Price of TLH Uterus Removal 250g or Less at NYU Langone
Last Updated: 2024-07-01
Locations
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NYU Langone|Tisch Hospital
550 1st Ave., New York, NY 10016About TLH Uterus Removal 250g or Less
Service Codes: CPT 58570
This procedure involves the laparoscopic removal of the uterus when it weighs 250 grams or less. It is performed to treat various conditions such as fibroids, heavy bleeding, or other uterine disorders.
Pricing Overview
Cash Price
$128,850.31
(Based on gross charge; uninsured discount not provided)Median Price
$11,131.94
Price Range
$2,330.10 - $108,234.26
Insurance Plan Prices
| Insurance Provider | Plan Type | Price |
|---|---|---|
| Hamaspik | Medicare Advantage | $22,263.89 |
| UnitedHealthcare | WTC Health Program | $11,131.94 |
| Fidelis Care | Essential Plan 3 | $2,889.32 |
| BCBS (Out of State) | Indemnity | $24,649.00 |
| EmblemHealth | Enhanced Care (Medicaid) (SOMOS) | $2,446.60 |
| MetroPlus | PlatinumPlus | $22,041.25 |
| EmblemHealth | HIP Access II | $7,558.00 |
| EmblemHealth | Select Care Gold Exchange | $9,585.45 |
| HealthSmart | WTC Health Program - Stony Brook | $11,131.94 |
| MetroPlus | GoldPlus | $22,041.25 |
| MagnaCare | National Health Plan | $13,547.57 |
| MultiPlan | Mutual of Omaha | $100,503.24 |
| UnitedHealthcare | Golden Rule Insurance | $11,467.00 |
| Senior Whole Health | All Plans | $11,131.94 |
| EmblemHealth | CMO Essential Plan 2 | $2,796.12 |
| AgeWell (Deprecated) | Medicare Advantage | $11,131.94 |
| MetroPlus | MedPlus | $22,041.25 |
| EmblemHealth | HIP Child Health Plus | $2,330.10 |
| HealthSmart | WTC Health Program - Northwell | $11,131.94 |
| MetroPlus | Essential Plan 3-4 | $2,330.10 |
| UnitedHealthcare | Medicare Advantage Complete Choice Regional PPO | $11,131.94 |
| EmblemHealth | HIP PPO | $7,558.00 |
| Blue Cross Blue Shield | Blue Priority HMO | $24,649.00 |
| Blue Cross Blue Shield | Open Access PPO (Home-based Only) | $24,649.00 |
| EmblemHealth | Enhanced Care (Medicaid) SNP HARP (SOMOS) | $2,446.60 |
| Blue Cross Blue Shield | Blue Access HMO (Small Group) | $19,719.00 |
| Blue Cross Blue Shield | Blue Access gEPO (Small Group) | $19,719.00 |
| CenterLight | PACE Medicare HMO | $11,354.58 |
| UnitedHealthcare | Core | $11,467.00 |
| UnitedHealthcare | Navigate | $11,467.00 |
| UnitedHealthcare | Charter | $11,467.00 |
| Healthfirst | Essential Plan 3-4 | $3,903.97 |
| EmblemHealth | HIP | $7,558.00 |
| HealthSmart | WTC Health Program - Mt. Sinai | $11,131.94 |
| Blue Cross Blue Shield | Blue Priority EPO (Small Group) | $19,719.00 |
| EmblemHealth | American Plan Administrators | $11,277.00 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 3 (SOMOS) | $2,446.60 |
| MultiPlan | PPO | $100,503.24 |
| Cigna | MVP-Cigna Network | $5,418.00 |
| Blue Cross Blue Shield | Pathway | $2,796.12 |
| Blue Cross Blue Shield | PPO | $24,649.00 |
| EmblemHealth | Healthcare Partners Essential Plan 4 | $2,330.10 |
| EmblemHealth | GHI Medicare Supplement | $11,131.94 |
| BCBS (Out of State) | PPO (No Suitcase Logo) | $24,649.00 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 3 | $2,446.60 |
