St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INTEGRA SUT DURA REGEN MTRIX

Facility

$3,404.00

Service Code	HCPCS C1762
Hospital Charge Code	40204217
Hospital Revenue Code	278
Min. Negotiated Rate	$1,702.00
Max. Negotiated Rate	$1,702.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,702.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,702.00

INTEGRA SUT DURA REGEN MTRIX

Facility

$3,404.00

Service Code	HCPCS C1762
Hospital Charge Code	40204217
Hospital Revenue Code	278
Min. Negotiated Rate	$1,191.40
Max. Negotiated Rate	$3,574.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,872.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$2,042.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,702.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,957.30
Rate for Payer: EmblemHealth Commercial	$1,702.00
Rate for Payer: Fidelis Medicare Advantage	$3,574.20
Rate for Payer: Group Health Inc Commercial	$1,702.00
Rate for Payer: Group Health Inc Medicare	$1,191.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,702.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,702.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,212.60

INTEGRA SUTURABLE DUREN DURAL

Facility

$1,496.00

Service Code	HCPCS C1762
Hospital Charge Code	40209960
Hospital Revenue Code	278
Min. Negotiated Rate	$523.60
Max. Negotiated Rate	$1,879.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$822.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$897.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$748.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$860.20
Rate for Payer: EmblemHealth Commercial	$748.00
Rate for Payer: Fidelis Medicare Advantage	$1,570.80
Rate for Payer: Group Health Inc Commercial	$748.00
Rate for Payer: Group Health Inc Medicare	$523.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$748.00
Rate for Payer: Hamaspik Choice Inc Medicare	$748.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$972.40

INTEGRA SUTURABLE DUREN DURAL

Facility

$1,496.00

Service Code	HCPCS C1762
Hospital Charge Code	40209960
Hospital Revenue Code	278
Min. Negotiated Rate	$748.00
Max. Negotiated Rate	$748.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$748.00
Rate for Payer: Hamaspik Choice Inc Medicare	$748.00

INTEGRATOR,STEAM,MOV FR,2X3/4

Facility

$0.21

Hospital Charge Code	64904408
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11

INTEGRATOR,STEAM,MOV FR,4X3/4

Facility

$0.25

Hospital Charge Code	64903704
Hospital Revenue Code	270
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

INTEGRATOR STEAM PLUS CLASS 5

Facility

$0.21

Hospital Charge Code	64904764
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11

INTEGRA VALVE ACCUD W ANTI-REFLUX

Facility

$895.00

Hospital Charge Code	40201552
Hospital Revenue Code	279
Min. Negotiated Rate	$313.25
Max. Negotiated Rate	$716.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$492.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$447.50
Rate for Payer: Aetna Government	$447.50
Rate for Payer: Brighton Health Commercial	$671.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$716.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$608.60
Rate for Payer: Group Health Inc Commercial	$447.50
Rate for Payer: Group Health Inc Medicare	$313.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$447.50
Rate for Payer: Hamaspik Choice Inc Medicare	$447.50

INTEGRA WOUND MATRIX PER SQ CM

Facility

$71.40

Service Code	HCPCS Q4108
Hospital Charge Code	42500221
Hospital Revenue Code	636
Min. Negotiated Rate	$24.99
Max. Negotiated Rate	$52.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.75
Rate for Payer: Aetna Government	$36.75
Rate for Payer: Brighton Health Commercial	$42.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.06
Rate for Payer: Group Health Inc Commercial	$35.70
Rate for Payer: Group Health Inc Medicare	$24.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.70
Rate for Payer: Hamaspik Choice Inc Medicare	$35.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.66
Rate for Payer: SOMOS Essential	$52.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.41

INTEGRA WOUND MATRIX PER SQ CM

Facility

$71.40

Service Code	HCPCS Q4108
Hospital Charge Code	42500221
Hospital Revenue Code	636
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.70
Rate for Payer: Hamaspik Choice Inc Medicare	$35.70

INTEGRO DBM

Facility

$600.00

Hospital Charge Code	40200261
Hospital Revenue Code	270
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$480.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$330.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$300.00
Rate for Payer: Aetna Government	$300.00
Rate for Payer: Brighton Health Commercial	$450.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$480.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$408.00
Rate for Payer: Group Health Inc Commercial	$300.00
Rate for Payer: Group Health Inc Medicare	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$300.00

INTEGRO DBM PASTE

Facility

$1,658.00

Service Code	HCPCS C1713
Hospital Charge Code	40205721
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,740.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$911.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$994.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$829.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$953.35
Rate for Payer: EmblemHealth Commercial	$829.00
Rate for Payer: Fidelis Medicare Advantage	$1,740.90
Rate for Payer: Group Health Inc Commercial	$829.00
Rate for Payer: Group Health Inc Medicare	$580.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$829.00
Rate for Payer: Hamaspik Choice Inc Medicare	$829.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,077.70

INTEGRO DBM PASTE

Facility

$1,658.00

Service Code	HCPCS C1713
Hospital Charge Code	40205721
Hospital Revenue Code	278
Min. Negotiated Rate	$829.00
Max. Negotiated Rate	$829.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$829.00
Rate for Payer: Hamaspik Choice Inc Medicare	$829.00

INTEG VENTRIC CATH SET

Facility

$222.56

Hospital Charge Code	40008306
Hospital Revenue Code	272
Min. Negotiated Rate	$77.90
Max. Negotiated Rate	$178.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$111.28
Rate for Payer: Aetna Government	$111.28
Rate for Payer: Brighton Health Commercial	$166.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$151.34
Rate for Payer: Group Health Inc Commercial	$111.28
Rate for Payer: Group Health Inc Medicare	$77.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.28
Rate for Payer: Hamaspik Choice Inc Medicare	$111.28

