St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ENALAPRILAT 1.25 MG/ML IV INJ [9929]

Facility

$5.69

Service Code	NDC 00143978601
Hospital Charge Code	00143978601
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84

ENALAPRILAT 1.25 MG/ML IV INJ [9929]

Facility

$6.37

Service Code	NDC 00143978701
Hospital Charge Code	00143978701
Hospital Revenue Code	278
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$6.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.18
Rate for Payer: Aetna Government	$3.18
Rate for Payer: Brighton Health Commercial	$3.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.66
Rate for Payer: EmblemHealth Commercial	$3.18
Rate for Payer: Fidelis Medicare Advantage	$6.69
Rate for Payer: Group Health Inc Commercial	$3.18
Rate for Payer: Group Health Inc Medicare	$2.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.18
Rate for Payer: Hamaspik Choice Inc Medicare	$3.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.14

ENALAPRILAT 1.25 MG/ML IV INJ [9929]

Facility

$5.69

Service Code	NDC 00143978610
Hospital Charge Code	00143978610
Hospital Revenue Code	278
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$5.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$3.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.27
Rate for Payer: EmblemHealth Commercial	$2.84
Rate for Payer: Fidelis Medicare Advantage	$5.97
Rate for Payer: Group Health Inc Commercial	$2.84
Rate for Payer: Group Health Inc Medicare	$1.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.70

ENALAPRILAT 1.25 MG/ML IV INJ [9929]

Facility

$6.37

Service Code	NDC 00143978710
Hospital Charge Code	00143978710
Hospital Revenue Code	278
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$3.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.19
Rate for Payer: Hamaspik Choice Inc Medicare	$3.19

ENALAPRIL MALEATE 10 MG PO TABS [9924]

Facility

$1.94

Service Code	NDC 64679092502
Hospital Charge Code	64679092502
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	$0.97
Rate for Payer: Aetna Government	$0.97
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	$1.32
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

ENALAPRIL MALEATE 10 MG PO TABS [9924]

Facility

$1.62

Service Code	NDC 00904561061
Hospital Charge Code	00904561061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$1.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.10
Rate for Payer: Group Health Inc Commercial	$0.81
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81
Rate for Payer: Hamaspik Choice Inc Medicare	$0.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.05

ENALAPRIL MALEATE 10 MG PO TABS [9924]

Facility

$1.94

Service Code	NDC 23155077201
Hospital Charge Code	23155077201
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	$0.97
Rate for Payer: Aetna Government	$0.97
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	$1.32
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

ENALAPRIL MALEATE 20 MG PO TABS [9926]

Facility

$2.77

Service Code	NDC 23155077301
Hospital Charge Code	23155077301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.88
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.80

ENALAPRIL MALEATE 20 MG PO TABS [9926]

Facility

$2.30

Service Code	NDC 00904561161
Hospital Charge Code	00904561161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.56
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.49

ENALAPRIL MALEATE 20 MG PO TABS [9926]

Facility

$2.77

Service Code	NDC 51672404001
Hospital Charge Code	51672404001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.88
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.80

ENALAPRIL MALEATE 2.5 MG PO TABS [9925]

Facility

$1.46

Service Code	NDC 00904560961
Hospital Charge Code	00904560961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Brighton Health Commercial	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.99
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.95

ENALAPRIL MALEATE 2.5 MG PO TABS [9925]

Facility

$1.46

Service Code	NDC 23155070401
Hospital Charge Code	23155070401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Brighton Health Commercial	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.99
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.95

ENALAPRIL MALEATE 2.5 MG PO TABS [9925]

Facility

$1.46

Service Code	NDC 64679092302
Hospital Charge Code	64679092302
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.73
Rate for Payer: Aetna Government	$0.73
Rate for Payer: Brighton Health Commercial	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.99
Rate for Payer: Group Health Inc Commercial	$0.73
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.73
Rate for Payer: Hamaspik Choice Inc Medicare	$0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.95

ENALAPRIL MALEATE 5 MG PO TABS [9927]

Facility

$1.54

Service Code	NDC 00904550261
Hospital Charge Code	00904550261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$1.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.77
Rate for Payer: Aetna Government	$0.77
Rate for Payer: Brighton Health Commercial	$1.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.05
Rate for Payer: Group Health Inc Commercial	$0.77
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.00

ENALAPRIL MALEATE 5 MG PO TABS [9927]

Facility

$1.85

Service Code	NDC 23155070501
Hospital Charge Code	23155070501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.26
Rate for Payer: Group Health Inc Commercial	$0.93
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93
Rate for Payer: Hamaspik Choice Inc Medicare	$0.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.20

ENALAPRIL MALEATE 5 MG PO TABS [9927]

Facility

$1.85

Service Code	NDC 51672403801
Hospital Charge Code	51672403801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.26
Rate for Payer: Group Health Inc Commercial	$0.93
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93
Rate for Payer: Hamaspik Choice Inc Medicare	$0.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.20

