St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HB TAU PHOSPHORYLATED EACH

Facility

$35.00

Service Code	CPT 84393
Hospital Charge Code	3018439301
Hospital Revenue Code	301
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50

HB THERA INTRVTN-COGNITIVE FUNC, 1ST 15 MINS

Facility

$153.00

Service Code	CPT 97129 GO
Hospital Charge Code	4309712901
Hospital Revenue Code	430
Min. Negotiated Rate	$14.42
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.42
Rate for Payer: Aetna Government	$14.42
Rate for Payer: Affinity Essential Plan 1&2	$150.85
Rate for Payer: Affinity Essential Plan 3&4	$150.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$67.05
Rate for Payer: Amida Care Medicaid	$67.05
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$76.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$150.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$67.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67.05
Rate for Payer: Fidelis Essential Plan Aliesa	$150.85
Rate for Payer: Fidelis Essential Plan QHP	$150.85
Rate for Payer: Fidelis Qualified Health Plan	$70.40
Rate for Payer: Group Health Inc Commercial	$76.50
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.05
Rate for Payer: Hamaspik Choice Inc Medicare	$67.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67.05
Rate for Payer: Healthfirst Essential Plan	$150.85
Rate for Payer: Healthfirst QHP	$109.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67.05
Rate for Payer: SOMOS Essential	$150.85
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$150.85
Rate for Payer: United Healthcare Essential Plan 3&4	$73.75
Rate for Payer: United Healthcare Medicaid	$67.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67.05
Rate for Payer: Wellcare Medicare	$55.00

HB THERA INTRVTN-COGNITIVE FUNC, 1ST 15 MINS

Facility

$153.00

Service Code	CPT 97129 GO
Hospital Charge Code	4309712901
Hospital Revenue Code	430
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.50

HB THERA INTRVTN-COGNITIVE FUNC, EACH ADD'L 15 MINS

Facility

$61.00

Service Code	CPT 97130 GO
Hospital Charge Code	4309713001
Hospital Revenue Code	430
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$30.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50

HB THERA INTRVTN-COGNITIVE FUNC, EACH ADD'L 15 MINS

Facility

$61.00

Service Code	CPT 97130 GO
Hospital Charge Code	4309713001
Hospital Revenue Code	430
Min. Negotiated Rate	$13.79
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.79
Rate for Payer: Aetna Government	$13.79
Rate for Payer: Affinity Essential Plan 1&2	$150.85
Rate for Payer: Affinity Essential Plan 3&4	$150.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$67.05
Rate for Payer: Amida Care Medicaid	$67.05
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$30.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$150.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$67.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67.05
Rate for Payer: Fidelis Essential Plan Aliesa	$150.85
Rate for Payer: Fidelis Essential Plan QHP	$150.85
Rate for Payer: Fidelis Qualified Health Plan	$70.40
Rate for Payer: Group Health Inc Commercial	$30.50
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.05
Rate for Payer: Hamaspik Choice Inc Medicare	$67.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67.05
Rate for Payer: Healthfirst Essential Plan	$150.85
Rate for Payer: Healthfirst QHP	$109.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67.05
Rate for Payer: SOMOS Essential	$150.85
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$150.85
Rate for Payer: United Healthcare Essential Plan 3&4	$73.75
Rate for Payer: United Healthcare Medicaid	$67.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67.05
Rate for Payer: Wellcare Medicare	$55.00

HB THRC FASCIAL PLN BLK BI NFS

Facility

$2,253.00

Service Code	CPT 64469 50
Hospital Charge Code	3616446901
Hospital Revenue Code	361
Min. Negotiated Rate	$1,126.50
Max. Negotiated Rate	$1,126.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.50

HB THRC FASCIAL PLN BLK BI NFS

Facility

$2,253.00

Service Code	CPT 64469 50
Hospital Charge Code	3616446901
Hospital Revenue Code	361
Min. Negotiated Rate	$788.55
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,239.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,126.50
Rate for Payer: Aetna Government	$1,126.50
Rate for Payer: Brighton Health Commercial	$1,689.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$1,126.50
Rate for Payer: Group Health Inc Commercial	$1,126.50
Rate for Payer: Group Health Inc Medicare	$788.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,126.50

HB THRC FASCIAL PLN BLK BI NJX

Facility

$2,253.00

Service Code	CPT 64468 50
Hospital Charge Code	3616446801
Hospital Revenue Code	361
Min. Negotiated Rate	$1,126.50
Max. Negotiated Rate	$1,126.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.50

