St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN [167874]

Facility

$21.29

Service Code	NDC 63323088510
Hospital Charge Code	63323088510
Hospital Revenue Code	278
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$22.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.64
Rate for Payer: Aetna Government	$10.64
Rate for Payer: Brighton Health Commercial	$12.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.24
Rate for Payer: EmblemHealth Commercial	$10.64
Rate for Payer: Fidelis Medicare Advantage	$22.35
Rate for Payer: Group Health Inc Commercial	$10.64
Rate for Payer: Group Health Inc Medicare	$7.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.64
Rate for Payer: Hamaspik Choice Inc Medicare	$10.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.84

LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN [167874]

Facility

$21.29

Service Code	NDC 63323088510
Hospital Charge Code	63323088510
Hospital Revenue Code	278
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$10.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.64
Rate for Payer: Hamaspik Choice Inc Medicare	$10.64

LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN [167874]

Facility

$17.98

Service Code	NDC 63323088512
Hospital Charge Code	63323088512
Hospital Revenue Code	278
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$18.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.99
Rate for Payer: Aetna Government	$8.99
Rate for Payer: Brighton Health Commercial	$10.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.34
Rate for Payer: EmblemHealth Commercial	$8.99
Rate for Payer: Fidelis Medicare Advantage	$18.88
Rate for Payer: Group Health Inc Commercial	$8.99
Rate for Payer: Group Health Inc Medicare	$6.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.99
Rate for Payer: Hamaspik Choice Inc Medicare	$8.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.69

LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113060]

Facility

$113.40

Service Code	NDC 25021046810
Hospital Charge Code	25021046810
Hospital Revenue Code	278
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$119.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.70
Rate for Payer: Aetna Government	$56.70
Rate for Payer: Brighton Health Commercial	$68.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.20
Rate for Payer: EmblemHealth Commercial	$56.70
Rate for Payer: Fidelis Medicare Advantage	$119.07
Rate for Payer: Group Health Inc Commercial	$56.70
Rate for Payer: Group Health Inc Medicare	$39.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$56.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.71

LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113060]

Facility

$113.40

Service Code	NDC 25021046810
Hospital Charge Code	25021046810
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$56.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$56.70

LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113060]

Facility

$126.70

Service Code	NDC 63323064907
Hospital Charge Code	63323064907
Hospital Revenue Code	278
Min. Negotiated Rate	$63.35
Max. Negotiated Rate	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.35
Rate for Payer: Hamaspik Choice Inc Medicare	$63.35

LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113060]

Facility

$110.17

Service Code	NDC 63323064994
Hospital Charge Code	63323064994
Hospital Revenue Code	278
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$115.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.08
Rate for Payer: Aetna Government	$55.08
Rate for Payer: Brighton Health Commercial	$66.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.35
Rate for Payer: EmblemHealth Commercial	$55.08
Rate for Payer: Fidelis Medicare Advantage	$115.68
Rate for Payer: Group Health Inc Commercial	$55.08
Rate for Payer: Group Health Inc Medicare	$38.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.08
Rate for Payer: Hamaspik Choice Inc Medicare	$55.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.61

LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113060]

Facility

$126.70

Service Code	NDC 63323064907
Hospital Charge Code	63323064907
Hospital Revenue Code	278
Min. Negotiated Rate	$44.34
Max. Negotiated Rate	$133.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.35
Rate for Payer: Aetna Government	$63.35
Rate for Payer: Brighton Health Commercial	$76.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.85
Rate for Payer: EmblemHealth Commercial	$63.35
Rate for Payer: Fidelis Medicare Advantage	$133.04
Rate for Payer: Group Health Inc Commercial	$63.35
Rate for Payer: Group Health Inc Medicare	$44.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.35
Rate for Payer: Hamaspik Choice Inc Medicare	$63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$82.36

LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113060]

