St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CORTICAL SCREW 3.5X85MM SELF-TAP

Facility

$207.66

Service Code	HCPCS C1713
Hospital Charge Code	40007053
Hospital Revenue Code	278
Min. Negotiated Rate	$72.68
Max. Negotiated Rate	$218.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$124.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$103.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.40
Rate for Payer: EmblemHealth Commercial	$103.83
Rate for Payer: Fidelis Medicare Advantage	$218.04
Rate for Payer: Group Health Inc Commercial	$103.83
Rate for Payer: Group Health Inc Medicare	$72.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.83
Rate for Payer: Hamaspik Choice Inc Medicare	$103.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$134.98

CORTICAL SCREW 3.5X85MM SELF-TAP

Facility

$207.66

Service Code	HCPCS C1713
Hospital Charge Code	40007053
Hospital Revenue Code	278
Min. Negotiated Rate	$103.83
Max. Negotiated Rate	$103.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.83
Rate for Payer: Hamaspik Choice Inc Medicare	$103.83

CORTICAL SCREW 45/20 MM

Facility

$6,294.30

Service Code	HCPCS C1713
Hospital Charge Code	40209663
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,609.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,461.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,776.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,147.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,619.22
Rate for Payer: EmblemHealth Commercial	$3,147.15
Rate for Payer: Fidelis Medicare Advantage	$6,609.02
Rate for Payer: Group Health Inc Commercial	$3,147.15
Rate for Payer: Group Health Inc Medicare	$2,203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,147.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,147.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,091.30

CORTICAL SCREW 45/20 MM

Facility

$6,294.30

Service Code	HCPCS C1713
Hospital Charge Code	40209663
Hospital Revenue Code	278
Min. Negotiated Rate	$3,147.15
Max. Negotiated Rate	$3,147.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,147.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,147.15

CORTICOTROPIN 80 UNITS/ML SOLN

Facility

$9,315.00

Service Code	HCPCS J0800
Hospital Charge Code	41653147
Hospital Revenue Code	636
Min. Negotiated Rate	$3,260.25
Max. Negotiated Rate	$6,054.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,123.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,809.25
Rate for Payer: Aetna Government	$3,809.25
Rate for Payer: Brighton Health Commercial	$5,589.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,657.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,356.12
Rate for Payer: Group Health Inc Commercial	$4,657.50
Rate for Payer: Group Health Inc Medicare	$3,260.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,657.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,657.50
Rate for Payer: United Healthcare Commercial	$3,870.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,054.75

CORTICOTROPIN 80 UNITS/ML SOLN

Facility

$9,315.00

Service Code	HCPCS J0800
Hospital Charge Code	41643147
Hospital Revenue Code	636
Min. Negotiated Rate	$3,260.25
Max. Negotiated Rate	$6,054.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,123.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,809.25
Rate for Payer: Aetna Government	$3,809.25
Rate for Payer: Brighton Health Commercial	$5,589.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,657.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,356.12
Rate for Payer: Group Health Inc Commercial	$4,657.50
Rate for Payer: Group Health Inc Medicare	$3,260.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,657.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,657.50
Rate for Payer: United Healthcare Commercial	$3,870.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,054.75

CORTICOTROPIN 80 UNITS/ML SOLN

Facility

$9,315.00

Service Code	HCPCS J0800
Hospital Charge Code	41653147
Hospital Revenue Code	636
Min. Negotiated Rate	$4,657.50
Max. Negotiated Rate	$4,657.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,657.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,657.50

CORTICOTROPIN 80 UNITS/ML SOLN

Facility

$9,315.00

Service Code	HCPCS J0800
Hospital Charge Code	41643147
Hospital Revenue Code	636
Min. Negotiated Rate	$4,657.50
Max. Negotiated Rate	$4,657.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,657.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,657.50

CORTISOL

Facility

$40.75

Service Code	HCPCS 82533
Hospital Charge Code	40602558
Hospital Revenue Code	300
Rate for Payer: Cash Price	$16.30

