St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FOMEPIZOLE 1000 MG/ML INJ 1.5 ML

Facility

$26.24

Service Code	HCPCS J1451
Hospital Charge Code	41651892
Hospital Revenue Code	636
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$17.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.06
Rate for Payer: Aetna Government	$6.06
Rate for Payer: Affinity Essential Plan 1&2	$4.24
Rate for Payer: Affinity Essential Plan 3&4	$4.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.24
Rate for Payer: Brighton Health Commercial	$15.74
Rate for Payer: Cash Price	$6.06
Rate for Payer: Cash Price	$6.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.09
Rate for Payer: Elderplan Medicare Advantage	$6.06
Rate for Payer: EmblemHealth Commercial	$6.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.06
Rate for Payer: Fidelis Essential Plan Aliesa	$6.06
Rate for Payer: Fidelis Essential Plan QHP	$6.36
Rate for Payer: Fidelis Medicare Advantage	$6.06
Rate for Payer: Fidelis Qualified Health Plan	$6.36
Rate for Payer: Group Health Inc Commercial	$6.06
Rate for Payer: Group Health Inc Medicare	$6.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.12
Rate for Payer: Hamaspik Choice Inc Medicare	$13.12
Rate for Payer: Healthfirst Medicare Advantage	$5.15
Rate for Payer: Healthfirst QHP	$6.06
Rate for Payer: Humana Medicare	$6.18
Rate for Payer: Senior Whole Health Medicare Advantage	$6.06
Rate for Payer: United Healthcare Commercial	$7.22
Rate for Payer: United Healthcare Medicare Advantage	$6.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.84
Rate for Payer: Wellcare Medicare	$5.75

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN [91363]

Facility

$1,200.00

Service Code	HCPCS J1451
Hospital Charge Code	70710147801
Hospital Revenue Code	278
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$780.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.06
Rate for Payer: Aetna Government	$6.06
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: Elderplan Medicare Advantage	$6.06
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$6.06
Rate for Payer: Group Health Inc Commercial	$6.06
Rate for Payer: Group Health Inc Medicare	$6.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: Healthfirst Medicare Advantage	$5.15
Rate for Payer: Healthfirst QHP	$6.06
Rate for Payer: Humana Medicare	$6.18
Rate for Payer: Senior Whole Health Medicare Advantage	$6.06
Rate for Payer: United Healthcare Medicare Advantage	$6.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.84

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN [91363]

Facility

$1,200.00

Service Code	HCPCS J1451
Hospital Charge Code	70710147801
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN [91363]

Facility

$1,385.29

Service Code	HCPCS J1451
Hospital Charge Code	00517071001
Hospital Revenue Code	278
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$900.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$761.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.06
Rate for Payer: Aetna Government	$6.06
Rate for Payer: Brighton Health Commercial	$831.17
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$692.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$796.54
Rate for Payer: Elderplan Medicare Advantage	$6.06
Rate for Payer: EmblemHealth Commercial	$692.64
Rate for Payer: Fidelis Medicare Advantage	$6.06
Rate for Payer: Group Health Inc Commercial	$6.06
Rate for Payer: Group Health Inc Medicare	$6.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.64
Rate for Payer: Hamaspik Choice Inc Medicare	$692.64
Rate for Payer: Healthfirst Medicare Advantage	$5.15
Rate for Payer: Healthfirst QHP	$6.06
Rate for Payer: Humana Medicare	$6.18
Rate for Payer: Senior Whole Health Medicare Advantage	$6.06
Rate for Payer: United Healthcare Medicare Advantage	$6.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$900.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.84

FOMEPIZOLE 1.5 GM/1.5ML IV SOLN [91363]

Facility

$1,385.29

Service Code	HCPCS J1451
Hospital Charge Code	00517071001
Hospital Revenue Code	278
Min. Negotiated Rate	$692.64
Max. Negotiated Rate	$692.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.64
Rate for Payer: Hamaspik Choice Inc Medicare	$692.64

FOMORAL HEAD/COMPONENT < 1999

Facility

$1,928.64

Service Code	HCPCS C1776
Hospital Charge Code	40203092
Hospital Revenue Code	278
Min. Negotiated Rate	$964.32
Max. Negotiated Rate	$964.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$964.32
Rate for Payer: Hamaspik Choice Inc Medicare	$964.32

FOMORAL HEAD/COMPONENT < 1999

Facility

$1,928.64

Service Code	HCPCS C1776
Hospital Charge Code	40203092
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,025.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,060.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,157.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$964.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,108.97
Rate for Payer: EmblemHealth Commercial	$964.32
Rate for Payer: Fidelis Medicare Advantage	$2,025.07
Rate for Payer: Group Health Inc Commercial	$964.32
Rate for Payer: Group Health Inc Medicare	$675.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$964.32
Rate for Payer: Hamaspik Choice Inc Medicare	$964.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,253.62

FONDAPARINUX 10 MG/0.8 ML INJ

Facility

$4.24

Service Code	HCPCS J1652
Hospital Charge Code	41653981
Hospital Revenue Code	636
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2.12

FONDAPARINUX 10 MG/0.8 ML INJ

Facility

$4.24

Service Code	HCPCS J1652
Hospital Charge Code	41643981
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$2.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.44
Rate for Payer: Group Health Inc Commercial	$2.12
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.09
Rate for Payer: SOMOS Essential	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.76

