St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CINACALCET HCL 60 MG PO TABS [38101]

Facility

$64.54

Service Code	NDC 55513007430
Hospital Charge Code	55513007430
Hospital Revenue Code	250
Min. Negotiated Rate	$22.59
Max. Negotiated Rate	$51.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.27
Rate for Payer: Aetna Government	$32.27
Rate for Payer: Brighton Health Commercial	$48.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.88
Rate for Payer: Group Health Inc Commercial	$32.27
Rate for Payer: Group Health Inc Medicare	$22.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.27
Rate for Payer: Hamaspik Choice Inc Medicare	$32.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.95

CINACALCET HCL 60 MG PO TABS [38101]

Facility

$61.31

Service Code	NDC 16729044110
Hospital Charge Code	16729044110
Hospital Revenue Code	250
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$49.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.65
Rate for Payer: Aetna Government	$30.65
Rate for Payer: Brighton Health Commercial	$45.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.69
Rate for Payer: Group Health Inc Commercial	$30.65
Rate for Payer: Group Health Inc Medicare	$21.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.65
Rate for Payer: Hamaspik Choice Inc Medicare	$30.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.85

CINACALCET HCL 90 MG PO TABS [38102]

Facility

$91.96

Service Code	NDC 47335060083
Hospital Charge Code	47335060083
Hospital Revenue Code	250
Min. Negotiated Rate	$32.19
Max. Negotiated Rate	$73.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.98
Rate for Payer: Aetna Government	$45.98
Rate for Payer: Brighton Health Commercial	$68.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.54
Rate for Payer: Group Health Inc Commercial	$45.98
Rate for Payer: Group Health Inc Medicare	$32.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.98
Rate for Payer: Hamaspik Choice Inc Medicare	$45.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59.78

CINACALCET HCL 90 MG PO TABS [38102]

Facility

$91.96

Service Code	NDC 16729044210
Hospital Charge Code	16729044210
Hospital Revenue Code	250
Min. Negotiated Rate	$32.19
Max. Negotiated Rate	$73.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.98
Rate for Payer: Aetna Government	$45.98
Rate for Payer: Brighton Health Commercial	$68.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.54
Rate for Payer: Group Health Inc Commercial	$45.98
Rate for Payer: Group Health Inc Medicare	$32.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.98
Rate for Payer: Hamaspik Choice Inc Medicare	$45.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59.78

CINACALCET HCL 90 MG PO TABS [38102]

Facility

$91.96

Service Code	NDC 64380088504
Hospital Charge Code	64380088504
Hospital Revenue Code	250
Min. Negotiated Rate	$32.19
Max. Negotiated Rate	$73.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.98
Rate for Payer: Aetna Government	$45.98
Rate for Payer: Brighton Health Commercial	$68.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.54
Rate for Payer: Group Health Inc Commercial	$45.98
Rate for Payer: Group Health Inc Medicare	$32.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.98
Rate for Payer: Hamaspik Choice Inc Medicare	$45.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59.78

CINACALCET HCL 90 MG PO TABS [38102]

Facility

$96.80

Service Code	NDC 55513007530
Hospital Charge Code	55513007530
Hospital Revenue Code	250
Min. Negotiated Rate	$33.88
Max. Negotiated Rate	$77.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.40
Rate for Payer: Aetna Government	$48.40
Rate for Payer: Brighton Health Commercial	$72.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.83
Rate for Payer: Group Health Inc Commercial	$48.40
Rate for Payer: Group Health Inc Medicare	$33.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.40
Rate for Payer: Hamaspik Choice Inc Medicare	$48.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.92

CIPROFLOXACIN 200 MG/100 ML IVPB PREMIX

Facility

$2.28

Service Code	HCPCS J0744
Hospital Charge Code	41654252
Hospital Revenue Code	636
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$1.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: Group Health Inc Commercial	$1.14
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.97
Rate for Payer: SOMOS Essential	$1.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.48

