Price of Extracorporeal Shock Wave Lithotripsy at NYU Langone
Last Updated: 2024-07-01
Locations
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NYU Langone|Tisch Hospital
550 1st Ave., New York, NY 10016About Extracorporeal Shock Wave Lithotripsy
Service Codes: CPT 50590, LOCAL 2025398
This procedure uses shock waves to break up kidney stones into smaller pieces, making them easier to pass through the urinary tract.
Pricing Overview
Cash Price
$2,516.51
Median Price
$7,558.00
Price Range
$1,558.76 - $17,520.26
Insurance Plan Prices
| Insurance Provider | Plan Type | Price |
|---|---|---|
| Blue Cross Blue Shield | Blue Connection | $12,625.00 |
| Fidelis Care | Silver 250 (Exchange) | $3,012.76 |
| MultiPlan | Nippon Life | $10,330.94 |
| BCBS (Out of State) | Medicare | $3,926.27 |
| Blue Cross Blue Shield | Healthy New York | $12,625.00 |
| MultiPlan | Guardian Life Insurance Co | $10,330.94 |
| EmblemHealth | GHI Medicare PPO | $3,926.27 |
| EmblemHealth | HIP Access II | $7,558.00 |
| EmblemHealth | Select Care Gold Exchange | $9,585.45 |
| MagnaCare | National Health Plan | $13,547.57 |
| MetroPlus | Essential Plan 3 | $1,673.76 |
| Carelon Behavioral Health | All Exchange Plans (Home-based Only) | $3,926.27 |
| UnitedHealthcare - Oxford | Metro | $7,606.00 |
| Anthem BCBS HealthPlus | Family Health Plus (Deprecated) | $1,673.76 |
| Carelon Behavioral Health | Medicare Advantage (Home-based Only) | $3,926.27 |
| EmblemHealth | HIP PPO | $7,558.00 |
| BCBS (Out of State) | Indemnity | $12,625.00 |
| MultiPlan | PHCS Savility | $10,330.94 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) Select HMO/Extra HMO | $3,926.27 |
| UnitedHealthcare | Choice | $7,738.00 |
| CenterLight | PACE | $4,004.80 |
| MultiPlan | PHP Healthcare (Champus) | $10,330.94 |
| EmblemHealth | CMO Essential Plan 2 | $2,008.51 |
| Blue Cross Blue Shield | UniCare | $12,625.00 |
| EmblemHealth | HIP | $7,558.00 |
| EmblemHealth | Healthcare Partners Essential Plan 1-2 | $2,008.51 |
| Riverspring Health Plans | Medicare Advantage | $3,926.27 |
| Healthfirst | Essential Plan 4 | $1,558.76 |
| EmblemHealth | American Plan Administrators | $11,277.00 |
| Cigna | MVP-Cigna Network | $5,418.00 |
| BCBS (Out of State) | POS (Suitcase Logo) | $12,625.00 |
| BCBS (Out of State) | HMO (No Suitcase Logo) | $12,625.00 |
| VNS Health | Total (Medicare + Medicaid) | $3,926.27 |
| Anthem BCBS HealthPlus | Special Needs Plan (SNP) | $1,673.76 |
| Fidelis Care | Silver (Exchange) | $3,012.76 |
| Healthfirst | Personal Wellness Plan (HARP) | $1,558.76 |
| Blue Cross Blue Shield | Open Access PPO (Home-based Only) | $12,625.00 |
| Healthfirst | Medicaid Managed Care | $1,558.76 |
| Anthem BCBS HealthPlus | SOMOS ny medicaid | $1,757.44 |
| HealthSmart | WTC Health Program - Stony Brook | $3,926.27 |
| UnitedHealthcare | Optum Health | $7,738.00 |
| UnitedHealthcare | Student Resources | $7,738.00 |
| Hamaspik | Medicare Advantage | $7,852.54 |
| EmblemHealth | HIP Optum Health | $7,558.00 |
| MetroPlus | GoldCare 2 | $3,581.84 |
| Blue Cross Blue Shield | Pathway | $2,008.51 |
| EmblemHealth | HIP Montefiore | $7,558.00 |
