St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LORAZEPAM 2 MG/ML INJ 10 ML

Facility

$1.20

Service Code	HCPCS J2060
Hospital Charge Code	41643226
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60

LORAZEPAM 2MG/ML INJ-1ML VIAL

Facility

$1.50

Service Code	HCPCS J2060
Hospital Charge Code	41645442
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75

LORAZEPAM 2MG/ML INJ-1ML VIAL

Facility

$1.50

Service Code	HCPCS J2060
Hospital Charge Code	41645442
Hospital Revenue Code	636
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.02
Rate for Payer: SOMOS Essential	$1.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.98

LORAZEPAM 2 MG/ML INJ SYRINGE

Facility

$11.96

Service Code	HCPCS J2060
Hospital Charge Code	41644153
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$7.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$7.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.88
Rate for Payer: Group Health Inc Commercial	$5.98
Rate for Payer: Group Health Inc Medicare	$4.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.98
Rate for Payer: Hamaspik Choice Inc Medicare	$5.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.02
Rate for Payer: SOMOS Essential	$1.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.77

LORAZEPAM 2 MG/ML INJ SYRINGE

Facility

$11.96

Service Code	HCPCS J2060
Hospital Charge Code	41654153
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$7.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$7.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.88
Rate for Payer: Group Health Inc Commercial	$5.98
Rate for Payer: Group Health Inc Medicare	$4.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.98
Rate for Payer: Hamaspik Choice Inc Medicare	$5.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.02
Rate for Payer: SOMOS Essential	$1.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.77

LORAZEPAM 2 MG/ML INJ SYRINGE

Facility

$11.96

Service Code	HCPCS J2060
Hospital Charge Code	41644153
Hospital Revenue Code	636
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$5.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.98
Rate for Payer: Hamaspik Choice Inc Medicare	$5.98

LORAZEPAM 2 MG/ML INJ SYRINGE

Facility

$11.96

Service Code	HCPCS J2060
Hospital Charge Code	41654153
Hospital Revenue Code	636
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$5.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.98
Rate for Payer: Hamaspik Choice Inc Medicare	$5.98

LORAZEPAM 2 MG/ML LIQUID

Facility

$3.00

Hospital Charge Code	41645151
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

LORAZEPAM 2 MG/ML LIQUID

Facility

$3.00

Hospital Charge Code	41655151
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

LORAZEPAM 2 MG/ML PO CONC [4571]

Facility

$1.60

Service Code	NDC 00054353244
Hospital Charge Code	00054353244
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

LOSARTAN 25 MG TAB

Facility

$0.83

Hospital Charge Code	41651631
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
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	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
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	$0.54

LOSARTAN 25 MG TAB

Facility

$0.83

Hospital Charge Code	41641631
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
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	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
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	$0.54

LOSARTAN 50 MG TAB

Facility

$26.38

Hospital Charge Code	41642053
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$21.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.19
Rate for Payer: Aetna Government	$13.19
Rate for Payer: Brighton Health Commercial	$19.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.94
Rate for Payer: Group Health Inc Commercial	$13.19
Rate for Payer: Group Health Inc Medicare	$9.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.19
Rate for Payer: Hamaspik Choice Inc Medicare	$13.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.15

LOSARTAN 50 MG TAB

Facility

$26.38

Hospital Charge Code	41652053
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$21.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.19
Rate for Payer: Aetna Government	$13.19
Rate for Payer: Brighton Health Commercial	$19.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.94
Rate for Payer: Group Health Inc Commercial	$13.19
Rate for Payer: Group Health Inc Medicare	$9.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.19
Rate for Payer: Hamaspik Choice Inc Medicare	$13.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.15

LOSARTAN POTASSIUM 25 MG PO TABS [14823]

Facility

$1.68

Service Code	NDC 65862020199
Hospital Charge Code	65862020199
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

LOSARTAN POTASSIUM 25 MG PO TABS [14823]

Facility

$1.68

Service Code	NDC 68382013510
Hospital Charge Code	68382013510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

LOSARTAN POTASSIUM 25 MG PO TABS [14823]

Facility

$0.70

Service Code	NDC 00904704761
Hospital Charge Code	00904704761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.24
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	$0.45

LOSARTAN POTASSIUM 25 MG PO TABS [14823]

Facility

$1.67

Service Code	NDC 62332002791
Hospital Charge Code	62332002791
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

LOSARTAN POTASSIUM 50 MG PO TABS [14824]

Facility

$2.26

Service Code	NDC 65862020299
Hospital Charge Code	65862020299
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.13
Rate for Payer: Aetna Government	$1.13
Rate for Payer: Brighton Health Commercial	$1.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.54
Rate for Payer: Group Health Inc Commercial	$1.13
Rate for Payer: Group Health Inc Medicare	$0.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.13
Rate for Payer: Hamaspik Choice Inc Medicare	$1.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.47

LOSARTAN POTASSIUM 50 MG PO TABS [14824]

Facility

$0.63

Service Code	NDC 50268050515
Hospital Charge Code	50268050515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.41

LOSARTAN POTASSIUM 50 MG PO TABS [14824]

Facility

$0.81

Service Code	NDC 00904704861
Hospital Charge Code	00904704861
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

LOSARTAN POTASSIUM 50 MG PO TABS [14824]

Facility

$2.25

Service Code	NDC 62332002891
Hospital Charge Code	62332002891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$1.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.53
Rate for Payer: Group Health Inc Commercial	$1.12
Rate for Payer: Group Health Inc Medicare	$0.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.46

LOSARTAN POTASSIUM 50 MG PO TABS [14824]

Facility

$2.26

Service Code	NDC 65862020290
Hospital Charge Code	65862020290
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.13
Rate for Payer: Aetna Government	$1.13
Rate for Payer: Brighton Health Commercial	$1.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.54
Rate for Payer: Group Health Inc Commercial	$1.13
Rate for Payer: Group Health Inc Medicare	$0.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.13
Rate for Payer: Hamaspik Choice Inc Medicare	$1.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.47

LOUDNESS BALANCE TEST

Facility

$419.03

Service Code	HCPCS 92562
Hospital Charge Code	42004502
Hospital Revenue Code	471
Min. Negotiated Rate	$158.00
Max. Negotiated Rate	$370.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

LOUDNESS BALANCE TEST

Facility

$419.03

Service Code	HCPCS 92562
Hospital Charge Code	42004502
Hospital Revenue Code	471
Rate for Payer: Cash Price	$362.98

Know your out-of-pocket cost for care.

All Charges