| Anthem BCBS HealthPlus | Essential Plan 2 | $4,660.19 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) Select/Extra HMO (HCP) | $11,131.94 |
| Aetna | HMO | $13,074.58 |
| Fidelis Care | Child Health Plus (CHP) | $2,889.32 |
| MultiPlan | Meritain Health | $100,503.24 |
| GEHA | All Plans | $13,074.58 |
| EmblemHealth | HIP Optum Health | $7,558.00 |
| EmblemHealth | HIP Montefiore | $7,558.00 |
| EmblemHealth | HIP VIP Medicare Bold | $11,131.94 |
| Blue Cross Blue Shield | Pathway X Enhanced | $2,796.12 |
| Fidelis Care | Gold for Children (Exchange) | $4,194.17 |
| MetroPlus | SilverPlus | $22,041.25 |
| MetroPlus | Essential Plan 1 | $2,330.10 |
| MultiPlan | Diversified Admin Corp | $100,503.24 |
| EmblemHealth | CMO Essential Plan 3 | $2,330.10 |
| Anthem BCBS HealthPlus | All Exchange Plans | $2,796.12 |
| UnitedHealthcare | Medicare Advantage | $11,131.94 |
| Anthem BCBS | Empire Plan, Value Options | $24,649.00 |
| UnitedHealthcare | AARP Medicare Advantage Complete Mosaic | $11,131.94 |
| MultiPlan | Teamsters Allied Benefits | $100,503.24 |
| MetroPlus | Essential Plan 4 | $2,330.10 |
| Aetna | Allied ASA PPO | $13,074.58 |
| Healthfirst | Senior Health Partners (MLTC) | $3,903.97 |
| Cigna | NALC PPO | $5,418.00 |
| Anthem BCBS HealthPlus | SOMOS Special Needs HARP | $2,446.60 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 4 | $2,446.60 |
| Cigna | Great West HMO | $5,418.00 |
| MultiPlan | Global Health Management | $100,503.24 |
| Cigna | Wellfleet Student | $5,418.00 |
| EmblemHealth | HIP compre health epo | $7,558.00 |
| First Health | PPO | $100,503.24 |
| MagnaCare | Independent Care Plus | $13,547.57 |
| Blue Cross Blue Shield | Indemnity | $24,649.00 |
| Aetna | Signature Administrators PPO | $13,074.58 |
| Cigna | Great West PPO | $5,418.00 |
| BCBS (Out of State) | PPO (Suitcase Logo) | $24,649.00 |
| MagnaCare | Capital District Physicians Health Plan | $13,547.57 |
| EmblemHealth | HIP POS | $7,558.00 |
| Aetna | Student Health | $13,074.58 |
| EmblemHealth | HIP Medicare Supplement | $11,131.94 |
| Blue Cross Blue Shield | PPO/EPO (Small Group) | $19,719.00 |
| Fidelis Care | Bronze (Exchange) | $4,194.17 |
| UnitedHealthcare | AARP Medicare Advantage Complete | $11,131.94 |
| EmblemHealth | HIP Long Island College Hospital (LICH) | $7,558.00 |
| CenterLight | Select | $11,354.58 |
| EmblemHealth | HIP Healthcare Partners HMO | $7,558.00 |
| UnitedHealthcare | Independent | $11,467.00 |
| Fidelis Care | Essential Plan 2 | $5,009.71 |
| Partners Health Plan | FIDA | $11,131.94 |
| EmblemHealth | Enhanced Care (Medicaid) Healthcare Partners | $2,330.10 |
| MagnaCare | Cement & Concrete Workers District Council | $13,547.57 |
| UnitedHealthcare | PPO | $11,467.00 |
| Health Net | PPO | $100,503.24 |
| EmblemHealth | HIP VIP Medicare Healthcare Partners | $11,131.94 |
| Aetna | Indemnity | $11,131.94 |
| Fidelis Care | Platinum (Exchange) | $4,194.17 |
| 1199SEIU Funds | PPO | $14,680.00 |
| EmblemHealth | Healthcare Partners Essential Plan 1, 200-250 | $2,796.12 |
| EmblemHealth | GHI Medicare HMO | $11,131.94 |
| UnitedHealthcare - Oxford | Metro | $10,145.00 |
| BCBS (Out of State) | HMO | $24,649.00 |
| BCBS (Out of State) | EPO (Suitcase Logo) | $24,649.00 |