HB THRC FASCIAL PLN BLK BI NJX

Facility

$2,253.00

Service Code	CPT 64468 50
Hospital Charge Code	3616446801
Hospital Revenue Code	361
Min. Negotiated Rate	$788.55
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,239.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,126.50
Rate for Payer: Aetna Government	$1,126.50
Rate for Payer: Brighton Health Commercial	$1,689.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$1,126.50
Rate for Payer: Group Health Inc Commercial	$1,126.50
Rate for Payer: Group Health Inc Medicare	$788.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,126.50

HB THRC FASCIAL PLN BLK UNI NFS

Facility

$2,253.00

Service Code	CPT 64467
Hospital Charge Code	3616446701
Hospital Revenue Code	361
Min. Negotiated Rate	$1,126.50
Max. Negotiated Rate	$1,126.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.50

HB THRC FASCIAL PLN BLK UNI NFS

Facility

$2,253.00

Service Code	CPT 64467
Hospital Charge Code	3616446701
Hospital Revenue Code	361
Min. Negotiated Rate	$84.19
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,239.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,126.50
Rate for Payer: Aetna Government	$1,126.50
Rate for Payer: Brighton Health Commercial	$1,689.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$1,126.50
Rate for Payer: Group Health Inc Commercial	$1,126.50
Rate for Payer: Group Health Inc Medicare	$788.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,126.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$84.19

HB THRC FASCIAL PLN BLK UNI NJX

Facility

$2,253.00

Service Code	CPT 64466
Hospital Charge Code	3616446601
Hospital Revenue Code	361
Min. Negotiated Rate	$73.37
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,239.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,126.50
Rate for Payer: Aetna Government	$1,126.50
Rate for Payer: Brighton Health Commercial	$1,689.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$1,126.50
Rate for Payer: Group Health Inc Commercial	$1,126.50
Rate for Payer: Group Health Inc Medicare	$788.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,126.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73.37

HB THRC FASCIAL PLN BLK UNI NJX

Facility

$2,253.00

Service Code	CPT 64466
Hospital Charge Code	3616446601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,126.50
Max. Negotiated Rate	$1,126.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,126.50

HB TOTAL TAU

Facility

$35.00

Service Code	CPT 84394
Hospital Charge Code	3018439401
Hospital Revenue Code	301
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50

HB TOTAL TAU

Facility

$35.00

Service Code	CPT 84394
Hospital Charge Code	3018439401
Hospital Revenue Code	301
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$28.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.50
Rate for Payer: Aetna Government	$17.50
Rate for Payer: Brighton Health Commercial	$26.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.80
Rate for Payer: EmblemHealth Commercial	$17.50
Rate for Payer: Group Health Inc Commercial	$17.50
Rate for Payer: Group Health Inc Medicare	$12.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50

HB TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER

Facility

$147.00

Service Code	CPT G0127
Hospital Charge Code	510G012701
Hospital Revenue Code	510
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$73.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.50

HB TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER

Facility

$147.00

Service Code	CPT G0127
Hospital Charge Code	510G012701
Hospital Revenue Code	510
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.58
Rate for Payer: Aetna Government	$72.58
Rate for Payer: Affinity Essential Plan 1&2	$50.81
Rate for Payer: Affinity Essential Plan 3&4	$50.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$50.81
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$72.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$72.58
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$65.32
Rate for Payer: Fidelis Essential Plan Aliesa	$61.69
Rate for Payer: Fidelis Essential Plan QHP	$64.60
Rate for Payer: Fidelis Medicare Advantage	$72.58
Rate for Payer: Fidelis Qualified Health Plan	$64.60
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.58
Rate for Payer: Hamaspik Choice Inc Medicare	$72.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.03
Rate for Payer: Healthfirst Medicare Advantage	$61.69
Rate for Payer: Healthfirst QHP	$72.58
Rate for Payer: Humana Medicare	$74.03
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$76.21
Rate for Payer: Senior Whole Health Medicare Advantage	$72.58
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$72.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$68.95
Rate for Payer: Wellcare Medicare	$68.95

HB TRNSPL REJ KDN MRNA QPCR 139

Facility

$420.00

Service Code	CPT 81558
Hospital Charge Code	3108155801
Hospital Revenue Code	310
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$3,304.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,240.00
Rate for Payer: Aetna Government	$3,240.00
Rate for Payer: Affinity Essential Plan 1&2	$2,268.00
Rate for Payer: Affinity Essential Plan 3&4	$2,268.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,268.00
Rate for Payer: Brighton Health Commercial	$3,240.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,240.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$336.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$285.60
Rate for Payer: Elderplan Medicare Advantage	$3,240.00
Rate for Payer: EmblemHealth Commercial	$3,240.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,916.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,754.00
Rate for Payer: Fidelis Essential Plan QHP	$2,883.60
Rate for Payer: Fidelis Medicare Advantage	$3,240.00
Rate for Payer: Fidelis Qualified Health Plan	$2,883.60
Rate for Payer: Group Health Inc Commercial	$3,240.00
Rate for Payer: Group Health Inc Medicare	$3,240.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,240.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,240.00
Rate for Payer: Healthfirst Medicare Advantage	$3,240.00
Rate for Payer: Healthfirst QHP	$3,240.00
Rate for Payer: Humana Medicare	$3,304.80
Rate for Payer: Senior Whole Health Medicare Advantage	$3,240.00
Rate for Payer: United Healthcare Medicare Advantage	$3,240.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,240.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,078.00
Rate for Payer: Wellcare Medicare	$2,916.00

