St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP

Facility

$8.80

Service Code	NDC 6131463006
Hospital Charge Code	6131463006
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$7.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.40
Rate for Payer: Aetna Government	$4.40
Rate for Payer: Brighton Health Commercial	$6.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.98
Rate for Payer: EmblemHealth Commercial	$4.40
Rate for Payer: Group Health Inc Commercial	$4.40
Rate for Payer: Group Health Inc Medicare	$3.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.40
Rate for Payer: Hamaspik Choice Inc Medicare	$4.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.72

NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP

Facility

$27.13

Service Code	NDC 0998063006
Hospital Charge Code	0998063006
Hospital Revenue Code	250
Min. Negotiated Rate	$13.56
Max. Negotiated Rate	$13.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.56

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT

Facility

$12.57

Service Code	NDC 6131463136
Hospital Charge Code	6131463136
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.29
Rate for Payer: Aetna Government	$6.29
Rate for Payer: Brighton Health Commercial	$9.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.55
Rate for Payer: EmblemHealth Commercial	$6.29
Rate for Payer: Group Health Inc Commercial	$6.29
Rate for Payer: Group Health Inc Medicare	$4.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.29
Rate for Payer: Hamaspik Choice Inc Medicare	$6.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.17

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT

Facility

$12.57

Service Code	NDC 6131463136
Hospital Charge Code	6131463136
Hospital Revenue Code	250
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$6.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.29

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT

Facility

$5.67

Service Code	NDC 2420879535
Hospital Charge Code	2420879535
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$4.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$4.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.86
Rate for Payer: EmblemHealth Commercial	$2.84
Rate for Payer: Group Health Inc Commercial	$2.84
Rate for Payer: Group Health Inc Medicare	$1.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.69

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT

Facility

$5.67

Service Code	NDC 2420879535
Hospital Charge Code	2420879535
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84

NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN

Facility

$10.07

Service Code	NDC 2420863110
Hospital Charge Code	2420863110
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$8.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.03
Rate for Payer: Aetna Government	$5.03
Rate for Payer: Brighton Health Commercial	$7.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.85
Rate for Payer: EmblemHealth Commercial	$5.03
Rate for Payer: Group Health Inc Commercial	$5.03
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.03
Rate for Payer: Hamaspik Choice Inc Medicare	$5.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.54

NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN

Facility

$10.07

Service Code	NDC 2420863110
Hospital Charge Code	2420863110
Hospital Revenue Code	250
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.03

NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP

Facility

$10.07

Service Code	NDC 2420863562
Hospital Charge Code	2420863562
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$8.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.03
Rate for Payer: Aetna Government	$5.03
Rate for Payer: Brighton Health Commercial	$7.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.85
Rate for Payer: EmblemHealth Commercial	$5.03
Rate for Payer: Group Health Inc Commercial	$5.03
Rate for Payer: Group Health Inc Medicare	$3.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.03
Rate for Payer: Hamaspik Choice Inc Medicare	$5.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.54

NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP

Facility

$10.07

Service Code	NDC 2420863562
Hospital Charge Code	2420863562
Hospital Revenue Code	250
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.03

NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP

Facility

$10.49

Service Code	NDC 6131464511
Hospital Charge Code	6131464511
Hospital Revenue Code	250
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$8.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.24
Rate for Payer: Aetna Government	$5.24
Rate for Payer: Brighton Health Commercial	$7.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.13
Rate for Payer: EmblemHealth Commercial	$5.24
Rate for Payer: Group Health Inc Commercial	$5.24
Rate for Payer: Group Health Inc Medicare	$3.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.24
Rate for Payer: Hamaspik Choice Inc Medicare	$5.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.82

NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP

Facility

$10.49

Service Code	NDC 6131464511
Hospital Charge Code	6131464511
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$5.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.24

NEOMYCIN SULFATE 500 MG PO TABS

Facility

$1.98

Service Code	NDC 5107901520
Hospital Charge Code	5107901520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99

