St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEPUY UNIPLATE 16MM

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40205383
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00

DEPUY UNIPLATE 16MM

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40205383
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,677.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,402.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,530.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,466.25
Rate for Payer: EmblemHealth Commercial	$1,275.00
Rate for Payer: Fidelis Medicare Advantage	$2,677.50
Rate for Payer: Group Health Inc Commercial	$1,275.00
Rate for Payer: Group Health Inc Medicare	$892.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,657.50

DEPUY UNIPLATE 18MM

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40209925
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,677.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,402.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,530.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,466.25
Rate for Payer: EmblemHealth Commercial	$1,275.00
Rate for Payer: Fidelis Medicare Advantage	$2,677.50
Rate for Payer: Group Health Inc Commercial	$1,275.00
Rate for Payer: Group Health Inc Medicare	$892.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,657.50

DEPUY UNIPLATE 18MM

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40209925
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00

DEPUY WIDE HOOK

Facility

$2,182.95

Hospital Charge Code	40024028
Hospital Revenue Code	279
Min. Negotiated Rate	$764.03
Max. Negotiated Rate	$1,746.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,200.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,091.48
Rate for Payer: Aetna Government	$1,091.48
Rate for Payer: Brighton Health Commercial	$1,637.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,746.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,484.41
Rate for Payer: Group Health Inc Commercial	$1,091.48
Rate for Payer: Group Health Inc Medicare	$764.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,091.48
Rate for Payer: Hamaspik Choice Inc Medicare	$1,091.48

DERMABOND .5ML - KIT

Facility

$48.00

Hospital Charge Code	41657072
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.00
Rate for Payer: Aetna Government	$24.00
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.64
Rate for Payer: Group Health Inc Commercial	$24.00
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00
Rate for Payer: Hamaspik Choice Inc Medicare	$24.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.20

DERMABOND .5ML - KIT

Facility

$48.00

Hospital Charge Code	41647072
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.00
Rate for Payer: Aetna Government	$24.00
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.64
Rate for Payer: Group Health Inc Commercial	$24.00
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00
Rate for Payer: Hamaspik Choice Inc Medicare	$24.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.20

DERMABOND .5ML - REFILL

Facility

$48.00

Hospital Charge Code	41657073
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.00
Rate for Payer: Aetna Government	$24.00
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.64
Rate for Payer: Group Health Inc Commercial	$24.00
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00
Rate for Payer: Hamaspik Choice Inc Medicare	$24.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.20

DERMABOND .5ML - REFILL

Facility

$48.00

Hospital Charge Code	41647073
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.00
Rate for Payer: Aetna Government	$24.00
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.64
Rate for Payer: Group Health Inc Commercial	$24.00
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00
Rate for Payer: Hamaspik Choice Inc Medicare	$24.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.20

DERMAGRAFT 2X3 (11045)

Facility

$562.50

Service Code	HCPCS Q4106
Hospital Charge Code	64901193
Hospital Revenue Code	636
Min. Negotiated Rate	$32.03
Max. Negotiated Rate	$365.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.03
Rate for Payer: Aetna Government	$32.03
Rate for Payer: Brighton Health Commercial	$337.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.44
Rate for Payer: Group Health Inc Commercial	$281.25
Rate for Payer: Group Health Inc Medicare	$196.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$365.62

DERMAGRAFT 2X3 (11045)

Facility

$562.50

Service Code	HCPCS Q4106
Hospital Charge Code	64901193
Hospital Revenue Code	636
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.25
Rate for Payer: Hamaspik Choice Inc Medicare	$281.25

DERMAGRAFT PER 1 SQ CM

Facility

$81.06

Service Code	HCPCS Q4106
Hospital Charge Code	42500213
Hospital Revenue Code	636
Min. Negotiated Rate	$28.37
Max. Negotiated Rate	$52.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.03
Rate for Payer: Aetna Government	$32.03
Rate for Payer: Brighton Health Commercial	$48.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.61
Rate for Payer: Group Health Inc Commercial	$40.53
Rate for Payer: Group Health Inc Medicare	$28.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.53
Rate for Payer: Hamaspik Choice Inc Medicare	$40.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.69

DERMAGRAFT PER 1 SQ CM

Facility

$81.06

Service Code	HCPCS Q4106
Hospital Charge Code	42500213
Hospital Revenue Code	636
Min. Negotiated Rate	$40.53
Max. Negotiated Rate	$40.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.53
Rate for Payer: Hamaspik Choice Inc Medicare	$40.53

DERMAPHOR EX OINT [17369]

Facility

$0.05

Service Code	NDC 61924018404
Hospital Charge Code	61924018404
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
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	$0.02
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

DERMASORB DRESSING

Facility

$9.92

Hospital Charge Code	40204860
Hospital Revenue Code	270
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$7.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.96
Rate for Payer: Aetna Government	$4.96
Rate for Payer: Brighton Health Commercial	$7.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.75
Rate for Payer: Group Health Inc Commercial	$4.96
Rate for Payer: Group Health Inc Medicare	$3.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.96
Rate for Payer: Hamaspik Choice Inc Medicare	$4.96

