St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEVOTHYROXINE SODIUM 125 MCG PO TABS [4424]

Facility

$0.66

Service Code	NDC 68180097109
Hospital Charge Code	68180097109
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
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	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
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	$0.43

LEVOTHYROXINE SODIUM 125 MCG PO TABS [4424]

Facility

$0.83

Service Code	NDC 00904695561
Hospital Charge Code	00904695561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
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	$0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
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	$0.54

LEVOTHYROXINE SODIUM 125 MCG PO TABS [4424]

Facility

$0.66

Service Code	NDC 00378181377
Hospital Charge Code	00378181377
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
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	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
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	$0.43

LEVOTHYROXINE SODIUM 150 MCG PO TABS [4425]

Facility

$0.85

Service Code	NDC 00904695661
Hospital Charge Code	00904695661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

LEVOTHYROXINE SODIUM 150 MCG PO TABS [4425]

Facility

$0.88

Service Code	NDC 60687053011
Hospital Charge Code	60687053011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

LEVOTHYROXINE SODIUM 150 MCG PO TABS [4425]

Facility

$0.71

Service Code	NDC 00527328846
Hospital Charge Code	00527328846
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 150 MCG PO TABS [4425]

Facility

$0.24

Service Code	NDC 72305015030
Hospital Charge Code	72305015030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

LEVOTHYROXINE SODIUM 150 MCG PO TABS [4425]

Facility

$0.68

Service Code	NDC 00378181577
Hospital Charge Code	00378181577
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 200 MCG/5ML IV SOLN [167876]

Facility

$53.21

Service Code	NDC 63323089010
Hospital Charge Code	63323089010
Hospital Revenue Code	278
Min. Negotiated Rate	$18.62
Max. Negotiated Rate	$55.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.61
Rate for Payer: Aetna Government	$26.61
Rate for Payer: Brighton Health Commercial	$31.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.60
Rate for Payer: EmblemHealth Commercial	$26.61
Rate for Payer: Fidelis Medicare Advantage	$55.87
Rate for Payer: Group Health Inc Commercial	$26.61
Rate for Payer: Group Health Inc Medicare	$18.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.61
Rate for Payer: Hamaspik Choice Inc Medicare	$26.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.59

LEVOTHYROXINE SODIUM 200 MCG/5ML IV SOLN [167876]

Facility

$53.21

Service Code	NDC 63323089010
Hospital Charge Code	63323089010
Hospital Revenue Code	278
Min. Negotiated Rate	$26.61
Max. Negotiated Rate	$26.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.61
Rate for Payer: Hamaspik Choice Inc Medicare	$26.61

LEVOTHYROXINE SODIUM 200 MCG IV SOLR [121483]

Facility

$228.42

Service Code	NDC 70860045210
Hospital Charge Code	70860045210
Hospital Revenue Code	278
Min. Negotiated Rate	$114.21
Max. Negotiated Rate	$114.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.21
Rate for Payer: Hamaspik Choice Inc Medicare	$114.21

LEVOTHYROXINE SODIUM 200 MCG IV SOLR [121483]

Facility

$253.39

Service Code	NDC 63323064710
Hospital Charge Code	63323064710
Hospital Revenue Code	278
Min. Negotiated Rate	$88.69
Max. Negotiated Rate	$266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$139.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$126.70
Rate for Payer: Aetna Government	$126.70
Rate for Payer: Brighton Health Commercial	$152.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$145.70
Rate for Payer: EmblemHealth Commercial	$126.70
Rate for Payer: Fidelis Medicare Advantage	$266.06
Rate for Payer: Group Health Inc Commercial	$126.70
Rate for Payer: Group Health Inc Medicare	$88.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.70
Rate for Payer: Hamaspik Choice Inc Medicare	$126.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$164.70

LEVOTHYROXINE SODIUM 200 MCG IV SOLR [121483]

