St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$71,384.00

Service Code	MSDRG 939
Min. Negotiated Rate	$24,140.77
Max. Negotiated Rate	$71,384.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47,409.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51,915.64
Rate for Payer: Aetna Government	$51,915.64
Rate for Payer: Brighton Health Commercial	$46,621.85
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$52,953.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55,525.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$45,821.63
Rate for Payer: Elderplan Medicare Advantage	$49,319.86
Rate for Payer: EmblemHealth Commercial	$27,571.20
Rate for Payer: Fidelis Medicare Advantage	$51,915.64
Rate for Payer: Group Health Inc Commercial	$51,915.64
Rate for Payer: Group Health Inc Medicare	$51,915.64
Rate for Payer: Hamaspik Choice Inc Medicare	$51,915.64
Rate for Payer: Healthfirst Medicare Advantage	$24,140.77
Rate for Payer: Humana Medicare	$71,384.00
Rate for Payer: Senior Whole Health Medicare Advantage	$51,915.64
Rate for Payer: United Healthcare Commercial	$63,942.67
Rate for Payer: United Healthcare Medicare Advantage	$51,915.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51,915.64
Rate for Payer: Wellcare Medicare	$49,319.86

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$45,465.36

Service Code	MSDRG 941
Min. Negotiated Rate	$15,375.56
Max. Negotiated Rate	$45,465.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27,366.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33,065.72
Rate for Payer: Aetna Government	$33,065.72
Rate for Payer: Brighton Health Commercial	$26,912.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$33,727.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32,051.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$26,450.08
Rate for Payer: Elderplan Medicare Advantage	$31,412.43
Rate for Payer: EmblemHealth Commercial	$15,915.20
Rate for Payer: Fidelis Medicare Advantage	$33,065.72
Rate for Payer: Group Health Inc Commercial	$33,065.72
Rate for Payer: Group Health Inc Medicare	$33,065.72
Rate for Payer: Hamaspik Choice Inc Medicare	$33,065.72
Rate for Payer: Healthfirst Medicare Advantage	$15,375.56
Rate for Payer: Humana Medicare	$45,465.36
Rate for Payer: Senior Whole Health Medicare Advantage	$33,065.72
Rate for Payer: United Healthcare Commercial	$36,910.27
Rate for Payer: United Healthcare Medicare Advantage	$33,065.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$33,065.72
Rate for Payer: Wellcare Medicare	$31,412.43

O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$74,208.34

Service Code	MSDRG 876
Min. Negotiated Rate	$1,859.00
Max. Negotiated Rate	$74,208.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,859.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59,073.99
Rate for Payer: Aetna Government	$59,073.99
Rate for Payer: Brighton Health Commercial	$54,106.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$60,255.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64,439.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$53,178.05
Rate for Payer: Elderplan Medicare Advantage	$56,120.29
Rate for Payer: EmblemHealth Commercial	$31,997.60
Rate for Payer: Fidelis Medicare Advantage	$59,073.99
Rate for Payer: Group Health Inc Commercial	$59,073.99
Rate for Payer: Group Health Inc Medicare	$59,073.99
Rate for Payer: Hamaspik Choice Inc Medicare	$59,073.99
Rate for Payer: Healthfirst Medicare Advantage	$27,469.41
Rate for Payer: Senior Whole Health Medicare Advantage	$59,073.99
Rate for Payer: United Healthcare Commercial	$74,208.34
Rate for Payer: United Healthcare Medicare Advantage	$59,073.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59,073.99
Rate for Payer: Wellcare Medicare	$56,120.29

ORTDNTC TX ACTIVE COMPRHN - SNCD

Facility

$453.60

Service Code	HCPCS X8672
Hospital Charge Code	42303230
Hospital Revenue Code	361
Min. Negotiated Rate	$158.76
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$249.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.80
Rate for Payer: Aetna Government	$226.80
Rate for Payer: Brighton Health Commercial	$340.20
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: Group Health Inc Commercial	$226.80
Rate for Payer: Group Health Inc Medicare	$158.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.80
Rate for Payer: Hamaspik Choice Inc Medicare	$226.80

