St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NEVIRAPINE 10 MG/ML SUSP

Facility

$1.08

Hospital Charge Code	41652617
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.70

NEVIRAPINE 10 MG/ML SUSP

Facility

$1.08

Hospital Charge Code	41642617
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.70

NEVIRAPINE 200 MG PO TABS [17403]

Facility

$10.85

Service Code	NDC 31722050560
Hospital Charge Code	31722050560
Hospital Revenue Code	250
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$8.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.42
Rate for Payer: Aetna Government	$5.42
Rate for Payer: Brighton Health Commercial	$8.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.37
Rate for Payer: Group Health Inc Commercial	$5.42
Rate for Payer: Group Health Inc Medicare	$3.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.42
Rate for Payer: Hamaspik Choice Inc Medicare	$5.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.05

NEVIRAPINE 200 MG PO TABS [17403]

Facility

$10.83

Service Code	NDC 00378405091
Hospital Charge Code	00378405091
Hospital Revenue Code	250
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$8.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.42
Rate for Payer: Aetna Government	$5.42
Rate for Payer: Brighton Health Commercial	$8.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.37
Rate for Payer: Group Health Inc Commercial	$5.42
Rate for Payer: Group Health Inc Medicare	$3.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.42
Rate for Payer: Hamaspik Choice Inc Medicare	$5.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.04

NEVIRAPINE 200 MG TAB

Facility

$19.87

Hospital Charge Code	41653596
Hospital Revenue Code	250
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$15.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.94
Rate for Payer: Aetna Government	$9.94
Rate for Payer: Brighton Health Commercial	$14.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.51
Rate for Payer: Group Health Inc Commercial	$9.94
Rate for Payer: Group Health Inc Medicare	$6.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.94
Rate for Payer: Hamaspik Choice Inc Medicare	$9.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.92

NEVIRAPINE 200 MG TAB

Facility

$19.87

Hospital Charge Code	41643596
Hospital Revenue Code	250
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$15.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.94
Rate for Payer: Aetna Government	$9.94
Rate for Payer: Brighton Health Commercial	$14.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.51
Rate for Payer: Group Health Inc Commercial	$9.94
Rate for Payer: Group Health Inc Medicare	$6.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.94
Rate for Payer: Hamaspik Choice Inc Medicare	$9.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.92

NEVIRAPINE 50 MG/5ML PO SUSP [24119]

Facility

$0.79

Service Code	NDC 65862005724
Hospital Charge Code	65862005724
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.51

NEW DEAL SYS SPIN SCREW LG14MM

Facility

$551.06

Service Code	HCPCS C1713
Hospital Charge Code	40209716
Hospital Revenue Code	278
Min. Negotiated Rate	$275.53
Max. Negotiated Rate	$275.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.53
Rate for Payer: Hamaspik Choice Inc Medicare	$275.53

NEW DEAL SYS SPIN SCREW LG14MM

Facility

$551.06

Service Code	HCPCS C1713
Hospital Charge Code	40209716
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$578.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$330.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$275.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.86
Rate for Payer: EmblemHealth Commercial	$275.53
Rate for Payer: Fidelis Medicare Advantage	$578.61
Rate for Payer: Group Health Inc Commercial	$275.53
Rate for Payer: Group Health Inc Medicare	$192.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.53
Rate for Payer: Hamaspik Choice Inc Medicare	$275.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$358.19

NEW HDACHE PED PT DIS

Facility

$0.01

Service Code	HCPCS G2194
Hospital Charge Code	30300322
Hospital Revenue Code	929
Max. Negotiated Rate	$94.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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: United Healthcare Commercial	$94.00

NEW PT PRE AGE 12-17

Facility

$358.63

Service Code	HCPCS 99384
Hospital Charge Code	30301238
Hospital Revenue Code	510
Min. Negotiated Rate	$123.04
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.04
Rate for Payer: Aetna Government	$123.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT PRE AGE 18-39

Facility

$358.63

Service Code	HCPCS 99385
Hospital Charge Code	30301239
Hospital Revenue Code	510
Min. Negotiated Rate	$72.57
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.57
Rate for Payer: Aetna Government	$72.57
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT PRE AGE 40-64

Facility

$358.63

Service Code	HCPCS 99386
Hospital Charge Code	30301240
Hospital Revenue Code	510
Min. Negotiated Rate	$88.46
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.46
Rate for Payer: Aetna Government	$88.46
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT PRE AGE 40-64 YRS