CIPROFLOXACIN 200 MG/100 ML IVPB PREMIX

Facility

$2.28

Service Code	HCPCS J0744
Hospital Charge Code	41654252
Hospital Revenue Code	636
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14

CIPROFLOXACIN 200 MG/100 ML IVPB PREMIX

Facility

$2.28

Service Code	HCPCS J0744
Hospital Charge Code	41644252
Hospital Revenue Code	636
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$1.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: Group Health Inc Commercial	$1.14
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.97
Rate for Payer: SOMOS Essential	$1.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.48

CIPROFLOXACIN 200 MG/100 ML IVPB PREMIX

Facility

$2.28

Service Code	HCPCS J0744
Hospital Charge Code	41644252
Hospital Revenue Code	636
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14

CIPROFLOXACIN 250 MG/5 ML SUSP

Facility

$2.00

Hospital Charge Code	41654374
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CIPROFLOXACIN 250 MG/5 ML SUSP

Facility

$2.00

Hospital Charge Code	41644374
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CIPROFLOXACIN 250 MG TAB

Facility

$0.25

Hospital Charge Code	41653694
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

CIPROFLOXACIN 250 MG TAB

Facility

$0.25

Hospital Charge Code	41643694
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

CIPROFLOXACIN 2 MG/ML INJ PEDIATRIC

Facility

$4.00

Hospital Charge Code	41651584
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

CIPROFLOXACIN 2 MG/ML INJ PEDIATRIC

Facility

$4.00

Hospital Charge Code	41641584
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

CIPROFLOXACIN 400 MG/200 ML IVPB PREMIX

Facility

$1.81

Service Code	HCPCS J0744
Hospital Charge Code	41644375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.04
Rate for Payer: Group Health Inc Commercial	$0.91
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.91
Rate for Payer: Hamaspik Choice Inc Medicare	$0.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.97
Rate for Payer: SOMOS Essential	$1.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.18

CIPROFLOXACIN 400 MG/200 ML IVPB PREMIX

Facility

$1.81

Service Code	HCPCS J0744
Hospital Charge Code	41644375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.91
Rate for Payer: Hamaspik Choice Inc Medicare	$0.91

CIPROFLOXACIN 400 MG/200 ML IVPB PREMIX

Facility

$1.81

Service Code	HCPCS J0744
Hospital Charge Code	41654375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.91
Rate for Payer: Hamaspik Choice Inc Medicare	$0.91

CIPROFLOXACIN 400 MG/200 ML IVPB PREMIX

Facility

$1.81

Service Code	HCPCS J0744
Hospital Charge Code	41654375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.04
Rate for Payer: Group Health Inc Commercial	$0.91
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.91
Rate for Payer: Hamaspik Choice Inc Medicare	$0.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.97
Rate for Payer: SOMOS Essential	$1.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.18

CIPROFLOXACIN 500 MG TAB

Facility

$1.00

Hospital Charge Code	41644707
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

CIPROFLOXACIN 500 MG TAB

Facility

$1.00

Hospital Charge Code	41654707
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

CIPROFLOXACIN 750 MG TAB

Facility

$0.77

Hospital Charge Code	41643696
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

CIPROFLOXACIN 750 MG TAB

Facility

$0.77

Hospital Charge Code	41653696
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP [36576]

Facility

$37.36

Service Code	NDC 62756042790
Hospital Charge Code	62756042790
Hospital Revenue Code	250
Min. Negotiated Rate	$13.08
Max. Negotiated Rate	$29.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.68
Rate for Payer: Aetna Government	$18.68
Rate for Payer: Brighton Health Commercial	$28.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.41
Rate for Payer: Group Health Inc Commercial	$18.68
Rate for Payer: Group Health Inc Medicare	$13.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.68
Rate for Payer: Hamaspik Choice Inc Medicare	$18.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.29

Know your out-of-pocket cost for care.

All Charges