Facility

$253.39

Service Code	NDC 42023020201
Hospital Charge Code	42023020201
Hospital Revenue Code	278
Min. Negotiated Rate	$88.69
Max. Negotiated Rate	$266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$139.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$126.70
Rate for Payer: Aetna Government	$126.70
Rate for Payer: Brighton Health Commercial	$152.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$145.70
Rate for Payer: EmblemHealth Commercial	$126.70
Rate for Payer: Fidelis Medicare Advantage	$266.06
Rate for Payer: Group Health Inc Commercial	$126.70
Rate for Payer: Group Health Inc Medicare	$88.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.70
Rate for Payer: Hamaspik Choice Inc Medicare	$126.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$164.70

LEVOTHYROXINE SODIUM 200 MCG IV SOLR [121483]

Facility

$228.42

Service Code	NDC 70860045210
Hospital Charge Code	70860045210
Hospital Revenue Code	278
Min. Negotiated Rate	$79.95
Max. Negotiated Rate	$239.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.21
Rate for Payer: Aetna Government	$114.21
Rate for Payer: Brighton Health Commercial	$137.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$114.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.34
Rate for Payer: EmblemHealth Commercial	$114.21
Rate for Payer: Fidelis Medicare Advantage	$239.84
Rate for Payer: Group Health Inc Commercial	$114.21
Rate for Payer: Group Health Inc Medicare	$79.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.21
Rate for Payer: Hamaspik Choice Inc Medicare	$114.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$148.47

LEVOTHYROXINE SODIUM 200 MCG IV SOLR [121483]

Facility

$253.39

Service Code	NDC 63323064710
Hospital Charge Code	63323064710
Hospital Revenue Code	278
Min. Negotiated Rate	$126.70
Max. Negotiated Rate	$126.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.70
Rate for Payer: Hamaspik Choice Inc Medicare	$126.70

LEVOTHYROXINE SODIUM 200 MCG IV SOLR [121483]

Facility

$253.39

Service Code	NDC 42023020201
Hospital Charge Code	42023020201
Hospital Revenue Code	278
Min. Negotiated Rate	$126.70
Max. Negotiated Rate	$126.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.70
Rate for Payer: Hamaspik Choice Inc Medicare	$126.70

LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]

Facility

$0.56

Service Code	NDC 60687045301
Hospital Charge Code	60687045301
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	$0.36

LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]

Facility

$0.46

Service Code	NDC 00527328046
Hospital Charge Code	00527328046
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]

Facility

$0.18

Service Code	NDC 72305002530
Hospital Charge Code	72305002530
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]

Facility

$0.55

Service Code	NDC 00904694961
Hospital Charge Code	00904694961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]

Facility

$0.44

Service Code	NDC 00378180077
Hospital Charge Code	00378180077
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.30
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]

Facility

$0.44

Service Code	NDC 68180096509
Hospital Charge Code	68180096509
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.30
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

LEVOTHYROXINE SODIUM 500 MCG IV SOLR [113058]

Facility

$633.49

Service Code	NDC 63323064810
Hospital Charge Code	63323064810
Hospital Revenue Code	278
Min. Negotiated Rate	$316.74
Max. Negotiated Rate	$316.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$316.74
Rate for Payer: Hamaspik Choice Inc Medicare	$316.74

LEVOTHYROXINE SODIUM 500 MCG IV SOLR [113058]

Facility

$633.49

Service Code	NDC 42023020301
Hospital Charge Code	42023020301
Hospital Revenue Code	278
Min. Negotiated Rate	$221.72
Max. Negotiated Rate	$665.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$348.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$316.74
Rate for Payer: Aetna Government	$316.74
Rate for Payer: Brighton Health Commercial	$380.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$316.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$364.26
Rate for Payer: EmblemHealth Commercial	$316.74
Rate for Payer: Fidelis Medicare Advantage	$665.16
Rate for Payer: Group Health Inc Commercial	$316.74
Rate for Payer: Group Health Inc Medicare	$221.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$316.74
Rate for Payer: Hamaspik Choice Inc Medicare	$316.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$411.77

LEVOTHYROXINE SODIUM 500 MCG IV SOLR [113058]

Facility

$633.49

Service Code	NDC 42023020301
Hospital Charge Code	42023020301
Hospital Revenue Code	278
Min. Negotiated Rate	$316.74
Max. Negotiated Rate	$316.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$316.74
Rate for Payer: Hamaspik Choice Inc Medicare	$316.74

Know your out-of-pocket cost for care.

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