FONDAPARINUX 10 MG/0.8 ML INJ

Facility

$4.24

Service Code	HCPCS J1652
Hospital Charge Code	41653981
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$2.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.44
Rate for Payer: Group Health Inc Commercial	$2.12
Rate for Payer: Group Health Inc Medicare	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.09
Rate for Payer: SOMOS Essential	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.76

FONDAPARINUX 10 MG/0.8 ML INJ

Facility

$4.24

Service Code	HCPCS J1652
Hospital Charge Code	41643981
Hospital Revenue Code	636
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.12
Rate for Payer: Hamaspik Choice Inc Medicare	$2.12

FONDAPARINUX 2.5 MG/0.5 ML INJ

Facility

$5.82

Service Code	HCPCS J1652
Hospital Charge Code	41654160
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$3.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$3.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.35
Rate for Payer: Group Health Inc Commercial	$2.91
Rate for Payer: Group Health Inc Medicare	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.09
Rate for Payer: SOMOS Essential	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.78

FONDAPARINUX 2.5 MG/0.5 ML INJ

Facility

$5.82

Service Code	HCPCS J1652
Hospital Charge Code	41654160
Hospital Revenue Code	636
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$2.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2.91

FONDAPARINUX 2.5 MG/0.5 ML INJ

Facility

$5.82

Service Code	HCPCS J1652
Hospital Charge Code	41644160
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$3.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$3.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.35
Rate for Payer: Group Health Inc Commercial	$2.91
Rate for Payer: Group Health Inc Medicare	$2.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.09
Rate for Payer: SOMOS Essential	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.78

FONDAPARINUX 2.5 MG/0.5 ML INJ

Facility

$5.82

Service Code	HCPCS J1652
Hospital Charge Code	41644160
Hospital Revenue Code	636
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$2.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2.91

FONDAPARINUX 5 MG/0.4 ML INJ

Facility

$8.49

Service Code	HCPCS J1652
Hospital Charge Code	41643979
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$5.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$5.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.88
Rate for Payer: Group Health Inc Commercial	$4.24
Rate for Payer: Group Health Inc Medicare	$2.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.24
Rate for Payer: Hamaspik Choice Inc Medicare	$4.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.09
Rate for Payer: SOMOS Essential	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.52

FONDAPARINUX 5 MG/0.4 ML INJ

Facility

$8.49

Service Code	HCPCS J1652
Hospital Charge Code	41643979
Hospital Revenue Code	636
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$4.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.24
Rate for Payer: Hamaspik Choice Inc Medicare	$4.24

FONDAPARINUX 5 MG/0.4 ML INJ

Facility

$8.49

Service Code	HCPCS J1652
Hospital Charge Code	41653979
Hospital Revenue Code	636
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$4.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.24
Rate for Payer: Hamaspik Choice Inc Medicare	$4.24

FONDAPARINUX 5 MG/0.4 ML INJ

Facility

$8.49

Service Code	HCPCS J1652
Hospital Charge Code	41653979
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$5.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$5.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.88
Rate for Payer: Group Health Inc Commercial	$4.24
Rate for Payer: Group Health Inc Medicare	$2.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.24
Rate for Payer: Hamaspik Choice Inc Medicare	$4.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.09
Rate for Payer: SOMOS Essential	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.52

FONDAPARINUX 7.5 MG/0.6 ML INJ

Facility

$5.67

Service Code	HCPCS J1652
Hospital Charge Code	41653980
Hospital Revenue Code	636
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

FONDAPARINUX 7.5 MG/0.6 ML INJ

Facility

$5.67

Service Code	HCPCS J1652
Hospital Charge Code	41653980
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$3.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$3.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.26
Rate for Payer: Group Health Inc Commercial	$2.84
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.09
Rate for Payer: SOMOS Essential	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.69

FONDAPARINUX 7.5 MG/0.6 ML INJ

Facility

$5.67

Service Code	HCPCS J1652
Hospital Charge Code	41643980
Hospital Revenue Code	636
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

FONDAPARINUX 7.5 MG/0.6 ML INJ

Facility

$5.67

Service Code	HCPCS J1652
Hospital Charge Code	41643980
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$3.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$3.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.26
Rate for Payer: Group Health Inc Commercial	$2.84
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.09
Rate for Payer: SOMOS Essential	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.69

FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN [108029]

Facility

$108.94

Service Code	HCPCS J1652
Hospital Charge Code	55150023310
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$87.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$81.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.08
Rate for Payer: Group Health Inc Commercial	$54.47
Rate for Payer: Group Health Inc Medicare	$38.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.47
Rate for Payer: Hamaspik Choice Inc Medicare	$54.47
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.03
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.09
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.09
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.81

FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN [108029]

Facility

$108.94

Service Code	HCPCS J1652
Hospital Charge Code	55150023300
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$87.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$81.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.08
Rate for Payer: Group Health Inc Commercial	$54.47
Rate for Payer: Group Health Inc Medicare	$38.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.47
Rate for Payer: Hamaspik Choice Inc Medicare	$54.47
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.03
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.09
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.09
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.81

Know your out-of-pocket cost for care.

All Charges