St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FNA BX W/US GDN 1ST LES

Facility

$1,847.58

Service Code	HCPCS 10005
Hospital Charge Code	30307905
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
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	$813.63
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$813.63
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

FNA BX W/US GDN 1ST LES

Facility

$1,847.58

Service Code	HCPCS 10005
Hospital Charge Code	30307905
Hospital Revenue Code	510
Rate for Payer: Cash Price	$813.63

FNA BX W/US GDN EA ADDL

Facility

$923.79

Service Code	HCPCS 10006
Hospital Charge Code	30307934
Hospital Revenue Code	510
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.17
Rate for Payer: Aetna Government	$42.17
Rate for Payer: Brighton Health Commercial	$233.00
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	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.90
Rate for Payer: Hamaspik Choice Inc Medicare	$461.90
Rate for Payer: United Healthcare Commercial	$222.00

FNA W/IMAGE

Facility

$1,631.20

Hospital Charge Code	30107812
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$815.60
Rate for Payer: Aetna Government	$815.60
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$815.60
Rate for Payer: Hamaspik Choice Inc Medicare	$815.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: United Healthcare Commercial	$569.00

FNA W/O IMAGE

Facility

$967.73

Service Code	HCPCS 10021
Hospital Charge Code	30301220
Hospital Revenue Code	510
Rate for Payer: Cash Price	$461.12

FNA W/O IMAGE

Facility

$967.73

Service Code	HCPCS 10021
Hospital Charge Code	30301220
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$461.12
Rate for Payer: Aetna Government	$461.12
Rate for Payer: Affinity Essential Plan 1&2	$322.78
Rate for Payer: Affinity Essential Plan 3&4	$322.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$322.78
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$461.12
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	$461.12
Rate for Payer: Fidelis Essential Plan Aliesa	$391.95
Rate for Payer: Fidelis Essential Plan QHP	$410.40
Rate for Payer: Fidelis Medicare Advantage	$461.12
Rate for Payer: Fidelis Qualified Health Plan	$410.40
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.86
Rate for Payer: Hamaspik Choice Inc Medicare	$461.12
Rate for Payer: Healthfirst Medicare Advantage	$391.95
Rate for Payer: Healthfirst QHP	$461.12
Rate for Payer: Humana Medicare	$470.34
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$461.12
Rate for Payer: Senior Whole Health Medicare Advantage	$461.12
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$461.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$461.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$368.90
Rate for Payer: Wellcare Medicare	$438.06

FOAM ONLY VAC WHITEFM LG

Facility

$33.12

Hospital Charge Code	64901132
Hospital Revenue Code	270
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$26.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.56
Rate for Payer: Aetna Government	$16.56
Rate for Payer: Brighton Health Commercial	$24.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.52
Rate for Payer: Group Health Inc Commercial	$16.56
Rate for Payer: Group Health Inc Medicare	$11.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56
Rate for Payer: Hamaspik Choice Inc Medicare	$16.56

FOAM (ONLY)VAC WHITEFOAM SM

Facility

$25.91

Hospital Charge Code	64901131
Hospital Revenue Code	270
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$20.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.96
Rate for Payer: Aetna Government	$12.96
Rate for Payer: Brighton Health Commercial	$19.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.62
Rate for Payer: Group Health Inc Commercial	$12.96
Rate for Payer: Group Health Inc Medicare	$9.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.96
Rate for Payer: Hamaspik Choice Inc Medicare	$12.96

FOGARTY CATHETER

Facility

$85.76

Hospital Charge Code	40207015
Hospital Revenue Code	270
Min. Negotiated Rate	$30.02
Max. Negotiated Rate	$68.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.88
Rate for Payer: Aetna Government	$42.88
Rate for Payer: Brighton Health Commercial	$64.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.32
Rate for Payer: Group Health Inc Commercial	$42.88
Rate for Payer: Group Health Inc Medicare	$30.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.88
Rate for Payer: Hamaspik Choice Inc Medicare	$42.88

