St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PENTAMIDINE 300 MG INJ

Facility

$168.10

Service Code	HCPCS J7699
Hospital Charge Code	41643430
Hospital Revenue Code	636
Min. Negotiated Rate	$58.84
Max. Negotiated Rate	$109.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.05
Rate for Payer: Aetna Government	$84.05
Rate for Payer: Brighton Health Commercial	$100.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.66
Rate for Payer: Group Health Inc Commercial	$84.05
Rate for Payer: Group Health Inc Medicare	$58.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.05
Rate for Payer: Hamaspik Choice Inc Medicare	$84.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$109.26

PENTAMIDINE 300 MG INJ

Facility

$168.10

Service Code	HCPCS J7699
Hospital Charge Code	41643430
Hospital Revenue Code	636
Min. Negotiated Rate	$84.05
Max. Negotiated Rate	$84.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.05
Rate for Payer: Hamaspik Choice Inc Medicare	$84.05

PENTAMIDINE 300 MG INJ

Facility

$168.10

Service Code	HCPCS J7699
Hospital Charge Code	41653430
Hospital Revenue Code	636
Min. Negotiated Rate	$58.84
Max. Negotiated Rate	$109.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.05
Rate for Payer: Aetna Government	$84.05
Rate for Payer: Brighton Health Commercial	$100.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.66
Rate for Payer: Group Health Inc Commercial	$84.05
Rate for Payer: Group Health Inc Medicare	$58.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.05
Rate for Payer: Hamaspik Choice Inc Medicare	$84.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$109.26

PENTAMIDINE ISETHIONATE 300 MG IJ SOLR [27430]

Facility

$200.27

Service Code	HCPCS J2545
Hospital Charge Code	63323011310
Hospital Revenue Code	250
Min. Negotiated Rate	$70.09
Max. Negotiated Rate	$160.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.72
Rate for Payer: Aetna Government	$123.72
Rate for Payer: Brighton Health Commercial	$150.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.18
Rate for Payer: Group Health Inc Commercial	$100.13
Rate for Payer: Group Health Inc Medicare	$70.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.13
Rate for Payer: Hamaspik Choice Inc Medicare	$100.13
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$87.10
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$92.32
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$92.32
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$92.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.17

PENTAMIDINE ISETHIONATE 300 MG IJ SOLR [27430]

Facility

$180.50

Service Code	HCPCS J2545
Hospital Charge Code	13925051510
Hospital Revenue Code	250
Min. Negotiated Rate	$63.18
Max. Negotiated Rate	$144.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.72
Rate for Payer: Aetna Government	$123.72
Rate for Payer: Brighton Health Commercial	$135.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.74
Rate for Payer: Group Health Inc Commercial	$90.25
Rate for Payer: Group Health Inc Medicare	$63.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.25
Rate for Payer: Hamaspik Choice Inc Medicare	$90.25
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$87.10
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$92.32
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$92.32
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$92.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.32

PENTAMIDINE ISETHIONATE 300 MG IN SOLR [28235]

Facility

$200.27

Service Code	HCPCS J2545
Hospital Charge Code	63323087715
Hospital Revenue Code	250
Min. Negotiated Rate	$70.09
Max. Negotiated Rate	$160.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.72
Rate for Payer: Aetna Government	$123.72
Rate for Payer: Brighton Health Commercial	$150.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.18
Rate for Payer: Group Health Inc Commercial	$100.14
Rate for Payer: Group Health Inc Medicare	$70.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.14
Rate for Payer: Hamaspik Choice Inc Medicare	$100.14
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$87.10
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$92.32
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$92.32
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$92.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$130.18

PENTAMIDINE NEB INHALATION 300 MG

Facility

$156.32

Hospital Charge Code	41653509
Hospital Revenue Code	636
Min. Negotiated Rate	$78.16
Max. Negotiated Rate	$78.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.16
Rate for Payer: Hamaspik Choice Inc Medicare	$78.16

PENTAMIDINE NEB INHALATION 300 MG

Facility

$156.32

Hospital Charge Code	41643509
Hospital Revenue Code	636
Min. Negotiated Rate	$54.71
Max. Negotiated Rate	$101.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$78.16
Rate for Payer: Aetna Government	$78.16
Rate for Payer: Brighton Health Commercial	$93.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.88
Rate for Payer: Group Health Inc Commercial	$78.16
Rate for Payer: Group Health Inc Medicare	$54.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.16
Rate for Payer: Hamaspik Choice Inc Medicare	$78.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.61

PENTAMIDINE NEB INHALATION 300 MG

Facility

$156.32

Hospital Charge Code	41653509
Hospital Revenue Code	636
Min. Negotiated Rate	$54.71
Max. Negotiated Rate	$101.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$78.16
Rate for Payer: Aetna Government	$78.16
Rate for Payer: Brighton Health Commercial	$93.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.88
Rate for Payer: Group Health Inc Commercial	$78.16
Rate for Payer: Group Health Inc Medicare	$54.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.16
Rate for Payer: Hamaspik Choice Inc Medicare	$78.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.61

PENTAMIDINE NEB INHALATION 300 MG

Facility

$156.32

Hospital Charge Code	41643509
Hospital Revenue Code	636
Min. Negotiated Rate	$78.16
Max. Negotiated Rate	$78.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.16
Rate for Payer: Hamaspik Choice Inc Medicare	$78.16

PENTOBARBITAL 50 MG/ML INJ

Facility

$700.00

Service Code	HCPCS J2515
Hospital Charge Code	41653154
Hospital Revenue Code	636
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

