St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MENINGOCOCCAL VACC (VFC) 0.5ML IM

Facility

$0.01

Service Code	HCPCS 90734
Hospital Charge Code	41659563
Hospital Revenue Code	636
Max. Negotiated Rate	$137.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.33
Rate for Payer: Aetna Government	$137.33
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 VACC (VFC) 0.5ML IM

Facility

$0.01

Service Code	HCPCS 90734
Hospital Charge Code	41659563
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 VACC (VFC) 0.5ML IM

Facility

$0.01

Service Code	HCPCS 90734
Hospital Charge Code	41649563
Hospital Revenue Code	636
Max. Negotiated Rate	$137.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.33
Rate for Payer: Aetna Government	$137.33
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

MENISCECTOMY

Facility

$8,291.05

Service Code	HCPCS 27332
Hospital Charge Code	40021540
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

MENISCECTOMY

Facility

$8,291.05

Service Code	HCPCS 27332
Hospital Charge Code	40021540
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$29,055.70

Service Code	MSDRG 760
Min. Negotiated Rate	$8,535.56
Max. Negotiated Rate	$29,055.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,677.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21,131.42
Rate for Payer: Aetna Government	$21,131.42
Rate for Payer: Brighton Health Commercial	$14,433.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21,554.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17,189.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,185.56
Rate for Payer: Elderplan Medicare Advantage	$20,074.85
Rate for Payer: EmblemHealth Commercial	$8,535.56
Rate for Payer: Fidelis Medicare Advantage	$21,131.42
Rate for Payer: Group Health Inc Commercial	$21,131.42
Rate for Payer: Group Health Inc Medicare	$21,131.42
Rate for Payer: Hamaspik Choice Inc Medicare	$21,131.42
Rate for Payer: Healthfirst Medicare Advantage	$9,826.11
Rate for Payer: Humana Medicare	$29,055.70
Rate for Payer: Senior Whole Health Medicare Advantage	$21,131.42
Rate for Payer: United Healthcare Commercial	$19,795.52
Rate for Payer: United Healthcare Medicare Advantage	$21,131.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,131.42
Rate for Payer: Wellcare Medicare	$20,074.85

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$21,623.14

Service Code	MSDRG 761
Min. Negotiated Rate	$5,193.02
Max. Negotiated Rate	$21,623.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,929.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15,725.92
Rate for Payer: Aetna Government	$15,725.92
Rate for Payer: Brighton Health Commercial	$8,781.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16,040.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10,458.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,630.48
Rate for Payer: Elderplan Medicare Advantage	$14,939.62
Rate for Payer: EmblemHealth Commercial	$5,193.02
Rate for Payer: Fidelis Medicare Advantage	$15,725.92
Rate for Payer: Group Health Inc Commercial	$15,725.92
Rate for Payer: Group Health Inc Medicare	$15,725.92
Rate for Payer: Hamaspik Choice Inc Medicare	$15,725.92
Rate for Payer: Healthfirst Medicare Advantage	$7,312.55
Rate for Payer: Humana Medicare	$21,623.14
Rate for Payer: Senior Whole Health Medicare Advantage	$15,725.92
Rate for Payer: United Healthcare Commercial	$12,043.57
Rate for Payer: United Healthcare Medicare Advantage	$15,725.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,725.92
Rate for Payer: Wellcare Medicare	$14,939.62

MENTHOL LOZENGE

Facility

$1.00

Hospital Charge Code	41655097
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MENTHOL LOZENGE

Facility

$1.00

Hospital Charge Code	41645097
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MENTOR CPX4 MED HT BREAST TISSUE

Facility

$3,662.50

Hospital Charge Code	64905964
Hospital Revenue Code	270
Min. Negotiated Rate	$1,281.88
Max. Negotiated Rate	$2,930.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,014.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,831.25
Rate for Payer: Aetna Government	$1,831.25
Rate for Payer: Brighton Health Commercial	$2,746.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,930.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,490.50
Rate for Payer: Group Health Inc Commercial	$1,831.25
Rate for Payer: Group Health Inc Medicare	$1,281.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,831.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,831.25

MENTOR SMOOTH ROUND 400CC

Facility

$1,800.00

Service Code	HCPCS C1789
Hospital Charge Code	40203004
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00

MENTOR SMOOTH ROUND 400CC

Facility

$1,800.00

Service Code	HCPCS C1789
Hospital Charge Code	40203004
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,890.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$990.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,080.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,035.00
Rate for Payer: EmblemHealth Commercial	$900.00
Rate for Payer: Fidelis Medicare Advantage	$1,890.00
Rate for Payer: Group Health Inc Commercial	$900.00
Rate for Payer: Group Health Inc Medicare	$630.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,170.00

MENTOR SMOOTH ROUND HIGH PROFILE

Facility

$1,900.00

Service Code	HCPCS L8600
Hospital Charge Code	40206223
Hospital Revenue Code	278
Min. Negotiated Rate	$950.00
Max. Negotiated Rate	$950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$950.00

