St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

UREA 20 % EX CREA

Facility

$0.14

Service Code	NDC 5898061030
Hospital Charge Code	5898061030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

UREA 20 % EX CREA

Facility

$0.17

Service Code	NDC 0536110945
Hospital Charge Code	0536110945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

UREA 20 % EX CREA

Facility

$0.17

Service Code	NDC 0536110945
Hospital Charge Code	0536110945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

UREA 20 % EX CREA

Facility

$0.17

Service Code	NDC 7139984343
Hospital Charge Code	7139984343
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

UREA 20 % EX CREA

Facility

$0.10

Service Code	NDC 4452361803
Hospital Charge Code	4452361803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

UREA 20 % EX CREA

Facility

$0.10

Service Code	NDC 4452361803
Hospital Charge Code	4452361803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

Urethral & transurethral procedures

Facility

$44,055.29

Service Code	APR-DRG 4461
Min. Negotiated Rate	$7,519.00
Max. Negotiated Rate	$44,055.29
Rate for Payer: Affinity Essential Plan 1&2	$44,055.29
Rate for Payer: Affinity Essential Plan 3&4	$44,055.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,580.13
Rate for Payer: Amida Care Medicaid	$19,580.13
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,055.29
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,580.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,580.13
Rate for Payer: Fidelis Qualified Health Plan	$23,496.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,580.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,580.13
Rate for Payer: Healthfirst Commercial	$12,609.00
Rate for Payer: Healthfirst Essential Plan	$44,055.29
Rate for Payer: Healthfirst QHP	$7,519.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,580.13
Rate for Payer: SOMOS Essential	$44,055.29
Rate for Payer: United Healthcare Essential Plan 1&2	$44,055.29
Rate for Payer: United Healthcare Essential Plan 3&4	$44,055.29
Rate for Payer: United Healthcare Medicaid	$19,580.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,580.13

Urethral & transurethral procedures

Facility

$45,914.29

Service Code	APR-DRG 4462
Min. Negotiated Rate	$8,662.00
Max. Negotiated Rate	$45,914.29
Rate for Payer: Affinity Essential Plan 1&2	$45,914.29
Rate for Payer: Affinity Essential Plan 3&4	$45,914.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,406.35
Rate for Payer: Amida Care Medicaid	$20,406.35
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,914.29
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,406.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,406.35
Rate for Payer: Fidelis Qualified Health Plan	$24,487.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,406.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,406.35
Rate for Payer: Healthfirst Commercial	$14,893.00
Rate for Payer: Healthfirst Essential Plan	$45,914.29
Rate for Payer: Healthfirst QHP	$8,662.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,406.35
Rate for Payer: SOMOS Essential	$45,914.29
Rate for Payer: United Healthcare Essential Plan 1&2	$45,914.29
Rate for Payer: United Healthcare Essential Plan 3&4	$45,914.29
Rate for Payer: United Healthcare Medicaid	$20,406.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,406.35

Urethral & transurethral procedures

Facility

$58,535.03

Service Code	APR-DRG 4463
Min. Negotiated Rate	$15,287.00
Max. Negotiated Rate	$58,535.03
Rate for Payer: Affinity Essential Plan 1&2	$58,535.03
Rate for Payer: Affinity Essential Plan 3&4	$58,535.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,015.57
Rate for Payer: Amida Care Medicaid	$26,015.57
Rate for Payer: EmblemHealth Essential Plan 1&2	$58,535.03
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,015.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,015.57
Rate for Payer: Fidelis Qualified Health Plan	$31,218.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,015.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,015.57
Rate for Payer: Healthfirst Commercial	$26,632.00
Rate for Payer: Healthfirst Essential Plan	$58,535.03
Rate for Payer: Healthfirst QHP	$15,287.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,015.57
Rate for Payer: SOMOS Essential	$58,535.03
Rate for Payer: United Healthcare Essential Plan 1&2	$58,535.03
Rate for Payer: United Healthcare Essential Plan 3&4	$58,535.03
Rate for Payer: United Healthcare Medicaid	$26,015.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,015.57