| UnitedHealthcare | Choice (NY Power Authority) | $7,738.00 |
| Blue Cross Blue Shield | Blue Access EPO (Large Group) | $11,363.00 |
| MultiPlan | Principal Financial Group | $10,330.94 |
| Senior Whole Health | All Plans | $3,926.27 |
| EmblemHealth | CMO Essential Plan 4 | $1,673.76 |
| AgeWell (Deprecated) | Medicare Advantage | $3,926.27 |
| HealthSmart | WTC Health Program - Northwell | $3,926.27 |
| Blue Cross Blue Shield | PPO | $12,625.00 |
| UnitedHealthcare | POMCO (UMR) | $7,738.00 |
| EmblemHealth | Enhanced Care (Medicaid) Montefiore | $1,673.76 |
| Aetna | Open Access HMO | $17,520.26 |
| BCBS (Out of State) | PPO (No Suitcase Logo) | $12,625.00 |
| Blue Cross Blue Shield | Blue Priority PPO | $12,625.00 |
| Carelon Behavioral Health | Medicaid Managed Care (Home-based Only) | $1,673.76 |
| Centers Plan for Healthy Living | All Plans | $3,926.27 |
| Aetna | HMO | $17,520.26 |
| Blue Cross Blue Shield | Pathway X Enhanced | $2,008.51 |
| EmblemHealth | Healthcare Partners Essential Plan 3 | $1,673.76 |
| GEHA | All Plans | $17,520.26 |
| Cigna | NALC PPO | $5,418.00 |
| UnitedHealthcare | EPO | $7,738.00 |
| MultiPlan | Humana Health Plan | $10,330.94 |
| HealthSmart | WTC Health Program - Mt. Sinai | $3,926.27 |
| MultiPlan | QualCare Inc | $10,330.94 |
| Fidelis Care | Platinum (Exchange) | $3,012.76 |
| CenterLight | Direct | $4,004.80 |
| VNS Health | EasyCare Plus (Medicare+Medicaid) | $3,926.27 |
| Cigna | Great West HMO | $5,418.00 |
| Cigna | Wellfleet Student | $5,418.00 |
| EmblemHealth | HIP compre health epo | $7,558.00 |
| Anthem BCBS HealthPlus | All Exchange Plans | $2,008.51 |
| MagnaCare | Independent Care Plus | $13,547.57 |
| Healthfirst | Essential Plan 3 | $1,558.76 |
| Aetna | Indemnity | $10,728.28 |
| EmblemHealth | GHI Medicare Supplement | $3,926.27 |
| Blue Cross Blue Shield | Open Access HMO (Home-based Only) | $12,625.00 |
| AgeWell (Deprecated) | Medicaid Managed Care | $1,673.76 |
| UnitedHealthcare - Oxford | Freedom | $7,606.00 |
| Cigna | Great West PPO | $5,418.00 |
| MagnaCare | Capital District Physicians Health Plan | $13,547.57 |
| Humana | All Commercial Plans | $10,330.94 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) Select/Extra HMO (HCP) | $3,926.27 |
| EmblemHealth | HIP POS | $7,558.00 |
| EmblemHealth | Essential Plan 4 | $1,673.76 |
| Healthfirst | Personal Wellness Plan (HARP) | $1,673.76 |
| Anthem BCBS | Empire Plan, Value Options | $12,625.00 |
| EmblemHealth | HIP Long Island College Hospital (LICH) | $7,558.00 |
| MultiPlan | PHCS Director Guild | $10,330.94 |
| Aetna | Allied ASA PPO | $17,520.26 |
| MultiPlan | AXA Global Insurance | $10,330.94 |
| EmblemHealth | HIP VIP Medicare Bold | $3,926.27 |
| EmblemHealth | HIP Healthcare Partners HMO | $7,558.00 |
| MultiPlan | Fiserv Health | $10,330.94 |
| MagnaCare | Cement & Concrete Workers District Council | $13,547.57 |
| UnitedHealthcare | POS | $7,738.00 |
| MetroPlus | BronzePlus | $7,774.02 |
| 1199SEIU Funds | PPO | $14,680.00 |
| Aetna | Signature Administrators PPO | $17,520.26 |
| Blue Cross Blue Shield | Indemnity | $12,625.00 |
| BCBS (Out of State) | PPO (Suitcase Logo) | $12,625.00 |
