St. Barnabas Hospital

All Charges

Charge

Type

Price

CEMENT BONE COBALT MV 40/20 SOFT

Facility OP

$962.50

Hospital Charge Code	64904864
Hospital Revenue Code	270
Min. Negotiated Rate	$336.88
Max. Negotiated Rate	$770.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$529.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$481.25
Rate for Payer: Aetna Government	$481.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$770.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$654.50
Rate for Payer: Group Health Inc Commercial	$481.25
Rate for Payer: Group Health Inc Medicare	$336.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$481.25
Rate for Payer: Hamaspik Choice Inc Medicare	$481.25

CEMENT BONE PALACOS R

Facility IP

$186.00

Service Code	HCPCS C1713
Hospital Charge Code	40209586
Hospital Revenue Code	278
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$93.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.00
Rate for Payer: Hamaspik Choice Inc Medicare	$93.00

CEMENT BONE PALACOS R

Facility OP

$186.00

Service Code	HCPCS C1713
Hospital Charge Code	40209586
Hospital Revenue Code	278
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$195.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$102.30
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	$93.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.95
Rate for Payer: Fidelis Medicare Advantage	$195.30
Rate for Payer: Group Health Inc Commercial	$93.00
Rate for Payer: Group Health Inc Medicare	$65.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.00
Rate for Payer: Hamaspik Choice Inc Medicare	$93.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$120.90

CEMENT BONE PALACOS R 1X40G

Facility OP

$550.00

Hospital Charge Code	64906468
Hospital Revenue Code	279
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.00
Rate for Payer: Aetna Government	$275.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.00
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

CEMENT BONE RADIOPAQ W/GEN

Facility OP

$1,550.00

Hospital Charge Code	64904693
Hospital Revenue Code	270
Min. Negotiated Rate	$542.50
Max. Negotiated Rate	$1,240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$852.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$775.00
Rate for Payer: Aetna Government	$775.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,054.00
Rate for Payer: Group Health Inc Commercial	$775.00
Rate for Payer: Group Health Inc Medicare	$542.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$775.00

CEMENT BONE SIMPLEX P RADIOPAQUE

Facility OP

$1,652.00

Service Code	HCPCS C1713
Hospital Charge Code	40209587
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,734.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$908.60
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	$826.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$949.90
Rate for Payer: Fidelis Medicare Advantage	$1,734.60
Rate for Payer: Group Health Inc Commercial	$826.00
Rate for Payer: Group Health Inc Medicare	$578.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$826.00
Rate for Payer: Hamaspik Choice Inc Medicare	$826.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,073.80

CEMENT BONE SIMPLEX P RADIOPAQUE

Facility OP

$348.50

Hospital Charge Code	64903940
Hospital Revenue Code	270
Min. Negotiated Rate	$121.98
Max. Negotiated Rate	$278.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$191.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$174.25
Rate for Payer: Aetna Government	$174.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$278.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$236.98
Rate for Payer: Group Health Inc Commercial	$174.25
Rate for Payer: Group Health Inc Medicare	$121.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.25
Rate for Payer: Hamaspik Choice Inc Medicare	$174.25

CEMENT BONE SIMPLEX P RADIOPAQUE

Facility IP

$1,652.00

Service Code	HCPCS C1713
Hospital Charge Code	40209587
Hospital Revenue Code	278
Min. Negotiated Rate	$826.00
Max. Negotiated Rate	$826.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$826.00
Rate for Payer: Hamaspik Choice Inc Medicare	$826.00

CEMENT BONE TOBRAMYCIN

Facility OP

$1,293.75

Hospital Charge Code	64904539
Hospital Revenue Code	270
Min. Negotiated Rate	$452.81
Max. Negotiated Rate	$1,035.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$711.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$646.88
Rate for Payer: Aetna Government	$646.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,035.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$879.75
Rate for Payer: Group Health Inc Commercial	$646.88
Rate for Payer: Group Health Inc Medicare	$452.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$646.88
Rate for Payer: Hamaspik Choice Inc Medicare	$646.88

CEMENTED HIP STEM

Facility IP

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	40200353
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

