St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RISPERIDONE 3 MG PO TABS

Facility

$11.54

Service Code	NDC 5045833001
Hospital Charge Code	5045833001
Hospital Revenue Code	250
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$5.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.77

RISPERIDONE 3 MG PO TABS

Facility

$0.60

Service Code	NDC 0904736461
Hospital Charge Code	0904736461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: EmblemHealth Commercial	$0.30
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

RISPERIDONE 3 MG PO TABS

Facility

$0.60

Service Code	NDC 0904736461
Hospital Charge Code	0904736461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30

RISPERIDONE 3 MG PO TABS

Facility

$11.54

Service Code	NDC 5045833001
Hospital Charge Code	5045833001
Hospital Revenue Code	250
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$9.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.77
Rate for Payer: Aetna Government	$5.77
Rate for Payer: Brighton Health Commercial	$8.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.85
Rate for Payer: EmblemHealth Commercial	$5.77
Rate for Payer: Group Health Inc Commercial	$5.77
Rate for Payer: Group Health Inc Medicare	$4.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.77
Rate for Payer: Hamaspik Choice Inc Medicare	$5.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.50

RISPERIDONE 3 MG PO TABS

Facility

$8.93

Service Code	NDC 1366803960
Hospital Charge Code	1366803960
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.07
Rate for Payer: EmblemHealth Commercial	$4.47
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

RISPERIDONE 3 MG PO TABS

Facility

$8.93

Service Code	NDC 1366803960
Hospital Charge Code	1366803960
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47

RISPERIDONE 4 MG PO TABS

Facility

$12.00

Service Code	NDC 6838211714
Hospital Charge Code	6838211714
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: EmblemHealth Commercial	$6.00
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

RISPERIDONE 4 MG PO TABS

Facility

$12.00

Service Code	NDC 6838211714
Hospital Charge Code	6838211714
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

RISPERIDONE 4 MG PO TABS

Facility

$12.00

Service Code	NDC 4354734406
Hospital Charge Code	4354734406
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

RISPERIDONE 4 MG PO TABS

Facility

$12.00

Service Code	NDC 4354734406
Hospital Charge Code	4354734406
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.00
Rate for Payer: Aetna Government	$6.00
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: EmblemHealth Commercial	$6.00
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

RISPERIDONE MICROSPHERES ER 12.5 MG IM SRER

Facility

$368.77

Service Code	HCPCS J2794
Hospital Charge Code	5045830911
Hospital Revenue Code	250
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$295.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$202.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.98
Rate for Payer: Aetna Government	$10.98
Rate for Payer: Affinity Essential Plan 1&2	$7.69
Rate for Payer: Affinity Essential Plan 3&4	$7.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.69
Rate for Payer: Brighton Health Commercial	$276.58
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$295.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$250.76
Rate for Payer: Elderplan Medicare Advantage	$10.98
Rate for Payer: EmblemHealth Commercial	$10.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9.88
Rate for Payer: Fidelis Essential Plan Aliesa	$9.33
Rate for Payer: Fidelis Essential Plan QHP	$9.77
Rate for Payer: Fidelis Medicare Advantage	$10.98
Rate for Payer: Fidelis Qualified Health Plan	$9.77
Rate for Payer: Group Health Inc Commercial	$10.98
Rate for Payer: Group Health Inc Medicare	$10.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.98
Rate for Payer: Hamaspik Choice Inc Medicare	$10.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.98
Rate for Payer: Healthfirst Medicare Advantage	$9.33
Rate for Payer: Healthfirst QHP	$10.98
Rate for Payer: Humana Medicare	$11.20
Rate for Payer: Senior Whole Health Medicare Advantage	$10.98
Rate for Payer: United Healthcare Medicare Advantage	$10.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$239.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.43
Rate for Payer: Wellcare Medicare	$10.43

RISPERIDONE MICROSPHERES ER 12.5 MG IM SRER

Facility

$368.77

Service Code	HCPCS J2794
Hospital Charge Code	5045830911
Hospital Revenue Code	250
Min. Negotiated Rate	$184.38
Max. Negotiated Rate	$184.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$184.38

