana Medicare	$7.52
Rate for Payer: Senior Whole Health Medicare Advantage	$7.37
Rate for Payer: United Healthcare Medicare Advantage	$7.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.90

CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR [127841]

Facility

$190.38

Service Code	HCPCS J0695
Hospital Charge Code	67919003001
Hospital Revenue Code	278
Min. Negotiated Rate	$95.19
Max. Negotiated Rate	$95.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.19
Rate for Payer: Hamaspik Choice Inc Medicare	$95.19

CEFTOLOZANE/TAZOBACTUM 1500MG

Facility

$13.18

Service Code	HCPCS J0695
Hospital Charge Code	41647842
Hospital Revenue Code	636
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$8.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.37
Rate for Payer: Aetna Government	$7.37
Rate for Payer: Affinity Essential Plan 1&2	$5.16
Rate for Payer: Affinity Essential Plan 3&4	$5.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.16
Rate for Payer: Brighton Health Commercial	$7.91
Rate for Payer: Cash Price	$7.37
Rate for Payer: Cash Price	$7.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.58
Rate for Payer: Elderplan Medicare Advantage	$7.37
Rate for Payer: EmblemHealth Commercial	$7.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.37
Rate for Payer: Fidelis Essential Plan Aliesa	$7.37
Rate for Payer: Fidelis Essential Plan QHP	$7.74
Rate for Payer: Fidelis Medicare Advantage	$7.37
Rate for Payer: Fidelis Qualified Health Plan	$7.74
Rate for Payer: Group Health Inc Commercial	$7.37
Rate for Payer: Group Health Inc Medicare	$7.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.59
Rate for Payer: Hamaspik Choice Inc Medicare	$6.59
Rate for Payer: Healthfirst Medicare Advantage	$6.26
Rate for Payer: Healthfirst QHP	$7.37
Rate for Payer: Humana Medicare	$7.52
Rate for Payer: Senior Whole Health Medicare Advantage	$7.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.73
Rate for Payer: SOMOS Essential	$7.73
Rate for Payer: United Healthcare Commercial	$6.56
Rate for Payer: United Healthcare Medicare Advantage	$7.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.90
Rate for Payer: Wellcare Medicare	$7.00

CEFTOLOZANE/TAZOBACTUM 1500MG

Facility

$13.18

Service Code	HCPCS J0695
Hospital Charge Code	41647842
Hospital Revenue Code	636
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$6.59
Rate for Payer: Cash Price	$7.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.59
Rate for Payer: Hamaspik Choice Inc Medicare	$6.59

CEFTRIAXONE 1000MG/250MG 1%IM

Facility

$0.82

Service Code	HCPCS J0696
Hospital Charge Code	41658407
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.53

CEFTRIAXONE 1000MG/250MG 1%IM

Facility

$0.82

Service Code	HCPCS J0696
Hospital Charge Code	41648407
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41

CEFTRIAXONE 1000MG/250MG 1%IM

Facility

$0.82

Service Code	HCPCS J0696
Hospital Charge Code	41648407
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.53

CEFTRIAXONE 1000MG/250MG 1%IM

Facility

$0.82

Service Code	HCPCS J0696
Hospital Charge Code	41658407
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41

CEFTRIAXONE 1000 MG INJ

Facility

$0.41

Service Code	HCPCS J0696
Hospital Charge Code	41644665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21

CEFTRIAXONE 1000 MG INJ

Facility

$0.41

Service Code	HCPCS J0696
Hospital Charge Code	41654665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

CEFTRIAXONE 1000 MG INJ

Facility

$0.41

Service Code	HCPCS J0696
Hospital Charge Code	41654665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21

CEFTRIAXONE 1000 MG INJ

Facility

$0.41

Service Code	HCPCS J0696
Hospital Charge Code	41644665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

CEFTRIAXONE 100 MG/ML INJ PEDIATRIC (IV)

Facility

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41641179
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

CEFTRIAXONE 100 MG/ML INJ PEDIATRIC (IV)

Facility

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41651179
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

CEFTRIAXONE 100 MG/ML INJ PEDIATRIC (IV)

Facility

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41641179
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CEFTRIAXONE 100 MG/ML INJ PEDIATRIC (IV)

Facility

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41651179
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CEFTRIAXONE 1G/50ML DEXT

Facility

$4.58

Service Code	HCPCS J0696
Hospital Charge Code	41657895
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$2.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.63
Rate for Payer: Group Health Inc Commercial	$2.29
Rate for Payer: Group Health Inc Medicare	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.29
Rate for Payer: Hamaspik Choice Inc Medicare	$2.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.98

CEFTRIAXONE 1G/50ML DEXT

Facility

$4.58

Service Code	HCPCS J0696
Hospital Charge Code	41647895
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$2.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.63
Rate for Payer: Group Health Inc Commercial	$2.29
Rate for Payer: Group Health Inc Medicare	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.29
Rate for Payer: Hamaspik Choice Inc Medicare	$2.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.98

CEFTRIAXONE 1G/50ML DEXT

Facility

$4.58

Service Code	HCPCS J0696
Hospital Charge Code	41657895
Hospital Revenue Code	636
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$2.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.29
Rate for Payer: Hamaspik Choice Inc Medicare	$2.29

CEFTRIAXONE 1G/50ML DEXT

Facility

$4.58

Service Code	HCPCS J0696
Hospital Charge Code	41647895
Hospital Revenue Code	636
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$2.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.29
Rate for Payer: Hamaspik Choice Inc Medicare	$2.29

CEFTRIAXONE 2000 MG INJ

Facility

$0.61

Service Code	HCPCS J0696
Hospital Charge Code	41644199
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

Know your out-of-pocket cost for care.

All Charges