| UnitedHealthcare | Medicare Advantage | $3,926.27 |
| Aetna | Student Health | $17,520.26 |
| EmblemHealth | Healthcare Partners Essential Plan 3-4 | $1,673.76 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) HMO (HCP) | $3,926.27 |
| UnitedHealthcare | AARP Medicare Advantage Complete Mosaic | $3,926.27 |
| EmblemHealth | Enhanced Care (Medicaid) | $1,673.76 |
| MultiPlan | Administrative Concepts | $10,330.94 |
| Anthem BCBS | All Plans | $12,625.00 |
| MetroPlus | Essential Plan 1-2, 200-250 | $1,673.76 |
| EmblemHealth | Select Care Catastrophic Exchangeu00a0 | $9,585.45 |
| EmblemHealth | American Plan Administrators c/o H.D.A | $11,277.00 |
| CenterLight | Select | $4,004.80 |
| MetroPlus | PlatinumPlus | $7,774.02 |
| EmblemHealth | Prime Silver | $9,585.45 |
| Amida Care | Medicaid Managed Care | $1,673.76 |
| MetroPlus | GoldPlus | $7,774.02 |
| MetroPlus | Essential Plan 2 | $1,673.76 |
| EmblemHealth | Select Care Silver Exchange | $9,585.45 |
| UnitedHealthcare | AARP Medicare Advantage Complete Essentials | $3,926.27 |
| MultiPlan | Capital District Physicians Health Plan | $10,330.94 |
| Blue Cross Blue Shield | Blue Access HMO (Small Group) | $10,100.00 |
| Partners Health Plan | Medicaid MLTC | $1,673.76 |
| EmblemHealth | Healthcare Partners Essential Plan 1, 200-250 | $2,008.51 |
| Cigna | Tufts Health Plan | $5,418.00 |
| MetroPlus | MedPlus | $7,774.02 |
| EmblemHealth | HIP Medicare Supplement | $3,926.27 |
| Blue Cross Blue Shield | Blue Priority EPO (Small Group) | $10,100.00 |
| Aetna | POS | $17,520.26 |
| MagnaCare | JIB Employees Security Fund | $13,547.57 |
| EmblemHealth | Essential Plan 3 | $1,673.76 |
| BCBS (Out of State) | HMO (Suitcase Logo) | $12,625.00 |
| EmblemHealth | Enhanced Care (Medicaid) (SOMOS) | $1,757.44 |
| MultiPlan | Screen Actors Guild | $10,330.94 |
| Healthfirst | Child Health Plus (CHP) | $1,558.76 |
| UnitedHealthcare | Navigate | $7,738.00 |
| UnitedHealthcare | AARP Medicare Advantage Complete | $3,926.27 |
| Fidelis Care | Gold for Children (Exchange) | $3,012.76 |
| EmblemHealth | Healthcare Partners Essential Plans | $2,008.51 |
| Aetna | Chesterfield Resources ASA PPO | $17,520.26 |
| UnitedHealthcare | POMCO (UMR) | $10,330.94 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 2 | $2,259.57 |
| UnitedHealthcare | Charter | $7,738.00 |
| Maksin Group | Consolidated Health Plan (Home-based only) | $5,418.00 |
| Partners Health Plan | FIDA | $3,926.27 |
| Fidelis Care | Essential Plan 2 | $3,598.58 |
| EmblemHealth | HIP VIP Medicare Healthcare Partners | $3,926.27 |
| Cigna | PPO | $5,418.00 |
| Blue Cross Blue Shield | Blue Priority HMO | $12,625.00 |
| MultiPlan | Global Excel Management | $10,330.94 |
| EmblemHealth | Select Care Bronze Exchange | $9,585.45 |
| EmblemHealth | GHI Medicare HMO | $3,926.27 |
| EmblemHealth | Essential Plan 1, 200-250 | $2,008.51 |
| Aetna | Open Access Elect Choice EPO | $17,520.26 |
| VNS Health | SelectHealth (Medicaid) | $1,673.76 |
| MultiPlan | Healthnet of California | $10,330.94 |
| 1199SEIU Funds | Member Choice Home Care Select | $14,680.00 |
| EmblemHealth | Enhanced Care (Medicaid) SNP HARP (SOMOS) | $1,757.44 |
