St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APTTMX+PTMX

Facility

$16.18

Service Code	HCPCS 85732
Hospital Charge Code	40629818
Hospital Revenue Code	305
Rate for Payer: Cash Price	$6.47

APUTATE TOE/METATARSAL

Facility

$8,291.05

Service Code	HCPCS 28810
Hospital Charge Code	42500137
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,743.15

APUTATE TOE/METATARSAL

Facility

$8,291.05

Service Code	HCPCS 28810
Hospital Charge Code	42500137
Hospital Revenue Code	361
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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	$3,743.15
Rate for Payer: EmblemHealth Commercial	$3,743.15
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

AQUEOUS SHUNT EYE

Facility

$11,564.78

Service Code	HCPCS 66179
Hospital Charge Code	40001156
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$8,673.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,044.08
Rate for Payer: Aetna Government	$6,044.08
Rate for Payer: Affinity Essential Plan 1&2	$4,230.86
Rate for Payer: Affinity Essential Plan 3&4	$4,230.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,230.86
Rate for Payer: Brighton Health Commercial	$8,673.58
Rate for Payer: Cash Price	$6,044.08
Rate for Payer: Cash Price	$6,044.08
Rate for Payer: Cash Price	$6,044.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,044.08
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	$6,044.08
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$5,137.47
Rate for Payer: Fidelis Essential Plan QHP	$5,379.23
Rate for Payer: Fidelis Medicare Advantage	$6,044.08
Rate for Payer: Fidelis Qualified Health Plan	$5,379.23
Rate for Payer: Group Health Inc Commercial	$6,044.08
Rate for Payer: Group Health Inc Medicare	$6,044.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,782.39
Rate for Payer: Hamaspik Choice Inc Medicare	$6,044.08
Rate for Payer: Healthfirst Medicare Advantage	$5,137.47
Rate for Payer: Healthfirst QHP	$6,044.08
Rate for Payer: Humana Medicare	$6,164.96
Rate for Payer: Senior Whole Health Medicare Advantage	$6,044.08
Rate for Payer: United Healthcare Commercial	$2,683.00
Rate for Payer: United Healthcare Medicare Advantage	$6,044.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,044.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,835.26
Rate for Payer: Wellcare Medicare	$5,741.88

AQUEOUS SHUNT EYE

Facility

$11,564.78

Service Code	HCPCS 66179
Hospital Charge Code	40001156
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,044.08

Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft

Facility

$4,795.87

Service Code	CPT 66180
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$4,795.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,701.83
Rate for Payer: Aetna Government	$4,701.83
Rate for Payer: Affinity Essential Plan 1&2	$3,291.28
Rate for Payer: Affinity Essential Plan 3&4	$3,291.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,291.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,701.83
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	$4,701.83
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,996.56
Rate for Payer: Fidelis Essential Plan QHP	$4,184.63
Rate for Payer: Fidelis Medicare Advantage	$4,701.83
Rate for Payer: Fidelis Qualified Health Plan	$4,184.63
Rate for Payer: Group Health Inc Commercial	$4,701.83
Rate for Payer: Group Health Inc Medicare	$4,701.83
Rate for Payer: Hamaspik Choice Inc Medicare	$4,701.83
Rate for Payer: Healthfirst Medicare Advantage	$3,996.56
Rate for Payer: Healthfirst QHP	$4,701.83
Rate for Payer: Humana Medicare	$4,795.87
Rate for Payer: Senior Whole Health Medicare Advantage	$4,701.83
Rate for Payer: United Healthcare Commercial	$2,683.00
Rate for Payer: United Healthcare Medicare Advantage	$4,701.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,701.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,761.46
Rate for Payer: Wellcare Medicare	$4,466.74

ARCH BAR REMOVAL- NOT BY 1ST O.S.

Facility

$851.00

Service Code	HCPCS D7997
Hospital Charge Code	42303359
Hospital Revenue Code	361
Min. Negotiated Rate	$84.72
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$468.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.72
Rate for Payer: Aetna Government	$84.72
Rate for Payer: Brighton Health Commercial	$638.25
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	$425.50
Rate for Payer: Group Health Inc Medicare	$297.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$425.50
Rate for Payer: Hamaspik Choice Inc Medicare	$425.50

ARCHON PLATE, 36MM 2-LEVEL

Facility

$3,595.00

Service Code	HCPCS C1713
Hospital Charge Code	64905576
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,774.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,977.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,157.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,797.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,067.12
Rate for Payer: EmblemHealth Commercial	$1,797.50
Rate for Payer: Fidelis Medicare Advantage	$3,774.75
Rate for Payer: Group Health Inc Commercial	$1,797.50
Rate for Payer: Group Health Inc Medicare	$1,258.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,797.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,336.75

ARCHON PLATE, 36MM 2-LEVEL

Facility

$3,595.00

Service Code	HCPCS C1713
Hospital Charge Code	64905576
Hospital Revenue Code	278
Min. Negotiated Rate	$1,797.50
Max. Negotiated Rate	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,797.50

ARCHON PLATE, 50MM 2-LEVEL

Facility

$3,595.00

Service Code	HCPCS C1713
Hospital Charge Code	64905581
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,774.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,977.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,157.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,797.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,067.12
Rate for Payer: EmblemHealth Commercial	$1,797.50
Rate for Payer: Fidelis Medicare Advantage	$3,774.75
Rate for Payer: Group Health Inc Commercial	$1,797.50
Rate for Payer: Group Health Inc Medicare	$1,258.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,797.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,336.75

ARCHON PLATE, 50MM 2-LEVEL

Facility

$3,595.00

Service Code	HCPCS C1713
Hospital Charge Code	64905581
Hospital Revenue Code	278
Min. Negotiated Rate	$1,797.50
Max. Negotiated Rate	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,797.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,797.50

ARCHON SCREW,4.0 X 13MM ST

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905422
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW,4.0 X 13MM ST

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905422
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$607.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: EmblemHealth Commercial	$506.25
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW, 4.0X15MM SELFTAP

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905578
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW, 4.0X15MM SELFTAP

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905578
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$607.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: EmblemHealth Commercial	$506.25
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW,4.0 X 15MM ST

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905420
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$607.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: EmblemHealth Commercial	$506.25
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW,4.0 X 15MM ST

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905420
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW, 4.0X17MM SELF-T

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905582
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW, 4.0X17MM SELF-T

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905582
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$607.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: EmblemHealth Commercial	$506.25
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW, 4.0X19MM SELFT

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905280
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$607.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: EmblemHealth Commercial	$506.25
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW, 4.0X19MM SELFT

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905280
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARCHON SCREW, 4.5X19MM SELFT

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905279
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$607.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: EmblemHealth Commercial	$506.25
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

ARCHON SCREW, 4.5X19MM SELFT

Facility

$1,012.50

Service Code	HCPCS C1713
Hospital Charge Code	64905279
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

ARGATROBAN 250MG/250ML NS - 5MG

Facility

$49.00

Hospital Charge Code	41658048
Hospital Revenue Code	250
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.50
Rate for Payer: Aetna Government	$24.50
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.85

ARGATROBAN 250MG/250ML NS -5MG

Facility

$49.00

Hospital Charge Code	41648048
Hospital Revenue Code	250
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.50
Rate for Payer: Aetna Government	$24.50
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.85

Know your out-of-pocket cost for care.

All Charges