St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - DEXAMETHASONE

Facility

$105.00

Service Code	CPT 80375
Hospital Charge Code	3018037502
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - DEXAMETHASONE

Facility

$105.00

Service Code	CPT 80375
Hospital Charge Code	3018037502
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: EmblemHealth Commercial	$52.50
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: United Healthcare Commercial	$19.94

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - ETHAMBUTOL

Facility

$105.00

Service Code	CPT 80375
Hospital Charge Code	3018037503
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: EmblemHealth Commercial	$52.50
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: United Healthcare Commercial	$19.94

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - ETHAMBUTOL

Facility

$105.00

Service Code	CPT 80375
Hospital Charge Code	3018037503
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - ISONIAZID

Facility

$105.00

Service Code	CPT 80375
Hospital Charge Code	3018037504
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: EmblemHealth Commercial	$52.50
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: United Healthcare Commercial	$19.94

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - ISONIAZID

Facility

$105.00

Service Code	CPT 80375
Hospital Charge Code	3018037504
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - METHAQUALONE

Facility

$105.00

Service Code	CPT 80375
Hospital Charge Code	3018037501
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - METHAQUALONE

Facility

$105.00

Service Code	CPT 80375
Hospital Charge Code	3018037501
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: EmblemHealth Commercial	$52.50
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: United Healthcare Commercial	$19.94

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - RIFAMPIN (RIFADIN)

Facility

$325.00

Service Code	CPT 80375
Hospital Charge Code	3018037505
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$243.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.00
Rate for Payer: EmblemHealth Commercial	$162.50
Rate for Payer: Group Health Inc Commercial	$162.50
Rate for Payer: Group Health Inc Medicare	$113.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.50
Rate for Payer: Hamaspik Choice Inc Medicare	$162.50
Rate for Payer: United Healthcare Commercial	$19.94

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - RIFAMPIN (RIFADIN)

Facility

$325.00

Service Code	CPT 80375
Hospital Charge Code	3018037505
Hospital Revenue Code	301
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$162.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.50

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4-6 GOLD - BUNDLED CHARGE

Facility

$210.00

Service Code	CPT 80376
Hospital Charge Code	3018037602
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$157.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.80
Rate for Payer: EmblemHealth Commercial	$105.00
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00
Rate for Payer: United Healthcare Commercial	$22.25

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4-6 GOLD - BUNDLED CHARGE

Facility

$210.00

Service Code	CPT 80376
Hospital Charge Code	3018037602
Hospital Revenue Code	301
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7+ GOLD - BUNDLED CHARGE

Facility

$146.00

Service Code	CPT 80377
Hospital Charge Code	3018037702
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$116.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$109.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.28
Rate for Payer: EmblemHealth Commercial	$73.00
Rate for Payer: Group Health Inc Commercial	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00
Rate for Payer: United Healthcare Commercial	$22.25

HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7+ GOLD - BUNDLED CHARGE

Facility

$146.00

Service Code	CPT 80377
Hospital Charge Code	3018037702
Hospital Revenue Code	301
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00

HC DRUG/SUBSTANCE DEFIN QUAL/QUANT NOS 4-6 CHLOROQUINE - BUNDLED CHARGE

Facility

$210.00

Service Code	CPT 80376
Hospital Charge Code	3018037601
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$157.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.80
Rate for Payer: EmblemHealth Commercial	$105.00
Rate for Payer: Group Health Inc Commercial	$105.00
Rate for Payer: Group Health Inc Medicare	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00
Rate for Payer: Hamaspik Choice Inc Medicare	$105.00
Rate for Payer: United Healthcare Commercial	$22.25

HC DRUG/SUBSTANCE DEFIN QUAL/QUANT NOS 4-6 CHLOROQUINE - BUNDLED CHARGE

Facility

$210.00

Service Code	CPT 80376
Hospital Charge Code	3018037601
Hospital Revenue Code	301
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.00

HC DRUG/SUBSTANCE DEFIN QUAL/QUANT NOS 7+, SULFONYLUREA SCRN - BUNDLED CHARGE

Facility

$315.00

Service Code	CPT 80377
Hospital Charge Code	3018037701
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$252.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$173.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$236.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$252.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$214.20
Rate for Payer: EmblemHealth Commercial	$157.50
Rate for Payer: Group Health Inc Commercial	$157.50
Rate for Payer: Group Health Inc Medicare	$110.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.50
Rate for Payer: Hamaspik Choice Inc Medicare	$157.50
Rate for Payer: United Healthcare Commercial	$22.25