CORTISOL

Facility

$40.75

Service Code	HCPCS 82533
Hospital Charge Code	40602558
Hospital Revenue Code	300
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$30.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.30
Rate for Payer: Aetna Government	$16.30
Rate for Payer: Affinity Essential Plan 1&2	$11.41
Rate for Payer: Affinity Essential Plan 3&4	$11.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.41
Rate for Payer: Brighton Health Commercial	$30.56
Rate for Payer: Cash Price	$16.30
Rate for Payer: Cash Price	$16.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.93
Rate for Payer: Elderplan Medicare Advantage	$16.30
Rate for Payer: EmblemHealth Commercial	$16.30
Rate for Payer: Fidelis Essential Plan Aliesa	$13.86
Rate for Payer: Fidelis Essential Plan QHP	$14.51
Rate for Payer: Fidelis Medicare Advantage	$16.30
Rate for Payer: Fidelis Qualified Health Plan	$14.51
Rate for Payer: Group Health Inc Commercial	$16.30
Rate for Payer: Group Health Inc Medicare	$16.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.38
Rate for Payer: Hamaspik Choice Inc Medicare	$16.30
Rate for Payer: Healthfirst Medicare Advantage	$16.30
Rate for Payer: Healthfirst QHP	$16.30
Rate for Payer: Humana Medicare	$16.63
Rate for Payer: Senior Whole Health Medicare Advantage	$16.30
Rate for Payer: United Healthcare Commercial	$20.66
Rate for Payer: United Healthcare Medicare Advantage	$16.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.04
Rate for Payer: Wellcare Medicare	$14.67

CORTISOL RIA PLASMA

Facility

$40.75

Service Code	HCPCS 82533
Hospital Charge Code	40607792
Hospital Revenue Code	301
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$30.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.30
Rate for Payer: Aetna Government	$16.30
Rate for Payer: Affinity Essential Plan 1&2	$11.41
Rate for Payer: Affinity Essential Plan 3&4	$11.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.41
Rate for Payer: Brighton Health Commercial	$30.56
Rate for Payer: Cash Price	$16.30
Rate for Payer: Cash Price	$16.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.93
Rate for Payer: Elderplan Medicare Advantage	$16.30
Rate for Payer: EmblemHealth Commercial	$16.30
Rate for Payer: Fidelis Essential Plan Aliesa	$13.86
Rate for Payer: Fidelis Essential Plan QHP	$14.51
Rate for Payer: Fidelis Medicare Advantage	$16.30
Rate for Payer: Fidelis Qualified Health Plan	$14.51
Rate for Payer: Group Health Inc Commercial	$16.30
Rate for Payer: Group Health Inc Medicare	$16.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.38
Rate for Payer: Hamaspik Choice Inc Medicare	$16.30
Rate for Payer: Healthfirst Medicare Advantage	$16.30
Rate for Payer: Healthfirst QHP	$16.30
Rate for Payer: Humana Medicare	$16.63
Rate for Payer: Senior Whole Health Medicare Advantage	$16.30
Rate for Payer: United Healthcare Commercial	$20.66
Rate for Payer: United Healthcare Medicare Advantage	$16.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.04
Rate for Payer: Wellcare Medicare	$14.67

CORTISOL RIA PLASMA

Facility

$40.75

Service Code	HCPCS 82533
Hospital Charge Code	40607792
Hospital Revenue Code	301
Rate for Payer: Cash Price	$16.30

COSYNTROPIN 0.25 MG IJ SOLR [9686]

Facility

$96.24

Service Code	HCPCS J0834
Hospital Charge Code	00781344071
Hospital Revenue Code	250
Min. Negotiated Rate	$28.59
Max. Negotiated Rate	$76.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.63
Rate for Payer: Aetna Government	$35.63
Rate for Payer: Brighton Health Commercial	$72.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.44
Rate for Payer: Group Health Inc Commercial	$48.12
Rate for Payer: Group Health Inc Medicare	$33.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.12
Rate for Payer: Hamaspik Choice Inc Medicare	$48.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$28.59
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$30.31
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$30.31
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$30.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.56

COSYNTROPIN 0.25 MG IJ SOLR [9686]

Facility

$96.24

Service Code	HCPCS J0834
Hospital Charge Code	00781344095
Hospital Revenue Code	250
Min. Negotiated Rate	$28.59
Max. Negotiated Rate	$76.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.63
Rate for Payer: Aetna Government	$35.63
Rate for Payer: Brighton Health Commercial	$72.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.44
Rate for Payer: Group Health Inc Commercial	$48.12
Rate for Payer: Group Health Inc Medicare	$33.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.12
Rate for Payer: Hamaspik Choice Inc Medicare	$48.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$28.59
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$30.31
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$30.31
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$30.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.56

COSYNTROPIN .25MG INJ

Facility

$211.84

Service Code	HCPCS J0834
Hospital Charge Code	41653071
Hospital Revenue Code	636
Min. Negotiated Rate	$105.92
Max. Negotiated Rate	$105.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.92
Rate for Payer: Hamaspik Choice Inc Medicare	$105.92