FOGARTY CATHETERS

Facility

$89.66

Hospital Charge Code	40000190
Hospital Revenue Code	272
Min. Negotiated Rate	$31.38
Max. Negotiated Rate	$71.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.83
Rate for Payer: Aetna Government	$44.83
Rate for Payer: Brighton Health Commercial	$67.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$71.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.97
Rate for Payer: Group Health Inc Commercial	$44.83
Rate for Payer: Group Health Inc Medicare	$31.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.83
Rate for Payer: Hamaspik Choice Inc Medicare	$44.83

FOG OUT ANTI-FOG SOL

Facility

$23.95

Hospital Charge Code	40202193
Hospital Revenue Code	270
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$19.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.98
Rate for Payer: Aetna Government	$11.98
Rate for Payer: Brighton Health Commercial	$17.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.29
Rate for Payer: Group Health Inc Commercial	$11.98
Rate for Payer: Group Health Inc Medicare	$8.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.98
Rate for Payer: Hamaspik Choice Inc Medicare	$11.98

FOLEY CAT 16 FR 5CC 3-WAY

Facility

$41.11

Hospital Charge Code	40201836
Hospital Revenue Code	270
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$32.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.56
Rate for Payer: Aetna Government	$20.56
Rate for Payer: Brighton Health Commercial	$30.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.95
Rate for Payer: Group Health Inc Commercial	$20.56
Rate for Payer: Group Health Inc Medicare	$14.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.56
Rate for Payer: Hamaspik Choice Inc Medicare	$20.56

FOLEY CAT 18 FR 30CC 3-WAY

Facility

$24.45

Hospital Charge Code	40201831
Hospital Revenue Code	270
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$19.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.22
Rate for Payer: Aetna Government	$12.22
Rate for Payer: Brighton Health Commercial	$18.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.63
Rate for Payer: Group Health Inc Commercial	$12.22
Rate for Payer: Group Health Inc Medicare	$8.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.22
Rate for Payer: Hamaspik Choice Inc Medicare	$12.22

FOLEY CAT 18 FR 5CC 3-WAY

Facility

$41.11

Hospital Charge Code	40201837
Hospital Revenue Code	270
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$32.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.56
Rate for Payer: Aetna Government	$20.56
Rate for Payer: Brighton Health Commercial	$30.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.95
Rate for Payer: Group Health Inc Commercial	$20.56
Rate for Payer: Group Health Inc Medicare	$14.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.56
Rate for Payer: Hamaspik Choice Inc Medicare	$20.56

FOLEY CAT 20 FR 30CC 2-WAY

Facility

$24.45

Hospital Charge Code	40201832
Hospital Revenue Code	270
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$19.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.22
Rate for Payer: Aetna Government	$12.22
Rate for Payer: Brighton Health Commercial	$18.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.63
Rate for Payer: Group Health Inc Commercial	$12.22
Rate for Payer: Group Health Inc Medicare	$8.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.22
Rate for Payer: Hamaspik Choice Inc Medicare	$12.22

FOLEY CAT 20 FR 5CC 3-WAY

Facility

$41.11

Hospital Charge Code	40201838
Hospital Revenue Code	270
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$32.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.56
Rate for Payer: Aetna Government	$20.56
Rate for Payer: Brighton Health Commercial	$30.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.95
Rate for Payer: Group Health Inc Commercial	$20.56
Rate for Payer: Group Health Inc Medicare	$14.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.56
Rate for Payer: Hamaspik Choice Inc Medicare	$20.56

FOLEY CAT 22 FR 30CC 2-WAY

Facility

$24.45

Hospital Charge Code	40201833
Hospital Revenue Code	270
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$19.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.22
Rate for Payer: Aetna Government	$12.22
Rate for Payer: Brighton Health Commercial	$18.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.63
Rate for Payer: Group Health Inc Commercial	$12.22
Rate for Payer: Group Health Inc Medicare	$8.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.22
Rate for Payer: Hamaspik Choice Inc Medicare	$12.22

