St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ANTIPSYCHOTICS NOS 4-6 TRIFLUOPERAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034307
Hospital Revenue Code	301
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$281.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00

HC ANTIPSYCHOTICS NOS 4-6 TRIFLUOPERAZINE - BUNDLED CHARGE

Facility

$562.00

Service Code	CPT 80343
Hospital Charge Code	3018034307
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$421.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.16
Rate for Payer: EmblemHealth Commercial	$281.00
Rate for Payer: Group Health Inc Commercial	$281.00
Rate for Payer: Group Health Inc Medicare	$196.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00
Rate for Payer: Hamaspik Choice Inc Medicare	$281.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 7+ CHLORPROMAZINE - BUNDLED CHARGE

Facility

$843.00

Service Code	CPT 80344
Hospital Charge Code	3018034401
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$674.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$463.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$632.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$674.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$573.24
Rate for Payer: EmblemHealth Commercial	$421.50
Rate for Payer: Group Health Inc Commercial	$421.50
Rate for Payer: Group Health Inc Medicare	$295.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$421.50
Rate for Payer: Hamaspik Choice Inc Medicare	$421.50
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 7+ CHLORPROMAZINE - BUNDLED CHARGE

Facility

$843.00

Service Code	CPT 80344
Hospital Charge Code	3018034401
Hospital Revenue Code	301
Min. Negotiated Rate	$421.50
Max. Negotiated Rate	$421.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$421.50

HC ANTIPSYCHOTICS NOS 7+ FLUPHENAZINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034402
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: EmblemHealth Commercial	$25.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 7+ FLUPHENAZINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034402
Hospital Revenue Code	301
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00

HC ANTIPSYCHOTICS NOS 7+ PHENOTHIAZINE SERUM - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034403
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: EmblemHealth Commercial	$25.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 7+ PHENOTHIAZINE SERUM - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034403
Hospital Revenue Code	301
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00

HC ANTIPSYCHOTICS NOS 7+ PHENOTHIAZINE URINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034404
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: EmblemHealth Commercial	$25.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 7+ PHENOTHIAZINE URINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034404
Hospital Revenue Code	301
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00

HC ANTIPSYCHOTICS NOS 7+ PROMAZINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034405
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: EmblemHealth Commercial	$25.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 7+ PROMAZINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034405
Hospital Revenue Code	301
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00

HC ANTIPSYCHOTICS NOS 7+ PROMETHAZINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034406
Hospital Revenue Code	301
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00

HC ANTIPSYCHOTICS NOS 7+ PROMETHAZINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034406
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: EmblemHealth Commercial	$25.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 7+ TRIFLUOPERAZINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034407
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$40.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: EmblemHealth Commercial	$25.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTIPSYCHOTICS NOS 7+ TRIFLUOPERAZINE - BUNDLED CHARGE

Facility

$50.00

Service Code	CPT 80344
Hospital Charge Code	3018034407
Hospital Revenue Code	301
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$25.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00

HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 - CHLORPROMAZINE LEVEL

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034201
Hospital Revenue Code	301
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$140.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50

HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 - CHLORPROMAZINE LEVEL

Facility

$281.00

Service Code	CPT 80342
Hospital Charge Code	3018034201
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$224.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$210.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.08
Rate for Payer: EmblemHealth Commercial	$140.50
Rate for Payer: Group Health Inc Commercial	$140.50
Rate for Payer: Group Health Inc Medicare	$98.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.50
Rate for Payer: Hamaspik Choice Inc Medicare	$140.50
Rate for Payer: United Healthcare Commercial	$19.07

HC ANTISTREPTOLYSIN O SCREEN - ANTI-STREPTOLYSIN O

Facility

$14.00

Service Code	CPT 86063
Hospital Charge Code	3028606301
Hospital Revenue Code	302
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00

HC ANTISTREPTOLYSIN O SCREEN - ANTI-STREPTOLYSIN O

Facility

$14.00

Service Code	CPT 86063
Hospital Charge Code	3028606301
Hospital Revenue Code	302
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$10.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.77
Rate for Payer: Aetna Government	$5.77
Rate for Payer: Affinity Essential Plan 1&2	$4.04
Rate for Payer: Affinity Essential Plan 3&4	$4.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.04
Rate for Payer: Brighton Health Commercial	$10.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.26
Rate for Payer: Elderplan Medicare Advantage	$5.77
Rate for Payer: EmblemHealth Commercial	$5.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.19
Rate for Payer: Fidelis Essential Plan Aliesa	$4.90
Rate for Payer: Fidelis Essential Plan QHP	$5.14
Rate for Payer: Fidelis Medicare Advantage	$5.77
Rate for Payer: Fidelis Qualified Health Plan	$5.14
Rate for Payer: Group Health Inc Commercial	$5.77
Rate for Payer: Group Health Inc Medicare	$5.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.77
Rate for Payer: Hamaspik Choice Inc Medicare	$5.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.79
Rate for Payer: Healthfirst Essential Plan	$8.53
Rate for Payer: Healthfirst Medicare Advantage	$5.77
Rate for Payer: Healthfirst QHP	$5.77
Rate for Payer: Humana Medicare	$5.89
Rate for Payer: Senior Whole Health Medicare Advantage	$5.77
Rate for Payer: United Healthcare Commercial	$7.32
Rate for Payer: United Healthcare Medicare Advantage	$5.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.79
Rate for Payer: Wellcare Medicare	$5.19

HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER

Facility

$18.00

Service Code	CPT 86060
Hospital Charge Code	3028606001
Hospital Revenue Code	302
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00

HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER

Facility

$18.00

Service Code	CPT 86060
Hospital Charge Code	3028606001
Hospital Revenue Code	302
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$13.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.30
Rate for Payer: Aetna Government	$7.30
Rate for Payer: Affinity Essential Plan 1&2	$5.11
Rate for Payer: Affinity Essential Plan 3&4	$5.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.11
Rate for Payer: Brighton Health Commercial	$13.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.45
Rate for Payer: Elderplan Medicare Advantage	$7.30
Rate for Payer: EmblemHealth Commercial	$7.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.57
Rate for Payer: Fidelis Essential Plan Aliesa	$6.21
Rate for Payer: Fidelis Essential Plan QHP	$6.50
Rate for Payer: Fidelis Medicare Advantage	$7.30
Rate for Payer: Fidelis Qualified Health Plan	$6.50
Rate for Payer: Group Health Inc Commercial	$7.30
Rate for Payer: Group Health Inc Medicare	$7.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.30
Rate for Payer: Hamaspik Choice Inc Medicare	$7.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.25
Rate for Payer: Healthfirst Essential Plan	$11.81
Rate for Payer: Healthfirst Medicare Advantage	$7.30
Rate for Payer: Healthfirst QHP	$7.30
Rate for Payer: Humana Medicare	$7.45
Rate for Payer: Senior Whole Health Medicare Advantage	$7.30
Rate for Payer: United Healthcare Commercial	$9.24
Rate for Payer: United Healthcare Medicare Advantage	$7.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.25
Rate for Payer: Wellcare Medicare	$6.57

HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN III

Facility

$29.00

Service Code	CPT 85300
Hospital Charge Code	3058530001
Hospital Revenue Code	305
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$14.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.50

HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN III

Facility

$29.00

Service Code	CPT 85300
Hospital Charge Code	3058530001
Hospital Revenue Code	305
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$21.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.85
Rate for Payer: Aetna Government	$11.85
Rate for Payer: Affinity Essential Plan 1&2	$8.29
Rate for Payer: Affinity Essential Plan 3&4	$8.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.29
Rate for Payer: Brighton Health Commercial	$21.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.95
Rate for Payer: Elderplan Medicare Advantage	$11.85
Rate for Payer: EmblemHealth Commercial	$11.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.66
Rate for Payer: Fidelis Essential Plan Aliesa	$10.07
Rate for Payer: Fidelis Essential Plan QHP	$10.55
Rate for Payer: Fidelis Medicare Advantage	$11.85
Rate for Payer: Fidelis Qualified Health Plan	$10.55
Rate for Payer: Group Health Inc Commercial	$11.85
Rate for Payer: Group Health Inc Medicare	$11.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.85
Rate for Payer: Hamaspik Choice Inc Medicare	$11.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.52
Rate for Payer: Healthfirst Essential Plan	$21.42
Rate for Payer: Healthfirst Medicare Advantage	$11.85
Rate for Payer: Healthfirst QHP	$11.85
Rate for Payer: Humana Medicare	$12.09
Rate for Payer: Senior Whole Health Medicare Advantage	$11.85
Rate for Payer: United Healthcare Commercial	$15.01
Rate for Payer: United Healthcare Medicare Advantage	$11.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.52
Rate for Payer: Wellcare Medicare	$10.66

HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN PANEL

Facility

$29.00

Service Code	CPT 85300
Hospital Charge Code	3058530002
Hospital Revenue Code	305
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$21.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.85
Rate for Payer: Aetna Government	$11.85
Rate for Payer: Affinity Essential Plan 1&2	$8.29
Rate for Payer: Affinity Essential Plan 3&4	$8.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.29
Rate for Payer: Brighton Health Commercial	$21.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.95
Rate for Payer: Elderplan Medicare Advantage	$11.85
Rate for Payer: EmblemHealth Commercial	$11.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.66
Rate for Payer: Fidelis Essential Plan Aliesa	$10.07
Rate for Payer: Fidelis Essential Plan QHP	$10.55
Rate for Payer: Fidelis Medicare Advantage	$11.85
Rate for Payer: Fidelis Qualified Health Plan	$10.55
Rate for Payer: Group Health Inc Commercial	$11.85
Rate for Payer: Group Health Inc Medicare	$11.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.85
Rate for Payer: Hamaspik Choice Inc Medicare	$11.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.52
Rate for Payer: Healthfirst Essential Plan	$21.42
Rate for Payer: Healthfirst Medicare Advantage	$11.85
Rate for Payer: Healthfirst QHP	$11.85
Rate for Payer: Humana Medicare	$12.09
Rate for Payer: Senior Whole Health Medicare Advantage	$11.85
Rate for Payer: United Healthcare Commercial	$15.01
Rate for Payer: United Healthcare Medicare Advantage	$11.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.52
Rate for Payer: Wellcare Medicare	$10.66

Know your out-of-pocket cost for care.

All Charges