St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FORCEP ENDO BIOPSY 2.8MM

Facility

$7.44

Hospital Charge Code	64906796
Hospital Revenue Code	270
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$5.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.72
Rate for Payer: Aetna Government	$3.72
Rate for Payer: Brighton Health Commercial	$5.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.06
Rate for Payer: Group Health Inc Commercial	$3.72
Rate for Payer: Group Health Inc Medicare	$2.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.72
Rate for Payer: Hamaspik Choice Inc Medicare	$3.72

FORCEP MICRO ALLIGATOR EB SER

Facility

$935.00

Hospital Charge Code	64903246
Hospital Revenue Code	270
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$748.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$514.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$467.50
Rate for Payer: Aetna Government	$467.50
Rate for Payer: Brighton Health Commercial	$701.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$748.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.80
Rate for Payer: Group Health Inc Commercial	$467.50
Rate for Payer: Group Health Inc Medicare	$327.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$467.50
Rate for Payer: Hamaspik Choice Inc Medicare	$467.50

FORCEP ROCHESTER PEAN HEMO CVD9

Facility

$28.28

Hospital Charge Code	40200446
Hospital Revenue Code	270
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$22.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.14
Rate for Payer: Aetna Government	$14.14
Rate for Payer: Brighton Health Commercial	$21.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.23
Rate for Payer: Group Health Inc Commercial	$14.14
Rate for Payer: Group Health Inc Medicare	$9.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.14
Rate for Payer: Hamaspik Choice Inc Medicare	$14.14

FORCEPS CRILE CVD 6-1/4

Facility

$12.36

Hospital Charge Code	40200447
Hospital Revenue Code	270
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$9.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.18
Rate for Payer: Aetna Government	$6.18
Rate for Payer: Brighton Health Commercial	$9.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.40
Rate for Payer: Group Health Inc Commercial	$6.18
Rate for Payer: Group Health Inc Medicare	$4.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.18
Rate for Payer: Hamaspik Choice Inc Medicare	$6.18

FORCEPS GRASPING 2.5 X 115CM

Facility

$434.25

Hospital Charge Code	64904822
Hospital Revenue Code	270
Min. Negotiated Rate	$151.99
Max. Negotiated Rate	$347.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$217.12
Rate for Payer: Aetna Government	$217.12
Rate for Payer: Brighton Health Commercial	$325.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$347.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$295.29
Rate for Payer: Group Health Inc Commercial	$217.12
Rate for Payer: Group Health Inc Medicare	$151.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.12
Rate for Payer: Hamaspik Choice Inc Medicare	$217.12

FORCEPS INTUBATING MAGILL

Facility

$28.00

Hospital Charge Code	40200817
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.04
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

FORCEPS INTUBATING MAGILL

Facility

$44.20

Hospital Charge Code	64902942
Hospital Revenue Code	270
Min. Negotiated Rate	$15.47
Max. Negotiated Rate	$35.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.10
Rate for Payer: Aetna Government	$22.10
Rate for Payer: Brighton Health Commercial	$33.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.06
Rate for Payer: Group Health Inc Commercial	$22.10
Rate for Payer: Group Health Inc Medicare	$15.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.10
Rate for Payer: Hamaspik Choice Inc Medicare	$22.10

FORCEPS MAGILL CHILD CLOSED

Facility

$39.93

Hospital Charge Code	64904450
Hospital Revenue Code	270
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$31.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.96
Rate for Payer: Aetna Government	$19.96
Rate for Payer: Brighton Health Commercial	$29.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.15
Rate for Payer: Group Health Inc Commercial	$19.96
Rate for Payer: Group Health Inc Medicare	$13.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.96
Rate for Payer: Hamaspik Choice Inc Medicare	$19.96

FORCEPS SPONGE STR SERR 9

Facility

$202.00

Hospital Charge Code	40200448
Hospital Revenue Code	270
Min. Negotiated Rate	$70.70
Max. Negotiated Rate	$161.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$111.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$101.00
Rate for Payer: Aetna Government	$101.00
Rate for Payer: Brighton Health Commercial	$151.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$161.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$137.36
Rate for Payer: Group Health Inc Commercial	$101.00
Rate for Payer: Group Health Inc Medicare	$70.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.00
Rate for Payer: Hamaspik Choice Inc Medicare	$101.00

FORCEPS TISSUE 1X2 TEETH ST

Facility

$51.88

Hospital Charge Code	40200449
Hospital Revenue Code	270
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$41.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.94
Rate for Payer: Aetna Government	$25.94
Rate for Payer: Brighton Health Commercial	$38.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.28
Rate for Payer: Group Health Inc Commercial	$25.94
Rate for Payer: Group Health Inc Medicare	$18.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.94
Rate for Payer: Hamaspik Choice Inc Medicare	$25.94

FORCEPS TISSUE THOMS-ALLIS

Facility

$35.94

Hospital Charge Code	40200450
Hospital Revenue Code	270
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$28.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.97
Rate for Payer: Aetna Government	$17.97
Rate for Payer: Brighton Health Commercial	$26.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.44
Rate for Payer: Group Health Inc Commercial	$17.97
Rate for Payer: Group Health Inc Medicare	$12.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.97
Rate for Payer: Hamaspik Choice Inc Medicare	$17.97