CEMENTED HIP STEM

Facility OP

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	40200353
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,887.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,512.50
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	$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

CEMENT PALACOS BONE 1X40SING

Facility OP

$197.13

Hospital Charge Code	64904436
Hospital Revenue Code	270
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$157.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.56
Rate for Payer: Aetna Government	$98.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$134.05
Rate for Payer: Group Health Inc Commercial	$98.56
Rate for Payer: Group Health Inc Medicare	$69.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.56
Rate for Payer: Hamaspik Choice Inc Medicare	$98.56

CEMENT RESTRICTER

Facility OP

$450.00

Hospital Charge Code	64906010
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$225.00
Rate for Payer: Aetna Government	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$306.00
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00

CENT DISTAL RELIANCE

Facility IP

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907267
Hospital Revenue Code	278
Min. Negotiated Rate	$203.88
Max. Negotiated Rate	$203.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88

CENT DISTAL RELIANCE

Facility OP

$407.75

Service Code	HCPCS C1776
Hospital Charge Code	64907267
Hospital Revenue Code	278
Min. Negotiated Rate	$142.71
Max. Negotiated Rate	$428.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.26
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	$203.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.46
Rate for Payer: Fidelis Medicare Advantage	$428.14
Rate for Payer: Group Health Inc Commercial	$203.88
Rate for Payer: Group Health Inc Medicare	$142.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.88
Rate for Payer: Hamaspik Choice Inc Medicare	$203.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.04

CENTRAL AUDITORY FUNC.TEST

Facility OP

$419.03

Service Code	HCPCS 92620
Hospital Charge Code	42004519
Hospital Revenue Code	471
Min. Negotiated Rate	$81.73
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.64
Rate for Payer: Aetna Government	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Elderplan Medicare Advantage	$180.64
Rate for Payer: EmblemHealth Commercial	$180.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$81.73
Rate for Payer: Fidelis Essential Plan Aliesa	$153.54
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$180.64
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$180.64
Rate for Payer: Group Health Inc Medicare	$180.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$180.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$90.81
Rate for Payer: Healthfirst Medicare Advantage	$153.54
Rate for Payer: Healthfirst QHP	$180.64
Rate for Payer: Senior Whole Health Medicare Advantage	$180.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.51
Rate for Payer: Wellcare Medicare	$171.61

CENTRAL VENOUS CATH > 5YRS

Facility OP

$4,940.28

Service Code	HCPCS 36556
Hospital Charge Code	30105875
Hospital Revenue Code	450
Min. Negotiated Rate	$90.69
Max. Negotiated Rate	$3,686.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$3,686.08
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,686.08
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	$3,686.08
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$90.69
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$3,686.08
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

CENTRAL VENOUS KIT

Facility OP

$70.52

Hospital Charge Code	40200869
Hospital Revenue Code	270
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$56.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.26
Rate for Payer: Aetna Government	$35.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.95
Rate for Payer: Group Health Inc Commercial	$35.26
Rate for Payer: Group Health Inc Medicare	$24.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.26
Rate for Payer: Hamaspik Choice Inc Medicare	$35.26

CEPACOL MOUTHWASH

Facility OP

$6.73

Hospital Charge Code	40200918
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

CEPHALEXIN 125 MG/5 ML SUSP

Facility OP

$0.10

Hospital Charge Code	41643594
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: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
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

CEPHALEXIN 125 MG/5 ML SUSP

Facility OP

$0.10

Hospital Charge Code	41653594
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: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
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

CEPHALEXIN 250 MG/5 ML SUSP

Facility OP

$0.11

Hospital Charge Code	41643504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

CEPHALEXIN 250 MG/5 ML SUSP

Facility OP

$0.11

Hospital Charge Code	41653504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

CEPHALEXIN 250MG/5ML UD

Facility OP

$1.52

Hospital Charge Code	41656556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: Group Health Inc Commercial	$0.76
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76
Rate for Payer: Hamaspik Choice Inc Medicare	$0.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

CEPHALEXIN 250 MG CAP

Facility OP

$0.04

Hospital Charge Code	41641655
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

Price Transparency.

All Charges