St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MALIGNANT BREAST DIAGNOSES

Facility

$206.54

Service Code	EAPG 00672
Min. Negotiated Rate	$150.43
Max. Negotiated Rate	$206.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.43
Rate for Payer: Healthfirst Commercial	$206.54

Malignant breast disorders

Facility

$42,964.85

Service Code	APR-DRG 3821
Min. Negotiated Rate	$5,233.00
Max. Negotiated Rate	$42,964.85
Rate for Payer: Affinity Essential Plan 1&2	$42,964.85
Rate for Payer: Affinity Essential Plan 3&4	$42,964.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,095.49
Rate for Payer: Amida Care Medicaid	$19,095.49
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,964.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,095.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,095.49
Rate for Payer: Fidelis Qualified Health Plan	$22,914.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,095.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,095.49
Rate for Payer: Healthfirst Commercial	$11,585.00
Rate for Payer: Healthfirst Essential Plan	$42,964.85
Rate for Payer: Healthfirst QHP	$5,233.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,095.49
Rate for Payer: SOMOS Essential	$42,964.85
Rate for Payer: United Healthcare Essential Plan 1&2	$42,964.85
Rate for Payer: United Healthcare Essential Plan 3&4	$42,964.85
Rate for Payer: United Healthcare Medicaid	$19,095.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,095.49

Malignant breast disorders

Facility

$82,909.51

Service Code	APR-DRG 3824
Min. Negotiated Rate	$25,699.00
Max. Negotiated Rate	$82,909.51
Rate for Payer: Affinity Essential Plan 1&2	$82,909.51
Rate for Payer: Affinity Essential Plan 3&4	$82,909.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,848.67
Rate for Payer: Amida Care Medicaid	$36,848.67
Rate for Payer: EmblemHealth Essential Plan 1&2	$82,909.51
Rate for Payer: EmblemHealth Essential Plan 3&4	$36,848.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,848.67
Rate for Payer: Fidelis Qualified Health Plan	$44,218.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,848.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,848.67
Rate for Payer: Healthfirst Commercial	$52,143.00
Rate for Payer: Healthfirst Essential Plan	$82,909.51
Rate for Payer: Healthfirst QHP	$25,699.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,848.67
Rate for Payer: SOMOS Essential	$82,909.51
Rate for Payer: United Healthcare Essential Plan 1&2	$82,909.51
Rate for Payer: United Healthcare Essential Plan 3&4	$82,909.51
Rate for Payer: United Healthcare Medicaid	$36,848.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,848.67

Malignant breast disorders

Facility

$58,505.15

Service Code	APR-DRG 3823
Min. Negotiated Rate	$15,775.00
Max. Negotiated Rate	$58,505.15
Rate for Payer: Affinity Essential Plan 1&2	$58,505.15
Rate for Payer: Affinity Essential Plan 3&4	$58,505.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,002.29
Rate for Payer: Amida Care Medicaid	$26,002.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$58,505.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,002.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,002.29
Rate for Payer: Fidelis Qualified Health Plan	$31,202.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,002.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,002.29
Rate for Payer: Healthfirst Commercial	$25,820.00
Rate for Payer: Healthfirst Essential Plan	$58,505.15
Rate for Payer: Healthfirst QHP	$15,775.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,002.29
Rate for Payer: SOMOS Essential	$58,505.15
Rate for Payer: United Healthcare Essential Plan 1&2	$58,505.15
Rate for Payer: United Healthcare Essential Plan 3&4	$58,505.15
Rate for Payer: United Healthcare Medicaid	$26,002.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,002.29