INTENSITY MOD RADIOTHERAPY PLAN

Facility

$3,771.83

Service Code	HCPCS 77301 TC
Hospital Charge Code	66542933
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$3,017.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,074.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,602.37
Rate for Payer: Aetna Government	$1,602.37
Rate for Payer: Affinity Essential Plan 1&2	$1,121.66
Rate for Payer: Affinity Essential Plan 3&4	$1,121.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,121.66
Rate for Payer: Brighton Health Commercial	$2,828.87
Rate for Payer: Cash Price	$1,602.37
Rate for Payer: Cash Price	$1,602.37
Rate for Payer: Cash Price	$1,602.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,602.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,017.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,564.84
Rate for Payer: Elderplan Medicare Advantage	$1,602.37
Rate for Payer: EmblemHealth Commercial	$1,602.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Medicare Advantage	$1,602.37
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$1,602.37
Rate for Payer: Group Health Inc Medicare	$1,602.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,885.92
Rate for Payer: Hamaspik Choice Inc Medicare	$1,602.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,442.13
Rate for Payer: Healthfirst Medicare Advantage	$1,602.37
Rate for Payer: Healthfirst QHP	$1,602.37
Rate for Payer: Humana Medicare	$1,634.42
Rate for Payer: Senior Whole Health Medicare Advantage	$1,602.37
Rate for Payer: United Healthcare Medicare Advantage	$1,602.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,602.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,281.90
Rate for Payer: Wellcare Medicare	$1,522.25

INTENSITY MOD RADIOTHERAPY PLAN

Facility

$3,771.83

Service Code	HCPCS 77301 TC
Hospital Charge Code	66542933
Hospital Revenue Code	333
Rate for Payer: Cash Price	$1,602.37

INTENSIVE OUTPATIENT PROGRAM

Facility

$276.96

Service Code	HCPCS S9480
Hospital Charge Code	30400247
Hospital Revenue Code	914
Min. Negotiated Rate	$63.28
Max. Negotiated Rate	$221.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$152.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.28
Rate for Payer: Aetna Government	$63.28
Rate for Payer: Brighton Health Commercial	$207.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$221.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$188.33
Rate for Payer: Group Health Inc Commercial	$138.48
Rate for Payer: Group Health Inc Medicare	$96.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.48
Rate for Payer: Hamaspik Choice Inc Medicare	$138.48

INTENTIONAL REPLANTATION(INCL. NE

Facility

$914.29

Service Code	HCPCS D3470
Hospital Charge Code	42300805
Hospital Revenue Code	361
Min. Negotiated Rate	$457.14
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$502.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$685.72
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	$457.14
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: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare 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

INTENTIONAL REPLANTATION(INCL. NE

Facility

$914.29

Service Code	HCPCS D3470
Hospital Charge Code	42300805
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

INTERACTIVE COMPLEXITY

Facility

$96.07

Service Code	HCPCS 90785
Hospital Charge Code	30305593
Hospital Revenue Code	900
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$76.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.08
Rate for Payer: Aetna Government	$17.08
Rate for Payer: Brighton Health Commercial	$72.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.33
Rate for Payer: Group Health Inc Commercial	$48.04
Rate for Payer: Group Health Inc Medicare	$33.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.04
Rate for Payer: Hamaspik Choice Inc Medicare	$48.04
Rate for Payer: United Healthcare Commercial	$48.04

INTERATIVE COMPLEXITY

Facility

$38.43

Service Code	HCPCS 90785
Hospital Charge Code	30105102
Hospital Revenue Code	900
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$30.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.08
Rate for Payer: Aetna Government	$17.08
Rate for Payer: Brighton Health Commercial	$28.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.13
Rate for Payer: Group Health Inc Commercial	$19.22
Rate for Payer: Group Health Inc Medicare	$13.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.22
Rate for Payer: Hamaspik Choice Inc Medicare	$19.22
Rate for Payer: United Healthcare Commercial	$19.22

INTERCATH

Facility

$10.64

Hospital Charge Code	40202713
Hospital Revenue Code	270
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$8.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.32
Rate for Payer: Aetna Government	$5.32
Rate for Payer: Brighton Health Commercial	$7.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.24
Rate for Payer: Group Health Inc Commercial	$5.32
Rate for Payer: Group Health Inc Medicare	$3.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.32
Rate for Payer: Hamaspik Choice Inc Medicare	$5.32

INTERCEPTIVE ORTHO PRIMARY DENT

Facility

$3,000.00

Service Code	HCPCS D8050
Hospital Charge Code	42303363
Hospital Revenue Code	361
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,500.00
Rate for Payer: Aetna Government	$1,500.00
Rate for Payer: Brighton Health Commercial	$2,250.00
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	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

INTERCEPTIVE ORTHO TRANS. DENT

Facility

$3,000.00

Service Code	HCPCS D8060
Hospital Charge Code	42303364
Hospital Revenue Code	361
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,500.00
Rate for Payer: Aetna Government	$1,500.00
Rate for Payer: Brighton Health Commercial	$2,250.00
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	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

INTERCOSTAL NERVE

Facility

$2,459.50

Service Code	HCPCS 64620
Hospital Charge Code	30305726
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Affinity Essential Plan 1&2	$737.84
Rate for Payer: Affinity Essential Plan 3&4	$737.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$737.84
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
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	$1,054.06
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
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	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Humana Medicare	$1,075.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

Know your out-of-pocket cost for care.

All Charges