St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEVETIRACETAM (KEPPRA), S

Facility

$33.13

Service Code	HCPCS 80177
Hospital Charge Code	40609004
Hospital Revenue Code	300
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$26.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.25
Rate for Payer: Aetna Government	$13.25
Rate for Payer: Affinity Essential Plan 1&2	$9.28
Rate for Payer: Affinity Essential Plan 3&4	$9.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.28
Rate for Payer: Brighton Health Commercial	$24.85
Rate for Payer: Cash Price	$13.25
Rate for Payer: Cash Price	$13.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.53
Rate for Payer: Elderplan Medicare Advantage	$13.25
Rate for Payer: EmblemHealth Commercial	$13.25
Rate for Payer: Fidelis Essential Plan Aliesa	$11.26
Rate for Payer: Fidelis Essential Plan QHP	$11.79
Rate for Payer: Fidelis Medicare Advantage	$13.25
Rate for Payer: Fidelis Qualified Health Plan	$11.79
Rate for Payer: Group Health Inc Commercial	$13.25
Rate for Payer: Group Health Inc Medicare	$13.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56
Rate for Payer: Hamaspik Choice Inc Medicare	$13.25
Rate for Payer: Healthfirst Medicare Advantage	$13.25
Rate for Payer: Healthfirst QHP	$13.25
Rate for Payer: Humana Medicare	$13.52
Rate for Payer: Senior Whole Health Medicare Advantage	$13.25
Rate for Payer: United Healthcare Commercial	$16.28
Rate for Payer: United Healthcare Medicare Advantage	$13.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.60
Rate for Payer: Wellcare Medicare	$11.92

LEVETIRACETAM (KEPPRA), S

Facility

$33.13

Service Code	HCPCS 80177
Hospital Charge Code	40609004
Hospital Revenue Code	300
Rate for Payer: Cash Price	$13.25

LEVETIRACETAN ORAL 500MG/5ML UD

Facility

$4.71

Hospital Charge Code	41657917
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.06

LEVETIRACETAN ORAL 500MG/5ML UD

Facility

$4.71

Hospital Charge Code	41647917
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.20
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.06

LEVINE TRAY

Facility

$45.36

Hospital Charge Code	40203620
Hospital Revenue Code	270
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$36.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.68
Rate for Payer: Aetna Government	$22.68
Rate for Payer: Brighton Health Commercial	$34.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.84
Rate for Payer: Group Health Inc Commercial	$22.68
Rate for Payer: Group Health Inc Medicare	$15.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.68
Rate for Payer: Hamaspik Choice Inc Medicare	$22.68

LEVINE TUBE

Facility

$10.28

Hospital Charge Code	40207603
Hospital Revenue Code	270
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14

LEVINE TUBE

Facility

$13.82

Hospital Charge Code	40000255
Hospital Revenue Code	272
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$11.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.91
Rate for Payer: Aetna Government	$6.91
Rate for Payer: Brighton Health Commercial	$10.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.40
Rate for Payer: Group Health Inc Commercial	$6.91
Rate for Payer: Group Health Inc Medicare	$4.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.91
Rate for Payer: Hamaspik Choice Inc Medicare	$6.91

LEVINE TUBE

Facility

$10.98

Hospital Charge Code	40193680
Hospital Revenue Code	710
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.49
Rate for Payer: Aetna Government	$5.49
Rate for Payer: Brighton Health Commercial	$8.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.47
Rate for Payer: Group Health Inc Commercial	$5.49
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.49
Rate for Payer: Hamaspik Choice Inc Medicare	$5.49

LEVOBUNOLOL 0.25% OPHTH SOLN

Facility

$7.70

Hospital Charge Code	41641199
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.85
Rate for Payer: Aetna Government	$3.85
Rate for Payer: Brighton Health Commercial	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: Group Health Inc Commercial	$3.85
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85
Rate for Payer: Hamaspik Choice Inc Medicare	$3.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.00

LEVOBUNOLOL 0.25% OPHTH SOLN

Facility

$7.70

Hospital Charge Code	41651199
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.85
Rate for Payer: Aetna Government	$3.85
Rate for Payer: Brighton Health Commercial	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: Group Health Inc Commercial	$3.85
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85
Rate for Payer: Hamaspik Choice Inc Medicare	$3.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.00

LEVOBUNOLOL 0.5% OPHTH SOLN

Facility

$11.44

Hospital Charge Code	41651509
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$9.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.72
Rate for Payer: Aetna Government	$5.72
Rate for Payer: Brighton Health Commercial	$8.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.78
Rate for Payer: Group Health Inc Commercial	$5.72
Rate for Payer: Group Health Inc Medicare	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.44