MENTOR SMOOTH ROUND HIGH PROFILE

Facility

$1,900.00

Service Code	HCPCS L8600
Hospital Charge Code	40206223
Hospital Revenue Code	278
Min. Negotiated Rate	$326.16
Max. Negotiated Rate	$1,995.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,045.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$326.16
Rate for Payer: Aetna Government	$326.16
Rate for Payer: Brighton Health Commercial	$1,140.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,092.50
Rate for Payer: EmblemHealth Commercial	$950.00
Rate for Payer: Fidelis Medicare Advantage	$1,995.00
Rate for Payer: Group Health Inc Commercial	$950.00
Rate for Payer: Group Health Inc Medicare	$665.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,235.00

MENTOR SMTH R GEL MAMPROSTH450CC

Facility

$1,800.00

Service Code	HCPCS C1789
Hospital Charge Code	40206077
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00

MENTOR SMTH R GEL MAMPROSTH450CC

Facility

$1,800.00

Service Code	HCPCS C1789
Hospital Charge Code	40206077
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,890.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$990.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,080.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,035.00
Rate for Payer: EmblemHealth Commercial	$900.00
Rate for Payer: Fidelis Medicare Advantage	$1,890.00
Rate for Payer: Group Health Inc Commercial	$900.00
Rate for Payer: Group Health Inc Medicare	$630.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,170.00

MENTOR SMTH ROUND MMP 250CC

Facility

$1,800.00

Service Code	HCPCS C1789
Hospital Charge Code	40208091
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00

MENTOR SMTH ROUND MMP 250CC

Facility

$1,800.00

Service Code	HCPCS C1789
Hospital Charge Code	40208091
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,890.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$990.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$1,080.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,035.00
Rate for Payer: EmblemHealth Commercial	$900.00
Rate for Payer: Fidelis Medicare Advantage	$1,890.00
Rate for Payer: Group Health Inc Commercial	$900.00
Rate for Payer: Group Health Inc Medicare	$630.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,170.00

MENTOR S RD M PRO SALINE 575CC

Facility

$1,200.00

Service Code	HCPCS C1789
Hospital Charge Code	40205486
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

MENTOR S RD M PRO SALINE 575CC

Facility

$1,200.00

Service Code	HCPCS C1789
Hospital Charge Code	40205486
Hospital Revenue Code	278
Min. Negotiated Rate	$402.32
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

MEP

Facility

$166.60

Service Code	HCPCS 94200 TC
Hospital Charge Code	40402910
Hospital Revenue Code	460
Min. Negotiated Rate	$49.52
Max. Negotiated Rate	$133.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.74
Rate for Payer: Aetna Government	$70.74
Rate for Payer: Affinity Essential Plan 1&2	$49.52
Rate for Payer: Affinity Essential Plan 3&4	$49.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$49.52
Rate for Payer: Brighton Health Commercial	$124.95
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.29
Rate for Payer: Elderplan Medicare Advantage	$70.74
Rate for Payer: EmblemHealth Commercial	$70.74
Rate for Payer: Fidelis Essential Plan Aliesa	$60.13
Rate for Payer: Fidelis Essential Plan QHP	$62.96
Rate for Payer: Fidelis Medicare Advantage	$70.74
Rate for Payer: Fidelis Qualified Health Plan	$62.96
Rate for Payer: Group Health Inc Commercial	$70.74
Rate for Payer: Group Health Inc Medicare	$70.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.30
Rate for Payer: Hamaspik Choice Inc Medicare	$70.74
Rate for Payer: Healthfirst Medicare Advantage	$60.13
Rate for Payer: Healthfirst QHP	$70.74
Rate for Payer: Humana Medicare	$72.15
Rate for Payer: Senior Whole Health Medicare Advantage	$70.74
Rate for Payer: United Healthcare Commercial	$83.30
Rate for Payer: United Healthcare Medicare Advantage	$70.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.59
Rate for Payer: Wellcare Medicare	$67.20

MEP

Facility

$166.60

Service Code	HCPCS 94200 TC
Hospital Charge Code	40402910
Hospital Revenue Code	460
Rate for Payer: Cash Price	$70.74

MEPERIDINE 100 MG/ML INJ

Facility

$3.00

Service Code	HCPCS J2175
Hospital Charge Code	41654244
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

MEPERIDINE 100 MG/ML INJ

Facility

$3.00

Service Code	HCPCS J2175
Hospital Charge Code	41644244
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

MEPERIDINE 100 MG/ML INJ

Facility

$3.00

Service Code	HCPCS J2175
Hospital Charge Code	41654244
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: SOMOS CHP/HARP/Medicaid	$7.31
Rate for Payer: SOMOS Essential	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

Know your out-of-pocket cost for care.

All Charges