Urethral & transurethral procedures

Facility

$89,860.07

Service Code	APR-DRG 4464
Min. Negotiated Rate	$27,304.00
Max. Negotiated Rate	$89,860.07
Rate for Payer: Affinity Essential Plan 1&2	$89,860.07
Rate for Payer: Affinity Essential Plan 3&4	$89,860.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,937.81
Rate for Payer: Amida Care Medicaid	$39,937.81
Rate for Payer: EmblemHealth Essential Plan 1&2	$89,860.07
Rate for Payer: EmblemHealth Essential Plan 3&4	$39,937.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,937.81
Rate for Payer: Fidelis Qualified Health Plan	$47,925.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,937.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,937.81
Rate for Payer: Healthfirst Commercial	$65,055.00
Rate for Payer: Healthfirst Essential Plan	$89,860.07
Rate for Payer: Healthfirst QHP	$27,304.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,937.81
Rate for Payer: SOMOS Essential	$89,860.07
Rate for Payer: United Healthcare Essential Plan 1&2	$89,860.07
Rate for Payer: United Healthcare Essential Plan 3&4	$89,860.07
Rate for Payer: United Healthcare Medicaid	$39,937.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,937.81

URINALYSIS

Facility

$20.99

Service Code	EAPG 00410
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$20.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.20
Rate for Payer: Healthfirst Commercial	$20.99

Urinary stones & acquired upper urinary tract obstruction

Facility

$39,899.36

Service Code	APR-DRG 4651
Min. Negotiated Rate	$5,301.00
Max. Negotiated Rate	$39,899.36
Rate for Payer: Affinity Essential Plan 1&2	$39,899.36
Rate for Payer: Affinity Essential Plan 3&4	$39,899.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,733.05
Rate for Payer: Amida Care Medicaid	$17,733.05
Rate for Payer: EmblemHealth Essential Plan 1&2	$39,899.36
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,733.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,733.05
Rate for Payer: Fidelis Qualified Health Plan	$21,279.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,733.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,733.05
Rate for Payer: Healthfirst Commercial	$9,131.00
Rate for Payer: Healthfirst Essential Plan	$39,899.36
Rate for Payer: Healthfirst QHP	$5,301.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,733.05
Rate for Payer: SOMOS Essential	$39,899.36
Rate for Payer: United Healthcare Essential Plan 1&2	$39,899.36
Rate for Payer: United Healthcare Essential Plan 3&4	$39,899.36
Rate for Payer: United Healthcare Medicaid	$17,733.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,733.05

Urinary stones & acquired upper urinary tract obstruction

Facility

$41,202.61

Service Code	APR-DRG 4652
Min. Negotiated Rate	$6,086.00
Max. Negotiated Rate	$41,202.61
Rate for Payer: Affinity Essential Plan 1&2	$41,202.61
Rate for Payer: Affinity Essential Plan 3&4	$41,202.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,312.27
Rate for Payer: Amida Care Medicaid	$18,312.27
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,202.61
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,312.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,312.27
Rate for Payer: Fidelis Qualified Health Plan	$21,974.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,312.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,312.27
Rate for Payer: Healthfirst Commercial	$10,470.00
Rate for Payer: Healthfirst Essential Plan	$41,202.61
Rate for Payer: Healthfirst QHP	$6,086.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,312.27
Rate for Payer: SOMOS Essential	$41,202.61
Rate for Payer: United Healthcare Essential Plan 1&2	$41,202.61
Rate for Payer: United Healthcare Essential Plan 3&4	$41,202.61
Rate for Payer: United Healthcare Medicaid	$18,312.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,312.27

Urinary stones & acquired upper urinary tract obstruction

Facility

$47,328.32

Service Code	APR-DRG 4653
Min. Negotiated Rate	$8,987.00
Max. Negotiated Rate	$47,328.32
Rate for Payer: Affinity Essential Plan 1&2	$47,328.32
Rate for Payer: Affinity Essential Plan 3&4	$47,328.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,034.81
Rate for Payer: Amida Care Medicaid	$21,034.81
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,328.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,034.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,034.81
Rate for Payer: Fidelis Qualified Health Plan	$25,241.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,034.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,034.81
Rate for Payer: Healthfirst Commercial	$16,599.00
Rate for Payer: Healthfirst Essential Plan	$47,328.32
Rate for Payer: Healthfirst QHP	$8,987.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,034.81
Rate for Payer: SOMOS Essential	$47,328.32
Rate for Payer: United Healthcare Essential Plan 1&2	$47,328.32
Rate for Payer: United Healthcare Essential Plan 3&4	$47,328.32
Rate for Payer: United Healthcare Medicaid	$21,034.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,034.81

