St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MEMANTINE HCL 10 MG PO TABS [36966]

Facility

$6.10

Service Code	NDC 00591387560
Hospital Charge Code	00591387560
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

MEMANTINE HCL 10 MG PO TABS [36966]

Facility

$6.10

Service Code	NDC 72578000414
Hospital Charge Code	72578000414
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

MEMANTINE HCL 10 MG PO TABS [36966]

Facility

$0.95

Service Code	NDC 00904650661
Hospital Charge Code	00904650661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

MEMANTINE HCL 10 MG PO TABS [36966]

Facility

$6.10

Service Code	NDC 29300017216
Hospital Charge Code	29300017216
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

MEMANTINE HCL 10 MG PO TABS [36966]

Facility

$6.10

Service Code	NDC 00591387544
Hospital Charge Code	00591387544
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

MEMANTINE HCL 10MG TABLET

Facility

$15.25

Hospital Charge Code	41650296
Hospital Revenue Code	250
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$12.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.62
Rate for Payer: Aetna Government	$7.62
Rate for Payer: Brighton Health Commercial	$11.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.37
Rate for Payer: Group Health Inc Commercial	$7.62
Rate for Payer: Group Health Inc Medicare	$5.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.62
Rate for Payer: Hamaspik Choice Inc Medicare	$7.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.91

MEMANTINE HCL 10MG TABLET

Facility

$15.25

Hospital Charge Code	41640296
Hospital Revenue Code	250
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$12.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.62
Rate for Payer: Aetna Government	$7.62
Rate for Payer: Brighton Health Commercial	$11.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.37
Rate for Payer: Group Health Inc Commercial	$7.62
Rate for Payer: Group Health Inc Medicare	$5.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.62
Rate for Payer: Hamaspik Choice Inc Medicare	$7.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.91

MEMANTINE HCL 5 MG PO TABS [37170]

Facility

$0.49

Service Code	NDC 00904650506
Hospital Charge Code	00904650506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

MEMANTINE HCL 5 MG PO TABS [37170]

Facility

$8.90

Service Code	NDC 00456320560
Hospital Charge Code	00456320560
Hospital Revenue Code	250
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$7.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.45
Rate for Payer: Aetna Government	$4.45
Rate for Payer: Brighton Health Commercial	$6.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.05
Rate for Payer: Group Health Inc Commercial	$4.45
Rate for Payer: Group Health Inc Medicare	$3.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.45
Rate for Payer: Hamaspik Choice Inc Medicare	$4.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.78

MEMANTINE HCL 5 MG PO TABS [37170]

Facility

$0.95

Service Code	NDC 00904650561
Hospital Charge Code	00904650561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

MEMANTINE HCL 5 MG PO TABS [37170]

Facility

$6.10

Service Code	NDC 00591387044
Hospital Charge Code	00591387044
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.15
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.97

MEMANTINE HCL 5 MG PO TABS [37170]

Facility

$6.09

Service Code	NDC 47335032186
Hospital Charge Code	47335032186
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.05
Rate for Payer: Aetna Government	$3.05
Rate for Payer: Brighton Health Commercial	$4.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: Group Health Inc Commercial	$3.05
Rate for Payer: Group Health Inc Medicare	$2.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.05
Rate for Payer: Hamaspik Choice Inc Medicare	$3.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.96

MEMANTINE HCL 5MG TABLET

Facility

$1.22

Hospital Charge Code	41650298
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.83
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

MEMANTINE HCL 5MG TABLET

Facility

$1.22

Hospital Charge Code	41640298
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.83
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

MEN ARTIS BLUE LCKNG SCRW 2.5X

Facility

$230.00

Service Code	HCPCS C1776
Hospital Charge Code	40208137
Hospital Revenue Code	278
Min. Negotiated Rate	$115.00
Max. Negotiated Rate	$115.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00

MEN ARTIS BLUE LCKNG SCRW 2.5X

Facility

$230.00

Service Code	HCPCS C1776
Hospital Charge Code	40208137
Hospital Revenue Code	278
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$138.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.25
Rate for Payer: EmblemHealth Commercial	$115.00
Rate for Payer: Fidelis Medicare Advantage	$241.50
Rate for Payer: Group Health Inc Commercial	$115.00
Rate for Payer: Group Health Inc Medicare	$80.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.00
Rate for Payer: Hamaspik Choice Inc Medicare	$115.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$149.50

