St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

COLLAR CERVICAL ASPEN MED

Facility

$8.53

Hospital Charge Code	64901891
Hospital Revenue Code	270
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.26
Rate for Payer: Aetna Government	$4.26
Rate for Payer: Brighton Health Commercial	$6.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.80
Rate for Payer: Group Health Inc Commercial	$4.26
Rate for Payer: Group Health Inc Medicare	$2.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.26
Rate for Payer: Hamaspik Choice Inc Medicare	$4.26

COLLAR CERVICAL ASPEN REGULAR 3

Facility

$75.00

Hospital Charge Code	64901012
Hospital Revenue Code	270
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$60.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.50
Rate for Payer: Aetna Government	$37.50
Rate for Payer: Brighton Health Commercial	$56.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.00
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

COLLAR CERVICAL ASPEN SM

Facility

$8.53

Hospital Charge Code	64901890
Hospital Revenue Code	270
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.26
Rate for Payer: Aetna Government	$4.26
Rate for Payer: Brighton Health Commercial	$6.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.80
Rate for Payer: Group Health Inc Commercial	$4.26
Rate for Payer: Group Health Inc Medicare	$2.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.26
Rate for Payer: Hamaspik Choice Inc Medicare	$4.26

COLLAR CERVICAL ASPEN XTALL 4 1/2

Facility

$75.00

Hospital Charge Code	64901020
Hospital Revenue Code	270
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$60.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.50
Rate for Payer: Aetna Government	$37.50
Rate for Payer: Brighton Health Commercial	$56.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.00
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

COLLAR CERVICAL MIAMI ADV PAD

Facility

$103.13

Hospital Charge Code	64901592
Hospital Revenue Code	270
Min. Negotiated Rate	$36.10
Max. Negotiated Rate	$82.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.56
Rate for Payer: Aetna Government	$51.56
Rate for Payer: Brighton Health Commercial	$77.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.13
Rate for Payer: Group Health Inc Commercial	$51.56
Rate for Payer: Group Health Inc Medicare	$36.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.56
Rate for Payer: Hamaspik Choice Inc Medicare	$51.56

COLLAR,CERVICAL,MIAMI J ADV

Facility

$84.20

Hospital Charge Code	64901589
Hospital Revenue Code	270
Min. Negotiated Rate	$29.47
Max. Negotiated Rate	$67.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.10
Rate for Payer: Aetna Government	$42.10
Rate for Payer: Brighton Health Commercial	$63.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.26
Rate for Payer: Group Health Inc Commercial	$42.10
Rate for Payer: Group Health Inc Medicare	$29.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.10
Rate for Payer: Hamaspik Choice Inc Medicare	$42.10

COLLAR,CERVICAL,UNIV,3X22

Facility

$10.03

Hospital Charge Code	64902587
Hospital Revenue Code	270
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$8.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.02
Rate for Payer: Aetna Government	$5.02
Rate for Payer: Brighton Health Commercial	$7.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.82
Rate for Payer: Group Health Inc Commercial	$5.02
Rate for Payer: Group Health Inc Medicare	$3.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.02
Rate for Payer: Hamaspik Choice Inc Medicare	$5.02

COLLAR CERVICAL UNIVERSAL

Facility

$5.95

Hospital Charge Code	64901282
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$4.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.98
Rate for Payer: Aetna Government	$2.98
Rate for Payer: Brighton Health Commercial	$4.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.05
Rate for Payer: Group Health Inc Commercial	$2.98
Rate for Payer: Group Health Inc Medicare	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.98
Rate for Payer: Hamaspik Choice Inc Medicare	$2.98

COLLAR STIFF NECK NO NECK IE745

Facility

$8.64

Hospital Charge Code	64901518
Hospital Revenue Code	270
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$6.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.32
Rate for Payer: Aetna Government	$4.32
Rate for Payer: Brighton Health Commercial	$6.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.88
Rate for Payer: Group Health Inc Commercial	$4.32
Rate for Payer: Group Health Inc Medicare	$3.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.32
Rate for Payer: Hamaspik Choice Inc Medicare	$4.32