NEOMYCIN SULFATE 500 MG PO TABS

Facility

$1.98

Service Code	NDC 5107901520
Hospital Charge Code	5107901520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.99
Rate for Payer: Aetna Government	$0.99
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.34
Rate for Payer: EmblemHealth Commercial	$0.99
Rate for Payer: Group Health Inc Commercial	$0.99
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99
Rate for Payer: Hamaspik Choice Inc Medicare	$0.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.28

Neonatal aftercare

Facility

$48,030.05

Service Code	APR-DRG 8631
Min. Negotiated Rate	$10,554.00
Max. Negotiated Rate	$48,030.05
Rate for Payer: Affinity Essential Plan 1&2	$48,030.05
Rate for Payer: Affinity Essential Plan 3&4	$48,030.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,346.69
Rate for Payer: Amida Care Medicaid	$21,346.69
Rate for Payer: EmblemHealth Essential Plan 1&2	$48,030.05
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,346.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,346.69
Rate for Payer: Fidelis Qualified Health Plan	$25,616.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,346.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,346.69
Rate for Payer: Healthfirst Commercial	$15,119.00
Rate for Payer: Healthfirst Essential Plan	$48,030.05
Rate for Payer: Healthfirst QHP	$10,554.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,346.69
Rate for Payer: SOMOS Essential	$48,030.05
Rate for Payer: United Healthcare Essential Plan 1&2	$48,030.05
Rate for Payer: United Healthcare Essential Plan 3&4	$48,030.05
Rate for Payer: United Healthcare Medicaid	$21,346.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,346.69

Neonatal aftercare

Facility

$105,031.01

Service Code	APR-DRG 8633
Min. Negotiated Rate	$34,701.00
Max. Negotiated Rate	$105,031.01
Rate for Payer: Affinity Essential Plan 1&2	$105,031.01
Rate for Payer: Affinity Essential Plan 3&4	$105,031.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$46,680.45
Rate for Payer: Amida Care Medicaid	$46,680.45
Rate for Payer: EmblemHealth Essential Plan 1&2	$105,031.01
Rate for Payer: EmblemHealth Essential Plan 3&4	$46,680.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46,680.45
Rate for Payer: Fidelis Qualified Health Plan	$56,016.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$46,680.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46,680.45
Rate for Payer: Healthfirst Commercial	$69,682.00
Rate for Payer: Healthfirst Essential Plan	$105,031.01
Rate for Payer: Healthfirst QHP	$34,701.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46,680.45
Rate for Payer: SOMOS Essential	$105,031.01
Rate for Payer: United Healthcare Essential Plan 1&2	$105,031.01
Rate for Payer: United Healthcare Essential Plan 3&4	$105,031.01
Rate for Payer: United Healthcare Medicaid	$46,680.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46,680.45

Neonatal aftercare

Facility

$125,212.63

Service Code	APR-DRG 8634
Min. Negotiated Rate	$48,995.00
Max. Negotiated Rate	$125,212.63
Rate for Payer: Affinity Essential Plan 1&2	$125,212.63
Rate for Payer: Affinity Essential Plan 3&4	$125,212.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$55,650.06
Rate for Payer: Amida Care Medicaid	$55,650.06
Rate for Payer: EmblemHealth Essential Plan 1&2	$125,212.63
Rate for Payer: EmblemHealth Essential Plan 3&4	$55,650.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$55,650.06
Rate for Payer: Fidelis Qualified Health Plan	$66,780.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$55,650.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55,650.06
Rate for Payer: Healthfirst Commercial	$92,215.00
Rate for Payer: Healthfirst Essential Plan	$125,212.63
Rate for Payer: Healthfirst QHP	$48,995.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55,650.06
Rate for Payer: SOMOS Essential	$125,212.63
Rate for Payer: United Healthcare Essential Plan 1&2	$125,212.63
Rate for Payer: United Healthcare Essential Plan 3&4	$125,212.63
Rate for Payer: United Healthcare Medicaid	$55,650.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$55,650.06