| UnitedHealthcare - Oxford | Medicare Advantage | $3,926.27 |
| MultiPlan | PHCS | $10,330.94 |
| Blue Cross Blue Shield | Blue Access PPO (Large Group) | $11,363.00 |
| Blue Cross Blue Shield | Senior Care Supplemental | $3,926.27 |
| UnitedHealthcare - Oxford | Optum Health | $7,606.00 |
| Cigna | Open Access | $5,418.00 |
| EmblemHealth | Select Care Silver Small Group | $9,585.45 |
| EmblemHealth | HIP VIP Medicare Affinity | $3,926.27 |
| MagnaCare | Direct Plus | $13,547.57 |
| UnitedHealthcare - Oxford | Liberty | $7,606.00 |
| Horizon BCBS | Direct | $12,625.00 |
| EmblemHealth | Prime Bronze | $9,585.45 |
| VNS Health | EasyCare (Medicare Advantage) | $3,926.27 |
| EmblemHealth | Select Care Healthcare Partners | $9,585.45 |
| UnitedHealthcare | HMO | $7,738.00 |
| Elderplan | FIDA | $3,926.27 |
| Anthem BCBS HealthPlus | Essential Plan 1, 200-250 | $3,347.51 |
| MetroPlus | Child Health Plus (CHP) | $1,673.76 |
| Aetna | Nippon Life ASA PPO | $17,520.26 |
| EmblemHealth | Healthcare Partners Essential Plan 4 | $1,673.76 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 3 (SOMOS) | $1,757.44 |
| Partners Health Plan | Medicaid | $1,673.76 |
| EmblemHealth | GHI HMO | $11,277.00 |
| Fidelis Care | Medicaid Managed Care | $2,075.46 |
| Fidelis Care | Bronze (Exchange) | $3,012.76 |
| BCBS (Out of State) | POS (No Suitcase Logo) | $12,625.00 |
| MetroPlus | SilverPlus | $7,774.02 |
| EmblemHealth | Select Care Platinum Small Group | $9,585.45 |
| Veterans Choice | Veterans Choice Program | $3,926.27 |
| MultiPlan | Mutual of Omaha | $10,330.94 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 3 | $1,757.44 |
| Aetna | Christian Brothers ASA PPO | $17,520.26 |
| Fidelis Care | Essential Plan 4 | $2,075.46 |
| EmblemHealth | HIP VIP Medicare Reserve | $3,926.27 |
| Partners Health Plan | Medicare Advantage | $3,926.27 |
| Cigna | Premier Plus | $5,418.00 |
| EmblemHealth | Select Care Basic Exchange | $9,585.45 |
| Anthem BCBS HealthPlus | Medicaid | $1,673.76 |
| Cigna | Indemnity | $5,418.00 |
| Blue Cross Blue Shield | PPO/EPO (Small Group) | $10,100.00 |
| Cigna | LifeSOURCE | $5,418.00 |
| EmblemHealth | Vytra HMO | $7,558.00 |
| Blue Cross Blue Shield | Blue Access gEPO (Large Group) | $11,363.00 |
| Cigna | Cigna Managed Care/POS | $5,418.00 |
| Aetna | Medicare Advantage | $3,926.27 |
| MultiPlan | PPO | $10,330.94 |
| Aetna | Starmark ASA PPO | $17,520.26 |
| UnitedHealthcare | Independent | $7,738.00 |
| Champus | Unysis Corp | $3,926.27 |
| Fidelis Care | Essential Plan 3 | $2,075.46 |
| UnitedHealthcare | PPO | $7,738.00 |
| Anthem BCBS HealthPlus | SOMOS Special Needs HARP | $1,757.44 |
| Cigna | Evernorth Behavioral Health | $5,418.00 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 2 (SOMOS) | $2,259.57 |
| HealthSmart | WTC Health Program - Logistic Health Inc | $3,926.27 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) HMO | $3,926.27 |
| BCBS (Out of State) | Medicare (No Suitcase Logo) | $3,926.27 |
| MultiPlan | Meritain Health | $10,330.94 |
| Anthem BCBS HealthPlus | Essential Plan 4 | $1,673.76 |
| EmblemHealth | GHI EPO | $11,277.00 |