PENTOBARBITAL 50 MG/ML INJ

Facility

$700.00

Service Code	HCPCS J2515
Hospital Charge Code	41643154
Hospital Revenue Code	636
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

PENTOBARBITAL 50 MG/ML INJ

Facility

$700.00

Service Code	HCPCS J2515
Hospital Charge Code	41643154
Hospital Revenue Code	636
Min. Negotiated Rate	$22.60
Max. Negotiated Rate	$455.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.41
Rate for Payer: Aetna Government	$26.41
Rate for Payer: Brighton Health Commercial	$420.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: United Healthcare Commercial	$22.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00

PENTOBARBITAL 50 MG/ML INJ

Facility

$700.00

Service Code	HCPCS J2515
Hospital Charge Code	41653154
Hospital Revenue Code	636
Min. Negotiated Rate	$22.60
Max. Negotiated Rate	$455.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.41
Rate for Payer: Aetna Government	$26.41
Rate for Payer: Brighton Health Commercial	$420.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: United Healthcare Commercial	$22.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00

PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN [6097]

Facility

$75.64

Service Code	HCPCS J2515
Hospital Charge Code	17478018120
Hospital Revenue Code	250
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$60.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.41
Rate for Payer: Aetna Government	$26.41
Rate for Payer: Brighton Health Commercial	$56.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.43
Rate for Payer: Group Health Inc Commercial	$37.82
Rate for Payer: Group Health Inc Medicare	$26.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.82
Rate for Payer: Hamaspik Choice Inc Medicare	$37.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.16

PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN [6097]

Facility

$75.64

Service Code	HCPCS J2515
Hospital Charge Code	76478050120
Hospital Revenue Code	250
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$60.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.41
Rate for Payer: Aetna Government	$26.41
Rate for Payer: Brighton Health Commercial	$56.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.43
Rate for Payer: Group Health Inc Commercial	$37.82
Rate for Payer: Group Health Inc Medicare	$26.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.82
Rate for Payer: Hamaspik Choice Inc Medicare	$37.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.16

PENTOXIFYLLINE 400 MG TAB CR

Facility

$0.31

Hospital Charge Code	41644505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

PENTOXIFYLLINE 400 MG TAB CR

Facility

$0.31

Hospital Charge Code	41654505
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

PENTOXIFYLLINE ER 400 MG PO TBCR [21300]

Facility

$1.50

Service Code	NDC 00904544861
Hospital Charge Code	00904544861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.02
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.97

PENUMBRA CANISTER TUBE FLTR IAPS2

Facility

$740.00

Hospital Charge Code	66523478
Hospital Revenue Code	272
Min. Negotiated Rate	$259.00
Max. Negotiated Rate	$592.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$407.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$370.00
Rate for Payer: Aetna Government	$370.00
Rate for Payer: Brighton Health Commercial	$555.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$592.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$503.20
Rate for Payer: Group Health Inc Commercial	$370.00
Rate for Payer: Group Health Inc Medicare	$259.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$370.00
Rate for Payer: Hamaspik Choice Inc Medicare	$370.00

PENUMBRA CAT RX ASP CATRXKIT

Facility

$4,280.00

Service Code	HCPCS C1757
Hospital Charge Code	66523476
Hospital Revenue Code	272
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$3,424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,354.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Brighton Health Commercial	$3,210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,424.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,910.40
Rate for Payer: Group Health Inc Commercial	$2,140.00
Rate for Payer: Group Health Inc Medicare	$1,498.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,140.00

PENUMBRA ENGINE CANISTER IAPS3

Facility

$740.00

Hospital Charge Code	66523482
Hospital Revenue Code	272
Min. Negotiated Rate	$259.00
Max. Negotiated Rate	$592.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$407.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$370.00
Rate for Payer: Aetna Government	$370.00
Rate for Payer: Brighton Health Commercial	$555.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$592.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$503.20
Rate for Payer: Group Health Inc Commercial	$370.00
Rate for Payer: Group Health Inc Medicare	$259.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$370.00
Rate for Payer: Hamaspik Choice Inc Medicare	$370.00

PENUMBRA SEPARATOR 4 SEPC4

Facility

$1,990.00

Service Code	HCPCS C1757
Hospital Charge Code	66523477
Hospital Revenue Code	272
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$1,592.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,094.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.33
Rate for Payer: Aetna Government	$16.33
Rate for Payer: Brighton Health Commercial	$1,492.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,592.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,353.20
Rate for Payer: Group Health Inc Commercial	$995.00
Rate for Payer: Group Health Inc Medicare	$696.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$995.00

PERAMPANEL 12 MG PO TABS [124446]

Facility

$49.08

Service Code	NDC 62856028230
Hospital Charge Code	62856028230
Hospital Revenue Code	250
Min. Negotiated Rate	$17.18
Max. Negotiated Rate	$39.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.54
Rate for Payer: Aetna Government	$24.54
Rate for Payer: Brighton Health Commercial	$36.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.37
Rate for Payer: Group Health Inc Commercial	$24.54
Rate for Payer: Group Health Inc Medicare	$17.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.54
Rate for Payer: Hamaspik Choice Inc Medicare	$24.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.90

PERAMPANEL 12MG TABLETS

Facility

$33.39

Service Code	HCPCS C9399
Hospital Charge Code	41650361
Hospital Revenue Code	250
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$26.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.70
Rate for Payer: Aetna Government	$16.70
Rate for Payer: Brighton Health Commercial	$25.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.71
Rate for Payer: Group Health Inc Commercial	$16.70
Rate for Payer: Group Health Inc Medicare	$11.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.70
Rate for Payer: Hamaspik Choice Inc Medicare	$16.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.70

Know your out-of-pocket cost for care.

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