| Anthem BCBS HealthPlus | Family Health Plus (Deprecated) | $2,330.10 |
| Aetna | POS | $13,074.58 |
| BCBS (Out of State) | HMO (Suitcase Logo) | $24,649.00 |
| UnitedHealthcare - Oxford | Medicare Advantage | $11,131.94 |
| EmblemHealth | Select Care Catastrophic Exchangeu00a0 | $9,585.45 |
| CenterLight | PACE | $11,354.58 |
| Blue Cross Blue Shield | Blue Access EPO (Small Group) | $19,719.00 |
| Blue Cross Blue Shield | Senior Care Supplemental | $11,131.94 |
| EmblemHealth | American Plan Administrators c/o H.D.A | $11,277.00 |
| EmblemHealth | Prime Silver | $9,585.45 |
| Aetna | Chesterfield Resources ASA PPO | $13,074.58 |
| Aetna | PPO | $13,074.58 |
| EmblemHealth | HIP VIP Medicare Affinity | $11,131.94 |
| Blue Cross Blue Shield | Blue Access EPO (Large Group) | $22,184.00 |
| EmblemHealth | Select Care Silver Exchange | $9,585.45 |
| VNS Health | EasyCare (Medicare Advantage) | $11,131.94 |
| Elderplan | FIDA | $11,131.94 |
| EmblemHealth | Healthcare Partners Essential Plans | $2,796.12 |
| Aetna | Healthscope ASA PPO | $13,074.58 |
| Cigna | Tufts Health Plan | $5,418.00 |
| Blue Cross Blue Shield | Hotel Trades Council | $24,649.00 |
| BCBS (Out of State) | EPO | $24,649.00 |
| Centers Plan for Healthy Living | All Plans | $11,131.94 |
| Aetna | Open Access Elect Choice EPO | $13,074.58 |
| Veterans Choice | Veterans Choice Program | $11,131.94 |
| EmblemHealth | BCBS GHI Composite | $24,649.00 |
| Aetna | Meritain Health | $13,074.58 |
| MagnaCare | JIB Employees Security Fund | $13,547.57 |
| EmblemHealth | HIP VIP Medicare Reserve | $11,131.94 |
| EmblemHealth | Essential Plan 1, 200-250 | $2,796.12 |
| Horizon BCBS | Direct | $24,649.00 |
| MultiPlan | Paramount Insurance | $100,503.24 |
| VNS Health | EasyCare Plus (Medicare+Medicaid) | $11,131.94 |
| Maksin Group | Consolidated Health Plan (Home-based only) | $5,418.00 |
| MetroPlus | GoldCare 2 | $4,986.41 |
| Blue Cross Blue Shield | Federal Program | $24,649.00 |
| EmblemHealth | CMO Essential Plan 1 | $2,796.12 |
| UnitedHealthcare | Choice | $11,467.00 |
| Aetna | Nippon Life ASA PPO | $13,074.58 |
| Cigna | PPO | $5,418.00 |
| Anthem BCBS HealthPlus | SOMOS Child Health Plus (CHP) | $2,446.60 |
| MultiPlan | US Life Insurance Co | $100,503.24 |
| BCBS (Out of State) | POS (No Suitcase Logo) | $24,649.00 |
| EmblemHealth | Select Care Bronze Exchange | $9,585.45 |
| Aetna | Global National Transplant | $13,074.58 |
| Aetna | Christian Brothers ASA PPO | $13,074.58 |
| 1199SEIU Funds | Member Choice Home Care Select | $14,680.00 |
| EmblemHealth | Enhanced Care (Medicaid) Child Health Plus (SOMOS) | $2,446.60 |
| Aetna | Medicare Advantage | $11,131.94 |
| Cigna | Open Access | $5,418.00 |
| EmblemHealth | Select Care Silver Small Group | $9,585.45 |
| MetroPlus | Gold | $4,986.41 |
| MultiPlan | Nippon Life | $100,503.24 |
| MagnaCare | Direct Plus | $13,547.57 |
| MultiPlan | Guardian Life Insurance Co | $100,503.24 |
| Anthem BCBS HealthPlus | Essential Plan 3 | $2,330.10 |
| EmblemHealth | Prime Bronze | $9,585.45 |
| Fidelis Care | Bronze for Children (Exchange) | $4,194.17 |
| EmblemHealth | Select Care Healthcare Partners | $9,585.45 |
