St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INJ TESTOSTERONE CYPIONATE, 1MG

Facility

$21.00

Service Code	HCPCS J1071
Hospital Charge Code	41642458
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$13.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$12.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.08
Rate for Payer: Group Health Inc Commercial	$10.50
Rate for Payer: Group Health Inc Medicare	$7.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.01
Rate for Payer: SOMOS Essential	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.65

INJ TESTOSTERONE CYPIONATE, 1MG

Facility

$21.00

Service Code	HCPCS J1071
Hospital Charge Code	41652458
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$13.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$12.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.08
Rate for Payer: Group Health Inc Commercial	$10.50
Rate for Payer: Group Health Inc Medicare	$7.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.01
Rate for Payer: SOMOS Essential	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.65

INJ TESTOSTERONE CYPIONATE, 1MG

Facility

$21.00

Service Code	HCPCS J1071
Hospital Charge Code	41642458
Hospital Revenue Code	636
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10.50

INJ TESTOSTERONE CYPIONATE, 1MG

Facility

$21.00

Service Code	HCPCS J1071
Hospital Charge Code	41652458
Hospital Revenue Code	636
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.50
Rate for Payer: Hamaspik Choice Inc Medicare	$10.50

INJ TRIGGER POINT 1/2 MUSCLE

Facility

$792.83

Service Code	HCPCS 20552
Hospital Charge Code	30107560
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Affinity Essential Plan 1&2	$239.76
Rate for Payer: Affinity Essential Plan 3&4	$239.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$239.76
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$342.51
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
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	$342.51
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
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	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: Humana Medicare	$349.36
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$342.51
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

INJ TRIGGER POINT 1/2 MUSCLE

Facility

$792.83

Service Code	HCPCS 20552
Hospital Charge Code	30107560
Hospital Revenue Code	450
Rate for Payer: Cash Price	$342.51

INJ VANCOMYCIN 1250MG/250ML-500MG

Facility

$12.00

Service Code	HCPCS J3370
Hospital Charge Code	41647116
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$7.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

INJ VANCOMYCIN 1250MG/250ML-500MG

Facility

$12.00

Service Code	HCPCS J3370
Hospital Charge Code	41647116
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

INJ VANCOMYCIN 1250MG/250ML-500MG

Facility

$12.00

Service Code	HCPCS J3370
Hospital Charge Code	41657116
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

INJ VANCOMYCIN 1250MG/250ML-500MG

Facility

$12.00

Service Code	HCPCS J3370
Hospital Charge Code	41657116
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$7.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

INJ VANCOMYCIN 1500MG/250ML-500MG

Facility

$16.00

Service Code	HCPCS J3370
Hospital Charge Code	41647117
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

INJ VANCOMYCIN 1500MG/250ML-500MG

Facility

$16.00

Service Code	HCPCS J3370
Hospital Charge Code	41647117
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

INJVANCOMYCIN 1500MG/250ML-500MG

Facility

$16.00

Service Code	HCPCS J3370
Hospital Charge Code	41657117
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

INJVANCOMYCIN 1500MG/250ML-500MG

Facility

$16.00

Service Code	HCPCS J3370
Hospital Charge Code	41657117
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

INJ VANCOMYCIN 1750MG PER 500MG

Facility

$19.00

Service Code	HCPCS J3370
Hospital Charge Code	41647118
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

INJ VANCOMYCIN 1750MG PER 500MG

Facility

$19.00

Service Code	HCPCS J3370
Hospital Charge Code	41657118
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$12.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$11.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.92
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.35

INJ VANCOMYCIN 1750MG PER 500MG

Facility

$19.00

Service Code	HCPCS J3370
Hospital Charge Code	41657118
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

INJ VANCOMYCIN 1750MG PER 500MG

Facility

$19.00

Service Code	HCPCS J3370
Hospital Charge Code	41647118
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$12.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$11.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.92
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.35

INJ VANCOMYCIN 2000MG PER 500MG

Facility

$19.00

Service Code	HCPCS J3370
Hospital Charge Code	41647119
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

INJ VANCOMYCIN 2000MG PER 500MG

Facility

$19.00

Service Code	HCPCS J3370
Hospital Charge Code	41647119
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$12.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$11.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.92
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.35

INJ VANCOMYCIN 2000MG PER 500MG

Facility

$19.00

Service Code	HCPCS J3370
Hospital Charge Code	41657119
Hospital Revenue Code	636
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$12.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$11.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.92
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.73
Rate for Payer: SOMOS Essential	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.35

INJ VANCOMYCIN 2000MG PER 500MG

Facility

$19.00

Service Code	HCPCS J3370
Hospital Charge Code	41657119
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

INLAY-COMPOSITE/RESIN-ONE SURF. (

Facility

$1,240.31

Service Code	HCPCS D2650
Hospital Charge Code	42300500
Hospital Revenue Code	361
Min. Negotiated Rate	$620.16
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$682.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$930.23
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

INLAY-COMPOSITE/RESIN-ONE SURF. (

Facility

$1,240.31

Service Code	HCPCS D2650
Hospital Charge Code	42300500
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

INLAY-COMPOSITE/RESIN-THREE SURF.

Facility

$1,240.31

Service Code	HCPCS D2652
Hospital Charge Code	42300510
Hospital Revenue Code	361
Min. Negotiated Rate	$620.16
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$682.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$930.23
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

Know your out-of-pocket cost for care.

All Charges