St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TRACE MINERALS CR-CU-MN-ZN 1-100-25-1000 MCG/ML IV SOLN

Facility

$4.86

Service Code	NDC 0517920325
Hospital Charge Code	0517920325
Hospital Revenue Code	258
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$2.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.43

TRACE MINERALS CU-MN-SE-ZN 300-55-60-3000 MCG/ML IV SOLN

Facility

$29.65

Service Code	NDC 0517930525
Hospital Charge Code	0517930525
Hospital Revenue Code	258
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$23.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.83
Rate for Payer: Aetna Government	$14.83
Rate for Payer: Brighton Health Commercial	$22.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.16
Rate for Payer: EmblemHealth Commercial	$14.83
Rate for Payer: Group Health Inc Commercial	$14.83
Rate for Payer: Group Health Inc Medicare	$10.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.83
Rate for Payer: Hamaspik Choice Inc Medicare	$14.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.27

TRACE MINERALS CU-MN-SE-ZN 300-55-60-3000 MCG/ML IV SOLN

Facility

$29.65

Service Code	NDC 0517930525
Hospital Charge Code	0517930525
Hospital Revenue Code	258
Min. Negotiated Rate	$14.83
Max. Negotiated Rate	$14.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.83

TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN

Facility

$27.38

Service Code	NDC 0517930225
Hospital Charge Code	0517930225
Hospital Revenue Code	258
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.69

TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN

Facility

$27.38

Service Code	NDC 0517930201
Hospital Charge Code	0517930201
Hospital Revenue Code	258
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$21.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.69
Rate for Payer: Aetna Government	$13.69
Rate for Payer: Brighton Health Commercial	$20.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.62
Rate for Payer: EmblemHealth Commercial	$13.69
Rate for Payer: Group Health Inc Commercial	$13.69
Rate for Payer: Group Health Inc Medicare	$9.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.69
Rate for Payer: Hamaspik Choice Inc Medicare	$13.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.80

TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN

Facility

$27.38

Service Code	NDC 0517930201
Hospital Charge Code	0517930201
Hospital Revenue Code	258
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.69

TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN

Facility

$27.38

Service Code	NDC 0517930225
Hospital Charge Code	0517930225
Hospital Revenue Code	258
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$21.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.69
Rate for Payer: Aetna Government	$13.69
Rate for Payer: Brighton Health Commercial	$20.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.62
Rate for Payer: EmblemHealth Commercial	$13.69
Rate for Payer: Group Health Inc Commercial	$13.69
Rate for Payer: Group Health Inc Medicare	$9.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.69
Rate for Payer: Hamaspik Choice Inc Medicare	$13.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.80

TRACHEOSTOMY AND RELATED TRACHEAL PROCEDURES

Facility

$2,520.27

Service Code	EAPG 00072
Min. Negotiated Rate	$2,520.27
Max. Negotiated Rate	$2,520.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,520.27

Tracheostomy w MV 96+ hours w extensive procedure or ECMO

Facility

$158,445.90

Service Code	APR-DRG 0041
Min. Negotiated Rate	$70,420.40
Max. Negotiated Rate	$158,445.90
Rate for Payer: Affinity Essential Plan 1&2	$158,445.90
Rate for Payer: Affinity Essential Plan 3&4	$158,445.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$70,420.40
Rate for Payer: Amida Care Medicaid	$70,420.40
Rate for Payer: EmblemHealth Essential Plan 1&2	$158,445.90
Rate for Payer: EmblemHealth Essential Plan 3&4	$70,420.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70,420.40
Rate for Payer: Fidelis Qualified Health Plan	$84,504.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$70,420.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$70,420.40
Rate for Payer: Healthfirst Commercial	$133,863.00
Rate for Payer: Healthfirst Essential Plan	$158,445.90
Rate for Payer: Healthfirst QHP	$87,809.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70,420.40
Rate for Payer: SOMOS Essential	$158,445.90
Rate for Payer: United Healthcare Essential Plan 1&2	$158,445.90
Rate for Payer: United Healthcare Essential Plan 3&4	$158,445.90
Rate for Payer: United Healthcare Medicaid	$70,420.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70,420.40

Tracheostomy w MV 96+ hours w extensive procedure or ECMO

Facility

$158,445.90

Service Code	APR-DRG 0042
Min. Negotiated Rate	$70,420.40
Max. Negotiated Rate	$158,445.90
Rate for Payer: Affinity Essential Plan 1&2	$158,445.90
Rate for Payer: Affinity Essential Plan 3&4	$158,445.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$70,420.40
Rate for Payer: Amida Care Medicaid	$70,420.40
Rate for Payer: EmblemHealth Essential Plan 1&2	$158,445.90
Rate for Payer: EmblemHealth Essential Plan 3&4	$70,420.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70,420.40
Rate for Payer: Fidelis Qualified Health Plan	$84,504.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$70,420.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$70,420.40
Rate for Payer: Healthfirst Commercial	$134,086.00
Rate for Payer: Healthfirst Essential Plan	$158,445.90
Rate for Payer: Healthfirst QHP	$89,139.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70,420.40
Rate for Payer: SOMOS Essential	$158,445.90
Rate for Payer: United Healthcare Essential Plan 1&2	$158,445.90
Rate for Payer: United Healthcare Essential Plan 3&4	$158,445.90
Rate for Payer: United Healthcare Medicaid	$70,420.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70,420.40