| Champus | Unysis Corp | $11,131.94 |
| Carelon Behavioral Health | Medicaid Managed Care (Home-based Only) | $2,330.10 |
| CenterLight | Direct | $11,354.58 |
| VNS Health | MLTC (Medicaid) | $2,330.10 |
| First Health | Commercial HMO | $108,234.26 |
| Aetna | Coresource ASA PPO | $13,074.58 |
| EmblemHealth | Healthcare Partners Essential Plan 3 | $2,330.10 |
| Fidelis Care | Gold (Exchange) | $4,194.17 |
| HealthSmart | WTC Health Program - Logistic Health Inc | $11,131.94 |
| MetroPlus | Medicaid Managed Care | $2,330.10 |
| EmblemHealth | GHI HMO | $11,277.00 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) HMO (HCP) | $11,131.94 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 4 (SOMOS) | $2,446.60 |
| EmblemHealth | Select Care Platinum Small Group | $9,585.45 |
| BCBS (Out of State) | POS | $24,649.00 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) HMO | $11,131.94 |
| Healthfirst | Essential Plan 4 | $3,903.97 |
| Blue Cross Blue Shield | Local 32 BJ | $24,649.00 |
| Anthem BCBS | Optum | $24,649.00 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) PPO | $11,131.94 |
| UnitedHealthcare | POMCO (UMR) | $11,467.00 |
| UnitedHealthcare | AARP Medicare Advantage Complete Essentials | $11,131.94 |
| Healthfirst | Personal Wellness Plan (HARP) | $3,903.97 |
| EmblemHealth | Essential Plan 2 | $2,796.12 |
| UnitedHealthcare - Oxford | Freedom | $10,145.00 |
| MultiPlan | PHCS Savility | $100,503.24 |
| Aetna | Starmark ASA PPO | $13,074.58 |
| EmblemHealth | Essential Plan 4 | $2,330.10 |
| Healthfirst | Personal Wellness Plan (HARP) | $2,330.10 |
| UnitedHealthcare | AARP | $11,131.94 |
| Anthem BCBS HealthPlus | Medicare Advantage | $11,131.94 |
| Healthfirst | Medicaid Managed Care | $3,903.97 |
| Blue Cross Blue Shield | Pathway Enhanced | $2,796.12 |
| Cigna | Premier Plus | $5,418.00 |
| Aetna | Wellnet ASA PPO | $13,074.58 |
| EmblemHealth | Healthcare Partners Essential Plan 2 | $2,796.12 |
| EmblemHealth | Select Care Basic Exchange | $9,585.45 |
| MultiPlan | PHP Healthcare (Champus) | $100,503.24 |
| Cigna | Indemnity | $5,418.00 |
| Fidelis Care | Silver for Children (Exchange) | $4,194.17 |
| Fidelis Care | Essential Plan 4 | $2,889.32 |
| Cigna | LifeSOURCE | $5,418.00 |
| Anthem BCBS HealthPlus | Child Health Plus (CHP) | $2,330.10 |
| EmblemHealth | Vytra HMO | $7,558.00 |
| Fidelis Care | Catastrophic (Exchange) | $4,194.17 |
| Blue Cross Blue Shield | HMO | $24,649.00 |
| Cigna | Cigna Managed Care/POS | $5,418.00 |
| Fidelis Care | Platinum for Children (Exchange) | $4,194.17 |
| Blue Cross Blue Shield | Blue Connection | $24,649.00 |
| VA Community Care Network | Optum | $11,131.94 |
| Anthem BCBS HealthPlus | Essential Plan 1, 200-250 | $4,660.19 |
| Blue Cross Blue Shield | Healthy New York | $24,649.00 |
| Better Health Plan | All Plans | $108,234.26 |
| UnitedHealthcare | Choice (North Shore - LIJ) | $11,467.00 |
| HealthSmart | WTC Health Program - FDNY | $11,131.94 |
| MetroPlus | Essential Plan 3 | $2,330.10 |
| MetroPlus | Essential Plan 1-2, 200-250 | $2,330.10 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 2 (SOMOS) | $3,145.63 |
| Cigna | Evernorth Behavioral Health | $5,418.00 |
