St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Lower extremity arterial procedures #

Facility

$103,954.66

Service Code	APR-DRG 1813
Min. Negotiated Rate	$46,202.07
Max. Negotiated Rate	$103,954.66
Rate for Payer: Affinity Essential Plan 1&2	$103,954.66
Rate for Payer: Affinity Essential Plan 3&4	$103,954.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$46,202.07
Rate for Payer: Amida Care Medicaid	$46,202.07
Rate for Payer: EmblemHealth Essential Plan 1&2	$103,954.66
Rate for Payer: EmblemHealth Essential Plan 3&4	$46,202.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46,202.07
Rate for Payer: Fidelis Qualified Health Plan	$55,442.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$46,202.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46,202.07
Rate for Payer: Healthfirst Essential Plan	$103,954.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46,202.07
Rate for Payer: SOMOS Essential	$103,954.66
Rate for Payer: United Healthcare Essential Plan 1&2	$103,954.66
Rate for Payer: United Healthcare Essential Plan 3&4	$103,954.66
Rate for Payer: United Healthcare Medicaid	$46,202.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46,202.07

Lower extremity arterial procedures #

Facility

$72,075.62

Service Code	APR-DRG 1812
Min. Negotiated Rate	$32,033.61
Max. Negotiated Rate	$72,075.62
Rate for Payer: Affinity Essential Plan 1&2	$72,075.62
Rate for Payer: Affinity Essential Plan 3&4	$72,075.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,033.61
Rate for Payer: Amida Care Medicaid	$32,033.61
Rate for Payer: EmblemHealth Essential Plan 1&2	$72,075.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,033.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,033.61
Rate for Payer: Fidelis Qualified Health Plan	$38,440.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,033.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,033.61
Rate for Payer: Healthfirst Essential Plan	$72,075.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,033.61
Rate for Payer: SOMOS Essential	$72,075.62
Rate for Payer: United Healthcare Essential Plan 1&2	$72,075.62
Rate for Payer: United Healthcare Essential Plan 3&4	$72,075.62
Rate for Payer: United Healthcare Medicaid	$32,033.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,033.61

Lower extremity arterial procedures #

Facility

$148,384.10

Service Code	APR-DRG 1814
Min. Negotiated Rate	$65,948.49
Max. Negotiated Rate	$148,384.10
Rate for Payer: Affinity Essential Plan 1&2	$148,384.10
Rate for Payer: Affinity Essential Plan 3&4	$148,384.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$65,948.49
Rate for Payer: Amida Care Medicaid	$65,948.49
Rate for Payer: EmblemHealth Essential Plan 1&2	$148,384.10
Rate for Payer: EmblemHealth Essential Plan 3&4	$65,948.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$65,948.49
Rate for Payer: Fidelis Qualified Health Plan	$79,138.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$65,948.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$65,948.49
Rate for Payer: Healthfirst Essential Plan	$148,384.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$65,948.49
Rate for Payer: SOMOS Essential	$148,384.10
Rate for Payer: United Healthcare Essential Plan 1&2	$148,384.10
Rate for Payer: United Healthcare Essential Plan 3&4	$148,384.10
Rate for Payer: United Healthcare Medicaid	$65,948.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65,948.49

LURASIDONE HCL 20 MG PO TABS

Facility

$51.07

Service Code	NDC 6818067006
Hospital Charge Code	6818067006
Hospital Revenue Code	250
Min. Negotiated Rate	$25.54
Max. Negotiated Rate	$25.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.54

LURASIDONE HCL 20 MG PO TABS

Facility

$56.75

Service Code	NDC 6340230230
Hospital Charge Code	6340230230
Hospital Revenue Code	250
Min. Negotiated Rate	$28.37
Max. Negotiated Rate	$28.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.37

LURASIDONE HCL 20 MG PO TABS

Facility

$0.83

Service Code	NDC 0904735504
Hospital Charge Code	0904735504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

LURASIDONE HCL 20 MG PO TABS

Facility

$51.07

Service Code	NDC 6818067006
Hospital Charge Code	6818067006
Hospital Revenue Code	250
Min. Negotiated Rate	$17.88
Max. Negotiated Rate	$40.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.54
Rate for Payer: Aetna Government	$25.54
Rate for Payer: Brighton Health Commercial	$38.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.73
Rate for Payer: EmblemHealth Commercial	$25.54
Rate for Payer: Group Health Inc Commercial	$25.54
Rate for Payer: Group Health Inc Medicare	$17.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.54
Rate for Payer: Hamaspik Choice Inc Medicare	$25.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.20

LURASIDONE HCL 20 MG PO TABS

Facility

$56.75

Service Code	NDC 6340230230
Hospital Charge Code	6340230230
Hospital Revenue Code	250
Min. Negotiated Rate	$19.86
Max. Negotiated Rate	$45.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.37
Rate for Payer: Aetna Government	$28.37
Rate for Payer: Brighton Health Commercial	$42.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$45.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.59
Rate for Payer: EmblemHealth Commercial	$28.37
Rate for Payer: Group Health Inc Commercial	$28.37
Rate for Payer: Group Health Inc Medicare	$19.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.37
Rate for Payer: Hamaspik Choice Inc Medicare	$28.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.89