HC DRUG/SUBSTANCE DEFIN QUAL/QUANT NOS 7+, SULFONYLUREA SCRN - BUNDLED CHARGE

Facility

$315.00

Service Code	CPT 80377
Hospital Charge Code	3018037701
Hospital Revenue Code	301
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.50

HC DRUG TEST DEF 1-7 CLASSES

Facility

$103.00

Service Code	CPT G0480
Hospital Charge Code	301G048001
Hospital Revenue Code	301
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$51.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50

HC DRUG TEST DEF 1-7 CLASSES

Facility

$103.00

Service Code	CPT G0480
Hospital Charge Code	301G048001
Hospital Revenue Code	301
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$116.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.43
Rate for Payer: Aetna Government	$114.43
Rate for Payer: Affinity Essential Plan 1&2	$80.10
Rate for Payer: Affinity Essential Plan 3&4	$80.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$80.10
Rate for Payer: Brighton Health Commercial	$77.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$114.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.04
Rate for Payer: Elderplan Medicare Advantage	$114.43
Rate for Payer: EmblemHealth Commercial	$114.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$102.99
Rate for Payer: Fidelis Essential Plan Aliesa	$97.27
Rate for Payer: Fidelis Essential Plan QHP	$101.84
Rate for Payer: Fidelis Medicare Advantage	$114.43
Rate for Payer: Fidelis Qualified Health Plan	$101.84
Rate for Payer: Group Health Inc Commercial	$114.43
Rate for Payer: Group Health Inc Medicare	$114.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.43
Rate for Payer: Hamaspik Choice Inc Medicare	$114.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.15
Rate for Payer: Healthfirst Essential Plan	$34.09
Rate for Payer: Healthfirst Medicare Advantage	$97.27
Rate for Payer: Healthfirst QHP	$114.43
Rate for Payer: Humana Medicare	$116.72
Rate for Payer: Senior Whole Health Medicare Advantage	$114.43
Rate for Payer: United Healthcare Commercial	$71.95
Rate for Payer: United Healthcare Medicare Advantage	$114.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.15
Rate for Payer: Wellcare Medicare	$102.99

HC DRUG TEST DEF 8-14 CLASSES

Facility

$155.00

Service Code	CPT G0481
Hospital Charge Code	301G048101
Hospital Revenue Code	301
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50

HC DRUG TEST DEF 8-14 CLASSES

Facility

$155.00

Service Code	CPT G0481
Hospital Charge Code	301G048101
Hospital Revenue Code	301
Min. Negotiated Rate	$85.25
Max. Negotiated Rate	$159.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.59
Rate for Payer: Aetna Government	$156.59
Rate for Payer: Affinity Essential Plan 1&2	$109.61
Rate for Payer: Affinity Essential Plan 3&4	$109.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$109.61
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$156.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: Elderplan Medicare Advantage	$156.59
Rate for Payer: EmblemHealth Commercial	$156.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$140.93
Rate for Payer: Fidelis Essential Plan Aliesa	$133.10
Rate for Payer: Fidelis Essential Plan QHP	$139.37
Rate for Payer: Fidelis Medicare Advantage	$156.59
Rate for Payer: Fidelis Qualified Health Plan	$139.37
Rate for Payer: Group Health Inc Commercial	$156.59
Rate for Payer: Group Health Inc Medicare	$156.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.59
Rate for Payer: Hamaspik Choice Inc Medicare	$156.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$156.59
Rate for Payer: Healthfirst Medicare Advantage	$133.10
Rate for Payer: Healthfirst QHP	$156.59
Rate for Payer: Humana Medicare	$159.72
Rate for Payer: Senior Whole Health Medicare Advantage	$156.59
Rate for Payer: United Healthcare Commercial	$110.69
Rate for Payer: United Healthcare Medicare Advantage	$156.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$148.76
Rate for Payer: Wellcare Medicare	$140.93

HC DRUG TEST PRSMV CHEM ANLYZR - AMPHETAMINE QUAL URINE

Facility

$155.00

Service Code	CPT 80307
Hospital Charge Code	3018030715
Hospital Revenue Code	301
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.50