Facility

$358.63

Hospital Charge Code	30400221
Hospital Revenue Code	510
Min. Negotiated Rate	$173.89
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$179.32
Rate for Payer: Aetna Government	$179.32
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT PRE AGE 65 AND OVER

Facility

$358.63

Service Code	HCPCS 99397
Hospital Charge Code	30301241
Hospital Revenue Code	510
Min. Negotiated Rate	$75.81
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.81
Rate for Payer: Aetna Government	$75.81
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT PRE AGE 65-OVER

Facility

$358.63

Service Code	HCPCS 99387
Hospital Charge Code	30400222
Hospital Revenue Code	510
Min. Negotiated Rate	$95.04
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.04
Rate for Payer: Aetna Government	$95.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$179.32
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT WELL CHILD CARE 12-17 YEAR

Facility

$399.45

Service Code	HCPCS 99384
Hospital Charge Code	30301278
Hospital Revenue Code	510
Min. Negotiated Rate	$123.04
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$219.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.04
Rate for Payer: Aetna Government	$123.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$199.72
Rate for Payer: Hamaspik Choice Inc Medicare	$199.72
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT WELL CHILD CARE 1-4 YEAR

Facility

$358.69

Service Code	HCPCS 99382
Hospital Charge Code	30301276
Hospital Revenue Code	510
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.44
Rate for Payer: Aetna Government	$71.44
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.34
Rate for Payer: Hamaspik Choice Inc Medicare	$179.34
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT WELL CHILD CARE 18 + YEAR

Facility

$572.53

Service Code	HCPCS 99385
Hospital Charge Code	30301279
Hospital Revenue Code	510
Min. Negotiated Rate	$72.57
Max. Negotiated Rate	$314.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$314.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.57
Rate for Payer: Aetna Government	$72.57
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$286.26
Rate for Payer: Hamaspik Choice Inc Medicare	$286.26
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT WELL CHILD CARE <1 YEAR

Facility

$146.25

Service Code	HCPCS 99381
Hospital Charge Code	30301274
Hospital Revenue Code	510
Min. Negotiated Rate	$62.88
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.88
Rate for Payer: Aetna Government	$62.88
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.12
Rate for Payer: Hamaspik Choice Inc Medicare	$73.12
Rate for Payer: United Healthcare Commercial	$222.00

NEW PT WELL CHILD CARE 5-11 YEAR

Facility

$294.20

Service Code	HCPCS 99383
Hospital Charge Code	30301277
Hospital Revenue Code	510
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$71.44
Rate for Payer: Aetna Government	$71.44
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.10
Rate for Payer: Hamaspik Choice Inc Medicare	$147.10
Rate for Payer: United Healthcare Commercial	$222.00

NEX COMP KNEE 3 5MM AUG SCRWW

Facility

$5,616.00

Service Code	HCPCS C1776
Hospital Charge Code	40004701
Hospital Revenue Code	278
Min. Negotiated Rate	$2,808.00
Max. Negotiated Rate	$2,808.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,808.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,808.00

NEX COMP KNEE 3 5MM AUG SCRWW

Facility

$5,616.00

Service Code	HCPCS C1776
Hospital Charge Code	40004701
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,896.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,088.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,369.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,808.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,229.20
Rate for Payer: EmblemHealth Commercial	$2,808.00
Rate for Payer: Fidelis Medicare Advantage	$5,896.80
Rate for Payer: Group Health Inc Commercial	$2,808.00
Rate for Payer: Group Health Inc Medicare	$1,965.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,808.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,808.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,650.40

NEX COMP KNEE STEM 12MMX100MM

Facility

$3,568.00

Service Code	HCPCS C1776
Hospital Charge Code	40004699
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,746.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,962.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,140.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,784.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,051.60
Rate for Payer: EmblemHealth Commercial	$1,784.00
Rate for Payer: Fidelis Medicare Advantage	$3,746.40
Rate for Payer: Group Health Inc Commercial	$1,784.00
Rate for Payer: Group Health Inc Medicare	$1,248.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,784.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,784.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,319.20

NEX COMP KNEE STEM 12MMX100MM

Facility

$3,568.00

Service Code	HCPCS C1776
Hospital Charge Code	40004699
Hospital Revenue Code	278
Min. Negotiated Rate	$1,784.00
Max. Negotiated Rate	$1,784.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,784.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,784.00

Know your out-of-pocket cost for care.

All Charges