St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

COMPREHENSIVE METABOLIC PANEL

Facility

$26.40

Service Code	HCPCS 80053
Hospital Charge Code	40602501
Hospital Revenue Code	301
Rate for Payer: Cash Price	$10.56

COMPREHENSIVE METABOLIC PANEL

Facility

$26.40

Service Code	HCPCS 80053
Hospital Charge Code	40602501
Hospital Revenue Code	301
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$19.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.56
Rate for Payer: Aetna Government	$10.56
Rate for Payer: Affinity Essential Plan 1&2	$7.39
Rate for Payer: Affinity Essential Plan 3&4	$7.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.39
Rate for Payer: Brighton Health Commercial	$19.80
Rate for Payer: Cash Price	$10.56
Rate for Payer: Cash Price	$10.56
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.21
Rate for Payer: Elderplan Medicare Advantage	$10.56
Rate for Payer: EmblemHealth Commercial	$10.56
Rate for Payer: Fidelis Essential Plan Aliesa	$8.98
Rate for Payer: Fidelis Essential Plan QHP	$9.40
Rate for Payer: Fidelis Medicare Advantage	$10.56
Rate for Payer: Fidelis Qualified Health Plan	$9.40
Rate for Payer: Group Health Inc Commercial	$10.56
Rate for Payer: Group Health Inc Medicare	$10.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.20
Rate for Payer: Hamaspik Choice Inc Medicare	$10.56
Rate for Payer: Healthfirst Medicare Advantage	$10.56
Rate for Payer: Healthfirst QHP	$10.56
Rate for Payer: Humana Medicare	$10.77
Rate for Payer: Senior Whole Health Medicare Advantage	$10.56
Rate for Payer: United Healthcare Commercial	$13.38
Rate for Payer: United Healthcare Medicare Advantage	$10.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.45
Rate for Payer: Wellcare Medicare	$9.50

COMPREHENSIVE NEW

Facility

$351.13

Service Code	HCPCS 92004
Hospital Charge Code	42101000
Hospital Revenue Code	920
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$280.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$152.87
Rate for Payer: Aetna Government	$152.87
Rate for Payer: Affinity Essential Plan 1&2	$107.01
Rate for Payer: Affinity Essential Plan 3&4	$107.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$107.01
Rate for Payer: Brighton Health Commercial	$263.35
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$152.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.77
Rate for Payer: Elderplan Medicare Advantage	$152.87
Rate for Payer: EmblemHealth Commercial	$152.87
Rate for Payer: Fidelis Essential Plan Aliesa	$129.94
Rate for Payer: Fidelis Essential Plan QHP	$136.05
Rate for Payer: Fidelis Medicare Advantage	$152.87
Rate for Payer: Fidelis Qualified Health Plan	$136.05
Rate for Payer: Group Health Inc Commercial	$152.87
Rate for Payer: Group Health Inc Medicare	$152.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.56
Rate for Payer: Hamaspik Choice Inc Medicare	$152.87
Rate for Payer: Healthfirst Medicare Advantage	$129.94
Rate for Payer: Healthfirst QHP	$152.87
Rate for Payer: Humana Medicare	$155.93
Rate for Payer: Senior Whole Health Medicare Advantage	$152.87
Rate for Payer: United Healthcare Commercial	$94.00
Rate for Payer: United Healthcare Medicare Advantage	$152.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$152.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.30
Rate for Payer: Wellcare Medicare	$145.23

COMPREHENSIVE NEW

Facility

$351.13

Service Code	HCPCS 92004
Hospital Charge Code	42101000
Hospital Revenue Code	920
Rate for Payer: Cash Price	$152.87

COMPREHENSIVE ORAL EVALUATION

Facility

$75.00

Service Code	HCPCS D0150
Hospital Charge Code	42303272
Hospital Revenue Code	361
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$152.87
Rate for Payer: Aetna Government	$152.87
Rate for Payer: Affinity Essential Plan 1&2	$107.01
Rate for Payer: Affinity Essential Plan 3&4	$107.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$107.01
Rate for Payer: Brighton Health Commercial	$56.25
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$152.87
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	$152.87
Rate for Payer: EmblemHealth Commercial	$152.87
Rate for Payer: Fidelis Essential Plan Aliesa	$129.94
Rate for Payer: Fidelis Essential Plan QHP	$136.05
Rate for Payer: Fidelis Medicare Advantage	$152.87
Rate for Payer: Fidelis Qualified Health Plan	$136.05
Rate for Payer: Group Health Inc Commercial	$152.87
Rate for Payer: Group Health Inc Medicare	$152.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$152.87
Rate for Payer: Healthfirst Medicare Advantage	$129.94
Rate for Payer: Healthfirst QHP	$152.87
Rate for Payer: Humana Medicare	$155.93
Rate for Payer: Senior Whole Health Medicare Advantage	$152.87
Rate for Payer: United Healthcare Medicare Advantage	$152.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$152.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.30
Rate for Payer: Wellcare Medicare	$145.23

