St. Barnabas Hospital

All Charges

Charge

Type

Price

BIL STENT 7FR

Facility IP

$240.00

Service Code	HCPCS C1713
Hospital Charge Code	40209673
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.00
Rate for Payer: Hamaspik Choice Inc Medicare	$120.00

BIL STENT 7FR

Facility OP

$240.00

Service Code	HCPCS C1713
Hospital Charge Code	40209673
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$252.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.00
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	$120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$138.00
Rate for Payer: Fidelis Medicare Advantage	$252.00
Rate for Payer: Group Health Inc Commercial	$120.00
Rate for Payer: Group Health Inc Medicare	$84.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.00
Rate for Payer: Hamaspik Choice Inc Medicare	$120.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$156.00

BINDER ABDOMINAL MED/LG

Facility OP

$14.58

Hospital Charge Code	64901197
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$11.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.29
Rate for Payer: Aetna Government	$7.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.91
Rate for Payer: Group Health Inc Commercial	$7.29
Rate for Payer: Group Health Inc Medicare	$5.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.29
Rate for Payer: Hamaspik Choice Inc Medicare	$7.29

BIO BI-METRIC PORO

Facility OP

$12,462.66

Service Code	HCPCS C1776
Hospital Charge Code	40004051
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$13,085.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,854.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,231.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,166.03
Rate for Payer: Fidelis Medicare Advantage	$13,085.79
Rate for Payer: Group Health Inc Commercial	$6,231.33
Rate for Payer: Group Health Inc Medicare	$4,361.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,231.33
Rate for Payer: Hamaspik Choice Inc Medicare	$6,231.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,100.73

BIO BI-METRIC PORO

Facility IP

$12,462.66

Service Code	HCPCS C1776
Hospital Charge Code	40004051
Hospital Revenue Code	278
Min. Negotiated Rate	$6,231.33
Max. Negotiated Rate	$6,231.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,231.33
Rate for Payer: Hamaspik Choice Inc Medicare	$6,231.33

BIO COCR MOD HD 3M

Facility OP

$1,771.88

Service Code	HCPCS C1776
Hospital Charge Code	40004053
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,860.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$974.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$885.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,018.83
Rate for Payer: Fidelis Medicare Advantage	$1,860.47
Rate for Payer: Group Health Inc Commercial	$885.94
Rate for Payer: Group Health Inc Medicare	$620.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$885.94
Rate for Payer: Hamaspik Choice Inc Medicare	$885.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,151.72

BIO COCR MOD HD 3M

Facility IP

$1,771.88

Service Code	HCPCS C1776
Hospital Charge Code	40004053
Hospital Revenue Code	278
Min. Negotiated Rate	$885.94
Max. Negotiated Rate	$885.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$885.94
Rate for Payer: Hamaspik Choice Inc Medicare	$885.94

BIOCOMP CLSD SWIVLCK 4.75X19.1MM

Facility IP

$543.00

Service Code	HCPCS C1713
Hospital Charge Code	40205469
Hospital Revenue Code	278
Min. Negotiated Rate	$271.50
Max. Negotiated Rate	$271.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.50
Rate for Payer: Hamaspik Choice Inc Medicare	$271.50

BIOCOMP CLSD SWIVLCK 4.75X19.1MM

Facility OP

$543.00

Service Code	HCPCS C1713
Hospital Charge Code	40205469
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$570.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$298.65
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	$271.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$312.22
Rate for Payer: Fidelis Medicare Advantage	$570.15
Rate for Payer: Group Health Inc Commercial	$271.50
Rate for Payer: Group Health Inc Medicare	$190.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$271.50
Rate for Payer: Hamaspik Choice Inc Medicare	$271.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$352.95

BIOCOMPOSITE PUSHLOCK

Facility OP

$800.00

Service Code	HCPCS C1713
Hospital Charge Code	64903086
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$840.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$440.00
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	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$460.00
Rate for Payer: Fidelis Medicare Advantage	$840.00
Rate for Payer: Group Health Inc Commercial	$400.00
Rate for Payer: Group Health Inc Medicare	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$520.00

BIOCOMPOSITE PUSHLOCK

Facility IP

$800.00

Service Code	HCPCS C1713
Hospital Charge Code	64903086
Hospital Revenue Code	278
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00

BIOCOMPOSITE SWIVELOCK

Facility IP

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64902818
Hospital Revenue Code	278
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

BIOCOMPOSITE SWIVELOCK

Facility OP

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64902818
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,050.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
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	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,050.00
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$650.00

BIOFEED TRAIN, 1ST 15 MIN

Facility OP

$127.15

Service Code	HCPCS 90912 GP
Hospital Charge Code	41704101
Hospital Revenue Code	420
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.58
Rate for Payer: Aetna Government	$63.58
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$63.58
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.58
Rate for Payer: Hamaspik Choice Inc Medicare	$63.58
Rate for Payer: Wellcare Medicare	$55.00

BIOFEED TRAIN, EA ADDL 15 MIN

Facility OP

$70.78

Service Code	HCPCS 90913 GP
Hospital Charge Code	41704102
Hospital Revenue Code	420
Min. Negotiated Rate	$35.39
Max. Negotiated Rate	$182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.39
Rate for Payer: Aetna Government	$35.39
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$35.39
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.39
Rate for Payer: Hamaspik Choice Inc Medicare	$35.39
Rate for Payer: Wellcare Medicare	$55.00