| Healthfirst | Essential Plan 3-4 | $1,558.76 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) PPO | $3,926.27 |
| Blue Cross Blue Shield | Child Health Plus (CHP) | $1,673.76 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 1 & 200-250 | $2,259.57 |
| EmblemHealth | Select Care HMO | $9,585.45 |
| UnitedHealthcare | Golden Rule Insurance | $7,738.00 |
| Blue Cross Blue Shield | Blue Access EPO (Large Group) (NY LI Local 1199SEIU) | $11,363.00 |
| 1199SEIU Funds | Home Care Benefit Fund | $14,680.00 |
| EmblemHealth | Select Care PPOu00a0 | $9,585.45 |
| MagnaCare | JIB Members | $13,547.57 |
| UnitedHealthcare | AARP | $3,926.27 |
| Anthem BCBS HealthPlus | Medicare Advantage | $3,926.27 |
| Blue Cross Blue Shield | Blue Access gEPO (Small Group) | $10,100.00 |
| EmblemHealth | Enhanced Care (Medicaid) Healthcare Partners | $1,673.76 |
| MultiPlan | Diversified Admin Corp | $10,330.94 |
| EmblemHealth | Select Care EPO | $9,585.45 |
| Anthem BCBS HealthPlus | Essential Plan 2 | $3,347.51 |
| First Health | Commercial HMO | $11,125.62 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 1, 200-250 (SOMOS) | $2,259.57 |
| BCBS (Out of State) | HMO | $12,625.00 |
| UnitedHealthcare | Core | $7,738.00 |
| BCBS (Out of State) | EPO (Suitcase Logo) | $12,625.00 |
| EmblemHealth | GHI Comprehensive Benefits Plan (CBP) | $11,277.00 |
| EmblemHealth | HIP Prime Basic | $9,585.45 |
| MultiPlan | Teamsters Allied Benefits | $10,330.94 |
| Blue Cross Blue Shield | EPO | $12,625.00 |
| Fidelis Care | Bronze for Children (Exchange) | $3,012.76 |
| EmblemHealth | Prime Platinum | $9,585.45 |
| Aetna | PPO | $17,520.26 |
| VA Community Care Network | Optum | $3,926.27 |
| Fidelis Care | Gold (Exchange) | $3,012.76 |
| MultiPlan | Global Health Management | $10,330.94 |
| Aetna | Healthscope ASA PPO | $17,520.26 |
| First Health | PPO | $10,330.94 |
| HealthSmart | WTC Health Program - FDNY | $3,926.27 |
| MetroPlus | Essential Plan 3-4 | $1,673.76 |
| EmblemHealth | HIP Child Health Plus | $1,673.76 |
| EmblemHealth | GHI PPO | $11,277.00 |
| EmblemHealth | Bridge | $7,558.00 |
| MagnaCare | Direct Plus Preferred | $13,547.57 |
| EmblemHealth | GHI composite | $11,277.00 |
| Blue Cross Blue Shield | Hotel Trades Council | $12,625.00 |
| Fidelis Care | Wellcare Medicare Advantage | $3,926.27 |
| EmblemHealth | HIP VIP Medicare Montefiore | $3,926.27 |
| BCBS (Out of State) | EPO | $12,625.00 |
| EmblemHealth | IUOE Local 14-14B | $11,277.00 |
| Aetna | Meritain Health | $17,520.26 |
| HealthSmart | WTC Health Program - NYCHHC | $3,926.27 |
| EmblemHealth | BCBS GHI Composite | $12,625.00 |
| EmblemHealth | CMO Essential Plan 1 | $2,008.51 |
| Fidelis Care | Child Health Plus (CHP) | $2,075.46 |
| Healthfirst | Senior Health Partners (MLTC) | $1,558.76 |
| Cigna | Open Access PPO | $5,418.00 |
| UnitedHealthcare | WTC Health Program | $3,926.27 |
| CenterLight | PACE Medicare HMO | $4,004.80 |
| Health Net | PPO | $10,330.94 |
| Better Health Plan | All Plans | $11,125.62 |
| Blue Cross Blue Shield | Federal Program | $12,625.00 |
| Fidelis Care | Silver for Children (Exchange) | $3,012.76 |
| MagnaCare | PPO | $13,547.57 |
| Cigna | Open Access HMO | $5,418.00 |