ORTHADAPT BIOSTRIPS-FX 5CMX15CM

Facility

$5,590.00

Service Code	HCPCS C1762
Hospital Charge Code	40202013
Hospital Revenue Code	278
Min. Negotiated Rate	$2,795.00
Max. Negotiated Rate	$2,795.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,795.00

ORTHADAPT BIOSTRIPS-FX 5CMX15CM

Facility

$5,590.00

Service Code	HCPCS C1762
Hospital Charge Code	40202013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,879.82
Max. Negotiated Rate	$5,869.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,074.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$3,354.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,795.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,214.25
Rate for Payer: EmblemHealth Commercial	$2,795.00
Rate for Payer: Fidelis Medicare Advantage	$5,869.50
Rate for Payer: Group Health Inc Commercial	$2,795.00
Rate for Payer: Group Health Inc Medicare	$1,956.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,795.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,795.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,633.50

ORTH BONE BLK 5CC SYN CAN

Facility

$4,950.00

Service Code	HCPCS C1762
Hospital Charge Code	40009284
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$5,197.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,722.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$2,970.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,475.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,846.25
Rate for Payer: EmblemHealth Commercial	$2,475.00
Rate for Payer: Fidelis Medicare Advantage	$5,197.50
Rate for Payer: Group Health Inc Commercial	$2,475.00
Rate for Payer: Group Health Inc Medicare	$1,732.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,475.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,217.50

ORTH BONE BLK 5CC SYN CAN

Facility

$4,950.00

Service Code	HCPCS C1762
Hospital Charge Code	40009284
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,475.00

ORTHDNTC TX ACTIVE COMPHRN -FIRST

Facility

$623.70

Service Code	HCPCS X8671
Hospital Charge Code	42303220
Hospital Revenue Code	361
Min. Negotiated Rate	$218.30
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$311.85
Rate for Payer: Aetna Government	$311.85
Rate for Payer: Brighton Health Commercial	$467.78
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: Group Health Inc Commercial	$311.85
Rate for Payer: Group Health Inc Medicare	$218.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$311.85
Rate for Payer: Hamaspik Choice Inc Medicare	$311.85

ORTHDNTC TX ACTIVE COMPHRN -THRD

Facility

$155.93

Service Code	HCPCS X8673
Hospital Charge Code	42303240
Hospital Revenue Code	361
Min. Negotiated Rate	$54.58
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.96
Rate for Payer: Aetna Government	$77.96
Rate for Payer: Brighton Health Commercial	$116.95
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: Group Health Inc Commercial	$77.96
Rate for Payer: Group Health Inc Medicare	$54.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.96
Rate for Payer: Hamaspik Choice Inc Medicare	$77.96

ORTHIVITA BONE GRAFT SUB 10CC

Facility

$3,850.00

Service Code	HCPCS C1768
Hospital Charge Code	40205939
Hospital Revenue Code	278
Min. Negotiated Rate	$1,925.00
Max. Negotiated Rate	$1,925.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,925.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,925.00

ORTHIVITA BONE GRAFT SUB 10CC

Facility

$3,850.00

Service Code	HCPCS C1768
Hospital Charge Code	40205939
Hospital Revenue Code	278
Min. Negotiated Rate	$322.77
Max. Negotiated Rate	$4,042.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,117.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.77
Rate for Payer: Aetna Government	$322.77
Rate for Payer: Brighton Health Commercial	$2,310.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,925.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,213.75
Rate for Payer: EmblemHealth Commercial	$1,925.00
Rate for Payer: Fidelis Medicare Advantage	$4,042.50
Rate for Payer: Group Health Inc Commercial	$1,925.00
Rate for Payer: Group Health Inc Medicare	$1,347.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,925.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,925.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,502.50