Facility

$113.40

Service Code	NDC 70860045110
Hospital Charge Code	70860045110
Hospital Revenue Code	278
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$119.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.70
Rate for Payer: Aetna Government	$56.70
Rate for Payer: Brighton Health Commercial	$68.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.20
Rate for Payer: EmblemHealth Commercial	$56.70
Rate for Payer: Fidelis Medicare Advantage	$119.07
Rate for Payer: Group Health Inc Commercial	$56.70
Rate for Payer: Group Health Inc Medicare	$39.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$56.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.71

LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113060]

Facility

$113.40

Service Code	NDC 70860045110
Hospital Charge Code	70860045110
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$56.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$56.70

LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113060]

Facility

$110.17

Service Code	NDC 63323064994
Hospital Charge Code	63323064994
Hospital Revenue Code	278
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$55.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.08
Rate for Payer: Hamaspik Choice Inc Medicare	$55.08

LEVOTHYROXINE SODIUM 100 MCG/ML IV SOLN [188764]

Facility

$89.92

Service Code	NDC 24201000201
Hospital Charge Code	24201000201
Hospital Revenue Code	278
Min. Negotiated Rate	$31.47
Max. Negotiated Rate	$94.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.96
Rate for Payer: Aetna Government	$44.96
Rate for Payer: Brighton Health Commercial	$53.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$44.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.70
Rate for Payer: EmblemHealth Commercial	$44.96
Rate for Payer: Fidelis Medicare Advantage	$94.42
Rate for Payer: Group Health Inc Commercial	$44.96
Rate for Payer: Group Health Inc Medicare	$31.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.96
Rate for Payer: Hamaspik Choice Inc Medicare	$44.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$58.45

LEVOTHYROXINE SODIUM 100 MCG/ML IV SOLN [188764]

Facility

$89.92

Service Code	NDC 24201000201
Hospital Charge Code	24201000201
Hospital Revenue Code	278
Min. Negotiated Rate	$44.96
Max. Negotiated Rate	$44.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.96
Rate for Payer: Hamaspik Choice Inc Medicare	$44.96

LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]

Facility

$0.56

Service Code	NDC 00378180977
Hospital Charge Code	00378180977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]

Facility

$0.70

Service Code	NDC 00904695361
Hospital Charge Code	00904695361
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]

Facility

$1.89

Service Code	NDC 00074662490
Hospital Charge Code	00074662490
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.29
Rate for Payer: Group Health Inc Commercial	$0.95
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.95
Rate for Payer: Hamaspik Choice Inc Medicare	$0.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.23

LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]

Facility

$0.56

Service Code	NDC 68180096901
Hospital Charge Code	68180096901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.37

LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]

Facility

$0.61

Service Code	NDC 51079044220
Hospital Charge Code	51079044220
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.31
Rate for Payer: Aetna Government	$0.31
Rate for Payer: Brighton Health Commercial	$0.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.42
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]

Facility

$0.72

Service Code	NDC 60687049711
Hospital Charge Code	60687049711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]

Facility

$0.20

Service Code	NDC 72305010030
Hospital Charge Code	72305010030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

LEVOTHYROXINE SODIUM 112 MCG PO TABS [10404]

Facility

$1.89

Service Code	NDC 00074929690
Hospital Charge Code	00074929690
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.29
Rate for Payer: Group Health Inc Commercial	$0.95
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.95
Rate for Payer: Hamaspik Choice Inc Medicare	$0.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.23

LEVOTHYROXINE SODIUM 112 MCG PO TABS [10404]

Facility

$0.65

Service Code	NDC 68180097009
Hospital Charge Code	68180097009
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

LEVOTHYROXINE SODIUM 112 MCG PO TABS [10404]

Facility

$0.68

Service Code	NDC 00527328546
Hospital Charge Code	00527328546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

LEVOTHYROXINE SODIUM 112 MCG PO TABS [10404]

Facility

$0.65

Service Code	NDC 00378181177
Hospital Charge Code	00378181177
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

LEVOTHYROXINE SODIUM 112 MCG PO TABS [10404]

Facility

$0.81

Service Code	NDC 00904695461
Hospital Charge Code	00904695461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.41
Rate for Payer: Aetna Government	$0.41
Rate for Payer: Brighton Health Commercial	$0.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.55
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.53

Know your out-of-pocket cost for care.

All Charges