FOLEY CAT 24 FR 30CC 2-WAY

Facility

$24.45

Hospital Charge Code	40201834
Hospital Revenue Code	270
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$19.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.22
Rate for Payer: Aetna Government	$12.22
Rate for Payer: Brighton Health Commercial	$18.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.63
Rate for Payer: Group Health Inc Commercial	$12.22
Rate for Payer: Group Health Inc Medicare	$8.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.22
Rate for Payer: Hamaspik Choice Inc Medicare	$12.22

FOLEY CAT 24 FR 5CC 3-WAY

Facility

$41.11

Hospital Charge Code	40201839
Hospital Revenue Code	270
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$32.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.56
Rate for Payer: Aetna Government	$20.56
Rate for Payer: Brighton Health Commercial	$30.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.95
Rate for Payer: Group Health Inc Commercial	$20.56
Rate for Payer: Group Health Inc Medicare	$14.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.56
Rate for Payer: Hamaspik Choice Inc Medicare	$20.56

FOLEY CAT 26 FR 30CC 2-WAY

Facility

$24.45

Hospital Charge Code	40201835
Hospital Revenue Code	270
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$19.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.22
Rate for Payer: Aetna Government	$12.22
Rate for Payer: Brighton Health Commercial	$18.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.63
Rate for Payer: Group Health Inc Commercial	$12.22
Rate for Payer: Group Health Inc Medicare	$8.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.22
Rate for Payer: Hamaspik Choice Inc Medicare	$12.22

FOLEY CAT 26 FR 5CC 3-WAY

Facility

$41.11

Hospital Charge Code	40201840
Hospital Revenue Code	270
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$32.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.56
Rate for Payer: Aetna Government	$20.56
Rate for Payer: Brighton Health Commercial	$30.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.95
Rate for Payer: Group Health Inc Commercial	$20.56
Rate for Payer: Group Health Inc Medicare	$14.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.56
Rate for Payer: Hamaspik Choice Inc Medicare	$20.56

FOLEY CATHETER

Facility

$21.62

Hospital Charge Code	40191940
Hospital Revenue Code	710
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$17.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.81
Rate for Payer: Aetna Government	$10.81
Rate for Payer: Brighton Health Commercial	$16.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.70
Rate for Payer: Group Health Inc Commercial	$10.81
Rate for Payer: Group Health Inc Medicare	$7.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.81
Rate for Payer: Hamaspik Choice Inc Medicare	$10.81

FOLEY CATHETER

Facility

$21.40

Hospital Charge Code	40207601
Hospital Revenue Code	270
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$17.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.70
Rate for Payer: Aetna Government	$10.70
Rate for Payer: Brighton Health Commercial	$16.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.55
Rate for Payer: Group Health Inc Commercial	$10.70
Rate for Payer: Group Health Inc Medicare	$7.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.70
Rate for Payer: Hamaspik Choice Inc Medicare	$10.70

FOLEY CATHETER #20 W/5CC BAG

Facility

$45.36

Hospital Charge Code	40201820
Hospital Revenue Code	270
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$36.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.68
Rate for Payer: Aetna Government	$22.68
Rate for Payer: Brighton Health Commercial	$34.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.84
Rate for Payer: Group Health Inc Commercial	$22.68
Rate for Payer: Group Health Inc Medicare	$15.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.68
Rate for Payer: Hamaspik Choice Inc Medicare	$22.68

FOLEY CATHETERS

Facility

$19.85

Hospital Charge Code	40000195
Hospital Revenue Code	272
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$15.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.92
Rate for Payer: Aetna Government	$9.92
Rate for Payer: Brighton Health Commercial	$14.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.50
Rate for Payer: Group Health Inc Commercial	$9.92
Rate for Payer: Group Health Inc Medicare	$6.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.92
Rate for Payer: Hamaspik Choice Inc Medicare	$9.92

Know your out-of-pocket cost for care.

All Charges