St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SP EACH ADDITIONAL CYST

Facility

$248.06

Service Code	HCPCS 19001 TC
Hospital Charge Code	41549615
Hospital Revenue Code	361
Min. Negotiated Rate	$86.82
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$136.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$124.03
Rate for Payer: Aetna Government	$124.03
Rate for Payer: Brighton Health Commercial	$186.04
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	$124.03
Rate for Payer: Group Health Inc Medicare	$86.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.03
Rate for Payer: Hamaspik Choice Inc Medicare	$124.03

SPEARS SURGICAL WECKCELL

Facility

$3.82

Hospital Charge Code	64904342
Hospital Revenue Code	270
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.91
Rate for Payer: Aetna Government	$1.91
Rate for Payer: Brighton Health Commercial	$2.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.60
Rate for Payer: Group Health Inc Commercial	$1.91
Rate for Payer: Group Health Inc Medicare	$1.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.91
Rate for Payer: Hamaspik Choice Inc Medicare	$1.91

SPECIAL NURSING DAY SHIFT

Facility

$1,154.20

Hospital Charge Code	40209998
Hospital Revenue Code	270
Min. Negotiated Rate	$403.97
Max. Negotiated Rate	$923.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$634.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$577.10
Rate for Payer: Aetna Government	$577.10
Rate for Payer: Brighton Health Commercial	$865.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$923.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$784.86
Rate for Payer: Group Health Inc Commercial	$577.10
Rate for Payer: Group Health Inc Medicare	$403.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$577.10
Rate for Payer: Hamaspik Choice Inc Medicare	$577.10

SPECIAL NURSING EVENING SHIFT

Facility

$1,271.50

Hospital Charge Code	40209997
Hospital Revenue Code	270
Min. Negotiated Rate	$445.02
Max. Negotiated Rate	$1,017.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$699.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$635.75
Rate for Payer: Aetna Government	$635.75
Rate for Payer: Brighton Health Commercial	$953.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,017.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$864.62
Rate for Payer: Group Health Inc Commercial	$635.75
Rate for Payer: Group Health Inc Medicare	$445.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$635.75
Rate for Payer: Hamaspik Choice Inc Medicare	$635.75

SPECIMEN INFECT AGNT CONCNTJ

Facility

$16.70

Service Code	HCPCS 87015
Hospital Charge Code	40614335
Hospital Revenue Code	300
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$12.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.68
Rate for Payer: Aetna Government	$6.68
Rate for Payer: Brighton Health Commercial	$12.52
Rate for Payer: Cash Price	$6.68
Rate for Payer: Cash Price	$6.68
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.99
Rate for Payer: Elderplan Medicare Advantage	$6.68
Rate for Payer: EmblemHealth Commercial	$6.68
Rate for Payer: Fidelis Essential Plan Aliesa	$5.68
Rate for Payer: Fidelis Essential Plan QHP	$5.95
Rate for Payer: Fidelis Medicare Advantage	$6.68
Rate for Payer: Fidelis Qualified Health Plan	$5.95
Rate for Payer: Group Health Inc Commercial	$6.68
Rate for Payer: Group Health Inc Medicare	$6.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.35
Rate for Payer: Hamaspik Choice Inc Medicare	$6.68
Rate for Payer: Healthfirst Medicare Advantage	$6.68
Rate for Payer: Healthfirst QHP	$6.68
Rate for Payer: Senior Whole Health Medicare Advantage	$6.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.34
Rate for Payer: Wellcare Medicare	$6.01

SPECIMEN INFECT AGNT CONCNTJ

Facility

$16.70

Service Code	HCPCS 87015
Hospital Charge Code	40614335
Hospital Revenue Code	300
Rate for Payer: Cash Price	$6.68

SPECTRA

Facility

$19,352.50

Hospital Charge Code	64904542
Hospital Revenue Code	279
Min. Negotiated Rate	$6,773.38
Max. Negotiated Rate	$15,482.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,643.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9,676.25
Rate for Payer: Aetna Government	$9,676.25
Rate for Payer: Brighton Health Commercial	$14,514.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15,482.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,159.70
Rate for Payer: Group Health Inc Commercial	$9,676.25
Rate for Payer: Group Health Inc Medicare	$6,773.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,676.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9,676.25

SPECTRANETICS PTCA BALLOON

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	66572919
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00

SPECTRANETICS PTCA BALLOON

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	66572919
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,837.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$962.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$1,050.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,006.25
Rate for Payer: EmblemHealth Commercial	$875.00
Rate for Payer: Fidelis Medicare Advantage	$1,837.50
Rate for Payer: Group Health Inc Commercial	$875.00
Rate for Payer: Group Health Inc Medicare	$612.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,137.50

SPECULA,OTOSCOPE,4.25MM,UNIV,K

Facility

$0.06

Hospital Charge Code	64902415
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

SPECULA OTOSCOPE KLEENSPEC

Facility

$0.16

Hospital Charge Code	64903504
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08