Tracheostomy w MV 96+ hours w extensive procedure or ECMO

Facility

$209,132.98

Service Code	APR-DRG 0043
Min. Negotiated Rate	$92,947.99
Max. Negotiated Rate	$209,132.98
Rate for Payer: Affinity Essential Plan 1&2	$209,132.98
Rate for Payer: Affinity Essential Plan 3&4	$209,132.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$92,947.99
Rate for Payer: Amida Care Medicaid	$92,947.99
Rate for Payer: EmblemHealth Essential Plan 1&2	$209,132.98
Rate for Payer: EmblemHealth Essential Plan 3&4	$92,947.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$92,947.99
Rate for Payer: Fidelis Qualified Health Plan	$111,537.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$92,947.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$92,947.99
Rate for Payer: Healthfirst Commercial	$189,011.00
Rate for Payer: Healthfirst Essential Plan	$209,132.98
Rate for Payer: Healthfirst QHP	$117,510.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92,947.99
Rate for Payer: SOMOS Essential	$209,132.98
Rate for Payer: United Healthcare Essential Plan 1&2	$209,132.98
Rate for Payer: United Healthcare Essential Plan 3&4	$209,132.98
Rate for Payer: United Healthcare Medicaid	$92,947.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$92,947.99

Tracheostomy w MV 96+ hours w extensive procedure or ECMO

Facility

$349,859.05

Service Code	APR-DRG 0044
Min. Negotiated Rate	$155,492.91
Max. Negotiated Rate	$349,859.05
Rate for Payer: Affinity Essential Plan 1&2	$349,859.05
Rate for Payer: Affinity Essential Plan 3&4	$349,859.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$155,492.91
Rate for Payer: Amida Care Medicaid	$155,492.91
Rate for Payer: EmblemHealth Essential Plan 1&2	$349,859.05
Rate for Payer: EmblemHealth Essential Plan 3&4	$155,492.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$155,492.91
Rate for Payer: Fidelis Qualified Health Plan	$186,591.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$155,492.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155,492.91
Rate for Payer: Healthfirst Commercial	$321,497.00
Rate for Payer: Healthfirst Essential Plan	$349,859.05
Rate for Payer: Healthfirst QHP	$202,120.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155,492.91
Rate for Payer: SOMOS Essential	$349,859.05
Rate for Payer: United Healthcare Essential Plan 1&2	$349,859.05
Rate for Payer: United Healthcare Essential Plan 3&4	$349,859.05
Rate for Payer: United Healthcare Medicaid	$155,492.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$155,492.91

Tracheostomy w MV 96+ hours w/o extensive procedure

Facility

$132,196.61

Service Code	APR-DRG 0051
Min. Negotiated Rate	$58,754.05
Max. Negotiated Rate	$132,196.61
Rate for Payer: Affinity Essential Plan 1&2	$132,196.61
Rate for Payer: Affinity Essential Plan 3&4	$132,196.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$58,754.05
Rate for Payer: Amida Care Medicaid	$58,754.05
Rate for Payer: EmblemHealth Essential Plan 1&2	$132,196.61
Rate for Payer: EmblemHealth Essential Plan 3&4	$58,754.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$58,754.05
Rate for Payer: Fidelis Qualified Health Plan	$70,504.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$58,754.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$58,754.05
Rate for Payer: Healthfirst Commercial	$107,519.00
Rate for Payer: Healthfirst Essential Plan	$132,196.61
Rate for Payer: Healthfirst QHP	$66,804.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58,754.05
Rate for Payer: SOMOS Essential	$132,196.61
Rate for Payer: United Healthcare Essential Plan 1&2	$132,196.61
Rate for Payer: United Healthcare Essential Plan 3&4	$132,196.61
Rate for Payer: United Healthcare Medicaid	$58,754.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58,754.05

