St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DANAZOL 100 MG CAP

Facility

$4.00

Hospital Charge Code	41653958
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

DANAZOL 100 MG CAP

Facility

$4.00

Hospital Charge Code	41643958
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

DANAZOL 200 MG CAP

Facility

$6.64

Hospital Charge Code	41653959
Hospital Revenue Code	250
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$5.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.32
Rate for Payer: Aetna Government	$3.32
Rate for Payer: Brighton Health Commercial	$4.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.52
Rate for Payer: Group Health Inc Commercial	$3.32
Rate for Payer: Group Health Inc Medicare	$2.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.32
Rate for Payer: Hamaspik Choice Inc Medicare	$3.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.32

DANAZOL 200 MG CAP

Facility

$6.64

Hospital Charge Code	41643959
Hospital Revenue Code	250
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$5.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.32
Rate for Payer: Aetna Government	$3.32
Rate for Payer: Brighton Health Commercial	$4.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.52
Rate for Payer: Group Health Inc Commercial	$3.32
Rate for Payer: Group Health Inc Medicare	$2.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.32
Rate for Payer: Hamaspik Choice Inc Medicare	$3.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.32

DANTROLENE 100 MG CAP

Facility

$3.00

Hospital Charge Code	41640794
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

DANTROLENE 100 MG CAP

Facility

$3.00

Hospital Charge Code	41650794
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

DANTROLENE 20 MG INJ

Facility

$130.00

Hospital Charge Code	41644793
Hospital Revenue Code	250
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$104.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.00
Rate for Payer: Aetna Government	$65.00
Rate for Payer: Brighton Health Commercial	$97.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.40
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

DANTROLENE 20 MG INJ

Facility

$130.00

Hospital Charge Code	41654793
Hospital Revenue Code	250
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$104.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.00
Rate for Payer: Aetna Government	$65.00
Rate for Payer: Brighton Health Commercial	$97.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.40
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

DANTROLENE SODIUM 100 MG PO CAPS [9717]

Facility

$1.95

Service Code	NDC 49884036401
Hospital Charge Code	49884036401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.98
Rate for Payer: Aetna Government	$0.98
Rate for Payer: Brighton Health Commercial	$1.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS [125075]

Facility

$23.29

Service Code	NDC 00310621030
Hospital Charge Code	00310621030
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$18.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.64
Rate for Payer: Aetna Government	$11.64
Rate for Payer: Brighton Health Commercial	$17.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.84
Rate for Payer: Group Health Inc Commercial	$11.64
Rate for Payer: Group Health Inc Medicare	$8.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.64
Rate for Payer: Hamaspik Choice Inc Medicare	$11.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.14

DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS [125074]

Facility

$23.29

Service Code	NDC 00310620530
Hospital Charge Code	00310620530
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$18.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.64
Rate for Payer: Aetna Government	$11.64
Rate for Payer: Brighton Health Commercial	$17.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.84
Rate for Payer: Group Health Inc Commercial	$11.64
Rate for Payer: Group Health Inc Medicare	$8.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.64
Rate for Payer: Hamaspik Choice Inc Medicare	$11.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.14

DAPSONE 100 MG PO TABS [2131]

Facility

$3.02

Service Code	NDC 70954013610
Hospital Charge Code	70954013610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.51
Rate for Payer: Aetna Government	$1.51
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.51
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.96

DAPSONE 100 MG PO TABS [2131]

Facility

$3.36

Service Code	NDC 49938010130
Hospital Charge Code	49938010130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$2.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.28
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

DAPSONE 100 MG TAB

Facility

$3.00

Hospital Charge Code	41650357
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

DAPSONE 100 MG TAB

Facility

$3.00

Hospital Charge Code	41640357
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

DAPSONE 25 MG PO TABS [2132]

Facility

$2.74

Service Code	NDC 49938010230
Hospital Charge Code	49938010230
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.37
Rate for Payer: Aetna Government	$1.37
Rate for Payer: Brighton Health Commercial	$2.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.86
Rate for Payer: Group Health Inc Commercial	$1.37
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.78

DAPSONE 25 MG TAB

Facility

$2.00

Hospital Charge Code	41640851
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

DAPSONE 25 MG TAB

Facility

$2.00

Hospital Charge Code	41650851
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

DAPTOMYCIN 350 MG IV SOLR [160136]

Facility

$30.00

Service Code	HCPCS J0878
Hospital Charge Code	71288001715
Hospital Revenue Code	278
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$31.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$18.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.25
Rate for Payer: EmblemHealth Commercial	$15.00
Rate for Payer: Fidelis Medicare Advantage	$31.50
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

DAPTOMYCIN 350 MG IV SOLR [160136]

Facility

$30.00

Service Code	HCPCS J0878
Hospital Charge Code	71288001715
Hospital Revenue Code	278
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00

DAPTOMYCIN 500 MG INJ

Facility

$2.00

Service Code	HCPCS J0878
Hospital Charge Code	41653134
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

DAPTOMYCIN 500 MG INJ

Facility

$2.00

Service Code	HCPCS J0878
Hospital Charge Code	41643134
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
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	$0.11
Rate for Payer: SOMOS Essential	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

DAPTOMYCIN 500 MG INJ

Facility

$2.00

Service Code	HCPCS J0878
Hospital Charge Code	41643134
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

DAPTOMYCIN 500 MG INJ

Facility

$2.00

Service Code	HCPCS J0878
Hospital Charge Code	41653134
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
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	$0.11
Rate for Payer: SOMOS Essential	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

DAPTOMYCIN 500 MG IV SOLR [36989]

Facility

$126.00

Service Code	HCPCS J0878
Hospital Charge Code	00703012501
Hospital Revenue Code	278
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$132.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$75.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.45
Rate for Payer: EmblemHealth Commercial	$63.00
Rate for Payer: Fidelis Medicare Advantage	$132.30
Rate for Payer: Group Health Inc Commercial	$63.00
Rate for Payer: Group Health Inc Medicare	$44.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.90

Know your out-of-pocket cost for care.

All Charges