RISPERIDONE MICROSPHERES ER 25 MG IM SRER

Facility

$737.47

Service Code	HCPCS J2794
Hospital Charge Code	5045830611
Hospital Revenue Code	250
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$589.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$405.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.98
Rate for Payer: Aetna Government	$10.98
Rate for Payer: Affinity Essential Plan 1&2	$7.69
Rate for Payer: Affinity Essential Plan 3&4	$7.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.69
Rate for Payer: Brighton Health Commercial	$553.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$589.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$501.48
Rate for Payer: Elderplan Medicare Advantage	$10.98
Rate for Payer: EmblemHealth Commercial	$10.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9.88
Rate for Payer: Fidelis Essential Plan Aliesa	$9.33
Rate for Payer: Fidelis Essential Plan QHP	$9.77
Rate for Payer: Fidelis Medicare Advantage	$10.98
Rate for Payer: Fidelis Qualified Health Plan	$9.77
Rate for Payer: Group Health Inc Commercial	$10.98
Rate for Payer: Group Health Inc Medicare	$10.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.98
Rate for Payer: Hamaspik Choice Inc Medicare	$10.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.98
Rate for Payer: Healthfirst Medicare Advantage	$9.33
Rate for Payer: Healthfirst QHP	$10.98
Rate for Payer: Humana Medicare	$11.20
Rate for Payer: Senior Whole Health Medicare Advantage	$10.98
Rate for Payer: United Healthcare Medicare Advantage	$10.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$479.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.43
Rate for Payer: Wellcare Medicare	$10.43

RISPERIDONE MICROSPHERES ER 25 MG IM SRER

Facility

$737.47

Service Code	HCPCS J2794
Hospital Charge Code	5045830611
Hospital Revenue Code	250
Min. Negotiated Rate	$368.74
Max. Negotiated Rate	$368.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$368.74

RISPERIDONE MICROSPHERES ER 37.5 MG IM SRER

Facility

$1.00

Service Code	HCPCS J2794
Hospital Charge Code	5045830711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

RISPERIDONE MICROSPHERES ER 37.5 MG IM SRER

Facility

$1.00

Service Code	HCPCS J2794
Hospital Charge Code	5045830711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.98
Rate for Payer: Aetna Government	$10.98
Rate for Payer: Affinity Essential Plan 1&2	$7.69
Rate for Payer: Affinity Essential Plan 3&4	$7.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.69
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$10.98
Rate for Payer: EmblemHealth Commercial	$10.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9.88
Rate for Payer: Fidelis Essential Plan Aliesa	$9.33
Rate for Payer: Fidelis Essential Plan QHP	$9.77
Rate for Payer: Fidelis Medicare Advantage	$10.98
Rate for Payer: Fidelis Qualified Health Plan	$9.77
Rate for Payer: Group Health Inc Commercial	$10.98
Rate for Payer: Group Health Inc Medicare	$10.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.98
Rate for Payer: Hamaspik Choice Inc Medicare	$10.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.98
Rate for Payer: Healthfirst Medicare Advantage	$9.33
Rate for Payer: Healthfirst QHP	$10.98
Rate for Payer: Humana Medicare	$11.20
Rate for Payer: Senior Whole Health Medicare Advantage	$10.98
Rate for Payer: United Healthcare Medicare Advantage	$10.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.43
Rate for Payer: Wellcare Medicare	$10.43

RISPERIDONE MICROSPHERES ER 50 MG IM SRER

Facility

$1.00

Service Code	HCPCS J2794
Hospital Charge Code	5045830811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