COMPREHENSIVE ORAL EVALUATION

Facility

$75.00

Service Code	HCPCS D0150
Hospital Charge Code	42303272
Hospital Revenue Code	361
Rate for Payer: Cash Price	$152.87

COMP REPAIR 2.6CM-7.5CM

Facility

$1,505.35

Service Code	HCPCS 13132
Hospital Charge Code	30105927
Hospital Revenue Code	450
Rate for Payer: Cash Price	$726.29

COMP REPAIR 2.6CM-7.5CM

Facility

$1,505.35

Service Code	HCPCS 13132
Hospital Charge Code	30105927
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$726.29
Rate for Payer: Aetna Government	$726.29
Rate for Payer: Affinity Essential Plan 1&2	$508.40
Rate for Payer: Affinity Essential Plan 3&4	$508.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$508.40
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$726.29
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Cash Price	$726.29
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$726.29
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	$726.29
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$617.35
Rate for Payer: Fidelis Essential Plan QHP	$646.40
Rate for Payer: Fidelis Medicare Advantage	$726.29
Rate for Payer: Fidelis Qualified Health Plan	$646.40
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$752.68
Rate for Payer: Hamaspik Choice Inc Medicare	$726.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$726.29
Rate for Payer: Humana Medicare	$740.82
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$726.29
Rate for Payer: Senior Whole Health Medicare Advantage	$726.29
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$726.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$726.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$581.03
Rate for Payer: Wellcare Medicare	$689.98

COMPRESSION/DISTRACTION TUBE

Facility

$750.00

Hospital Charge Code	40200531
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$600.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$375.00
Rate for Payer: Aetna Government	$375.00
Rate for Payer: Brighton Health Commercial	$562.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$510.00
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

COMPRESSION HIP

Facility

$911.45

Hospital Charge Code	40202140
Hospital Revenue Code	270
Min. Negotiated Rate	$319.01
Max. Negotiated Rate	$729.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$501.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$455.72
Rate for Payer: Aetna Government	$455.72
Rate for Payer: Brighton Health Commercial	$683.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$729.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$619.79
Rate for Payer: Group Health Inc Commercial	$455.72
Rate for Payer: Group Health Inc Medicare	$319.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$455.72
Rate for Payer: Hamaspik Choice Inc Medicare	$455.72

COMPRESSION PLATE, 6 HOLE

Facility

$728.00

Service Code	HCPCS C1713
Hospital Charge Code	40201321
Hospital Revenue Code	278
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$364.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.00
Rate for Payer: Hamaspik Choice Inc Medicare	$364.00

COMPRESSION PLATE, 6 HOLE

Facility

$728.00

Service Code	HCPCS C1713
Hospital Charge Code	40201321
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$764.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$400.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$436.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$364.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$418.60
Rate for Payer: EmblemHealth Commercial	$364.00
Rate for Payer: Fidelis Medicare Advantage	$764.40
Rate for Payer: Group Health Inc Commercial	$364.00
Rate for Payer: Group Health Inc Medicare	$254.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.00
Rate for Payer: Hamaspik Choice Inc Medicare	$364.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$473.20

COMPRESSION PLATE, 8-HOLE

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	40203578
Hospital Revenue Code	278
Min. Negotiated Rate	$125.50
Max. Negotiated Rate	$125.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.50
Rate for Payer: Hamaspik Choice Inc Medicare	$125.50

COMPRESSION PLATE, 8-HOLE

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	40203578
Hospital Revenue Code	278
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$263.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$150.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.32
Rate for Payer: EmblemHealth Commercial	$125.50
Rate for Payer: Fidelis Medicare Advantage	$263.55
Rate for Payer: Group Health Inc Commercial	$125.50
Rate for Payer: Group Health Inc Medicare	$87.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.50
Rate for Payer: Hamaspik Choice Inc Medicare	$125.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.15

COMPRESSION PLATE, 9-HOLE

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	40203577
Hospital Revenue Code	278
Min. Negotiated Rate	$125.50
Max. Negotiated Rate	$125.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.50
Rate for Payer: Hamaspik Choice Inc Medicare	$125.50