FORCEP TRICEP

Facility

$529.40

Hospital Charge Code	64907140
Hospital Revenue Code	270
Min. Negotiated Rate	$185.29
Max. Negotiated Rate	$423.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$264.70
Rate for Payer: Aetna Government	$264.70
Rate for Payer: Brighton Health Commercial	$397.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$423.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$359.99
Rate for Payer: Group Health Inc Commercial	$264.70
Rate for Payer: Group Health Inc Medicare	$185.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.70
Rate for Payer: Hamaspik Choice Inc Medicare	$264.70

FOREIGN BODY REMOVAL

Facility

$967.73

Service Code	HCPCS 10120
Hospital Charge Code	42201365
Hospital Revenue Code	361
Rate for Payer: Cash Price	$461.12

FOREIGN BODY REMOVAL

Facility

$967.73

Service Code	HCPCS 10120
Hospital Charge Code	42201365
Hospital Revenue Code	361
Min. Negotiated Rate	$322.78
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	$725.80
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: EmblemHealth Commercial	$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	$461.12
Rate for Payer: Group Health Inc Medicare	$461.12
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: Senior Whole Health Medicare Advantage	$461.12
Rate for Payer: United Healthcare Commercial	$1,113.00
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

FORESKIN MANIP INCLUDING LYSIS

Facility

$711.45

Service Code	HCPCS 54450
Hospital Charge Code	30105787
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$285.81
Rate for Payer: Aetna Government	$285.81
Rate for Payer: Affinity Essential Plan 1&2	$200.07
Rate for Payer: Affinity Essential Plan 3&4	$200.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$200.07
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$285.81
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$285.81
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	$285.81
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$242.94
Rate for Payer: Fidelis Essential Plan QHP	$254.37
Rate for Payer: Fidelis Medicare Advantage	$285.81
Rate for Payer: Fidelis Qualified Health Plan	$254.37
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	$355.72
Rate for Payer: Hamaspik Choice Inc Medicare	$285.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$285.81
Rate for Payer: Humana Medicare	$291.53
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$285.81
Rate for Payer: Senior Whole Health Medicare Advantage	$285.81
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$285.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$285.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$228.65
Rate for Payer: Wellcare Medicare	$271.52

FORESKIN MANIP INCLUDING LYSIS

Facility

$711.45

Service Code	HCPCS 54450
Hospital Charge Code	30105787
Hospital Revenue Code	450
Rate for Payer: Cash Price	$285.81

FORMAGRAFT STRIPS LG

Facility

$3,960.00

Service Code	HCPCS C1713
Hospital Charge Code	64903532
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,158.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,178.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,376.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,980.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,277.00
Rate for Payer: EmblemHealth Commercial	$1,980.00
Rate for Payer: Fidelis Medicare Advantage	$4,158.00
Rate for Payer: Group Health Inc Commercial	$1,980.00
Rate for Payer: Group Health Inc Medicare	$1,386.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,980.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,980.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,574.00

FORMAGRAFT STRIPS LG

Facility

$3,960.00

Service Code	HCPCS C1713
Hospital Charge Code	64903532
Hospital Revenue Code	278
Min. Negotiated Rate	$1,980.00
Max. Negotiated Rate	$1,980.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,980.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,980.00

FORMALIN 10% BUFFERED 120ML

Facility

$2.96

Hospital Charge Code	64904603
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$2.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$2.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.01
Rate for Payer: Group Health Inc Commercial	$1.48
Rate for Payer: Group Health Inc Medicare	$1.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.48
Rate for Payer: Hamaspik Choice Inc Medicare	$1.48

FORMALIN 10% BUFFERED 30ML

Facility

$1.15

Hospital Charge Code	64902686
Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.58
Rate for Payer: Aetna Government	$0.58
Rate for Payer: Brighton Health Commercial	$0.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58
Rate for Payer: Hamaspik Choice Inc Medicare	$0.58

FORMALIN 10% BUFFERED 40ML

Facility

$1.52

Hospital Charge Code	64904606
Hospital Revenue Code	270
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Brighton Health Commercial	$1.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: Group Health Inc Commercial	$0.76
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76
Rate for Payer: Hamaspik Choice Inc Medicare	$0.76

FORMALIN, BUFFERED 10% 5GAL

Facility

$76.78

Hospital Charge Code	64901525
Hospital Revenue Code	270
Min. Negotiated Rate	$26.87
Max. Negotiated Rate	$61.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.39
Rate for Payer: Aetna Government	$38.39
Rate for Payer: Brighton Health Commercial	$57.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$52.21
Rate for Payer: Group Health Inc Commercial	$38.39
Rate for Payer: Group Health Inc Medicare	$26.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.39
Rate for Payer: Hamaspik Choice Inc Medicare	$38.39

FORMALIN STS 480ML 10% NEUT BUFF

Facility

$4.08

Hospital Charge Code	64904593
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.77
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04

FORMULA ENFAMIL PREMIUM 6-OZ

Facility

$2.98

Hospital Charge Code	64901350
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$2.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.49
Rate for Payer: Aetna Government	$1.49
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.03
Rate for Payer: Group Health Inc Commercial	$1.49
Rate for Payer: Group Health Inc Medicare	$1.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.49
Rate for Payer: Hamaspik Choice Inc Medicare	$1.49

FORMULA ENFAMIL PREMIUM NEWBORN

Facility

$1.68

Hospital Charge Code	64902371
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84

Know your out-of-pocket cost for care.

All Charges