DERMATONE BLADES

Facility

$8.51

Hospital Charge Code	40000180
Hospital Revenue Code	272
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.26
Rate for Payer: Aetna Government	$4.26
Rate for Payer: Brighton Health Commercial	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.79
Rate for Payer: Group Health Inc Commercial	$4.26
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.26
Rate for Payer: Hamaspik Choice Inc Medicare	$4.26

DERMATUME II AIR BLADES

Facility

$323.94

Hospital Charge Code	64905363
Hospital Revenue Code	270
Min. Negotiated Rate	$113.38
Max. Negotiated Rate	$259.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$161.97
Rate for Payer: Aetna Government	$161.97
Rate for Payer: Brighton Health Commercial	$242.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$259.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.28
Rate for Payer: Group Health Inc Commercial	$161.97
Rate for Payer: Group Health Inc Medicare	$113.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.97
Rate for Payer: Hamaspik Choice Inc Medicare	$161.97

DERMAVEST, PER SQ CM

Facility

$208.35

Service Code	HCPCS Q4153
Hospital Charge Code	30308127
Hospital Revenue Code	636
Min. Negotiated Rate	$104.18
Max. Negotiated Rate	$104.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.18
Rate for Payer: Hamaspik Choice Inc Medicare	$104.18

DERMAVEST, PER SQ CM

Facility

$208.35

Service Code	HCPCS Q4153
Hospital Charge Code	30308127
Hospital Revenue Code	636
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$135.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.60
Rate for Payer: Aetna Government	$47.60
Rate for Payer: Brighton Health Commercial	$125.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.80
Rate for Payer: Group Health Inc Commercial	$104.18
Rate for Payer: Group Health Inc Medicare	$72.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.18
Rate for Payer: Hamaspik Choice Inc Medicare	$104.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$133.09
Rate for Payer: SOMOS Essential	$133.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$135.43

DERM PROCEDURE FUNGUS CULTURE

Facility

$19.28

Service Code	HCPCS 87101
Hospital Charge Code	42201210
Hospital Revenue Code	306
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$14.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.71
Rate for Payer: Aetna Government	$7.71
Rate for Payer: Affinity Essential Plan 1&2	$5.40
Rate for Payer: Affinity Essential Plan 3&4	$5.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.40
Rate for Payer: Brighton Health Commercial	$14.46
Rate for Payer: Cash Price	$7.71
Rate for Payer: Cash Price	$7.71
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.38
Rate for Payer: Elderplan Medicare Advantage	$7.71
Rate for Payer: EmblemHealth Commercial	$7.71
Rate for Payer: Fidelis Essential Plan Aliesa	$6.55
Rate for Payer: Fidelis Essential Plan QHP	$6.86
Rate for Payer: Fidelis Medicare Advantage	$7.71
Rate for Payer: Fidelis Qualified Health Plan	$6.86
Rate for Payer: Group Health Inc Commercial	$7.71
Rate for Payer: Group Health Inc Medicare	$7.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.64
Rate for Payer: Hamaspik Choice Inc Medicare	$7.71
Rate for Payer: Healthfirst Medicare Advantage	$7.71
Rate for Payer: Healthfirst QHP	$7.71
Rate for Payer: Humana Medicare	$7.86
Rate for Payer: Senior Whole Health Medicare Advantage	$7.71
Rate for Payer: United Healthcare Commercial	$9.77
Rate for Payer: United Healthcare Medicare Advantage	$7.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.17
Rate for Payer: Wellcare Medicare	$6.94

DERM PROCEDURE FUNGUS CULTURE

Facility

$19.28

Service Code	HCPCS 87101
Hospital Charge Code	42201210
Hospital Revenue Code	306
Rate for Payer: Cash Price	$7.71

DERM PROCEDURE INTRALESIONAL

Facility

$529.23

Service Code	HCPCS 11900
Hospital Charge Code	42201220
Hospital Revenue Code	510
Rate for Payer: Cash Price	$231.52

DERM PROCEDURE INTRALESIONAL

Facility

$529.23

Service Code	HCPCS 11900
Hospital Charge Code	30305360
Hospital Revenue Code	510
Min. Negotiated Rate	$162.06
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Affinity Essential Plan 1&2	$162.06
Rate for Payer: Affinity Essential Plan 3&4	$162.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$162.06
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
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	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: Humana Medicare	$236.15
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

DERM PROCEDURE INTRALESIONAL

Facility

$529.23

Service Code	HCPCS 11900
Hospital Charge Code	30305360
Hospital Revenue Code	510
Rate for Payer: Cash Price	$231.52

DERM PROCEDURE INTRALESIONAL

Facility

$529.23

Service Code	HCPCS 11900
Hospital Charge Code	42201220
Hospital Revenue Code	510
Min. Negotiated Rate	$162.06
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Affinity Essential Plan 1&2	$162.06
Rate for Payer: Affinity Essential Plan 3&4	$162.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$162.06
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
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	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: Humana Medicare	$236.15
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$231.52
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

Know your out-of-pocket cost for care.

All Charges