St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC VENOGRAM SUPER VENA CAVA - IR VENO CAVAL SUPERIOR W SERIALOGRAPHY

Facility

$1,909.00

Service Code	CPT 75827 TC
Hospital Charge Code	3237582701
Hospital Revenue Code	323
Min. Negotiated Rate	$954.50
Max. Negotiated Rate	$954.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50

HC VENOUS ANASTOMOSIS, OPEN, PORTOCAVAL

Facility

$4,320.00

Service Code	CPT 37140 TC
Hospital Charge Code	3613714001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$3,240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,376.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,576.98
Rate for Payer: Aetna Government	$2,576.98
Rate for Payer: Brighton Health Commercial	$3,240.00
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	$2,160.00
Rate for Payer: Group Health Inc Commercial	$2,160.00
Rate for Payer: Group Health Inc Medicare	$1,512.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,160.00
Rate for Payer: United Healthcare Commercial	$1,496.00

HC VENOUS ANASTOMOSIS, OPEN, PORTOCAVAL

Facility

$4,320.00

Service Code	CPT 37140 TC
Hospital Charge Code	3613714001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$2,160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,160.00

HC VENOUS SAMPLING BY CATHETER - IR VENOUS SAMPLING CATHETERIZATION

Facility

$13,920.00

Service Code	CPT 75893 TC
Hospital Charge Code	3237589301
Hospital Revenue Code	323
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC VENOUS SAMPLING BY CATHETER - IR VENOUS SAMPLING CATHETERIZATION

Facility

$13,920.00

Service Code	CPT 75893 TC
Hospital Charge Code	3237589301
Hospital Revenue Code	323
Min. Negotiated Rate	$72.11
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,656.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.11
Rate for Payer: Aetna Government	$72.11
Rate for Payer: Brighton Health Commercial	$10,440.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$84.61
Rate for Payer: Group Health Inc Commercial	$6,960.00
Rate for Payer: Group Health Inc Medicare	$4,872.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$84.61
Rate for Payer: Healthfirst Essential Plan	$621.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$276.35

HC VENOUS SELECT SAMPLING W CATH

Facility

$600.00

Service Code	CPT 36500 TC
Hospital Charge Code	3613650001
Hospital Revenue Code	361
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00

HC VENOUS SELECT SAMPLING W CATH

Facility

$600.00

Service Code	CPT 36500 TC
Hospital Charge Code	3613650001
Hospital Revenue Code	361
Min. Negotiated Rate	$199.69
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$199.69
Rate for Payer: Aetna Government	$199.69
Rate for Payer: Brighton Health Commercial	$450.00
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	$300.00
Rate for Payer: Group Health Inc Commercial	$300.00
Rate for Payer: Group Health Inc Medicare	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$300.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC VENOUS THROMBOSIS IMAGING - NM EXTREMITY VEINS THROMBOSIS

Facility

$3,853.00

Service Code	CPT 78457 TC
Hospital Charge Code	3417845701
Hospital Revenue Code	341
Min. Negotiated Rate	$103.17
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$103.17
Rate for Payer: Aetna Government	$103.17
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$428.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.89
Rate for Payer: EmblemHealth Commercial	$126.94
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$126.94
Rate for Payer: Healthfirst Essential Plan	$320.58
Rate for Payer: United Healthcare Commercial	$160.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$142.48

HC VENOUS THROMBOSIS IMAGING - NM EXTREMITY VEINS THROMBOSIS

Facility

$3,853.00

Service Code	CPT 78457 TC
Hospital Charge Code	3417845701
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC VEN THROMBOSIS IMAGES BILAT - NM EXTREMITY VEINS THROMBOSIS BILAT

Facility

$1,114.00

Service Code	CPT 78458 TC
Hospital Charge Code	3417845801
Hospital Revenue Code	341
Min. Negotiated Rate	$557.00
Max. Negotiated Rate	$557.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00

HC VEN THROMBOSIS IMAGES BILAT - NM EXTREMITY VEINS THROMBOSIS BILAT

Facility

$1,114.00

Service Code	CPT 78458 TC
Hospital Charge Code	3417845801
Hospital Revenue Code	341
Min. Negotiated Rate	$89.12
Max. Negotiated Rate	$835.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$612.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$89.12
Rate for Payer: Aetna Government	$89.12
Rate for Payer: Brighton Health Commercial	$835.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$428.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.89
Rate for Payer: EmblemHealth Commercial	$155.93
Rate for Payer: Group Health Inc Commercial	$557.00
Rate for Payer: Group Health Inc Medicare	$389.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00
Rate for Payer: Hamaspik Choice Inc Medicare	$557.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.93
Rate for Payer: Healthfirst Essential Plan	$377.66
Rate for Payer: United Healthcare Commercial	$160.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$167.85

HC VENTILATOR TRANSPORT(IN HOUSE)

Facility

$421.00

Service Code	CPT 94799 TC
Hospital Charge Code	4609479901
Hospital Revenue Code	460
Min. Negotiated Rate	$210.50
Max. Negotiated Rate	$210.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.50

