St. Barnabas Hospital

All Charges

Charge

Type

Price

SILDENAFIL CIT 10MG/12.5ML

Facility OP

$55.00

Service Code	HCPCS J3490
Hospital Charge Code	41640293
Hospital Revenue Code	636
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$35.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.50
Rate for Payer: Aetna Government	$27.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
Rate for Payer: Group Health Inc Commercial	$27.50
Rate for Payer: Group Health Inc Medicare	$19.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.75

SILDENAFIL CIT 10MG/12.5ML

Facility OP

$55.00

Service Code	HCPCS J3490
Hospital Charge Code	41650293
Hospital Revenue Code	636
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$35.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.50
Rate for Payer: Aetna Government	$27.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
Rate for Payer: Group Health Inc Commercial	$27.50
Rate for Payer: Group Health Inc Medicare	$19.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.75

SILDENAFIL CIT 10MG/12.5ML

Facility IP

$55.00

Service Code	HCPCS J3490
Hospital Charge Code	41640293
Hospital Revenue Code	636
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$27.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50

SILDENAFIL CIT 10MG/12.5ML

Facility IP

$55.00

Service Code	HCPCS J3490
Hospital Charge Code	41650293
Hospital Revenue Code	636
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$27.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50

SILK SUTURES 2-0 SH

Facility OP

$295.00

Hospital Charge Code	64905813
Hospital Revenue Code	270
Min. Negotiated Rate	$103.25
Max. Negotiated Rate	$236.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.50
Rate for Payer: Aetna Government	$147.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$236.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$200.60
Rate for Payer: Group Health Inc Commercial	$147.50
Rate for Payer: Group Health Inc Medicare	$103.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.50
Rate for Payer: Hamaspik Choice Inc Medicare	$147.50

SILTEX LOW/MED HT CONTOUR PROF 2

Facility OP

$816.60

Service Code	HCPCS C1789
Hospital Charge Code	40205210
Hospital Revenue Code	278
Min. Negotiated Rate	$285.81
Max. Negotiated Rate	$857.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$449.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$408.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$469.54
Rate for Payer: Fidelis Medicare Advantage	$857.43
Rate for Payer: Group Health Inc Commercial	$408.30
Rate for Payer: Group Health Inc Medicare	$285.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$408.30
Rate for Payer: Hamaspik Choice Inc Medicare	$408.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$530.79

SILTEX LOW/MED HT CONTOUR PROF 2

Facility IP

$816.60

Service Code	HCPCS C1789
Hospital Charge Code	40205210
Hospital Revenue Code	278
Min. Negotiated Rate	$408.30
Max. Negotiated Rate	$408.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$408.30
Rate for Payer: Hamaspik Choice Inc Medicare	$408.30

SILTEX LOW/MED HT CONTOUR PROF 3

Facility OP

$2,850.00

Service Code	HCPCS C1789
Hospital Charge Code	40205763
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,992.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,567.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,425.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,638.75
Rate for Payer: Fidelis Medicare Advantage	$2,992.50
Rate for Payer: Group Health Inc Commercial	$1,425.00
Rate for Payer: Group Health Inc Medicare	$997.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,425.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,425.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,852.50

SILTEX LOW/MED HT CONTOUR PROF 3

Facility IP

$2,850.00

Service Code	HCPCS C1789
Hospital Charge Code	40205763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,425.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,425.00

SILTEX LOW/MED HT CONTOUR PROF I

Facility OP

$2,850.00

Service Code	HCPCS C1789
Hospital Charge Code	40208177
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$2,992.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,567.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,425.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,638.75
Rate for Payer: Fidelis Medicare Advantage	$2,992.50
Rate for Payer: Group Health Inc Commercial	$1,425.00
Rate for Payer: Group Health Inc Medicare	$997.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,425.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,425.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,852.50

SILTEX LOW/MED HT CONTOUR PROF I

Facility IP

$2,850.00

Service Code	HCPCS C1789
Hospital Charge Code	40208177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,425.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,425.00

SILTEX MED HT CON PRO XPNDR 500CC

Facility OP

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	40202281
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,887.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,512.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,581.25
Rate for Payer: Fidelis Medicare Advantage	$2,887.50
Rate for Payer: Group Health Inc Commercial	$1,375.00
Rate for Payer: Group Health Inc Medicare	$962.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,787.50

SILTEX MED HT CON PRO XPNDR 500CC

Facility IP

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	40202281
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.00
Max. Negotiated Rate	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,375.00