Neonatal aftercare

Facility

$70,519.14

Service Code	APR-DRG 8632
Min. Negotiated Rate	$20,424.00
Max. Negotiated Rate	$70,519.14
Rate for Payer: Affinity Essential Plan 1&2	$70,519.14
Rate for Payer: Affinity Essential Plan 3&4	$70,519.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,341.84
Rate for Payer: Amida Care Medicaid	$31,341.84
Rate for Payer: EmblemHealth Essential Plan 1&2	$70,519.14
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,341.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,341.84
Rate for Payer: Fidelis Qualified Health Plan	$37,610.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,341.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,341.84
Rate for Payer: Healthfirst Commercial	$29,534.00
Rate for Payer: Healthfirst Essential Plan	$70,519.14
Rate for Payer: Healthfirst QHP	$20,424.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,341.84
Rate for Payer: SOMOS Essential	$70,519.14
Rate for Payer: United Healthcare Essential Plan 1&2	$70,519.14
Rate for Payer: United Healthcare Essential Plan 3&4	$70,519.14
Rate for Payer: United Healthcare Medicaid	$31,341.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,341.84

NEONATAL AFTERCARE

Facility

$236.76

Service Code	EAPG 00873
Min. Negotiated Rate	$171.26
Max. Negotiated Rate	$236.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$171.26
Rate for Payer: Healthfirst Commercial	$236.76

NEONATAL DIAGNOSES

Facility

$246.47

Service Code	EAPG 00771
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$246.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$178.20
Rate for Payer: Healthfirst Commercial	$246.47

Neonate birthwt 1000-1249g w or w/o other significant condition

Facility

$153,343.78

Service Code	APR-DRG 6032
Min. Negotiated Rate	$62,863.00
Max. Negotiated Rate	$153,343.78
Rate for Payer: Affinity Essential Plan 1&2	$153,343.78
Rate for Payer: Affinity Essential Plan 3&4	$153,343.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$68,152.79
Rate for Payer: Amida Care Medicaid	$68,152.79
Rate for Payer: EmblemHealth Essential Plan 1&2	$153,343.78
Rate for Payer: EmblemHealth Essential Plan 3&4	$68,152.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$68,152.79
Rate for Payer: Fidelis Qualified Health Plan	$81,783.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$68,152.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$68,152.79
Rate for Payer: Healthfirst Commercial	$113,885.00
Rate for Payer: Healthfirst Essential Plan	$153,343.78
Rate for Payer: Healthfirst QHP	$62,863.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68,152.79
Rate for Payer: SOMOS Essential	$153,343.78
Rate for Payer: United Healthcare Essential Plan 1&2	$153,343.78
Rate for Payer: United Healthcare Essential Plan 3&4	$153,343.78
Rate for Payer: United Healthcare Medicaid	$68,152.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$68,152.79

Neonate birthwt 1000-1249g w or w/o other significant condition

Facility

$189,925.70

Service Code	APR-DRG 6033
Min. Negotiated Rate	$82,692.00
Max. Negotiated Rate	$189,925.70
Rate for Payer: Affinity Essential Plan 1&2	$189,925.70
Rate for Payer: Affinity Essential Plan 3&4	$189,925.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$84,411.42
Rate for Payer: Amida Care Medicaid	$84,411.42
Rate for Payer: EmblemHealth Essential Plan 1&2	$189,925.70
Rate for Payer: EmblemHealth Essential Plan 3&4	$84,411.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$84,411.42
Rate for Payer: Fidelis Qualified Health Plan	$101,293.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$84,411.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$84,411.42
Rate for Payer: Healthfirst Commercial	$147,446.00
Rate for Payer: Healthfirst Essential Plan	$189,925.70
Rate for Payer: Healthfirst QHP	$82,692.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84,411.42
Rate for Payer: SOMOS Essential	$189,925.70
Rate for Payer: United Healthcare Essential Plan 1&2	$189,925.70
Rate for Payer: United Healthcare Essential Plan 3&4	$189,925.70
Rate for Payer: United Healthcare Medicaid	$84,411.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84,411.42