| MagnaCare | American Plan Administrators | $13,547.57 |
| Fidelis Care | Catastrophic (Exchange) | $3,012.76 |
| EmblemHealth | HIP SmartStart | $7,558.00 |
| Fidelis Care | Platinum for Children (Exchange) | $3,012.76 |
| Anthem BCBS HealthPlus | SOMOS Child Health Plus (CHP) | $1,757.44 |
| Aetna | Global National Transplant | $17,520.26 |
| Blue Cross Blue Shield | POS | $12,625.00 |
| Blue Cross Blue Shield | Global Transplants | $12,625.00 |
| UnitedHealthcare | Medicare Advantage Complete Choice Regional PPO | $3,926.27 |
| EmblemHealth | VIP Prime HMO Medicare Advantage | $3,926.27 |
| MultiPlan | Kaiser Permanente | $10,330.94 |
| EmblemHealth | Enhanced Care (Medicaid) Child Health Plus (SOMOS) | $1,757.44 |
| HealthSmart | WTC Health Program - UMDNJ Rutgers | $3,926.27 |
| Anthem BCBS HealthPlus | Essential Plan 3 | $1,673.76 |
| EmblemHealth | HIP Access I | $7,558.00 |
| MetroPlus | Medicare Advantage | $3,926.27 |
| MetroPlus | Essential Plan 1 | $1,673.76 |
| Aetna | Coresource ASA PPO | $17,520.26 |
| Elderplan | All Plans | $3,926.27 |
| MetroPlus | Gold | $3,581.84 |
| EmblemHealth | Select Care Bronze Small Group | $9,585.45 |
| BCBS (Out of State) | Medicare (Suitcase Logo) | $3,926.27 |
| VNS Health | MLTC (Medicaid) | $1,673.76 |
| EmblemHealth | CMO Essential Plan 3 | $1,673.76 |
| VillageCareMAX | All Plans | $3,926.27 |
| MetroPlus | Medicaid Managed Care | $1,673.76 |
| BCBS (Out of State) | POS | $12,625.00 |
| Cigna | HMO | $5,418.00 |
| EmblemHealth | Essential Plan 2 | $2,008.51 |
| Blue Cross Blue Shield | Local 32 BJ | $12,625.00 |
| EmblemHealth | HIP EPO | $7,558.00 |
| EmblemHealth | GHI Behavioral Management Program | $11,277.00 |
| Anthem BCBS | Optum | $12,625.00 |
| Three Rivers | All Plans (Home-based Only) | $11,920.31 |
| MultiPlan | Paramount Insurance | $10,330.94 |
| BCBS (Out of State) | PPO | $12,625.00 |
| EmblemHealth | HIP HMO | $7,558.00 |
| Blue Cross Blue Shield | Pathway Enhanced | $2,008.51 |
| MetroPlus | Essential Plan 4 | $1,673.76 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 4 (SOMOS) | $1,757.44 |
| EmblemHealth | Healthcare Partners Essential Plan 2 | $2,008.51 |
| EmblemHealth | HIP compre health | $7,558.00 |
| HealthSmart | WTC Health Program - NYU | $3,926.27 |
| EmblemHealth | WLNY-TV | $11,277.00 |
| Partners Health Plan | Medicare Advantage (Home-based Only) | $3,926.27 |
| UnitedHealthcare | Choice (North Shore - LIJ) | $7,738.00 |
| Aetna | Wellnet ASA PPO | $17,520.26 |
| MultiPlan | US Life Insurance Co | $10,330.94 |
| EmblemHealth | Prime Gold | $9,585.45 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 4 | $1,757.44 |
| BCBS (Out of State) | EPO (No Suitcase Logo) | $12,625.00 |
| Blue Cross Blue Shield | Blue Access EPO (Small Group) | $10,100.00 |
| EmblemHealth | Select Care Gold Small Group | $9,585.45 |
| Fidelis Care | Essential Plan 1 | $3,598.58 |
| EmblemHealth | Select Care Platinum Exchange | $9,585.45 |
| Fidelis Care | Native American (Exchange) | $3,012.76 |
| Anthem BCBS HealthPlus | Child Health Plus (CHP) | $1,673.76 |
| Sedgwick | WTC Health Program - Northwell | $3,926.27 |
| Blue Cross Blue Shield | HMO | $12,625.00 |