Urinary stones & acquired upper urinary tract obstruction

Facility

$70,163.87

Service Code	APR-DRG 4654
Min. Negotiated Rate	$16,749.00
Max. Negotiated Rate	$70,163.87
Rate for Payer: Affinity Essential Plan 1&2	$70,163.87
Rate for Payer: Affinity Essential Plan 3&4	$70,163.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,183.94
Rate for Payer: Amida Care Medicaid	$31,183.94
Rate for Payer: EmblemHealth Essential Plan 1&2	$70,163.87
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,183.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,183.94
Rate for Payer: Fidelis Qualified Health Plan	$37,420.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,183.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,183.94
Rate for Payer: Healthfirst Commercial	$32,557.00
Rate for Payer: Healthfirst Essential Plan	$70,163.87
Rate for Payer: Healthfirst QHP	$16,749.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,183.94
Rate for Payer: SOMOS Essential	$70,163.87
Rate for Payer: United Healthcare Essential Plan 1&2	$70,163.87
Rate for Payer: United Healthcare Essential Plan 3&4	$70,163.87
Rate for Payer: United Healthcare Medicaid	$31,183.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,183.94

URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$243.55

Service Code	EAPG 00724
Min. Negotiated Rate	$175.89
Max. Negotiated Rate	$243.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$175.89
Rate for Payer: Healthfirst Commercial	$243.55

URINARY STUDIES AND PROCEDURES

Facility

$739.63

Service Code	EAPG 00161
Min. Negotiated Rate	$536.92
Max. Negotiated Rate	$739.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$536.92
Rate for Payer: Healthfirst Commercial	$739.63

URSODIOL 250 MG PO TABS

Facility

$2.68

Service Code	NDC 6438091806
Hospital Charge Code	6438091806
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$2.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.34
Rate for Payer: Aetna Government	$1.34
Rate for Payer: Brighton Health Commercial	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.82
Rate for Payer: EmblemHealth Commercial	$1.34
Rate for Payer: Group Health Inc Commercial	$1.34
Rate for Payer: Group Health Inc Medicare	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.74

URSODIOL 250 MG PO TABS

Facility

$3.95

Service Code	NDC 0904689004
Hospital Charge Code	0904689004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$3.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.98
Rate for Payer: Aetna Government	$1.98
Rate for Payer: Brighton Health Commercial	$2.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.69
Rate for Payer: EmblemHealth Commercial	$1.98
Rate for Payer: Group Health Inc Commercial	$1.98
Rate for Payer: Group Health Inc Medicare	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.57

URSODIOL 250 MG PO TABS

Facility

$2.68

Service Code	NDC 4988441201
Hospital Charge Code	4988441201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34

URSODIOL 250 MG PO TABS

Facility

$2.68

Service Code	NDC 6438091806
Hospital Charge Code	6438091806
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34

URSODIOL 250 MG PO TABS

Facility

$3.95

Service Code	NDC 0904689004
Hospital Charge Code	0904689004
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98

URSODIOL 250 MG PO TABS

Facility

$2.68

Service Code	NDC 4988441201
Hospital Charge Code	4988441201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$2.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.34
Rate for Payer: Aetna Government	$1.34
Rate for Payer: Brighton Health Commercial	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.82
Rate for Payer: EmblemHealth Commercial	$1.34
Rate for Payer: Group Health Inc Commercial	$1.34
Rate for Payer: Group Health Inc Medicare	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.74

URSODIOL 300 MG PO CAPS

Facility

$5.27

Service Code	NDC 0904622161
Hospital Charge Code	0904622161
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64

URSODIOL 300 MG PO CAPS

Facility

$5.27

Service Code	NDC 0904622161
Hospital Charge Code	0904622161
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.64
Rate for Payer: Aetna Government	$2.64
Rate for Payer: Brighton Health Commercial	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.58
Rate for Payer: EmblemHealth Commercial	$2.64
Rate for Payer: Group Health Inc Commercial	$2.64
Rate for Payer: Group Health Inc Medicare	$1.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64
Rate for Payer: Hamaspik Choice Inc Medicare	$2.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.43

Know your out-of-pocket cost for care.

All Charges