COLLAR STIFF NECK REGULAR IE745

Facility

$22.50

Hospital Charge Code	64901521
Hospital Revenue Code	270
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$18.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.25
Rate for Payer: Aetna Government	$11.25
Rate for Payer: Brighton Health Commercial	$16.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.30
Rate for Payer: Group Health Inc Commercial	$11.25
Rate for Payer: Group Health Inc Medicare	$7.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.25
Rate for Payer: Hamaspik Choice Inc Medicare	$11.25

COLLAR STIFF NECK TALL IE745

Facility

$22.50

Hospital Charge Code	64901523
Hospital Revenue Code	270
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$18.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.25
Rate for Payer: Aetna Government	$11.25
Rate for Payer: Brighton Health Commercial	$16.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.30
Rate for Payer: Group Health Inc Commercial	$11.25
Rate for Payer: Group Health Inc Medicare	$7.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.25
Rate for Payer: Hamaspik Choice Inc Medicare	$11.25

COLLAR SUPPORT LARGE

Facility

$25.53

Hospital Charge Code	64901209
Hospital Revenue Code	270
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$20.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.76
Rate for Payer: Aetna Government	$12.76
Rate for Payer: Brighton Health Commercial	$19.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.36
Rate for Payer: Group Health Inc Commercial	$12.76
Rate for Payer: Group Health Inc Medicare	$8.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.76
Rate for Payer: Hamaspik Choice Inc Medicare	$12.76

COLLAR SUPPORT PEDIATRIC

Facility

$22.51

Hospital Charge Code	64901117
Hospital Revenue Code	270
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$18.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.26
Rate for Payer: Aetna Government	$11.26
Rate for Payer: Brighton Health Commercial	$16.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.31
Rate for Payer: Group Health Inc Commercial	$11.26
Rate for Payer: Group Health Inc Medicare	$7.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.26
Rate for Payer: Hamaspik Choice Inc Medicare	$11.26

COLLAR SUPPORT SMALL

Facility

$25.79

Hospital Charge Code	64901207
Hospital Revenue Code	270
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$20.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.90
Rate for Payer: Aetna Government	$12.90
Rate for Payer: Brighton Health Commercial	$19.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.54
Rate for Payer: Group Health Inc Commercial	$12.90
Rate for Payer: Group Health Inc Medicare	$9.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.90
Rate for Payer: Hamaspik Choice Inc Medicare	$12.90

COLLAR SUPPORT SOFT CHILD

Facility

$16.14

Hospital Charge Code	64902423
Hospital Revenue Code	270
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$12.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.07
Rate for Payer: Aetna Government	$8.07
Rate for Payer: Brighton Health Commercial	$12.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.98
Rate for Payer: Group Health Inc Commercial	$8.07
Rate for Payer: Group Health Inc Medicare	$5.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.07
Rate for Payer: Hamaspik Choice Inc Medicare	$8.07

COLL CAPILLARY BLOOD

Facility

$115.98

Service Code	HCPCS 36416
Hospital Charge Code	30105184
Hospital Revenue Code	300
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$86.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.54
Rate for Payer: Group Health Inc Commercial	$57.99
Rate for Payer: Group Health Inc Medicare	$40.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.99
Rate for Payer: Hamaspik Choice Inc Medicare	$57.99
Rate for Payer: United Healthcare Commercial	$2.58

COLLECTION & APP OF AUTOLOGOUS

Facility

$300.00

Service Code	HCPCS D7921
Hospital Charge Code	42300748
Hospital Revenue Code	361
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$131.81
Rate for Payer: Aetna Government	$131.81
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
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

COLLECTION SET, DISPOSABLE

Facility

$152.80

Hospital Charge Code	40200467
Hospital Revenue Code	270
Min. Negotiated Rate	$53.48
Max. Negotiated Rate	$122.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$76.40
Rate for Payer: Aetna Government	$76.40
Rate for Payer: Brighton Health Commercial	$114.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$103.90
Rate for Payer: Group Health Inc Commercial	$76.40
Rate for Payer: Group Health Inc Medicare	$53.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.40
Rate for Payer: Hamaspik Choice Inc Medicare	$76.40

COLLECTOR FECAL TAPERD DRNABLE

Facility

$138.13

Hospital Charge Code	64903274
Hospital Revenue Code	270
Min. Negotiated Rate	$48.35
Max. Negotiated Rate	$110.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.06
Rate for Payer: Aetna Government	$69.06
Rate for Payer: Brighton Health Commercial	$103.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.93
Rate for Payer: Group Health Inc Commercial	$69.06
Rate for Payer: Group Health Inc Medicare	$48.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$69.06
Rate for Payer: Hamaspik Choice Inc Medicare	$69.06