Neonate birthwt 1000-1249g w or w/o other significant condition

Facility

$123,017.71

Service Code	APR-DRG 6031
Min. Negotiated Rate	$44,928.00
Max. Negotiated Rate	$123,017.71
Rate for Payer: Affinity Essential Plan 1&2	$123,017.71
Rate for Payer: Affinity Essential Plan 3&4	$123,017.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$54,674.54
Rate for Payer: Amida Care Medicaid	$54,674.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$123,017.71
Rate for Payer: EmblemHealth Essential Plan 3&4	$54,674.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$54,674.54
Rate for Payer: Fidelis Qualified Health Plan	$65,609.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$54,674.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$54,674.54
Rate for Payer: Healthfirst Commercial	$95,145.00
Rate for Payer: Healthfirst Essential Plan	$123,017.71
Rate for Payer: Healthfirst QHP	$44,928.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54,674.54
Rate for Payer: SOMOS Essential	$123,017.71
Rate for Payer: United Healthcare Essential Plan 1&2	$123,017.71
Rate for Payer: United Healthcare Essential Plan 3&4	$123,017.71
Rate for Payer: United Healthcare Medicaid	$54,674.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$54,674.54

Neonate birthwt 1000-1249g w or w/o other significant condition

Facility

$277,006.50

Service Code	APR-DRG 6034
Min. Negotiated Rate	$123,114.00
Max. Negotiated Rate	$277,006.50
Rate for Payer: Affinity Essential Plan 1&2	$277,006.50
Rate for Payer: Affinity Essential Plan 3&4	$277,006.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$123,114.00
Rate for Payer: Amida Care Medicaid	$123,114.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$277,006.50
Rate for Payer: EmblemHealth Essential Plan 3&4	$123,114.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$123,114.00
Rate for Payer: Fidelis Qualified Health Plan	$147,736.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$123,114.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$123,114.00
Rate for Payer: Healthfirst Commercial	$182,989.00
Rate for Payer: Healthfirst Essential Plan	$277,006.50
Rate for Payer: Healthfirst QHP	$138,816.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123,114.00
Rate for Payer: SOMOS Essential	$277,006.50
Rate for Payer: United Healthcare Essential Plan 1&2	$277,006.50
Rate for Payer: United Healthcare Essential Plan 3&4	$277,006.50
Rate for Payer: United Healthcare Medicaid	$123,114.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$123,114.00

Neonate birthwt 1500-1999g w congenital/perinatal infection

Facility

$123,086.32

Service Code	APR-DRG 6134
Min. Negotiated Rate	$54,705.03
Max. Negotiated Rate	$123,086.32
Rate for Payer: Affinity Essential Plan 1&2	$123,086.32
Rate for Payer: Affinity Essential Plan 3&4	$123,086.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$54,705.03
Rate for Payer: Amida Care Medicaid	$54,705.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$123,086.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$54,705.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$54,705.03
Rate for Payer: Fidelis Qualified Health Plan	$65,646.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$54,705.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$54,705.03
Rate for Payer: Healthfirst Commercial	$90,994.00
Rate for Payer: Healthfirst Essential Plan	$123,086.32
Rate for Payer: Healthfirst QHP	$57,735.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54,705.03
Rate for Payer: SOMOS Essential	$123,086.32
Rate for Payer: United Healthcare Essential Plan 1&2	$123,086.32
Rate for Payer: United Healthcare Essential Plan 3&4	$123,086.32
Rate for Payer: United Healthcare Medicaid	$54,705.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$54,705.03

Know your out-of-pocket cost for care.

All Charges