HC DRUG TEST PRSMV CHEM ANLYZR - AMPHETAMINE QUAL URINE

Facility

$155.00

Service Code	CPT 80307
Hospital Charge Code	3018030715
Hospital Revenue Code	301
Min. Negotiated Rate	$27.63
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.14
Rate for Payer: Aetna Government	$62.14
Rate for Payer: Affinity Essential Plan 1&2	$62.17
Rate for Payer: Affinity Essential Plan 3&4	$62.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$27.63
Rate for Payer: Amida Care Medicaid	$27.63
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$62.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: Elderplan Medicare Advantage	$62.14
Rate for Payer: EmblemHealth Commercial	$62.14
Rate for Payer: EmblemHealth Essential Plan 1&2	$62.17
Rate for Payer: EmblemHealth Essential Plan 3&4	$27.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.63
Rate for Payer: Fidelis Essential Plan Aliesa	$62.17
Rate for Payer: Fidelis Essential Plan QHP	$62.17
Rate for Payer: Fidelis Medicare Advantage	$62.14
Rate for Payer: Fidelis Qualified Health Plan	$29.01
Rate for Payer: Group Health Inc Commercial	$62.14
Rate for Payer: Group Health Inc Medicare	$62.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.63
Rate for Payer: Hamaspik Choice Inc Medicare	$62.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.63
Rate for Payer: Healthfirst Essential Plan	$62.17
Rate for Payer: Healthfirst Medicare Advantage	$62.14
Rate for Payer: Healthfirst QHP	$45.04
Rate for Payer: Humana Medicare	$63.38
Rate for Payer: Senior Whole Health Medicare Advantage	$62.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.63
Rate for Payer: SOMOS Essential	$62.17
Rate for Payer: United Healthcare Commercial	$71.83
Rate for Payer: United Healthcare Essential Plan 1&2	$62.17
Rate for Payer: United Healthcare Essential Plan 3&4	$30.40
Rate for Payer: United Healthcare Medicaid	$27.63
Rate for Payer: United Healthcare Medicare Advantage	$62.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.63
Rate for Payer: Wellcare Medicare	$55.93

HC DRUG TEST PRSMV CHEM ANLYZR - BENZODIAZEPINE URINE QUAL

Facility

$155.00

Service Code	CPT 80307
Hospital Charge Code	3018030702
Hospital Revenue Code	301
Min. Negotiated Rate	$27.63
Max. Negotiated Rate	$124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.14
Rate for Payer: Aetna Government	$62.14
Rate for Payer: Affinity Essential Plan 1&2	$62.17
Rate for Payer: Affinity Essential Plan 3&4	$62.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$27.63
Rate for Payer: Amida Care Medicaid	$27.63
Rate for Payer: Brighton Health Commercial	$116.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$62.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.40
Rate for Payer: Elderplan Medicare Advantage	$62.14
Rate for Payer: EmblemHealth Commercial	$62.14
Rate for Payer: EmblemHealth Essential Plan 1&2	$62.17
Rate for Payer: EmblemHealth Essential Plan 3&4	$27.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.63
Rate for Payer: Fidelis Essential Plan Aliesa	$62.17
Rate for Payer: Fidelis Essential Plan QHP	$62.17
Rate for Payer: Fidelis Medicare Advantage	$62.14
Rate for Payer: Fidelis Qualified Health Plan	$29.01
Rate for Payer: Group Health Inc Commercial	$62.14
Rate for Payer: Group Health Inc Medicare	$62.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.63
Rate for Payer: Hamaspik Choice Inc Medicare	$62.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.63
Rate for Payer: Healthfirst Essential Plan	$62.17
Rate for Payer: Healthfirst Medicare Advantage	$62.14
Rate for Payer: Healthfirst QHP	$45.04
Rate for Payer: Humana Medicare	$63.38
Rate for Payer: Senior Whole Health Medicare Advantage	$62.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.63
Rate for Payer: SOMOS Essential	$62.17
Rate for Payer: United Healthcare Commercial	$71.83
Rate for Payer: United Healthcare Essential Plan 1&2	$62.17
Rate for Payer: United Healthcare Essential Plan 3&4	$30.40
Rate for Payer: United Healthcare Medicaid	$27.63
Rate for Payer: United Healthcare Medicare Advantage	$62.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.63
Rate for Payer: Wellcare Medicare	$55.93

Know your out-of-pocket cost for care.

All Charges