St. Barnabas Hospital

All Charges

Charge

Type

Price

AORTIC GRAFT

Facility IP

$1,990.00

Service Code	HCPCS C1768
Hospital Charge Code	40202224
Hospital Revenue Code	278
Min. Negotiated Rate	$995.00
Max. Negotiated Rate	$995.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$995.00

AORTIC GRAFT

Facility OP

$1,990.00

Service Code	HCPCS C1768
Hospital Charge Code	40202224
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$2,089.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,094.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$995.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,144.25
Rate for Payer: Fidelis Medicare Advantage	$2,089.50
Rate for Payer: Group Health Inc Commercial	$995.00
Rate for Payer: Group Health Inc Medicare	$696.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$995.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,293.50

AORTO-BIFEMORAL GRAFT

Facility OP

$4,844.00

Service Code	HCPCS 35540
Hospital Charge Code	40031840
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,105.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,664.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,800.82
Rate for Payer: Aetna Government	$2,800.82
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: Fidelis CHP/HARP/Medicaid	$2,794.72
Rate for Payer: Group Health Inc Commercial	$2,422.00
Rate for Payer: Group Health Inc Medicare	$1,695.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,422.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,422.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,105.24

AORTO BI-FEMORAL PROSTHESIS

Facility OP

$5,836.20

Service Code	HCPCS 34832
Hospital Charge Code	40039870
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,209.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,209.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,143.62
Rate for Payer: Aetna Government	$2,143.62
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: Fidelis CHP/HARP/Medicaid	$2,168.04
Rate for Payer: Group Health Inc Commercial	$2,918.10
Rate for Payer: Group Health Inc Medicare	$2,042.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,918.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2,918.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,408.93

AORTO BI-ILIAC PROSTHESIS

Facility OP

$5,506.93

Service Code	HCPCS 34831
Hospital Charge Code	40039869
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,028.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,028.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,167.99
Rate for Payer: Aetna Government	$2,167.99
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: Fidelis CHP/HARP/Medicaid	$2,203.52
Rate for Payer: Group Health Inc Commercial	$2,753.46
Rate for Payer: Group Health Inc Medicare	$1,927.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,753.46
Rate for Payer: Hamaspik Choice Inc Medicare	$2,753.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,448.36

AORTO FEMORAL BYPASS

Facility OP

$4,844.00

Service Code	HCPCS 35539
Hospital Charge Code	40031835
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,664.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,497.79
Rate for Payer: Aetna Government	$2,497.79
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: Fidelis CHP/HARP/Medicaid	$2,506.56
Rate for Payer: Group Health Inc Commercial	$2,422.00
Rate for Payer: Group Health Inc Medicare	$1,695.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,422.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,422.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,785.07

APENDECTOMY INCIDENTAL

Facility OP

$213.88

Service Code	HCPCS 44955
Hospital Charge Code	40019513
Hospital Revenue Code	360
Min. Negotiated Rate	$74.86
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.65
Rate for Payer: Aetna Government	$99.65
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: Fidelis CHP/HARP/Medicaid	$95.74
Rate for Payer: Group Health Inc Commercial	$106.94
Rate for Payer: Group Health Inc Medicare	$74.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.94
Rate for Payer: Hamaspik Choice Inc Medicare	$106.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$106.38

APEX HOLE ELIM POSITIV STOP

Facility IP

$847.50

Service Code	HCPCS C1713
Hospital Charge Code	64905282
Hospital Revenue Code	278
Min. Negotiated Rate	$423.75
Max. Negotiated Rate	$423.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$423.75
Rate for Payer: Hamaspik Choice Inc Medicare	$423.75

APEX HOLE ELIM POSITIV STOP

Facility OP

$847.50

Service Code	HCPCS C1713
Hospital Charge Code	64905282
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$889.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$466.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$423.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$487.31
Rate for Payer: Fidelis Medicare Advantage	$889.88
Rate for Payer: Group Health Inc Commercial	$423.75
Rate for Payer: Group Health Inc Medicare	$296.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$423.75
Rate for Payer: Hamaspik Choice Inc Medicare	$423.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$550.88

APEX HOLE ELIM POS STOP

Facility OP

$678.00

Service Code	HCPCS C1713
Hospital Charge Code	40005155
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$711.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$372.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$339.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$389.85
Rate for Payer: Fidelis Medicare Advantage	$711.90
Rate for Payer: Group Health Inc Commercial	$339.00
Rate for Payer: Group Health Inc Medicare	$237.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$339.00
Rate for Payer: Hamaspik Choice Inc Medicare	$339.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$440.70

