St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE 2% + EPINEPHRINE 1

Facility

$4.00

Hospital Charge Code	41654278
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

LIDOCAINE 2% + EPINEPHRINE 1

Facility

$9.00

Hospital Charge Code	41641605
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

LIDOCAINE 2% + EPINEPHRINE 1

Facility

$9.00

Hospital Charge Code	41651605
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

LIDOCAINE 2% INJ 100 MG/ML CARDIAC

Facility

$5.15

Service Code	HCPCS J2001
Hospital Charge Code	41643822
Hospital Revenue Code	636
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58

LIDOCAINE 2% INJ 100 MG/ML CARDIAC

Facility

$5.15

Service Code	HCPCS J2001
Hospital Charge Code	41653822
Hospital Revenue Code	636
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58

LIDOCAINE 2% INJ 100 MG/ML CARDIAC

Facility

$5.15

Service Code	HCPCS J2001
Hospital Charge Code	41653822
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$3.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$3.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.96
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.03
Rate for Payer: SOMOS Essential	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.35

LIDOCAINE 2% INJ 100 MG/ML CARDIAC

Facility

$5.15

Service Code	HCPCS J2001
Hospital Charge Code	41643822
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$3.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$3.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.96
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.03
Rate for Payer: SOMOS Essential	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.35

LIDOCAINE 2% INJ 10 ML POLYAMP

Facility

$0.24

Service Code	HCPCS J2001
Hospital Charge Code	41642462
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
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: SOMOS CHP/HARP/Medicaid	$0.03
Rate for Payer: SOMOS Essential	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

LIDOCAINE 2% INJ 10 ML POLYAMP

Facility

$0.24

Service Code	HCPCS J2001
Hospital Charge Code	41642462
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12

LIDOCAINE 2% INJ 10 ML POLYAMP

Facility

$0.24

Service Code	HCPCS J2001
Hospital Charge Code	41652462
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12

LIDOCAINE 2% INJ 10 ML POLYAMP

Facility

$0.24

Service Code	HCPCS J2001
Hospital Charge Code	41652462
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
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: SOMOS CHP/HARP/Medicaid	$0.03
Rate for Payer: SOMOS Essential	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

LIDOCAINE 2% INJ 20 ML

Facility

$1.53

Service Code	HCPCS J2001
Hospital Charge Code	41654157
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$1.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.04
Rate for Payer: Group Health Inc Commercial	$0.77
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.03
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.03
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.03
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

LIDOCAINE 2% INJ 20 ML

Facility

$1.53

Service Code	HCPCS J2001
Hospital Charge Code	41644157
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.88
Rate for Payer: Group Health Inc Commercial	$0.77
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.03
Rate for Payer: SOMOS Essential	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

LIDOCAINE 2% INJ 20 ML

Facility

$1.53

Service Code	HCPCS J2001
Hospital Charge Code	41644157
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.77
Rate for Payer: Hamaspik Choice Inc Medicare	$0.77

LIDOCAINE 2% INJ 2 ML PF

Facility

$4.00

Hospital Charge Code	41655327
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

LIDOCAINE 2% INJ 2 ML PF

Facility

$4.00

Hospital Charge Code	41645327
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

LIDOCAINE 2% INJ 5 ML

Facility

$0.31

Hospital Charge Code	41645504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

LIDOCAINE 2% INJ 5 ML

Facility

$0.31

Hospital Charge Code	41655504
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

LIDOCAINE 2% TOPICAL JELLY 30 ML

Facility

$13.00

Hospital Charge Code	41642539
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

LIDOCAINE 2% TOPICAL JELLY 30 ML

Facility

$13.00

Hospital Charge Code	41652539
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

LIDOCAINE 2% TOPICAL URO JET 10 ML

Facility

$11.00

Hospital Charge Code	41655048
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

LIDOCAINE 2% TOPICAL URO JET 10 ML

Facility

$11.00

Hospital Charge Code	41645048
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

LIDOCAINE 2% TOPICAL URO JET 5 ML

Facility

$8.51

Hospital Charge Code	41651589
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.26
Rate for Payer: Aetna Government	$4.26
Rate for Payer: Brighton Health Commercial	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.79
Rate for Payer: Group Health Inc Commercial	$4.26
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.26
Rate for Payer: Hamaspik Choice Inc Medicare	$4.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

LIDOCAINE 2% TOPICAL URO JET 5 ML

Facility

$8.51

Hospital Charge Code	41641589
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$6.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.26
Rate for Payer: Aetna Government	$4.26
Rate for Payer: Brighton Health Commercial	$6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.79
Rate for Payer: Group Health Inc Commercial	$4.26
Rate for Payer: Group Health Inc Medicare	$2.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.26
Rate for Payer: Hamaspik Choice Inc Medicare	$4.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.53

LIDOCAINE 2% VISCOUS SOLN 100 ML

Facility

$4.00

Hospital Charge Code	41650428
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

Know your out-of-pocket cost for care.

All Charges