SILVER BUNIONECTOMY

Facility OP

$8,291.05

Service Code	HCPCS 28292
Hospital Charge Code	40082745
Hospital Revenue Code	360
Min. Negotiated Rate	$520.56
Max. Negotiated Rate	$4,145.52
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: 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	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$520.56
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 CHP/FHP/Medicaid	$578.40
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Senior Whole Health 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

SILVER NITRATE TOPICAL STICK

Facility OP

$1.00

Hospital Charge Code	41640491
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

SILVER NITRATE TOPICAL STICK

Facility OP

$1.00

Hospital Charge Code	41650491
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

SILVER PTX STENT

Facility IP

$3,737.50

Service Code	HCPCS C1874
Hospital Charge Code	64903949
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.75
Max. Negotiated Rate	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75

SILVER PTX STENT

Facility OP

$3,737.50

Service Code	HCPCS C1874
Hospital Charge Code	64903949
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$3,924.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,055.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,868.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,149.06
Rate for Payer: Fidelis Medicare Advantage	$3,924.38
Rate for Payer: Group Health Inc Commercial	$1,868.75
Rate for Payer: Group Health Inc Medicare	$1,308.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,868.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,868.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,429.38

SILVER SULFADIAZINE 1% CREAM 400 GRAMS

Facility OP

$34.90

Hospital Charge Code	41653443
Hospital Revenue Code	250
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$27.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.45
Rate for Payer: Aetna Government	$17.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.73
Rate for Payer: Group Health Inc Commercial	$17.45
Rate for Payer: Group Health Inc Medicare	$12.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.45
Rate for Payer: Hamaspik Choice Inc Medicare	$17.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.68

SILVER SULFADIAZINE 1% CREAM 400 GRAMS

Facility OP

$34.90

Hospital Charge Code	41643443
Hospital Revenue Code	250
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$27.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.45
Rate for Payer: Aetna Government	$17.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.73
Rate for Payer: Group Health Inc Commercial	$17.45
Rate for Payer: Group Health Inc Medicare	$12.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.45
Rate for Payer: Hamaspik Choice Inc Medicare	$17.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.68

SILVER SULFADIAZINE 1% CREAM 50 GRAMS

Facility OP

$2.18

Hospital Charge Code	41652371
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.09
Rate for Payer: Aetna Government	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.48
Rate for Payer: Group Health Inc Commercial	$1.09
Rate for Payer: Group Health Inc Medicare	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.09
Rate for Payer: Hamaspik Choice Inc Medicare	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.42

SILVER SULFADIAZINE 1% CREAM 50 GRAMS

Facility OP

$2.18

Hospital Charge Code	41642371
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$1.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.09
Rate for Payer: Aetna Government	$1.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.48
Rate for Payer: Group Health Inc Commercial	$1.09
Rate for Payer: Group Health Inc Medicare	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.09
Rate for Payer: Hamaspik Choice Inc Medicare	$1.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.42

SIM- 3/OR > TREAT AREAS

Facility OP

$1,015.13

Service Code	HCPCS 77290 TC
Hospital Charge Code	66542997
Hospital Revenue Code	333
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$812.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$558.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$507.56
Rate for Payer: Aetna Government	$507.56
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$812.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.29
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 Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$507.56
Rate for Payer: Group Health Inc Medicare	$355.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$507.56
Rate for Payer: Hamaspik Choice Inc Medicare	$507.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$456.22

SIM-3/OR > TREAT AREAS

Facility OP

$241.73

Service Code	HCPCS 77290
Hospital Charge Code	66542929
Hospital Revenue Code	333
Min. Negotiated Rate	$120.86
Max. Negotiated Rate	$427.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$427.29
Rate for Payer: Aetna Government	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Cash Price	$427.29
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$427.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.38
Rate for Payer: Elderplan Medicare Advantage	$427.29
Rate for Payer: EmblemHealth Commercial	$427.29
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	$427.29
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$427.29
Rate for Payer: Group Health Inc Medicare	$427.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.86
Rate for Payer: Hamaspik Choice Inc Medicare	$427.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$384.56
Rate for Payer: Healthfirst Medicare Advantage	$427.29
Rate for Payer: Healthfirst QHP	$427.29
Rate for Payer: Senior Whole Health Medicare Advantage	$427.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$341.83
Rate for Payer: Wellcare Medicare	$405.93

SIMETHICONE 40 MG/0.6 ML LIQUID

Facility OP

$1.00

Hospital Charge Code	41650344
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

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