RISPERIDONE MICROSPHERES ER 50 MG IM SRER

Facility

$1.00

Service Code	HCPCS J2794
Hospital Charge Code	5045830811
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.98
Rate for Payer: Aetna Government	$10.98
Rate for Payer: Affinity Essential Plan 1&2	$7.69
Rate for Payer: Affinity Essential Plan 3&4	$7.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.69
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$10.98
Rate for Payer: EmblemHealth Commercial	$10.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9.88
Rate for Payer: Fidelis Essential Plan Aliesa	$9.33
Rate for Payer: Fidelis Essential Plan QHP	$9.77
Rate for Payer: Fidelis Medicare Advantage	$10.98
Rate for Payer: Fidelis Qualified Health Plan	$9.77
Rate for Payer: Group Health Inc Commercial	$10.98
Rate for Payer: Group Health Inc Medicare	$10.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.98
Rate for Payer: Hamaspik Choice Inc Medicare	$10.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.98
Rate for Payer: Healthfirst Medicare Advantage	$9.33
Rate for Payer: Healthfirst QHP	$10.98
Rate for Payer: Humana Medicare	$11.20
Rate for Payer: Senior Whole Health Medicare Advantage	$10.98
Rate for Payer: United Healthcare Medicare Advantage	$10.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.43
Rate for Payer: Wellcare Medicare	$10.43

RITONAVIR 100 MG PO TABS

Facility

$10.29

Service Code	NDC 0074234030
Hospital Charge Code	0074234030
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14

RITONAVIR 100 MG PO TABS

Facility

$9.26

Service Code	NDC 6586268730
Hospital Charge Code	6586268730
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$7.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.63
Rate for Payer: Aetna Government	$4.63
Rate for Payer: Brighton Health Commercial	$6.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.30
Rate for Payer: EmblemHealth Commercial	$4.63
Rate for Payer: Group Health Inc Commercial	$4.63
Rate for Payer: Group Health Inc Medicare	$3.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.63
Rate for Payer: Hamaspik Choice Inc Medicare	$4.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.02

RITONAVIR 100 MG PO TABS

Facility

$9.26

Service Code	NDC 6586268730
Hospital Charge Code	6586268730
Hospital Revenue Code	250
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$4.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.63

RITONAVIR 100 MG PO TABS

Facility

$10.29

Service Code	NDC 0074234030
Hospital Charge Code	0074234030
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.00
Rate for Payer: EmblemHealth Commercial	$5.14
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.69

RITUXIMAB 100 MG/10ML IV SOLN

Facility

$112.74

Service Code	HCPCS J9312
Hospital Charge Code	5024205121
Hospital Revenue Code	258
Min. Negotiated Rate	$56.37
Max. Negotiated Rate	$56.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.37

RITUXIMAB 100 MG/10ML IV SOLN

Facility

$112.74

Service Code	HCPCS J9312
Hospital Charge Code	5024205121
Hospital Revenue Code	258
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$90.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.22
Rate for Payer: Aetna Government	$75.22
Rate for Payer: Affinity Essential Plan 1&2	$52.65
Rate for Payer: Affinity Essential Plan 3&4	$52.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$52.65
Rate for Payer: Brighton Health Commercial	$84.56
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$75.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.66
Rate for Payer: Elderplan Medicare Advantage	$75.22
Rate for Payer: EmblemHealth Commercial	$75.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67.70
Rate for Payer: Fidelis Essential Plan Aliesa	$63.94
Rate for Payer: Fidelis Essential Plan QHP	$66.95
Rate for Payer: Fidelis Medicare Advantage	$75.22
Rate for Payer: Fidelis Qualified Health Plan	$66.95
Rate for Payer: Group Health Inc Commercial	$75.22
Rate for Payer: Group Health Inc Medicare	$75.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.22
Rate for Payer: Hamaspik Choice Inc Medicare	$75.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$75.22
Rate for Payer: Healthfirst Medicare Advantage	$63.94
Rate for Payer: Healthfirst QHP	$75.22
Rate for Payer: Humana Medicare	$76.72
Rate for Payer: Senior Whole Health Medicare Advantage	$75.22
Rate for Payer: United Healthcare Medicare Advantage	$75.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$73.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71.46
Rate for Payer: Wellcare Medicare	$71.46

RITUXIMAB 500 MG/50ML IV SOLN

Facility

$112.74

Service Code	HCPCS J9312
Hospital Charge Code	5024205306
Hospital Revenue Code	258
Min. Negotiated Rate	$56.37
Max. Negotiated Rate	$56.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.37

Know your out-of-pocket cost for care.

All Charges