| Fidelis Care | Wellcare Medicare Advantage | $11,131.94 |
| Amida Care | Medicaid Managed Care | $2,330.10 |
| EmblemHealth | HIP VIP Medicare Montefiore | $11,131.94 |
| MetroPlus | Essential Plan 2 | $2,330.10 |
| Blue Cross Blue Shield | EPO | $24,649.00 |
| HealthSmart | WTC Health Program - NYCHHC | $11,131.94 |
| MultiPlan | Principal Financial Group | $100,503.24 |
| EmblemHealth | GHI EPO | $11,277.00 |
| Blue Cross Blue Shield | Blue Access PPO (Large Group) | $22,184.00 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 1 & 200-250 | $3,145.63 |
| Healthfirst | Essential Plan 3 | $3,903.97 |
| EmblemHealth | Select Care HMO | $9,585.45 |
| MultiPlan | Kaiser Permanente | $100,503.24 |
| 1199SEIU Funds | Home Care Benefit Fund | $14,680.00 |
| EmblemHealth | Select Care PPOu00a0 | $9,585.45 |
| MagnaCare | JIB Members | $13,547.57 |
| EmblemHealth | Essential Plan 3 | $2,330.10 |
| EmblemHealth | Select Care EPO | $9,585.45 |
| Blue Cross Blue Shield | UniCare | $24,649.00 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 1, 200-250 (SOMOS) | $3,145.63 |
| BCBS (Out of State) | POS (Suitcase Logo) | $24,649.00 |
| MultiPlan | Humana Health Plan | $100,503.24 |
| BCBS (Out of State) | HMO (No Suitcase Logo) | $24,649.00 |
| EmblemHealth | GHI Comprehensive Benefits Plan (CBP) | $11,277.00 |
| MultiPlan | QualCare Inc | $100,503.24 |
| EmblemHealth | HIP Prime Basic | $9,585.45 |
| Anthem BCBS HealthPlus | Special Needs Plan (SNP) | $2,330.10 |
| Anthem BCBS HealthPlus | SOMOS ny medicaid | $2,446.60 |
| EmblemHealth | Prime Platinum | $9,585.45 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 2 | $3,145.63 |
| EmblemHealth | Healthcare Partners Essential Plan 1-2 | $2,796.12 |
| EmblemHealth | VIP Prime HMO Medicare Advantage | $11,131.94 |
| Fidelis Care | Native American (Exchange) | $4,194.17 |
| HealthSmart | WTC Health Program - UMDNJ Rutgers | $11,131.94 |
| Fidelis Care | Silver 250 (Exchange) | $4,194.17 |
| Partners Health Plan | Medicare Advantage | $11,131.94 |
| Humana | All Commercial Plans | $100,503.24 |
| MetroPlus | Medicare Advantage | $11,131.94 |
| EmblemHealth | GHI PPO | $11,277.00 |
| VNS Health | SelectHealth (Medicaid) | $2,330.10 |
| EmblemHealth | Bridge | $7,558.00 |
| Elderplan | All Plans | $11,131.94 |
| BCBS (Out of State) | Medicare (Suitcase Logo) | $11,131.94 |
| VillageCareMAX | All Plans | $11,131.94 |
| MagnaCare | Direct Plus Preferred | $13,547.57 |
| EmblemHealth | GHI composite | $11,277.00 |
| UnitedHealthcare - Oxford | Optum Health | $10,145.00 |
| Blue Cross Blue Shield | Blue Access gEPO (Large Group) | $22,184.00 |
| MultiPlan | PHCS Director Guild | $100,503.24 |
| EmblemHealth | CMO Essential Plan 4 | $2,330.10 |
| MultiPlan | AXA Global Insurance | $100,503.24 |
| EmblemHealth | IUOE Local 14-14B | $11,277.00 |
| UnitedHealthcare - Oxford | Liberty | $10,145.00 |
| Blue Cross Blue Shield | POS | $24,649.00 |
| Blue Cross Blue Shield | Global Transplants | $24,649.00 |
| MultiPlan | Fiserv Health | $100,503.24 |
| MetroPlus | Child Health Plus (CHP) | $2,330.10 |
| Cigna | Open Access PPO | $5,418.00 |
| EmblemHealth | Enhanced Care (Medicaid) Montefiore | $2,330.10 |