Malignant breast disorders

Facility

$46,674.07

Service Code	APR-DRG 3822
Min. Negotiated Rate	$9,349.00
Max. Negotiated Rate	$46,674.07
Rate for Payer: Affinity Essential Plan 1&2	$46,674.07
Rate for Payer: Affinity Essential Plan 3&4	$46,674.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,744.03
Rate for Payer: Amida Care Medicaid	$20,744.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$46,674.07
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,744.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,744.03
Rate for Payer: Fidelis Qualified Health Plan	$24,892.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,744.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,744.03
Rate for Payer: Healthfirst Commercial	$14,137.00
Rate for Payer: Healthfirst Essential Plan	$46,674.07
Rate for Payer: Healthfirst QHP	$9,349.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,744.03
Rate for Payer: SOMOS Essential	$46,674.07
Rate for Payer: United Healthcare Essential Plan 1&2	$46,674.07
Rate for Payer: United Healthcare Essential Plan 3&4	$46,674.07
Rate for Payer: United Healthcare Medicaid	$20,744.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,744.03

MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DIAGNOSES

Facility

$228.66

Service Code	EAPG 00690
Min. Negotiated Rate	$166.63
Max. Negotiated Rate	$228.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$166.63
Rate for Payer: Healthfirst Commercial	$228.66

Malnutrition, failure to thrive & other nutritional disorders

Facility

$48,079.31

Service Code	APR-DRG 4212
Min. Negotiated Rate	$8,702.00
Max. Negotiated Rate	$48,079.31
Rate for Payer: Affinity Essential Plan 1&2	$48,079.31
Rate for Payer: Affinity Essential Plan 3&4	$48,079.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,368.58
Rate for Payer: Amida Care Medicaid	$21,368.58
Rate for Payer: EmblemHealth Essential Plan 1&2	$48,079.31
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,368.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,368.58
Rate for Payer: Fidelis Qualified Health Plan	$25,642.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,368.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,368.58
Rate for Payer: Healthfirst Commercial	$15,691.00
Rate for Payer: Healthfirst Essential Plan	$48,079.31
Rate for Payer: Healthfirst QHP	$8,702.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,368.58
Rate for Payer: SOMOS Essential	$48,079.31
Rate for Payer: United Healthcare Essential Plan 1&2	$48,079.31
Rate for Payer: United Healthcare Essential Plan 3&4	$48,079.31
Rate for Payer: United Healthcare Medicaid	$21,368.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,368.58

Malnutrition, failure to thrive & other nutritional disorders

Facility

$88,319.41

Service Code	APR-DRG 4214
Min. Negotiated Rate	$29,561.00
Max. Negotiated Rate	$88,319.41
Rate for Payer: Affinity Essential Plan 1&2	$88,319.41
Rate for Payer: Affinity Essential Plan 3&4	$88,319.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,253.07
Rate for Payer: Amida Care Medicaid	$39,253.07
Rate for Payer: EmblemHealth Essential Plan 1&2	$88,319.41
Rate for Payer: EmblemHealth Essential Plan 3&4	$39,253.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,253.07
Rate for Payer: Fidelis Qualified Health Plan	$47,103.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,253.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,253.07
Rate for Payer: Healthfirst Commercial	$52,245.00
Rate for Payer: Healthfirst Essential Plan	$88,319.41
Rate for Payer: Healthfirst QHP	$29,561.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,253.07
Rate for Payer: SOMOS Essential	$88,319.41
Rate for Payer: United Healthcare Essential Plan 1&2	$88,319.41
Rate for Payer: United Healthcare Essential Plan 3&4	$88,319.41
Rate for Payer: United Healthcare Medicaid	$39,253.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,253.07

Malnutrition, failure to thrive & other nutritional disorders

Facility

$56,421.02

Service Code	APR-DRG 4213
Min. Negotiated Rate	$13,380.00
Max. Negotiated Rate	$56,421.02
Rate for Payer: Affinity Essential Plan 1&2	$56,421.02
Rate for Payer: Affinity Essential Plan 3&4	$56,421.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,076.01
Rate for Payer: Amida Care Medicaid	$25,076.01
Rate for Payer: EmblemHealth Essential Plan 1&2	$56,421.02
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,076.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,076.01
Rate for Payer: Fidelis Qualified Health Plan	$30,091.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,076.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,076.01
Rate for Payer: Healthfirst Commercial	$22,425.00
Rate for Payer: Healthfirst Essential Plan	$56,421.02
Rate for Payer: Healthfirst QHP	$13,380.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,076.01
Rate for Payer: SOMOS Essential	$56,421.02
Rate for Payer: United Healthcare Essential Plan 1&2	$56,421.02
Rate for Payer: United Healthcare Essential Plan 3&4	$56,421.02
Rate for Payer: United Healthcare Medicaid	$25,076.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,076.01