BIOFIRE RESPIRATORY PANEL 2.1

Facility OP

$337.50

Service Code	HCPCS 0202U
Hospital Charge Code	40601994
Hospital Revenue Code	306
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$416.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$185.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$416.78
Rate for Payer: Aetna Government	$416.78
Rate for Payer: Cash Price	$416.78
Rate for Payer: Cash Price	$416.78
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$416.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$270.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$229.50
Rate for Payer: Elderplan Medicare Advantage	$416.78
Rate for Payer: EmblemHealth Commercial	$416.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$375.10
Rate for Payer: Fidelis Essential Plan Aliesa	$354.26
Rate for Payer: Fidelis Essential Plan QHP	$370.93
Rate for Payer: Fidelis Medicare Advantage	$416.78
Rate for Payer: Fidelis Qualified Health Plan	$370.93
Rate for Payer: Group Health Inc Commercial	$416.78
Rate for Payer: Group Health Inc Medicare	$416.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.75
Rate for Payer: Hamaspik Choice Inc Medicare	$416.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$416.78
Rate for Payer: Healthfirst Medicare Advantage	$354.26
Rate for Payer: Healthfirst QHP	$416.78
Rate for Payer: Senior Whole Health Medicare Advantage	$416.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$416.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$333.42
Rate for Payer: Wellcare Medicare	$375.10

BIOIMPEND/THORACIC

Facility OP

$330.23

Service Code	HCPCS 93701
Hospital Charge Code	30301326
Hospital Revenue Code	480
Min. Negotiated Rate	$29.54
Max. Negotiated Rate	$264.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.72
Rate for Payer: Aetna Government	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$264.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.56
Rate for Payer: Elderplan Medicare Advantage	$147.72
Rate for Payer: EmblemHealth Commercial	$147.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29.54
Rate for Payer: Fidelis Essential Plan Aliesa	$125.56
Rate for Payer: Fidelis Essential Plan QHP	$131.47
Rate for Payer: Fidelis Medicare Advantage	$147.72
Rate for Payer: Fidelis Qualified Health Plan	$131.47
Rate for Payer: Group Health Inc Commercial	$147.72
Rate for Payer: Group Health Inc Medicare	$147.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$147.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32.82
Rate for Payer: Healthfirst Medicare Advantage	$125.56
Rate for Payer: Healthfirst QHP	$147.72
Rate for Payer: Senior Whole Health Medicare Advantage	$147.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$147.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.18
Rate for Payer: Wellcare Medicare	$140.33

BIO IPERIA 7 DR-T ICD 392409

Facility OP

$28,500.00

Service Code	HCPCS C1721
Hospital Charge Code	66573280
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$29,925.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,675.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16,387.50
Rate for Payer: Fidelis Medicare Advantage	$29,925.00
Rate for Payer: Group Health Inc Commercial	$14,250.00
Rate for Payer: Group Health Inc Medicare	$9,975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18,525.00

BIOLOGICAL MESH 20 X 30CM

Facility IP

$42,572.00

Service Code	HCPCS Q4130
Hospital Charge Code	40005501
Hospital Revenue Code	636
Min. Negotiated Rate	$21,286.00
Max. Negotiated Rate	$21,286.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,286.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21,286.00

BIOLOGICAL MESH 20 X 30CM

Facility OP

$42,572.00

Service Code	HCPCS Q4130
Hospital Charge Code	40005501
Hospital Revenue Code	636
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$27,671.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23,414.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.94
Rate for Payer: Aetna Government	$13.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21,286.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$24,478.90
Rate for Payer: Group Health Inc Commercial	$21,286.00
Rate for Payer: Group Health Inc Medicare	$14,900.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,286.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21,286.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,671.80

BIOLOGIC GRAFTJACKET PER SQ CM

Facility OP

$28.28

Service Code	HCPCS Q4107
Hospital Charge Code	40203013
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$69.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.78
Rate for Payer: Aetna Government	$69.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.26
Rate for Payer: Group Health Inc Commercial	$14.14
Rate for Payer: Group Health Inc Medicare	$9.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.14
Rate for Payer: Hamaspik Choice Inc Medicare	$14.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.38

BIOLOGIC GRAFTJACKET PER SQ CM

Facility IP

$28.28

Service Code	HCPCS Q4107
Hospital Charge Code	40203013
Hospital Revenue Code	636
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$14.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.14
Rate for Payer: Hamaspik Choice Inc Medicare	$14.14

BIOLOGIC MATERIALS-S&O TIS REGE

Facility OP

$255.15

Service Code	HCPCS D4265
Hospital Charge Code	42303392
Hospital Revenue Code	361
Min. Negotiated Rate	$127.58
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$140.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
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	$127.58
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: Senior Whole Health 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

BIOLOGIC VITSS BMDL FM PK 5CC

Facility OP

$4,000.00

Hospital Charge Code	64906685
Hospital Revenue Code	279
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$3,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,720.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

BIOLOX DELTA CERAMIC 36MM

Facility OP

$5,194.00

Service Code	HCPCS C1776
Hospital Charge Code	40205018
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,453.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,856.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,597.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,986.55
Rate for Payer: Fidelis Medicare Advantage	$5,453.70
Rate for Payer: Group Health Inc Commercial	$2,597.00
Rate for Payer: Group Health Inc Medicare	$1,817.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,597.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,597.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,376.10

Price Transparency.

All Charges