St. Barnabas Hospital

All Charges

Charge

Type

Price

FLUOXETINE 20 MG CAP

Facility OP

$0.14

Hospital Charge Code	41643788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

FLUOXETINE 20 MG CAP

Facility OP

$0.14

Hospital Charge Code	41653788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

FLUOXYMESTERONE 10 MG TAB

Facility OP

$4.00

Hospital Charge Code	41644052
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: 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

FLUOXYMESTERONE 10 MG TAB

Facility OP

$4.00

Hospital Charge Code	41654052
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: 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

FLUPHENAZINE 10 MG TAB

Facility OP

$0.39

Hospital Charge Code	41651187
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

FLUPHENAZINE 10 MG TAB

Facility OP

$0.39

Hospital Charge Code	41641187
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

FLUPHENAZINE 2.5MG 5ML ELIXIR

Facility OP

$1.00

Hospital Charge Code	41658043
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: 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

FLUPHENAZINE 2.5MG/5ML ELIXIR

Facility OP

$1.00

Hospital Charge Code	41648043
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: 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

FLUPHENAZINE 2.5 MG TAB

Facility OP

$1.00

Hospital Charge Code	41640778
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: 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

FLUPHENAZINE 2.5 MG TAB

Facility OP

$1.00

Hospital Charge Code	41650778
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: 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

FLUPHENAZINE 5 MG/ML ELIXIR

Facility OP

$1.00

Hospital Charge Code	41640943
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: 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

FLUPHENAZINE 5 MG/ML ELIXIR

Facility OP

$1.00

Hospital Charge Code	41650943
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: 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

FLUPHENAZINE 5 MG TAB

Facility OP

$1.00

Hospital Charge Code	41650866
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: 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

FLUPHENAZINE 5 MG TAB

Facility OP

$1.00

Hospital Charge Code	41640866
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: 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

FLUPHENAZINE DECANOATE 25 MG/ML INJ 5 ML

Facility OP

$146.46

Service Code	HCPCS J2680
Hospital Charge Code	41650342
Hospital Revenue Code	636
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$95.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.30
Rate for Payer: Aetna Government	$10.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9.86
Rate for Payer: Group Health Inc Commercial	$73.23
Rate for Payer: Group Health Inc Medicare	$51.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.23
Rate for Payer: Hamaspik Choice Inc Medicare	$73.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10.30
Rate for Payer: SOMOS Essential	$10.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.20

FLUPHENAZINE DECANOATE 25 MG/ML INJ 5 ML

Facility OP

$146.46

Service Code	HCPCS J2680
Hospital Charge Code	41640342
Hospital Revenue Code	636
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$95.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.30
Rate for Payer: Aetna Government	$10.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9.86
Rate for Payer: Group Health Inc Commercial	$73.23
Rate for Payer: Group Health Inc Medicare	$51.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.23
Rate for Payer: Hamaspik Choice Inc Medicare	$73.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10.30
Rate for Payer: SOMOS Essential	$10.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$95.20

FLUPHENAZINE DECANOATE 25 MG/ML INJ 5 ML

Facility IP

$146.46

Service Code	HCPCS J2680
Hospital Charge Code	41640342
Hospital Revenue Code	636
Min. Negotiated Rate	$73.23
Max. Negotiated Rate	$73.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.23
Rate for Payer: Hamaspik Choice Inc Medicare	$73.23

FLUPHENAZINE DECANOATE 25 MG/ML INJ 5 ML

Facility IP

$146.46

Service Code	HCPCS J2680
Hospital Charge Code	41650342
Hospital Revenue Code	636
Min. Negotiated Rate	$73.23
Max. Negotiated Rate	$73.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.23
Rate for Payer: Hamaspik Choice Inc Medicare	$73.23

FLUPHENAZINE HCL 2.5 MG/ML INJ

Facility OP

$129.00

Hospital Charge Code	41655381
Hospital Revenue Code	250
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$103.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.50
Rate for Payer: Aetna Government	$64.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.72
Rate for Payer: Group Health Inc Commercial	$64.50
Rate for Payer: Group Health Inc Medicare	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.85

FLUPHENAZINE HCL 2.5 MG/ML INJ

Facility OP

$129.00

Hospital Charge Code	41645381
Hospital Revenue Code	250
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$103.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.50
Rate for Payer: Aetna Government	$64.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.72
Rate for Payer: Group Health Inc Commercial	$64.50
Rate for Payer: Group Health Inc Medicare	$45.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.50
Rate for Payer: Hamaspik Choice Inc Medicare	$64.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.85

FL UPPR GI TRACT

Facility OP

$551.90

Service Code	HCPCS 74246 TC
Hospital Charge Code	41102506
Hospital Revenue Code	320
Min. Negotiated Rate	$110.48
Max. Negotiated Rate	$441.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.95
Rate for Payer: Aetna Government	$275.95
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$441.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$375.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$110.48
Rate for Payer: Group Health Inc Commercial	$275.95
Rate for Payer: Group Health Inc Medicare	$193.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.95
Rate for Payer: Hamaspik Choice Inc Medicare	$275.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$122.76

FLURBIPROFEN 0.03% OPHTHALMIC SOLN

Facility OP

$8.00

Hospital Charge Code	41650299
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

FLURBIPROFEN 0.03% OPHTHALMIC SOLN

Facility OP

$8.00

Hospital Charge Code	41640299
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

FL UROGRAPHY NFS DRIP&/BLS W/NF

Facility OP

$551.90

Service Code	HCPCS 74415 TC
Hospital Charge Code	41102148
Hospital Revenue Code	320
Min. Negotiated Rate	$147.79
Max. Negotiated Rate	$441.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.95
Rate for Payer: Aetna Government	$275.95
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$441.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$375.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$147.79
Rate for Payer: Group Health Inc Commercial	$275.95
Rate for Payer: Group Health Inc Medicare	$193.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.95
Rate for Payer: Hamaspik Choice Inc Medicare	$275.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$164.21

FL UROGRAPHY NFS DRIP&/BOLUS

Facility OP

$551.90

Service Code	HCPCS 74410 TC
Hospital Charge Code	41102140
Hospital Revenue Code	320
Min. Negotiated Rate	$132.63
Max. Negotiated Rate	$441.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.95
Rate for Payer: Aetna Government	$275.95
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$441.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$375.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$132.63
Rate for Payer: Group Health Inc Commercial	$275.95
Rate for Payer: Group Health Inc Medicare	$193.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.95
Rate for Payer: Hamaspik Choice Inc Medicare	$275.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$147.37

Price Transparency.

All Charges