St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SOL NATURALYTE W/DEXTROSE 1014

Facility

$10.00

Hospital Charge Code	40209468
Hospital Revenue Code	270
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

SOL. NORMAL SALINE

Facility

$50.40

Hospital Charge Code	64902782
Hospital Revenue Code	270
Min. Negotiated Rate	$17.64
Max. Negotiated Rate	$40.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.20
Rate for Payer: Aetna Government	$25.20
Rate for Payer: Brighton Health Commercial	$37.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.27
Rate for Payer: Group Health Inc Commercial	$25.20
Rate for Payer: Group Health Inc Medicare	$17.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.20
Rate for Payer: Hamaspik Choice Inc Medicare	$25.20

SOL PREPODYNE 4 OZ.

Facility

$1.18

Hospital Charge Code	40209457
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.80
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59

SOL RENALPR ACID LQD R-135 K-FREE

Facility

$9.29

Hospital Charge Code	64902276
Hospital Revenue Code	270
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$7.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.64
Rate for Payer: Aetna Government	$4.64
Rate for Payer: Brighton Health Commercial	$6.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.32
Rate for Payer: Group Health Inc Commercial	$4.64
Rate for Payer: Group Health Inc Medicare	$3.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.64
Rate for Payer: Hamaspik Choice Inc Medicare	$4.64

SOLUBLE LIVER AG (IGG AB)

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40729241
Hospital Revenue Code	300
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$21.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.53
Rate for Payer: Aetna Government	$11.53
Rate for Payer: Brighton Health Commercial	$21.62
Rate for Payer: Cash Price	$11.53
Rate for Payer: Cash Price	$11.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.52
Rate for Payer: Elderplan Medicare Advantage	$11.53
Rate for Payer: EmblemHealth Commercial	$11.53
Rate for Payer: Fidelis Essential Plan Aliesa	$9.80
Rate for Payer: Fidelis Essential Plan QHP	$10.26
Rate for Payer: Fidelis Medicare Advantage	$11.53
Rate for Payer: Fidelis Qualified Health Plan	$10.26
Rate for Payer: Group Health Inc Commercial	$11.53
Rate for Payer: Group Health Inc Medicare	$11.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.42
Rate for Payer: Hamaspik Choice Inc Medicare	$11.53
Rate for Payer: Healthfirst Medicare Advantage	$11.53
Rate for Payer: Healthfirst QHP	$11.53
Rate for Payer: Senior Whole Health Medicare Advantage	$11.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.22
Rate for Payer: Wellcare Medicare	$10.38

SOLUBLE LIVER AG (IGG AB)

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40729241
Hospital Revenue Code	300
Rate for Payer: Cash Price	$11.53

SOLUBLE_TRANSFERRIN_RECEPTOR

Facility

$91.43

Service Code	HCPCS 84238
Hospital Charge Code	40609113
Hospital Revenue Code	300
Min. Negotiated Rate	$29.26
Max. Negotiated Rate	$68.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.57
Rate for Payer: Aetna Government	$36.57
Rate for Payer: Brighton Health Commercial	$68.57
Rate for Payer: Cash Price	$36.57
Rate for Payer: Cash Price	$36.57
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$36.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.18
Rate for Payer: Elderplan Medicare Advantage	$36.57
Rate for Payer: EmblemHealth Commercial	$36.57
Rate for Payer: Fidelis Essential Plan Aliesa	$31.08
Rate for Payer: Fidelis Essential Plan QHP	$32.55
Rate for Payer: Fidelis Medicare Advantage	$36.57
Rate for Payer: Fidelis Qualified Health Plan	$32.55
Rate for Payer: Group Health Inc Commercial	$36.57
Rate for Payer: Group Health Inc Medicare	$36.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.72
Rate for Payer: Hamaspik Choice Inc Medicare	$36.57
Rate for Payer: Healthfirst Medicare Advantage	$36.57
Rate for Payer: Healthfirst QHP	$36.57
Rate for Payer: Senior Whole Health Medicare Advantage	$36.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29.26
Rate for Payer: Wellcare Medicare	$32.91

SOLUBLE_TRANSFERRIN_RECEPTOR

Facility

$91.43

Service Code	HCPCS 84238
Hospital Charge Code	40609113
Hospital Revenue Code	300
Rate for Payer: Cash Price	$36.57

SOLUSET (METRIC SET)

Facility

$12.40

Hospital Charge Code	40193910
Hospital Revenue Code	710
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$9.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.20
Rate for Payer: Aetna Government	$6.20
Rate for Payer: Brighton Health Commercial	$9.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.43
Rate for Payer: Group Health Inc Commercial	$6.20
Rate for Payer: Group Health Inc Medicare	$4.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.20
Rate for Payer: Hamaspik Choice Inc Medicare	$6.20

SOLUTION BETADINE 5% OPHTHALMIC

Facility

$15.88

Hospital Charge Code	64904042
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$12.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.94
Rate for Payer: Aetna Government	$7.94
Rate for Payer: Brighton Health Commercial	$11.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
Rate for Payer: Group Health Inc Commercial	$7.94
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.94
Rate for Payer: Hamaspik Choice Inc Medicare	$7.94

SOLUTION BETADINE5% OPHTHALMIC

Facility

$12.00

Hospital Charge Code	40200482
Hospital Revenue Code	270
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: 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