HC VENTILATOR TRANSPORT(IN HOUSE)

Facility

$421.00

Service Code	CPT 94799 TC
Hospital Charge Code	4609479901
Hospital Revenue Code	460
Min. Negotiated Rate	$147.35
Max. Negotiated Rate	$336.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$210.50
Rate for Payer: Aetna Government	$210.50
Rate for Payer: Brighton Health Commercial	$315.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$336.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$286.28
Rate for Payer: EmblemHealth Commercial	$210.50
Rate for Payer: Group Health Inc Commercial	$210.50
Rate for Payer: Group Health Inc Medicare	$147.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.50
Rate for Payer: Hamaspik Choice Inc Medicare	$210.50
Rate for Payer: United Healthcare Commercial	$210.50

HC VENTILATOR TRANSPORT(OUTSIDE)

Facility

$421.00

Service Code	CPT 94799 TC
Hospital Charge Code	4609479902
Hospital Revenue Code	460
Min. Negotiated Rate	$147.35
Max. Negotiated Rate	$336.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$231.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$210.50
Rate for Payer: Aetna Government	$210.50
Rate for Payer: Brighton Health Commercial	$315.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$336.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$286.28
Rate for Payer: EmblemHealth Commercial	$210.50
Rate for Payer: Group Health Inc Commercial	$210.50
Rate for Payer: Group Health Inc Medicare	$147.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.50
Rate for Payer: Hamaspik Choice Inc Medicare	$210.50
Rate for Payer: United Healthcare Commercial	$210.50

HC VENTILATOR TRANSPORT(OUTSIDE)

Facility

$421.00

Service Code	CPT 94799 TC
Hospital Charge Code	4609479902
Hospital Revenue Code	460
Min. Negotiated Rate	$210.50
Max. Negotiated Rate	$210.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$210.50

HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL

Facility

$1,957.00

Service Code	CPT 22512 TC
Hospital Charge Code	3612251201
Hospital Revenue Code	361
Min. Negotiated Rate	$684.95
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$997.09
Rate for Payer: Aetna Government	$997.09
Rate for Payer: Brighton Health Commercial	$1,467.75
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	$978.50
Rate for Payer: Group Health Inc Commercial	$978.50
Rate for Payer: Group Health Inc Medicare	$684.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$978.50
Rate for Payer: Hamaspik Choice Inc Medicare	$978.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL

Facility

$1,957.00

Service Code	CPT 22512 TC
Hospital Charge Code	3612251201
Hospital Revenue Code	361
Min. Negotiated Rate	$978.50
Max. Negotiated Rate	$978.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$978.50

HC VIRUS ID,NON-IMMUNOLOGIC METHOD - HSV CULTURE

Facility

$84.00

Service Code	CPT 87255
Hospital Charge Code	3068725501
Hospital Revenue Code	306
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00

HC VIRUS ID,NON-IMMUNOLOGIC METHOD - HSV CULTURE

Facility

$84.00

Service Code	CPT 87255
Hospital Charge Code	3068725501
Hospital Revenue Code	306
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$63.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33.86
Rate for Payer: Aetna Government	$33.86
Rate for Payer: Affinity Essential Plan 1&2	$23.70
Rate for Payer: Affinity Essential Plan 3&4	$23.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$23.70
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$33.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.46
Rate for Payer: Elderplan Medicare Advantage	$33.86
Rate for Payer: EmblemHealth Commercial	$33.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30.47
Rate for Payer: Fidelis Essential Plan Aliesa	$28.78
Rate for Payer: Fidelis Essential Plan QHP	$30.14
Rate for Payer: Fidelis Medicare Advantage	$33.86
Rate for Payer: Fidelis Qualified Health Plan	$30.14
Rate for Payer: Group Health Inc Commercial	$33.86
Rate for Payer: Group Health Inc Medicare	$33.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.86
Rate for Payer: Hamaspik Choice Inc Medicare	$33.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.83
Rate for Payer: Healthfirst Essential Plan	$15.37
Rate for Payer: Healthfirst Medicare Advantage	$33.86
Rate for Payer: Healthfirst QHP	$33.86
Rate for Payer: Humana Medicare	$34.54
Rate for Payer: Senior Whole Health Medicare Advantage	$33.86
Rate for Payer: United Healthcare Commercial	$42.89
Rate for Payer: United Healthcare Medicare Advantage	$33.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.83
Rate for Payer: Wellcare Medicare	$30.47