COLLECTOR FECAL TAPERD DRNABLE LG

Facility

$110.50

Hospital Charge Code	40202181
Hospital Revenue Code	270
Min. Negotiated Rate	$38.68
Max. Negotiated Rate	$88.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.25
Rate for Payer: Aetna Government	$55.25
Rate for Payer: Brighton Health Commercial	$82.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$88.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.14
Rate for Payer: Group Health Inc Commercial	$55.25
Rate for Payer: Group Health Inc Medicare	$38.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.25
Rate for Payer: Hamaspik Choice Inc Medicare	$55.25

COLLECTOR SPECIMEN ANAEROBIC

Facility

$11.36

Hospital Charge Code	64901922
Hospital Revenue Code	270
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$9.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.68
Rate for Payer: Aetna Government	$5.68
Rate for Payer: Brighton Health Commercial	$8.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.72
Rate for Payer: Group Health Inc Commercial	$5.68
Rate for Payer: Group Health Inc Medicare	$3.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.68
Rate for Payer: Hamaspik Choice Inc Medicare	$5.68

COLLECT & PREP GENETIC SAMPLE

Facility

$250.00

Service Code	HCPCS D0422
Hospital Charge Code	42303461
Hospital Revenue Code	361
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.90
Rate for Payer: Aetna Government	$6.90
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
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

COLONOSCOPY, BIOPSY

Facility

$3,041.53

Service Code	HCPCS 45380
Hospital Charge Code	41118020
Hospital Revenue Code	360
Min. Negotiated Rate	$955.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,364.66
Rate for Payer: Aetna Government	$1,364.66
Rate for Payer: Affinity Essential Plan 1&2	$955.26
Rate for Payer: Affinity Essential Plan 3&4	$955.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$955.26
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,364.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,364.66
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,159.96
Rate for Payer: Fidelis Essential Plan QHP	$1,214.55
Rate for Payer: Fidelis Medicare Advantage	$1,364.66
Rate for Payer: Fidelis Qualified Health Plan	$1,214.55
Rate for Payer: Group Health Inc Commercial	$1,364.66
Rate for Payer: Group Health Inc Medicare	$1,364.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,520.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1,364.66
Rate for Payer: Healthfirst Medicare Advantage	$1,159.96
Rate for Payer: Healthfirst QHP	$1,364.66
Rate for Payer: Humana Medicare	$1,391.95
Rate for Payer: Senior Whole Health Medicare Advantage	$1,364.66
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,364.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,364.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,091.73
Rate for Payer: Wellcare Medicare	$1,296.43

COLONOSCOPY, BIOPSY

Facility

$3,041.53

Service Code	HCPCS 45380
Hospital Charge Code	41118020
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,364.66

COLONOSCOPY/CONTROL BLEEDING

Facility

$3,041.53

Service Code	HCPCS 45382
Hospital Charge Code	41118205
Hospital Revenue Code	360
Min. Negotiated Rate	$955.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,364.66
Rate for Payer: Aetna Government	$1,364.66
Rate for Payer: Affinity Essential Plan 1&2	$955.26
Rate for Payer: Affinity Essential Plan 3&4	$955.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$955.26
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,364.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,364.66
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,159.96
Rate for Payer: Fidelis Essential Plan QHP	$1,214.55
Rate for Payer: Fidelis Medicare Advantage	$1,364.66
Rate for Payer: Fidelis Qualified Health Plan	$1,214.55
Rate for Payer: Group Health Inc Commercial	$1,364.66
Rate for Payer: Group Health Inc Medicare	$1,364.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,520.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1,364.66
Rate for Payer: Healthfirst Medicare Advantage	$1,159.96
Rate for Payer: Healthfirst QHP	$1,364.66
Rate for Payer: Humana Medicare	$1,391.95
Rate for Payer: Senior Whole Health Medicare Advantage	$1,364.66
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,364.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,364.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,091.73
Rate for Payer: Wellcare Medicare	$1,296.43

Know your out-of-pocket cost for care.

All Charges