SOLUTION,DEXTROSE,10,1000 ML

Facility

$4.51

Hospital Charge Code	64902053
Hospital Revenue Code	270
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$3.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$3.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.07
Rate for Payer: Group Health Inc Commercial	$2.26
Rate for Payer: Group Health Inc Medicare	$1.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.26
Rate for Payer: Hamaspik Choice Inc Medicare	$2.26

SOLUTION, DEXTROSE, 10, 500 ML

Facility

$4.21

Hospital Charge Code	64902077
Hospital Revenue Code	270
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.10
Rate for Payer: Aetna Government	$2.10
Rate for Payer: Brighton Health Commercial	$3.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10

SOLUTION,DEXTROSE,5,0.33,500

Facility

$3.28

Hospital Charge Code	64901119
Hospital Revenue Code	270
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$2.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.64
Rate for Payer: Aetna Government	$1.64
Rate for Payer: Brighton Health Commercial	$2.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.23
Rate for Payer: Group Health Inc Commercial	$1.64
Rate for Payer: Group Health Inc Medicare	$1.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64
Rate for Payer: Hamaspik Choice Inc Medicare	$1.64

SOLUTION DEXTROSE,5,0.45,1000

Facility

$3.42

Service Code	HCPCS S5010
Hospital Charge Code	64901398
Hospital Revenue Code	258
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$5.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.59
Rate for Payer: Aetna Government	$5.59
Rate for Payer: Brighton Health Commercial	$2.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.33
Rate for Payer: Group Health Inc Commercial	$1.71
Rate for Payer: Group Health Inc Medicare	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

SOLUTION,DEXTROSE,5,0.45,500

Facility

$3.27

Hospital Charge Code	64901421
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.64
Rate for Payer: Aetna Government	$1.64
Rate for Payer: Brighton Health Commercial	$2.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.22
Rate for Payer: Group Health Inc Commercial	$1.64
Rate for Payer: Group Health Inc Medicare	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64
Rate for Payer: Hamaspik Choice Inc Medicare	$1.64

SOLUTION,DEXTROSE,5,0.9

Facility

$3.28

Hospital Charge Code	64901475
Hospital Revenue Code	270
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$2.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.64
Rate for Payer: Aetna Government	$1.64
Rate for Payer: Brighton Health Commercial	$2.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.23
Rate for Payer: Group Health Inc Commercial	$1.64
Rate for Payer: Group Health Inc Medicare	$1.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64
Rate for Payer: Hamaspik Choice Inc Medicare	$1.64

SOLUTION,DEXTROSE,5,0.9,1000

Facility

$3.61

Hospital Charge Code	64901418
Hospital Revenue Code	270
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.80
Rate for Payer: Aetna Government	$1.80
Rate for Payer: Brighton Health Commercial	$2.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.45
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80

SOLUTION,DEXTROSE,5,1000ML,US

Facility

$3.34

Service Code	HCPCS S5010
Hospital Charge Code	64901410
Hospital Revenue Code	258
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$5.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.59
Rate for Payer: Aetna Government	$5.59
Rate for Payer: Brighton Health Commercial	$2.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.27
Rate for Payer: Group Health Inc Commercial	$1.67
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.67
Rate for Payer: Hamaspik Choice Inc Medicare	$1.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.17

SOLUTION,DEXTROSE,5 100 ML

Facility

$2.93

Hospital Charge Code	64901411
Hospital Revenue Code	270
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.46
Rate for Payer: Aetna Government	$1.46
Rate for Payer: Brighton Health Commercial	$2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.99
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46

SOLUTION,DEXTROSE,5,250 ML,US

Facility

$2.93

Service Code	HCPCS S5010
Hospital Charge Code	64901390
Hospital Revenue Code	258
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$5.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.59
Rate for Payer: Aetna Government	$5.59
Rate for Payer: Brighton Health Commercial	$2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.99
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.90

SOLUTION DEXTROSE,5,500 ML,US

Facility

$3.03

Service Code	HCPCS S5010
Hospital Charge Code	64901394
Hospital Revenue Code	258
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$5.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.59
Rate for Payer: Aetna Government	$5.59
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

SOLUTION,DEXTROSE,5,50 ML

Facility

$2.93

Hospital Charge Code	64901412
Hospital Revenue Code	270
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.46
Rate for Payer: Aetna Government	$1.46
Rate for Payer: Brighton Health Commercial	$2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.99
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46

SOLUTION,DEXTRSE,INJ, 5,MIN50

Facility

$23.59

Service Code	HCPCS S5010
Hospital Charge Code	64902282
Hospital Revenue Code	258
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$18.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.59
Rate for Payer: Aetna Government	$5.59
Rate for Payer: Brighton Health Commercial	$17.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.04
Rate for Payer: Group Health Inc Commercial	$11.80
Rate for Payer: Group Health Inc Medicare	$8.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.80
Rate for Payer: Hamaspik Choice Inc Medicare	$11.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.33

SOLUTION,DEXTRSE,INJ, 5,MINI0

Facility

$23.59

Service Code	HCPCS S5010
Hospital Charge Code	64902285
Hospital Revenue Code	258
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$18.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.59
Rate for Payer: Aetna Government	$5.59
Rate for Payer: Brighton Health Commercial	$17.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.04
Rate for Payer: Group Health Inc Commercial	$11.80
Rate for Payer: Group Health Inc Medicare	$8.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.80
Rate for Payer: Hamaspik Choice Inc Medicare	$11.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.33

Know your out-of-pocket cost for care.

All Charges