Tracheostomy w MV 96+ hours w/o extensive procedure

Facility

$134,790.77

Service Code	APR-DRG 0052
Min. Negotiated Rate	$59,907.01
Max. Negotiated Rate	$134,790.77
Rate for Payer: Affinity Essential Plan 1&2	$134,790.77
Rate for Payer: Affinity Essential Plan 3&4	$134,790.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$59,907.01
Rate for Payer: Amida Care Medicaid	$59,907.01
Rate for Payer: EmblemHealth Essential Plan 1&2	$134,790.77
Rate for Payer: EmblemHealth Essential Plan 3&4	$59,907.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$59,907.01
Rate for Payer: Fidelis Qualified Health Plan	$71,888.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$59,907.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59,907.01
Rate for Payer: Healthfirst Commercial	$110,713.00
Rate for Payer: Healthfirst Essential Plan	$134,790.77
Rate for Payer: Healthfirst QHP	$69,079.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59,907.01
Rate for Payer: SOMOS Essential	$134,790.77
Rate for Payer: United Healthcare Essential Plan 1&2	$134,790.77
Rate for Payer: United Healthcare Essential Plan 3&4	$134,790.77
Rate for Payer: United Healthcare Medicaid	$59,907.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59,907.01

Tracheostomy w MV 96+ hours w/o extensive procedure

Facility

$194,396.42

Service Code	APR-DRG 0053
Min. Negotiated Rate	$86,398.41
Max. Negotiated Rate	$194,396.42
Rate for Payer: Affinity Essential Plan 1&2	$194,396.42
Rate for Payer: Affinity Essential Plan 3&4	$194,396.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$86,398.41
Rate for Payer: Amida Care Medicaid	$86,398.41
Rate for Payer: EmblemHealth Essential Plan 1&2	$194,396.42
Rate for Payer: EmblemHealth Essential Plan 3&4	$86,398.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$86,398.41
Rate for Payer: Fidelis Qualified Health Plan	$103,678.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$86,398.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$86,398.41
Rate for Payer: Healthfirst Commercial	$163,828.00
Rate for Payer: Healthfirst Essential Plan	$194,396.42
Rate for Payer: Healthfirst QHP	$97,208.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86,398.41
Rate for Payer: SOMOS Essential	$194,396.42
Rate for Payer: United Healthcare Essential Plan 1&2	$194,396.42
Rate for Payer: United Healthcare Essential Plan 3&4	$194,396.42
Rate for Payer: United Healthcare Medicaid	$86,398.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$86,398.41

Tracheostomy w MV 96+ hours w/o extensive procedure

Facility

$274,538.99

Service Code	APR-DRG 0054
Min. Negotiated Rate	$122,017.33
Max. Negotiated Rate	$274,538.99
Rate for Payer: Affinity Essential Plan 1&2	$274,538.99
Rate for Payer: Affinity Essential Plan 3&4	$274,538.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$122,017.33
Rate for Payer: Amida Care Medicaid	$122,017.33
Rate for Payer: EmblemHealth Essential Plan 1&2	$274,538.99
Rate for Payer: EmblemHealth Essential Plan 3&4	$122,017.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$122,017.33
Rate for Payer: Fidelis Qualified Health Plan	$146,420.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$122,017.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$122,017.33
Rate for Payer: Healthfirst Commercial	$235,733.00
Rate for Payer: Healthfirst Essential Plan	$274,538.99
Rate for Payer: Healthfirst QHP	$146,282.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$122,017.33
Rate for Payer: SOMOS Essential	$274,538.99
Rate for Payer: United Healthcare Essential Plan 1&2	$274,538.99
Rate for Payer: United Healthcare Essential Plan 3&4	$274,538.99
Rate for Payer: United Healthcare Medicaid	$122,017.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122,017.33

TRAMADOL HCL 50 MG PO TABS

Facility

$0.18

Service Code	NDC 0904749661
Hospital Charge Code	0904749661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

TRAMADOL HCL 50 MG PO TABS

Facility

$0.18

Service Code	NDC 0904749661
Hospital Charge Code	0904749661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

TRAMADOL HCL 50 MG PO TABS

Facility

$0.84

Service Code	NDC 5766437708
Hospital Charge Code	5766437708
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.67
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	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
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

TRAMADOL HCL 50 MG PO TABS

Facility

$0.18

Service Code	NDC 6068779511
Hospital Charge Code	6068779511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: EmblemHealth Commercial	$0.09
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

TRAMADOL HCL 50 MG PO TABS

Facility

$0.83

Service Code	NDC 6516262710
Hospital Charge Code	6516262710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.67
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	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
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

TRAMADOL HCL 50 MG PO TABS

Facility

$0.83

Service Code	NDC 6516262710
Hospital Charge Code	6516262710
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

TRAMADOL HCL 50 MG PO TABS

Facility

$0.84

Service Code	NDC 5766437708
Hospital Charge Code	5766437708
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

TRAMADOL HCL 50 MG PO TABS

Facility

$0.18

Service Code	NDC 6068779511
Hospital Charge Code	6068779511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$2.52

Service Code	HCPCS J3290
Hospital Charge Code	6050561690
Hospital Revenue Code	258
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.26

Know your out-of-pocket cost for care.

All Charges