HC VIRUS ISOLATION, SHELL VIAL, EACH VIRUS

Facility

$48.00

Service Code	CPT 87254
Hospital Charge Code	3068725401
Hospital Revenue Code	306
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$36.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.56
Rate for Payer: Aetna Government	$19.56
Rate for Payer: Affinity Essential Plan 1&2	$13.69
Rate for Payer: Affinity Essential Plan 3&4	$13.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.69
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.99
Rate for Payer: Elderplan Medicare Advantage	$19.56
Rate for Payer: EmblemHealth Commercial	$19.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17.60
Rate for Payer: Fidelis Essential Plan Aliesa	$16.63
Rate for Payer: Fidelis Essential Plan QHP	$17.41
Rate for Payer: Fidelis Medicare Advantage	$19.56
Rate for Payer: Fidelis Qualified Health Plan	$17.41
Rate for Payer: Group Health Inc Commercial	$19.56
Rate for Payer: Group Health Inc Medicare	$19.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.56
Rate for Payer: Hamaspik Choice Inc Medicare	$19.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.83
Rate for Payer: Healthfirst Essential Plan	$15.37
Rate for Payer: Healthfirst Medicare Advantage	$19.56
Rate for Payer: Healthfirst QHP	$19.56
Rate for Payer: Humana Medicare	$19.95
Rate for Payer: Senior Whole Health Medicare Advantage	$19.56
Rate for Payer: United Healthcare Commercial	$24.77
Rate for Payer: United Healthcare Medicare Advantage	$19.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.83
Rate for Payer: Wellcare Medicare	$17.60

HC VIRUS ISOLATION, SHELL VIAL, EACH VIRUS

Facility

$48.00

Service Code	CPT 87254
Hospital Charge Code	3068725401
Hospital Revenue Code	306
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00

HC VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE IDENTIFICATION

Facility

$65.00

Service Code	CPT 87253
Hospital Charge Code	3068725301
Hospital Revenue Code	306
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50

HC VIRUS ISOLATION; TISSUE CULTURE, ADDITIONAL STUDIES OR DEFINITIVE IDENTIFICATION

Facility

$65.00

Service Code	CPT 87253
Hospital Charge Code	3068725301
Hospital Revenue Code	306
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$48.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.20
Rate for Payer: Aetna Government	$20.20
Rate for Payer: Affinity Essential Plan 1&2	$14.14
Rate for Payer: Affinity Essential Plan 3&4	$14.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.14
Rate for Payer: Brighton Health Commercial	$48.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.89
Rate for Payer: Elderplan Medicare Advantage	$20.20
Rate for Payer: EmblemHealth Commercial	$20.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.18
Rate for Payer: Fidelis Essential Plan Aliesa	$17.17
Rate for Payer: Fidelis Essential Plan QHP	$17.98
Rate for Payer: Fidelis Medicare Advantage	$20.20
Rate for Payer: Fidelis Qualified Health Plan	$17.98
Rate for Payer: Group Health Inc Commercial	$20.20
Rate for Payer: Group Health Inc Medicare	$20.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.20
Rate for Payer: Hamaspik Choice Inc Medicare	$20.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.20
Rate for Payer: Healthfirst Essential Plan	$45.45
Rate for Payer: Healthfirst Medicare Advantage	$20.20
Rate for Payer: Healthfirst QHP	$20.20
Rate for Payer: Humana Medicare	$20.60
Rate for Payer: Senior Whole Health Medicare Advantage	$20.20
Rate for Payer: United Healthcare Commercial	$25.58
Rate for Payer: United Healthcare Medicare Advantage	$20.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.20
Rate for Payer: Wellcare Medicare	$18.18

HC VIRUS ISOLATION, TISSUE CULTURE INOCULATION

Facility

$65.00

Service Code	CPT 87252
Hospital Charge Code	3068725201
Hospital Revenue Code	306
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50

HC VIRUS ISOLATION, TISSUE CULTURE INOCULATION

Facility

$65.00

Service Code	CPT 87252
Hospital Charge Code	3068725201
Hospital Revenue Code	306
Min. Negotiated Rate	$18.25
Max. Negotiated Rate	$58.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.07
Rate for Payer: Aetna Government	$26.07
Rate for Payer: Affinity Essential Plan 1&2	$18.25
Rate for Payer: Affinity Essential Plan 3&4	$18.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$18.25
Rate for Payer: Brighton Health Commercial	$48.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$26.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.29
Rate for Payer: Elderplan Medicare Advantage	$26.07
Rate for Payer: EmblemHealth Commercial	$26.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23.46
Rate for Payer: Fidelis Essential Plan Aliesa	$22.16
Rate for Payer: Fidelis Essential Plan QHP	$23.20
Rate for Payer: Fidelis Medicare Advantage	$26.07
Rate for Payer: Fidelis Qualified Health Plan	$23.20
Rate for Payer: Group Health Inc Commercial	$26.07
Rate for Payer: Group Health Inc Medicare	$26.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.07
Rate for Payer: Hamaspik Choice Inc Medicare	$26.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26.07
Rate for Payer: Healthfirst Essential Plan	$58.66
Rate for Payer: Healthfirst Medicare Advantage	$26.07
Rate for Payer: Healthfirst QHP	$26.07
Rate for Payer: Humana Medicare	$26.59
Rate for Payer: Senior Whole Health Medicare Advantage	$26.07
Rate for Payer: United Healthcare Commercial	$33.01
Rate for Payer: United Healthcare Medicare Advantage	$26.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.07
Rate for Payer: Wellcare Medicare	$23.46

Know your out-of-pocket cost for care.

All Charges