ORTHO 2.7M BALL TIP WIRE

Facility

$544.00

Hospital Charge Code	40203552
Hospital Revenue Code	272
Min. Negotiated Rate	$190.40
Max. Negotiated Rate	$435.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$299.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$272.00
Rate for Payer: Aetna Government	$272.00
Rate for Payer: Brighton Health Commercial	$408.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$435.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$369.92
Rate for Payer: Group Health Inc Commercial	$272.00
Rate for Payer: Group Health Inc Medicare	$190.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$272.00
Rate for Payer: Hamaspik Choice Inc Medicare	$272.00

ORTHOBLEND SM DEFECT 1ML GEL

Facility

$2,602.00

Hospital Charge Code	40202034
Hospital Revenue Code	270
Min. Negotiated Rate	$910.70
Max. Negotiated Rate	$2,081.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,431.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,301.00
Rate for Payer: Aetna Government	$1,301.00
Rate for Payer: Brighton Health Commercial	$1,951.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,081.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,769.36
Rate for Payer: Group Health Inc Commercial	$1,301.00
Rate for Payer: Group Health Inc Medicare	$910.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,301.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,301.00

ORTHOCHROME FEMORAL STEM

Facility

$101.00

Hospital Charge Code	40202150
Hospital Revenue Code	270
Min. Negotiated Rate	$35.35
Max. Negotiated Rate	$80.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.50
Rate for Payer: Aetna Government	$50.50
Rate for Payer: Brighton Health Commercial	$75.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.68
Rate for Payer: Group Health Inc Commercial	$50.50
Rate for Payer: Group Health Inc Medicare	$35.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50
Rate for Payer: Hamaspik Choice Inc Medicare	$50.50

ORTHO COBALT BONE CEMENT 40/20

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209436
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$78.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: EmblemHealth Commercial	$65.00
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

ORTHO COBALT BONE CEMENT 40/20

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40209436
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

ORTHODONTIC- PRIMARY/LIMITED

Facility

$3,500.00

Service Code	HCPCS D8010
Hospital Charge Code	42303333
Hospital Revenue Code	361
Min. Negotiated Rate	$917.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,925.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$917.50
Rate for Payer: Aetna Government	$917.50
Rate for Payer: Brighton Health Commercial	$2,625.00
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: Group Health Inc Commercial	$1,750.00
Rate for Payer: Group Health Inc Medicare	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,750.00

ORTHOFIX 2.0MM K-WIRE

Facility

$74.00

Service Code	HCPCS C1769
Hospital Charge Code	40208180
Hospital Revenue Code	278
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$37.00

ORTHOFIX 2.0MM K-WIRE

Facility

$74.00

Service Code	HCPCS C1769
Hospital Charge Code	40208180
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$77.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$44.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.55
Rate for Payer: EmblemHealth Commercial	$37.00
Rate for Payer: Fidelis Medicare Advantage	$77.70
Rate for Payer: Group Health Inc Commercial	$37.00
Rate for Payer: Group Health Inc Medicare	$25.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$37.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.10

ORTHOFIX 2HOLE PLATE

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	40208181
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

ORTHOFIX 2HOLE PLATE

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	40208181
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

ORTHOFIX 3.2MM CANN. SCREW

Facility

$280.00

Service Code	HCPCS C1713
Hospital Charge Code	40208183
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$294.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$168.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.00
Rate for Payer: EmblemHealth Commercial	$140.00
Rate for Payer: Fidelis Medicare Advantage	$294.00
Rate for Payer: Group Health Inc Commercial	$140.00
Rate for Payer: Group Health Inc Medicare	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.00

ORTHOFIX 3.2MM CANN. SCREW

Facility

$280.00

Service Code	HCPCS C1713
Hospital Charge Code	40208183
Hospital Revenue Code	278
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00

ORTHOFIX 3.2MM DRILL BIT

Facility

$300.00

Hospital Charge Code	40208182
Hospital Revenue Code	270
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.00
Rate for Payer: Aetna Government	$150.00
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$204.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

Know your out-of-pocket cost for care.

All Charges