| HealthSmart | WTC Health Program - NYU | $11,131.94 |
| Partners Health Plan | Medicaid | $2,330.10 |
| Aetna | Open Access HMO | $13,074.58 |
| Partners Health Plan | Medicare Advantage (Home-based Only) | $11,131.94 |
| Blue Cross Blue Shield | Blue Priority PPO | $24,649.00 |
| UnitedHealthcare | Optum Health | $11,467.00 |
| UnitedHealthcare | Student Resources | $11,467.00 |
| MagnaCare | PPO | $13,547.57 |
| Cigna | Open Access HMO | $5,418.00 |
| MagnaCare | American Plan Administrators | $13,547.57 |
| Fidelis Care | Essential Plan 1 | $5,009.71 |
| MultiPlan | Administrative Concepts | $100,503.24 |
| UnitedHealthcare | Choice (NY Power Authority) | $11,467.00 |
| EmblemHealth | HIP SmartStart | $7,558.00 |
| Healthfirst | Child Health Plus (CHP) | $3,903.97 |
| BCBS (Out of State) | Medicare (No Suitcase Logo) | $11,131.94 |
| Sedgwick | WTC Health Program - Northwell | $11,131.94 |
| UnitedHealthcare | HMO | $11,467.00 |
| BCBS (Out of State) | PPO | $24,649.00 |
| MultiPlan | Capital District Physicians Health Plan | $100,503.24 |
| AgeWell (Deprecated) | Medicaid Managed Care | $2,330.10 |
| BCBS (Out of State) | Medicare | $11,131.94 |
| Blue Cross Blue Shield | Open Access HMO (Home-based Only) | $24,649.00 |
| Anthem BCBS HealthPlus | Medicaid | $2,330.10 |
| EmblemHealth | GHI Medicare PPO | $11,131.94 |
| Blue Cross Blue Shield | Blue Access EPO (Large Group) (NY LI Local 1199SEIU) | $22,184.00 |
| Fidelis Care | Medicaid Managed Care | $2,889.32 |
| Fidelis Care | Silver (Exchange) | $4,194.17 |
| EmblemHealth | HIP Access I | $7,558.00 |
| BCBS (Out of State) | EPO (No Suitcase Logo) | $24,649.00 |
| EmblemHealth | Select Care Bronze Small Group | $9,585.45 |
| Carelon Behavioral Health | All Exchange Plans (Home-based Only) | $11,131.94 |
| UnitedHealthcare | EPO | $11,467.00 |
| MultiPlan | Screen Actors Guild | $100,503.24 |
| UnitedHealthcare | POMCO (UMR) | $100,503.24 |
| Cigna | HMO | $5,418.00 |
| Carelon Behavioral Health | Medicare Advantage (Home-based Only) | $11,131.94 |
| EmblemHealth | HIP EPO | $7,558.00 |
| EmblemHealth | GHI Behavioral Management Program | $11,277.00 |
| EmblemHealth | HIP HMO | $7,558.00 |
| MultiPlan | Global Excel Management | $100,503.24 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) Select HMO/Extra HMO | $11,131.94 |
| EmblemHealth | HIP compre health | $7,558.00 |
| EmblemHealth | WLNY-TV | $11,277.00 |
| EmblemHealth | Healthcare Partners Essential Plan 3-4 | $2,330.10 |
| EmblemHealth | Enhanced Care (Medicaid) | $2,330.10 |
| Anthem BCBS | All Plans | $24,649.00 |
| EmblemHealth | Prime Gold | $9,585.45 |
| Anthem BCBS HealthPlus | Essential Plan 4 | $2,330.10 |
| MultiPlan | Healthnet of California | $100,503.24 |
| MultiPlan | PHCS | $100,503.24 |
| Blue Cross Blue Shield | Child Health Plus (CHP) | $2,330.10 |
| EmblemHealth | Select Care Gold Small Group | $9,585.45 |
| Riverspring Health Plans | Medicare Advantage | $11,131.94 |
| EmblemHealth | Select Care Platinum Exchange | $9,585.45 |
| MetroPlus | BronzePlus | $22,041.25 |
| UnitedHealthcare | POS | $11,467.00 |
| Partners Health Plan | Medicaid MLTC | $2,330.10 |
| VNS Health | Total (Medicare + Medicaid) | $11,131.94 |