COMPRESSION PLATE, 9-HOLE

Facility

$251.00

Service Code	HCPCS C1713
Hospital Charge Code	40203577
Hospital Revenue Code	278
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$263.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$150.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.32
Rate for Payer: EmblemHealth Commercial	$125.50
Rate for Payer: Fidelis Medicare Advantage	$263.55
Rate for Payer: Group Health Inc Commercial	$125.50
Rate for Payer: Group Health Inc Medicare	$87.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.50
Rate for Payer: Hamaspik Choice Inc Medicare	$125.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$163.15

COMPRESSION PLT, 4 HOLES

Facility

$500.00

Service Code	HCPCS C1781
Hospital Charge Code	40209730
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

COMPRESSION PLT, 4 HOLES

Facility

$500.00

Service Code	HCPCS C1781
Hospital Charge Code	40209730
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

COMPRESSION PLT, 6 HOLES

Facility

$728.00

Service Code	HCPCS C1781
Hospital Charge Code	40209731
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$764.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$400.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$436.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$364.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$418.60
Rate for Payer: EmblemHealth Commercial	$364.00
Rate for Payer: Fidelis Medicare Advantage	$764.40
Rate for Payer: Group Health Inc Commercial	$364.00
Rate for Payer: Group Health Inc Medicare	$254.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.00
Rate for Payer: Hamaspik Choice Inc Medicare	$364.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$473.20

COMPRESSION PLT, 6 HOLES

Facility

$728.00

Service Code	HCPCS C1781
Hospital Charge Code	40209731
Hospital Revenue Code	278
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$364.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$364.00
Rate for Payer: Hamaspik Choice Inc Medicare	$364.00

COMPRESSION WHEEL

Facility

$592.00

Service Code	HCPCS C1713
Hospital Charge Code	40006136
Hospital Revenue Code	278
Min. Negotiated Rate	$296.00
Max. Negotiated Rate	$296.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$296.00
Rate for Payer: Hamaspik Choice Inc Medicare	$296.00

COMPRESSION WHEEL

Facility

$592.00

Service Code	HCPCS C1713
Hospital Charge Code	40006136
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$621.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$325.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$355.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$296.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.40
Rate for Payer: EmblemHealth Commercial	$296.00
Rate for Payer: Fidelis Medicare Advantage	$621.60
Rate for Payer: Group Health Inc Commercial	$296.00
Rate for Payer: Group Health Inc Medicare	$207.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$296.00
Rate for Payer: Hamaspik Choice Inc Medicare	$296.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$384.80

COMPRESSION WHEEL CAPTURED

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Charge Code	40006141
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,116.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,108.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,209.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,008.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,159.20
Rate for Payer: EmblemHealth Commercial	$1,008.00
Rate for Payer: Fidelis Medicare Advantage	$2,116.80
Rate for Payer: Group Health Inc Commercial	$1,008.00
Rate for Payer: Group Health Inc Medicare	$705.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,008.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,008.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,310.40

COMPRESSION WHEEL CAPTURED

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Charge Code	40006141
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,008.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,008.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,008.00

COMPRESS LER LEG BIL

Facility

$405.08

Service Code	HCPCS 29581 50
Hospital Charge Code	42500170
Hospital Revenue Code	761
Min. Negotiated Rate	$127.55
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.22
Rate for Payer: Aetna Government	$182.22
Rate for Payer: Affinity Essential Plan 1&2	$127.55
Rate for Payer: Affinity Essential Plan 3&4	$127.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$127.55
Rate for Payer: Brighton Health Commercial	$303.81
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cash Price	$182.22
Rate for Payer: Cash Price	$182.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$182.22
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	$182.22
Rate for Payer: Fidelis Essential Plan Aliesa	$154.89
Rate for Payer: Fidelis Essential Plan QHP	$162.18
Rate for Payer: Fidelis Medicare Advantage	$182.22
Rate for Payer: Fidelis Qualified Health Plan	$162.18
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.54
Rate for Payer: Hamaspik Choice Inc Medicare	$182.22
Rate for Payer: Healthfirst Medicare Advantage	$154.89
Rate for Payer: Healthfirst QHP	$182.22
Rate for Payer: Humana Medicare	$185.86
Rate for Payer: Senior Whole Health Medicare Advantage	$182.22
Rate for Payer: United Healthcare Medicare Advantage	$182.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$145.78
Rate for Payer: Wellcare Medicare	$173.11

Know your out-of-pocket cost for care.

All Charges