MENING ACY&W-135 DIPHTH CONJ IM SOLN [180673]

Facility

$356.70

Service Code	NDC 49281058958
Hospital Charge Code	49281058958
Hospital Revenue Code	250
Min. Negotiated Rate	$124.84
Max. Negotiated Rate	$285.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$178.35
Rate for Payer: Aetna Government	$178.35
Rate for Payer: Brighton Health Commercial	$267.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$285.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$242.55
Rate for Payer: Group Health Inc Commercial	$178.35
Rate for Payer: Group Health Inc Medicare	$124.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$178.35
Rate for Payer: Hamaspik Choice Inc Medicare	$178.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.85

MENING ACY&W-135 TETANUS CONJ IM SOLN [180674]

Facility

$400.46

Service Code	NDC 49281059005
Hospital Charge Code	49281059005
Hospital Revenue Code	250
Min. Negotiated Rate	$140.16
Max. Negotiated Rate	$320.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.23
Rate for Payer: Aetna Government	$200.23
Rate for Payer: Brighton Health Commercial	$300.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.31
Rate for Payer: Group Health Inc Commercial	$200.23
Rate for Payer: Group Health Inc Medicare	$140.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.23
Rate for Payer: Hamaspik Choice Inc Medicare	$200.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.30

MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR [101034]

Facility

$188.67

Service Code	NDC 58160095509
Hospital Charge Code	58160095509
Hospital Revenue Code	250
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$150.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$94.34
Rate for Payer: Aetna Government	$94.34
Rate for Payer: Brighton Health Commercial	$141.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.30
Rate for Payer: Group Health Inc Commercial	$94.34
Rate for Payer: Group Health Inc Medicare	$66.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.34
Rate for Payer: Hamaspik Choice Inc Medicare	$94.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$122.64

MENINGOCOCCAL B LIPO VACC IM (VFC

Facility

$0.01

Service Code	HCPCS 90621
Hospital Charge Code	41656595
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

MENINGOCOCCAL B LIPO VACC IM (VFC

Facility

$0.01

Service Code	HCPCS 90621
Hospital Charge Code	41656595
Hospital Revenue Code	636
Max. Negotiated Rate	$160.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$160.37
Rate for Payer: Aetna Government	$160.37
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

MENINGOCOCCAL B OMV VACC IM

Facility

$321.10

Service Code	HCPCS 90620
Hospital Charge Code	41656643
Hospital Revenue Code	636
Min. Negotiated Rate	$112.38
Max. Negotiated Rate	$208.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.45
Rate for Payer: Aetna Government	$195.45
Rate for Payer: Brighton Health Commercial	$192.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.63
Rate for Payer: Group Health Inc Commercial	$160.55
Rate for Payer: Group Health Inc Medicare	$112.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.55
Rate for Payer: Hamaspik Choice Inc Medicare	$160.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.72

MENINGOCOCCAL B OMV VACC IM

Facility

$321.10

Service Code	HCPCS 90620
Hospital Charge Code	41646643
Hospital Revenue Code	250
Min. Negotiated Rate	$112.38
Max. Negotiated Rate	$256.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.45
Rate for Payer: Aetna Government	$195.45
Rate for Payer: Brighton Health Commercial	$240.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$256.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.35
Rate for Payer: Group Health Inc Commercial	$160.55
Rate for Payer: Group Health Inc Medicare	$112.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.55
Rate for Payer: Hamaspik Choice Inc Medicare	$160.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.72

MENINGOCOCCAL B OMV VACC IM

Facility

$321.10

Service Code	HCPCS 90620
Hospital Charge Code	41656643
Hospital Revenue Code	636
Min. Negotiated Rate	$160.55
Max. Negotiated Rate	$160.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.55
Rate for Payer: Hamaspik Choice Inc Medicare	$160.55

MENINGOCOCCAL B OMV VACC IM (VFC)

Facility

$0.01

Service Code	HCPCS 90620
Hospital Charge Code	41656596
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

Know your out-of-pocket cost for care.

All Charges