LURASIDONE HCL 20 MG PO TABS

Facility

$0.83

Service Code	NDC 0904735504
Hospital Charge Code	0904735504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

LURASIDONE HCL 40 MG PO TABS

Facility

$56.75

Service Code	NDC 6340230430
Hospital Charge Code	6340230430
Hospital Revenue Code	250
Min. Negotiated Rate	$28.37
Max. Negotiated Rate	$28.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.37

LURASIDONE HCL 40 MG PO TABS

Facility

$56.75

Service Code	NDC 6340230430
Hospital Charge Code	6340230430
Hospital Revenue Code	250
Min. Negotiated Rate	$19.86
Max. Negotiated Rate	$45.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.37
Rate for Payer: Aetna Government	$28.37
Rate for Payer: Brighton Health Commercial	$42.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$45.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.59
Rate for Payer: EmblemHealth Commercial	$28.37
Rate for Payer: Group Health Inc Commercial	$28.37
Rate for Payer: Group Health Inc Medicare	$19.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.37
Rate for Payer: Hamaspik Choice Inc Medicare	$28.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.89

LURASIDONE HCL 40 MG PO TABS

Facility

$1.11

Service Code	NDC 0904735661
Hospital Charge Code	0904735661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56

LURASIDONE HCL 40 MG PO TABS

Facility

$1.11

Service Code	NDC 0904735661
Hospital Charge Code	0904735661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.56
Rate for Payer: Aetna Government	$0.56
Rate for Payer: Brighton Health Commercial	$0.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.75
Rate for Payer: EmblemHealth Commercial	$0.56
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.72

LURASIDONE HCL 80 MG PO TABS

Facility

$51.02

Service Code	NDC 4733568583
Hospital Charge Code	4733568583
Hospital Revenue Code	250
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$40.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.51
Rate for Payer: Aetna Government	$25.51
Rate for Payer: Brighton Health Commercial	$38.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.69
Rate for Payer: EmblemHealth Commercial	$25.51
Rate for Payer: Group Health Inc Commercial	$25.51
Rate for Payer: Group Health Inc Medicare	$17.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.51
Rate for Payer: Hamaspik Choice Inc Medicare	$25.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.16

LURASIDONE HCL 80 MG PO TABS

Facility

$56.75

Service Code	NDC 6340230830
Hospital Charge Code	6340230830
Hospital Revenue Code	250
Min. Negotiated Rate	$19.86
Max. Negotiated Rate	$45.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.37
Rate for Payer: Aetna Government	$28.37
Rate for Payer: Brighton Health Commercial	$42.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$45.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.59
Rate for Payer: EmblemHealth Commercial	$28.37
Rate for Payer: Group Health Inc Commercial	$28.37
Rate for Payer: Group Health Inc Medicare	$19.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.37
Rate for Payer: Hamaspik Choice Inc Medicare	$28.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.89

LURASIDONE HCL 80 MG PO TABS

Facility

$51.02

Service Code	NDC 4733568583
Hospital Charge Code	4733568583
Hospital Revenue Code	250
Min. Negotiated Rate	$25.51
Max. Negotiated Rate	$25.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.51

LURASIDONE HCL 80 MG PO TABS

Facility

$56.75

Service Code	NDC 6340230830
Hospital Charge Code	6340230830
Hospital Revenue Code	250
Min. Negotiated Rate	$28.37
Max. Negotiated Rate	$28.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.37

LUSPATERCEPT-AAMT 75 MG SC SOLR

Facility

$13.00

Service Code	HCPCS J0896
Hospital Charge Code	5957277501
Hospital Revenue Code	250
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50

LUSPATERCEPT-AAMT 75 MG SC SOLR

Facility

$13.00

Service Code	HCPCS J0896
Hospital Charge Code	5957277501
Hospital Revenue Code	250
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$42.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.98
Rate for Payer: Aetna Government	$41.98
Rate for Payer: Affinity Essential Plan 1&2	$29.39
Rate for Payer: Affinity Essential Plan 3&4	$29.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$29.39
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$41.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Elderplan Medicare Advantage	$41.98
Rate for Payer: EmblemHealth Commercial	$41.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37.78
Rate for Payer: Fidelis Essential Plan Aliesa	$35.68
Rate for Payer: Fidelis Essential Plan QHP	$37.36
Rate for Payer: Fidelis Medicare Advantage	$41.98
Rate for Payer: Fidelis Qualified Health Plan	$37.36
Rate for Payer: Group Health Inc Commercial	$41.98
Rate for Payer: Group Health Inc Medicare	$41.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.98
Rate for Payer: Hamaspik Choice Inc Medicare	$41.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41.98
Rate for Payer: Healthfirst Medicare Advantage	$35.68
Rate for Payer: Healthfirst QHP	$41.98
Rate for Payer: Humana Medicare	$42.82
Rate for Payer: Senior Whole Health Medicare Advantage	$41.98
Rate for Payer: United Healthcare Medicare Advantage	$41.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39.88
Rate for Payer: Wellcare Medicare	$39.88

LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$245.64

Service Code	EAPG 00804
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$245.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$178.20
Rate for Payer: Healthfirst Commercial	$245.64

Lymphatic & other malignancies & neoplasms of uncertain behavior

Facility

$60,524.19

Service Code	APR-DRG 6943
Min. Negotiated Rate	$16,448.00
Max. Negotiated Rate	$60,524.19
Rate for Payer: Affinity Essential Plan 1&2	$60,524.19
Rate for Payer: Affinity Essential Plan 3&4	$60,524.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,899.64
Rate for Payer: Amida Care Medicaid	$26,899.64
Rate for Payer: EmblemHealth Essential Plan 1&2	$60,524.19
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,899.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,899.64
Rate for Payer: Fidelis Qualified Health Plan	$32,279.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,899.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,899.64
Rate for Payer: Healthfirst Commercial	$25,508.00
Rate for Payer: Healthfirst Essential Plan	$60,524.19
Rate for Payer: Healthfirst QHP	$16,448.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,899.64
Rate for Payer: SOMOS Essential	$60,524.19
Rate for Payer: United Healthcare Essential Plan 1&2	$60,524.19
Rate for Payer: United Healthcare Essential Plan 3&4	$60,524.19
Rate for Payer: United Healthcare Medicaid	$26,899.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,899.64

Lymphatic & other malignancies & neoplasms of uncertain behavior

Facility

$42,968.39

Service Code	APR-DRG 6941
Min. Negotiated Rate	$6,419.00
Max. Negotiated Rate	$42,968.39
Rate for Payer: Affinity Essential Plan 1&2	$42,968.39
Rate for Payer: Affinity Essential Plan 3&4	$42,968.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,097.06
Rate for Payer: Amida Care Medicaid	$19,097.06
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,968.39
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,097.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,097.06
Rate for Payer: Fidelis Qualified Health Plan	$22,916.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,097.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,097.06
Rate for Payer: Healthfirst Commercial	$12,138.00
Rate for Payer: Healthfirst Essential Plan	$42,968.39
Rate for Payer: Healthfirst QHP	$6,419.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,097.06
Rate for Payer: SOMOS Essential	$42,968.39
Rate for Payer: United Healthcare Essential Plan 1&2	$42,968.39
Rate for Payer: United Healthcare Essential Plan 3&4	$42,968.39
Rate for Payer: United Healthcare Medicaid	$19,097.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,097.06

Lymphatic & other malignancies & neoplasms of uncertain behavior

Facility

$49,278.76

Service Code	APR-DRG 6942
Min. Negotiated Rate	$10,205.00
Max. Negotiated Rate	$49,278.76
Rate for Payer: Affinity Essential Plan 1&2	$49,278.76
Rate for Payer: Affinity Essential Plan 3&4	$49,278.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,901.67
Rate for Payer: Amida Care Medicaid	$21,901.67
Rate for Payer: EmblemHealth Essential Plan 1&2	$49,278.76
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,901.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,901.67
Rate for Payer: Fidelis Qualified Health Plan	$26,282.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,901.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,901.67
Rate for Payer: Healthfirst Commercial	$14,870.00
Rate for Payer: Healthfirst Essential Plan	$49,278.76
Rate for Payer: Healthfirst QHP	$10,205.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,901.67
Rate for Payer: SOMOS Essential	$49,278.76
Rate for Payer: United Healthcare Essential Plan 1&2	$49,278.76
Rate for Payer: United Healthcare Essential Plan 3&4	$49,278.76
Rate for Payer: United Healthcare Medicaid	$21,901.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,901.67

Lymphatic & other malignancies & neoplasms of uncertain behavior

Facility

$91,486.91

Service Code	APR-DRG 6944
Min. Negotiated Rate	$33,987.00
Max. Negotiated Rate	$91,486.91
Rate for Payer: Affinity Essential Plan 1&2	$91,486.91
Rate for Payer: Affinity Essential Plan 3&4	$91,486.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$40,660.85
Rate for Payer: Amida Care Medicaid	$40,660.85
Rate for Payer: EmblemHealth Essential Plan 1&2	$91,486.91
Rate for Payer: EmblemHealth Essential Plan 3&4	$40,660.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,660.85
Rate for Payer: Fidelis Qualified Health Plan	$48,793.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,660.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,660.85
Rate for Payer: Healthfirst Commercial	$61,735.00
Rate for Payer: Healthfirst Essential Plan	$91,486.91
Rate for Payer: Healthfirst QHP	$33,987.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,660.85
Rate for Payer: SOMOS Essential	$91,486.91
Rate for Payer: United Healthcare Essential Plan 1&2	$91,486.91
Rate for Payer: United Healthcare Essential Plan 3&4	$91,486.91
Rate for Payer: United Healthcare Medicaid	$40,660.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,660.85

LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$244.78

Service Code	EAPG 00801
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$244.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$178.20
Rate for Payer: Healthfirst Commercial	$244.78

Know your out-of-pocket cost for care.

All Charges