ENAMEL MICROABRASION

Facility

$184.00

Service Code	HCPCS D9970
Hospital Charge Code	42303376
Hospital Revenue Code	361
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.51
Rate for Payer: Aetna Government	$16.51
Rate for Payer: Brighton Health Commercial	$138.00
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	$92.00
Rate for Payer: Group Health Inc Medicare	$64.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.00
Rate for Payer: Hamaspik Choice Inc Medicare	$92.00

ENDARTERECTOMY

Facility

$6,846.53

Service Code	HCPCS 35301
Hospital Charge Code	40031865
Hospital Revenue Code	360
Min. Negotiated Rate	$1,290.82
Max. Negotiated Rate	$5,134.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,765.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,290.82
Rate for Payer: Aetna Government	$1,290.82
Rate for Payer: Brighton Health Commercial	$5,134.90
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$3,423.26
Rate for Payer: Group Health Inc Medicare	$2,396.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,423.26
Rate for Payer: Hamaspik Choice Inc Medicare	$3,423.26
Rate for Payer: United Healthcare Commercial	$1,496.00

END CAP- +10MM

Facility

$266.00

Hospital Charge Code	40200508
Hospital Revenue Code	270
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$212.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$133.00
Rate for Payer: Aetna Government	$133.00
Rate for Payer: Brighton Health Commercial	$199.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$212.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.88
Rate for Payer: Group Health Inc Commercial	$133.00
Rate for Payer: Group Health Inc Medicare	$93.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.00
Rate for Payer: Hamaspik Choice Inc Medicare	$133.00

END CAP + 15MM

Facility

$278.00

Hospital Charge Code	40200507
Hospital Revenue Code	270
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$222.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$139.00
Rate for Payer: Aetna Government	$139.00
Rate for Payer: Brighton Health Commercial	$208.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$222.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.04
Rate for Payer: Group Health Inc Commercial	$139.00
Rate for Payer: Group Health Inc Medicare	$97.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.00
Rate for Payer: Hamaspik Choice Inc Medicare	$139.00

ENDCAP LARGE ROUND 12MM

Facility

$382.87

Hospital Charge Code	64906234
Hospital Revenue Code	270
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$306.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.44
Rate for Payer: Aetna Government	$191.44
Rate for Payer: Brighton Health Commercial	$287.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$306.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$260.35
Rate for Payer: Group Health Inc Commercial	$191.44
Rate for Payer: Group Health Inc Medicare	$134.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.44
Rate for Payer: Hamaspik Choice Inc Medicare	$191.44

ENDCAP LARGE ROUND 16MM

Facility

$382.87

Hospital Charge Code	64906232
Hospital Revenue Code	270
Min. Negotiated Rate	$134.00
Max. Negotiated Rate	$306.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.44
Rate for Payer: Aetna Government	$191.44
Rate for Payer: Brighton Health Commercial	$287.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$306.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$260.35
Rate for Payer: Group Health Inc Commercial	$191.44
Rate for Payer: Group Health Inc Medicare	$134.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.44
Rate for Payer: Hamaspik Choice Inc Medicare	$191.44

END CAP LOWER

Facility

$866.80

Service Code	HCPCS C1889
Hospital Charge Code	64907516
Hospital Revenue Code	278
Min. Negotiated Rate	$303.38
Max. Negotiated Rate	$910.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$476.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$433.40
Rate for Payer: Aetna Government	$433.40
Rate for Payer: Brighton Health Commercial	$520.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$433.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$498.41
Rate for Payer: EmblemHealth Commercial	$433.40
Rate for Payer: Fidelis Medicare Advantage	$910.14
Rate for Payer: Group Health Inc Commercial	$433.40
Rate for Payer: Group Health Inc Medicare	$303.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$433.40
Rate for Payer: Hamaspik Choice Inc Medicare	$433.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$563.42

END CAP LOWER

Facility

$866.80

Service Code	HCPCS C1889
Hospital Charge Code	64907516
Hospital Revenue Code	278
Min. Negotiated Rate	$433.40
Max. Negotiated Rate	$433.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$433.40
Rate for Payer: Hamaspik Choice Inc Medicare	$433.40

ENDCAP ORTHO 8MM DIA 4MML

Facility

$450.13

Hospital Charge Code	64906001
Hospital Revenue Code	270
Min. Negotiated Rate	$157.55
Max. Negotiated Rate	$360.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$225.06
Rate for Payer: Aetna Government	$225.06
Rate for Payer: Brighton Health Commercial	$337.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$360.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$306.09
Rate for Payer: Group Health Inc Commercial	$225.06
Rate for Payer: Group Health Inc Medicare	$157.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.06
Rate for Payer: Hamaspik Choice Inc Medicare	$225.06

Know your out-of-pocket cost for care.

All Charges