COSYNTROPIN .25MG INJ

Facility

$211.84

Service Code	HCPCS J0834
Hospital Charge Code	41643071
Hospital Revenue Code	636
Min. Negotiated Rate	$30.31
Max. Negotiated Rate	$137.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.63
Rate for Payer: Aetna Government	$35.63
Rate for Payer: Brighton Health Commercial	$127.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$121.81
Rate for Payer: Group Health Inc Commercial	$105.92
Rate for Payer: Group Health Inc Medicare	$74.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.92
Rate for Payer: Hamaspik Choice Inc Medicare	$105.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30.31
Rate for Payer: SOMOS Essential	$30.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$137.70

COSYNTROPIN .25MG INJ

Facility

$211.84

Service Code	HCPCS J0834
Hospital Charge Code	41653071
Hospital Revenue Code	636
Min. Negotiated Rate	$30.31
Max. Negotiated Rate	$137.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.63
Rate for Payer: Aetna Government	$35.63
Rate for Payer: Brighton Health Commercial	$127.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$121.81
Rate for Payer: Group Health Inc Commercial	$105.92
Rate for Payer: Group Health Inc Medicare	$74.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.92
Rate for Payer: Hamaspik Choice Inc Medicare	$105.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30.31
Rate for Payer: SOMOS Essential	$30.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$137.70

COSYNTROPIN .25MG INJ

Facility

$211.84

Service Code	HCPCS J0834
Hospital Charge Code	41643071
Hospital Revenue Code	636
Min. Negotiated Rate	$105.92
Max. Negotiated Rate	$105.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.92
Rate for Payer: Hamaspik Choice Inc Medicare	$105.92

COT FINGER LATEX STD SIZE

Facility

$0.03

Hospital Charge Code	64901151
Hospital Revenue Code	270
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
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: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
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

COTTLE NASEL KNIFE 5-1/2

Facility

$63.72

Hospital Charge Code	64905720
Hospital Revenue Code	270
Min. Negotiated Rate	$22.30
Max. Negotiated Rate	$50.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.86
Rate for Payer: Aetna Government	$31.86
Rate for Payer: Brighton Health Commercial	$47.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.33
Rate for Payer: Group Health Inc Commercial	$31.86
Rate for Payer: Group Health Inc Medicare	$22.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.86
Rate for Payer: Hamaspik Choice Inc Medicare	$31.86

Coude Cath.

Facility

$71.59

Hospital Charge Code	40200926
Hospital Revenue Code	270
Min. Negotiated Rate	$25.06
Max. Negotiated Rate	$57.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Brighton Health Commercial	$53.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.68
Rate for Payer: Group Health Inc Commercial	$35.80
Rate for Payer: Group Health Inc Medicare	$25.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.80
Rate for Payer: Hamaspik Choice Inc Medicare	$35.80

COUDE CATHETER

Facility

$22.32

Hospital Charge Code	40200075
Hospital Revenue Code	270
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$17.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.16
Rate for Payer: Aetna Government	$11.16
Rate for Payer: Brighton Health Commercial	$16.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.18
Rate for Payer: Group Health Inc Commercial	$11.16
Rate for Payer: Group Health Inc Medicare	$7.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.16
Rate for Payer: Hamaspik Choice Inc Medicare	$11.16

COUNTERSINK

Facility

$406.25

Service Code	HCPCS C1713
Hospital Charge Code	64903121
Hospital Revenue Code	278
Min. Negotiated Rate	$203.12
Max. Negotiated Rate	$203.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.12
Rate for Payer: Hamaspik Choice Inc Medicare	$203.12

COUNTERSINK

Facility

$406.25

Service Code	HCPCS C1713
Hospital Charge Code	64903121
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$426.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$243.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$203.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.59
Rate for Payer: EmblemHealth Commercial	$203.12
Rate for Payer: Fidelis Medicare Advantage	$426.56
Rate for Payer: Group Health Inc Commercial	$203.12
Rate for Payer: Group Health Inc Medicare	$142.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.12
Rate for Payer: Hamaspik Choice Inc Medicare	$203.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$264.06

COUNTER SINK 2.012.4

Facility

$286.00

Service Code	HCPCS C1713
Hospital Charge Code	40202305
Hospital Revenue Code	278
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$300.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$157.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$143.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.45
Rate for Payer: EmblemHealth Commercial	$143.00
Rate for Payer: Fidelis Medicare Advantage	$300.30
Rate for Payer: Group Health Inc Commercial	$143.00
Rate for Payer: Group Health Inc Medicare	$100.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.00
Rate for Payer: Hamaspik Choice Inc Medicare	$143.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.90

Know your out-of-pocket cost for care.

All Charges