Malnutrition, failure to thrive & other nutritional disorders

Facility

$43,008.84

Service Code	APR-DRG 4211
Min. Negotiated Rate	$6,336.00
Max. Negotiated Rate	$43,008.84
Rate for Payer: Affinity Essential Plan 1&2	$43,008.84
Rate for Payer: Affinity Essential Plan 3&4	$43,008.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,115.04
Rate for Payer: Amida Care Medicaid	$19,115.04
Rate for Payer: EmblemHealth Essential Plan 1&2	$43,008.84
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,115.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,115.04
Rate for Payer: Fidelis Qualified Health Plan	$22,938.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,115.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,115.04
Rate for Payer: Healthfirst Commercial	$11,872.00
Rate for Payer: Healthfirst Essential Plan	$43,008.84
Rate for Payer: Healthfirst QHP	$6,336.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,115.04
Rate for Payer: SOMOS Essential	$43,008.84
Rate for Payer: United Healthcare Essential Plan 1&2	$43,008.84
Rate for Payer: United Healthcare Essential Plan 3&4	$43,008.84
Rate for Payer: United Healthcare Medicaid	$19,115.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,115.04

MAMMOGRAPHY & OTHER RELATED PROCEDURES

Facility

$213.22

Service Code	EAPG 00286
Min. Negotiated Rate	$155.06
Max. Negotiated Rate	$213.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.06
Rate for Payer: Healthfirst Commercial	$213.22

MANNITOL 20 % IV SOLN

Facility

$0.15

Service Code	NDC 0338035703
Hospital Charge Code	0338035703
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

MANNITOL 20 % IV SOLN

Facility

$0.15

Service Code	NDC 0338035703
Hospital Charge Code	0338035703
Hospital Revenue Code	258
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

MANNITOL 25 % IV SOLN

Facility

$0.13

Service Code	HCPCS J2151
Hospital Charge Code	6332302425
Hospital Revenue Code	258
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

MANNITOL 25 % IV SOLN

Facility

$0.13

Service Code	HCPCS J2151
Hospital Charge Code	6332302425
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

MARAVIROC 150 MG PO TABS

Facility

$29.39

Service Code	NDC 3172257960
Hospital Charge Code	3172257960
Hospital Revenue Code	250
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.70

MARAVIROC 150 MG PO TABS

Facility

$29.39

Service Code	NDC 3172257960
Hospital Charge Code	3172257960
Hospital Revenue Code	250
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$23.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.70
Rate for Payer: Aetna Government	$14.70
Rate for Payer: Brighton Health Commercial	$22.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.99
Rate for Payer: EmblemHealth Commercial	$14.70
Rate for Payer: Group Health Inc Commercial	$14.70
Rate for Payer: Group Health Inc Medicare	$10.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.70
Rate for Payer: Hamaspik Choice Inc Medicare	$14.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.10

MARAVIROC 150 MG PO TABS

Facility

$34.60

Service Code	NDC 4970222318
Hospital Charge Code	4970222318
Hospital Revenue Code	250
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$27.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.30
Rate for Payer: Aetna Government	$17.30
Rate for Payer: Brighton Health Commercial	$25.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.53
Rate for Payer: EmblemHealth Commercial	$17.30
Rate for Payer: Group Health Inc Commercial	$17.30
Rate for Payer: Group Health Inc Medicare	$12.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.30
Rate for Payer: Hamaspik Choice Inc Medicare	$17.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.49

MARAVIROC 150 MG PO TABS

Facility

$34.60

Service Code	NDC 4970222318
Hospital Charge Code	4970222318
Hospital Revenue Code	250
Min. Negotiated Rate	$17.30
Max. Negotiated Rate	$17.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.30