LEVOBUNOLOL 0.5% OPHTH SOLN

Facility

$11.44

Hospital Charge Code	41641509
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$9.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.72
Rate for Payer: Aetna Government	$5.72
Rate for Payer: Brighton Health Commercial	$8.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.78
Rate for Payer: Group Health Inc Commercial	$5.72
Rate for Payer: Group Health Inc Medicare	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.44

LEVOBUNOLOL HCL 0.5 % OP SOLN [10394]

Facility

$4.84

Service Code	NDC 24208050505
Hospital Charge Code	24208050505
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$3.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$3.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.29
Rate for Payer: Group Health Inc Commercial	$2.42
Rate for Payer: Group Health Inc Medicare	$1.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.42
Rate for Payer: Hamaspik Choice Inc Medicare	$2.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.14

LEVOCARNITINE 100 MG/ML LIQUID

Facility

$0.26

Service Code	HCPCS J1955
Hospital Charge Code	41652663
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

LEVOCARNITINE 100 MG/ML LIQUID

Facility

$0.26

Service Code	HCPCS J1955
Hospital Charge Code	41642663
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$37.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.06
Rate for Payer: Aetna Government	$21.06
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.24
Rate for Payer: SOMOS Essential	$37.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

LEVOCARNITINE 100 MG/ML LIQUID

Facility

$0.26

Service Code	HCPCS J1955
Hospital Charge Code	41642663
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13

LEVOCARNITINE 100 MG/ML LIQUID

Facility

$0.26

Service Code	HCPCS J1955
Hospital Charge Code	41652663
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$37.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.06
Rate for Payer: Aetna Government	$21.06
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.24
Rate for Payer: SOMOS Essential	$37.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

LEVOCARNITINE 1 GM/10ML PO SOLN [41623]

Facility

$0.42

Service Code	NDC 54482014508
Hospital Charge Code	54482014508
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

LEVOCARNITINE 1 GM/10ML PO SOLN [41623]

Facility

$0.39

Service Code	NDC 64980050312
Hospital Charge Code	64980050312
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

LEVOCARNITINE 1 GM/10ML PO SOLN [41623]

Facility

$0.39

Service Code	NDC 70954014010
Hospital Charge Code	70954014010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

LEVOCARNITINE 200 MG/ML IV SOLN [20954]

Facility

$9.11

Service Code	HCPCS J1955
Hospital Charge Code	54482014701
Hospital Revenue Code	278
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.55
Rate for Payer: Hamaspik Choice Inc Medicare	$4.55

LEVOCARNITINE 200 MG/ML IV SOLN [20954]

Facility

$9.11

Service Code	HCPCS J1955
Hospital Charge Code	54482014701
Hospital Revenue Code	278
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$21.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.06
Rate for Payer: Aetna Government	$21.06
Rate for Payer: Brighton Health Commercial	$5.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: EmblemHealth Commercial	$4.55
Rate for Payer: Fidelis Medicare Advantage	$9.56
Rate for Payer: Group Health Inc Commercial	$4.55
Rate for Payer: Group Health Inc Medicare	$3.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.55
Rate for Payer: Hamaspik Choice Inc Medicare	$4.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.92

LEVOCARNITINE IV 1000MG/5ML

Facility

$82.60

Service Code	HCPCS J1955
Hospital Charge Code	41646647
Hospital Revenue Code	636
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$41.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.30
Rate for Payer: Hamaspik Choice Inc Medicare	$41.30

LEVOCARNITINE IV 1000MG/5ML

Facility

$82.60

Service Code	HCPCS J1955
Hospital Charge Code	41656647
Hospital Revenue Code	636
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$53.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.06
Rate for Payer: Aetna Government	$21.06
Rate for Payer: Brighton Health Commercial	$49.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.50
Rate for Payer: Group Health Inc Commercial	$41.30
Rate for Payer: Group Health Inc Medicare	$28.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.30
Rate for Payer: Hamaspik Choice Inc Medicare	$41.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.24
Rate for Payer: SOMOS Essential	$37.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.69

LEVOCARNITINE IV 1000MG/5ML

Facility

$82.60

Service Code	HCPCS J1955
Hospital Charge Code	41646647
Hospital Revenue Code	636
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$53.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.06
Rate for Payer: Aetna Government	$21.06
Rate for Payer: Brighton Health Commercial	$49.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.50
Rate for Payer: Group Health Inc Commercial	$41.30
Rate for Payer: Group Health Inc Medicare	$28.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.30
Rate for Payer: Hamaspik Choice Inc Medicare	$41.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.24
Rate for Payer: SOMOS Essential	$37.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.69

Know your out-of-pocket cost for care.

All Charges