APEX HOLE ELIM POS STOP

Facility IP

$678.00

Service Code	HCPCS C1713
Hospital Charge Code	40005155
Hospital Revenue Code	278
Min. Negotiated Rate	$339.00
Max. Negotiated Rate	$339.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$339.00
Rate for Payer: Hamaspik Choice Inc Medicare	$339.00

APEXIFICATION/RECALCIFICATION-FIN

Facility OP

$257.50

Service Code	HCPCS D3353
Hospital Charge Code	42300760
Hospital Revenue Code	361
Min. Negotiated Rate	$128.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

APEX PIN

Facility OP

$242.00

Service Code	HCPCS C1713
Hospital Charge Code	40201189
Hospital Revenue Code	278
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$254.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$133.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$121.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$139.15
Rate for Payer: Fidelis Medicare Advantage	$254.10
Rate for Payer: Group Health Inc Commercial	$121.00
Rate for Payer: Group Health Inc Medicare	$84.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.00
Rate for Payer: Hamaspik Choice Inc Medicare	$121.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.30

APEX PIN

Facility IP

$242.00

Service Code	HCPCS C1713
Hospital Charge Code	40201189
Hospital Revenue Code	278
Min. Negotiated Rate	$121.00
Max. Negotiated Rate	$121.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.00
Rate for Payer: Hamaspik Choice Inc Medicare	$121.00

APEX PIN 4MMX90MM

Facility OP

$126.00

Service Code	HCPCS C1713
Hospital Charge Code	40200571
Hospital Revenue Code	278
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.45
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

APEX PIN 4MMX90MM

Facility IP

$126.00

Service Code	HCPCS C1713
Hospital Charge Code	40200571
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.00
Rate for Payer: Hamaspik Choice Inc Medicare	$63.00

APEX PIN 4 X 150MM

Facility OP

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40201205
Hospital Revenue Code	278
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$180.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.90
Rate for Payer: Fidelis Medicare Advantage	$180.60
Rate for Payer: Group Health Inc Commercial	$86.00
Rate for Payer: Group Health Inc Medicare	$60.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$111.80

APEX PIN 4 X 150MM

Facility IP

$172.00

Service Code	HCPCS C1713
Hospital Charge Code	40201205
Hospital Revenue Code	278
Min. Negotiated Rate	$86.00
Max. Negotiated Rate	$86.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00

APEX PIN 4 X 300MM

Facility OP

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	40201206
Hospital Revenue Code	278
Min. Negotiated Rate	$61.25
Max. Negotiated Rate	$183.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.62
Rate for Payer: Fidelis Medicare Advantage	$183.75
Rate for Payer: Group Health Inc Commercial	$87.50
Rate for Payer: Group Health Inc Medicare	$61.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.50
Rate for Payer: Hamaspik Choice Inc Medicare	$87.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$113.75

APEX PIN 4 X 300MM

Facility IP

$175.00

Service Code	HCPCS C1713
Hospital Charge Code	40201206
Hospital Revenue Code	278
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.50
Rate for Payer: Hamaspik Choice Inc Medicare	$87.50

APEX PIN 5X120MM R-DISTAL TIBIA

Facility IP

$119.00

Service Code	HCPCS C1713
Hospital Charge Code	40209448
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50

APEX PIN 5X120MM R-DISTAL TIBIA

Facility OP

$119.00

Service Code	HCPCS C1713
Hospital Charge Code	40209448
Hospital Revenue Code	278
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.42
Rate for Payer: Fidelis Medicare Advantage	$124.95
Rate for Payer: Group Health Inc Commercial	$59.50
Rate for Payer: Group Health Inc Medicare	$41.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.35

APEX./RECAL.-INITIAL VISIT(AP.CLO

Facility OP

$205.00

Service Code	HCPCS D3351
Hospital Charge Code	42300750
Hospital Revenue Code	361
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$112.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

APEX./RECAL.-INTERIM MEDICATION R

Facility OP

$200.00

Service Code	HCPCS D3352
Hospital Charge Code	42300755
Hospital Revenue Code	361
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

APHASIA EVAL, PER HR

Facility OP

$298.45

Service Code	HCPCS 96105 GN
Hospital Charge Code	41904867
Hospital Revenue Code	444
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$164.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$149.22
Rate for Payer: Aetna Government	$149.22
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$149.22
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.22
Rate for Payer: Hamaspik Choice Inc Medicare	$149.22
Rate for Payer: Wellcare Medicare	$55.00

Price Transparency.

All Charges