MARAVIROC 300 MG PO TABS

Facility

$34.60

Service Code	NDC 4970222418
Hospital Charge Code	4970222418
Hospital Revenue Code	250
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$27.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.30
Rate for Payer: Aetna Government	$17.30
Rate for Payer: Brighton Health Commercial	$25.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.53
Rate for Payer: EmblemHealth Commercial	$17.30
Rate for Payer: Group Health Inc Commercial	$17.30
Rate for Payer: Group Health Inc Medicare	$12.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.30
Rate for Payer: Hamaspik Choice Inc Medicare	$17.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.49

MARAVIROC 300 MG PO TABS

Facility

$34.60

Service Code	NDC 4970222418
Hospital Charge Code	4970222418
Hospital Revenue Code	250
Min. Negotiated Rate	$17.30
Max. Negotiated Rate	$17.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.30

MARAVIROC 300 MG PO TABS

Facility

$29.39

Service Code	NDC 3172258060
Hospital Charge Code	3172258060
Hospital Revenue Code	250
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$23.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.70
Rate for Payer: Aetna Government	$14.70
Rate for Payer: Brighton Health Commercial	$22.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.99
Rate for Payer: EmblemHealth Commercial	$14.70
Rate for Payer: Group Health Inc Commercial	$14.70
Rate for Payer: Group Health Inc Medicare	$10.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.70
Rate for Payer: Hamaspik Choice Inc Medicare	$14.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.10

MARAVIROC 300 MG PO TABS

Facility

$29.39

Service Code	NDC 3172258060
Hospital Charge Code	3172258060
Hospital Revenue Code	250
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.70

Mastectomy procedures

Facility

$56,000.70

Service Code	APR-DRG 3621
Min. Negotiated Rate	$11,823.00
Max. Negotiated Rate	$56,000.70
Rate for Payer: Affinity Essential Plan 1&2	$56,000.70
Rate for Payer: Affinity Essential Plan 3&4	$56,000.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,889.20
Rate for Payer: Amida Care Medicaid	$24,889.20
Rate for Payer: EmblemHealth Essential Plan 1&2	$56,000.70
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,889.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,889.20
Rate for Payer: Fidelis Qualified Health Plan	$29,867.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,889.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,889.20
Rate for Payer: Healthfirst Commercial	$20,350.00
Rate for Payer: Healthfirst Essential Plan	$56,000.70
Rate for Payer: Healthfirst QHP	$11,823.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,889.20
Rate for Payer: SOMOS Essential	$56,000.70
Rate for Payer: United Healthcare Essential Plan 1&2	$56,000.70
Rate for Payer: United Healthcare Essential Plan 3&4	$56,000.70
Rate for Payer: United Healthcare Medicaid	$24,889.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,889.20

Mastectomy procedures

Facility

$80,879.92

Service Code	APR-DRG 3623
Min. Negotiated Rate	$25,303.00
Max. Negotiated Rate	$80,879.92
Rate for Payer: Affinity Essential Plan 1&2	$80,879.92
Rate for Payer: Affinity Essential Plan 3&4	$80,879.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,946.63
Rate for Payer: Amida Care Medicaid	$35,946.63
Rate for Payer: EmblemHealth Essential Plan 1&2	$80,879.92
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,946.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,946.63
Rate for Payer: Fidelis Qualified Health Plan	$43,135.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,946.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,946.63
Rate for Payer: Healthfirst Commercial	$39,404.00
Rate for Payer: Healthfirst Essential Plan	$80,879.92
Rate for Payer: Healthfirst QHP	$25,303.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,946.63
Rate for Payer: SOMOS Essential	$80,879.92
Rate for Payer: United Healthcare Essential Plan 1&2	$80,879.92
Rate for Payer: United Healthcare Essential Plan 3&4	$80,879.92
Rate for Payer: United Healthcare Medicaid	$35,946.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,946.63

Know your out-of-pocket cost for care.

All Charges