HB TRNSPL REJ KDN MRNA QPCR 139

Facility

$420.00

Service Code	CPT 81558
Hospital Charge Code	3108155801
Hospital Revenue Code	310
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.00

HB VEN-ARTL SHUNT DET MBUBB NJX

Facility

$377.00

Service Code	CPT 93898
Hospital Charge Code	9209389801
Hospital Revenue Code	920
Min. Negotiated Rate	$188.50
Max. Negotiated Rate	$188.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.50

HB VEN-ARTL SHUNT DET MBUBB NJX

Facility

$377.00

Service Code	CPT 93898
Hospital Charge Code	9209389801
Hospital Revenue Code	920
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$301.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$207.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$188.50
Rate for Payer: Aetna Government	$188.50
Rate for Payer: Brighton Health Commercial	$282.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$301.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$256.36
Rate for Payer: EmblemHealth Commercial	$188.50
Rate for Payer: Group Health Inc Commercial	$188.50
Rate for Payer: Group Health Inc Medicare	$131.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.50
Rate for Payer: Hamaspik Choice Inc Medicare	$188.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$271.55
Rate for Payer: United Healthcare Commercial	$94.00

HB VSRCTV STD TCD ICR ART COMPL

Facility

$377.00

Service Code	CPT 93896
Hospital Charge Code	9209389601
Hospital Revenue Code	920
Min. Negotiated Rate	$188.50
Max. Negotiated Rate	$188.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.50

HB VSRCTV STD TCD ICR ART COMPL

Facility

$377.00

Service Code	CPT 93896
Hospital Charge Code	9209389601
Hospital Revenue Code	920
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$301.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$207.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$188.50
Rate for Payer: Aetna Government	$188.50
Rate for Payer: Brighton Health Commercial	$282.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$301.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$256.36
Rate for Payer: EmblemHealth Commercial	$188.50
Rate for Payer: Group Health Inc Commercial	$188.50
Rate for Payer: Group Health Inc Medicare	$131.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.50
Rate for Payer: Hamaspik Choice Inc Medicare	$188.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$205.51
Rate for Payer: United Healthcare Commercial	$94.00

HC 1ST PSYC COLLAB CARE MGMT

Facility

$237.00

Service Code	CPT 99492
Hospital Charge Code	9009949201
Hospital Revenue Code	900
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$118.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.50

HC 1ST PSYC COLLAB CARE MGMT

Facility

$237.00

Service Code	CPT 99492
Hospital Charge Code	9009949201
Hospital Revenue Code	900
Min. Negotiated Rate	$79.11
Max. Negotiated Rate	$189.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.02
Rate for Payer: Aetna Government	$113.02
Rate for Payer: Affinity Essential Plan 1&2	$79.11
Rate for Payer: Affinity Essential Plan 3&4	$79.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$79.11
Rate for Payer: Brighton Health Commercial	$177.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$113.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$189.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.16
Rate for Payer: Elderplan Medicare Advantage	$113.02
Rate for Payer: EmblemHealth Commercial	$113.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$101.72
Rate for Payer: Fidelis Essential Plan Aliesa	$96.07
Rate for Payer: Fidelis Essential Plan QHP	$100.59
Rate for Payer: Fidelis Medicare Advantage	$113.02
Rate for Payer: Fidelis Qualified Health Plan	$100.59
Rate for Payer: Group Health Inc Commercial	$113.02
Rate for Payer: Group Health Inc Medicare	$113.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.02
Rate for Payer: Hamaspik Choice Inc Medicare	$113.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$103.85
Rate for Payer: Healthfirst Medicare Advantage	$96.07
Rate for Payer: Healthfirst QHP	$113.02
Rate for Payer: Humana Medicare	$115.28
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$118.67
Rate for Payer: Senior Whole Health Medicare Advantage	$113.02
Rate for Payer: United Healthcare Commercial	$118.50
Rate for Payer: United Healthcare Medicare Advantage	$113.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$113.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$107.37
Rate for Payer: Wellcare Medicare	$107.37

Know your out-of-pocket cost for care.

All Charges