SPECULA OTOSCOPE PEDS 2.75 MM

Facility

$0.06

Hospital Charge Code	64902007
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

SPECULUM,VAGINAL,LARGE,DISPOS

Facility

$0.65

Hospital Charge Code	64901454
Hospital Revenue Code	270
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33

SPECULUM,VAGINAL,MEDIUM,DISPOS

Facility

$0.53

Hospital Charge Code	64901149
Hospital Revenue Code	270
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27

SPECULUM,VAGINAL SM DISPOSABLE NS

Facility

$0.53

Hospital Charge Code	64901146
Hospital Revenue Code	270
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27

SPEECH AID PROSTHESIS, ADULT

Facility

$2,846.00

Service Code	HCPCS D5953
Hospital Charge Code	42301335
Hospital Revenue Code	361
Min. Negotiated Rate	$996.10
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,565.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,943.35
Rate for Payer: Aetna Government	$1,943.35
Rate for Payer: Brighton Health Commercial	$2,134.50
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	$1,423.00
Rate for Payer: Group Health Inc Medicare	$996.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,423.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,423.00

SPEECH AID PROSTHESIS, MODIFICATI

Facility

$322.00

Service Code	HCPCS D5960
Hospital Charge Code	42301360
Hospital Revenue Code	361
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,295.90
Rate for Payer: Aetna Government	$1,295.90
Rate for Payer: Brighton Health Commercial	$241.50
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	$161.00
Rate for Payer: Group Health Inc Medicare	$112.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.00
Rate for Payer: Hamaspik Choice Inc Medicare	$161.00

SPEECH AID PROSTHESIS, PEDIATRIC

Facility

$753.00

Service Code	HCPCS D5952
Hospital Charge Code	42301330
Hospital Revenue Code	361
Min. Negotiated Rate	$263.55
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$414.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,023.18
Rate for Payer: Aetna Government	$1,023.18
Rate for Payer: Brighton Health Commercial	$564.75
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	$376.50
Rate for Payer: Group Health Inc Medicare	$263.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$376.50
Rate for Payer: Hamaspik Choice Inc Medicare	$376.50

SPEECH AUDIOMETRY COMPLETE

Facility

$101.25

Service Code	HCPCS 92556
Hospital Charge Code	30304751
Hospital Revenue Code	471
Rate for Payer: Cash Price	$70.74

SPEECH AUDIOMETRY COMPLETE

Facility

$101.25

Service Code	HCPCS 92556
Hospital Charge Code	30304751
Hospital Revenue Code	471
Min. Negotiated Rate	$50.62
Max. Negotiated Rate	$81.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.74
Rate for Payer: Aetna Government	$70.74
Rate for Payer: Brighton Health Commercial	$75.94
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.85
Rate for Payer: Elderplan Medicare Advantage	$70.74
Rate for Payer: EmblemHealth Commercial	$70.74
Rate for Payer: Fidelis Essential Plan Aliesa	$60.13
Rate for Payer: Fidelis Essential Plan QHP	$62.96
Rate for Payer: Fidelis Medicare Advantage	$70.74
Rate for Payer: Fidelis Qualified Health Plan	$62.96
Rate for Payer: Group Health Inc Commercial	$70.74
Rate for Payer: Group Health Inc Medicare	$70.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.62
Rate for Payer: Hamaspik Choice Inc Medicare	$70.74
Rate for Payer: Healthfirst Medicare Advantage	$60.13
Rate for Payer: Healthfirst QHP	$70.74
Rate for Payer: Senior Whole Health Medicare Advantage	$70.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.59
Rate for Payer: Wellcare Medicare	$67.20

SPEECH AUDIOMETRY THRESHOLD

Facility

$101.25

Service Code	HCPCS 92555
Hospital Charge Code	42003005
Hospital Revenue Code	471
Rate for Payer: Cash Price	$70.74

SPEECH AUDIOMETRY THRESHOLD

Facility

$101.25

Service Code	HCPCS 92555
Hospital Charge Code	42003005
Hospital Revenue Code	471
Min. Negotiated Rate	$50.62
Max. Negotiated Rate	$81.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.74
Rate for Payer: Aetna Government	$70.74
Rate for Payer: Brighton Health Commercial	$75.94
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.85
Rate for Payer: Elderplan Medicare Advantage	$70.74
Rate for Payer: EmblemHealth Commercial	$70.74
Rate for Payer: Fidelis Essential Plan Aliesa	$60.13
Rate for Payer: Fidelis Essential Plan QHP	$62.96
Rate for Payer: Fidelis Medicare Advantage	$70.74
Rate for Payer: Fidelis Qualified Health Plan	$62.96
Rate for Payer: Group Health Inc Commercial	$70.74
Rate for Payer: Group Health Inc Medicare	$70.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.62
Rate for Payer: Hamaspik Choice Inc Medicare	$70.74
Rate for Payer: Healthfirst Medicare Advantage	$60.13
Rate for Payer: Healthfirst QHP	$70.74
Rate for Payer: Senior Whole Health Medicare Advantage	$70.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.59
Rate for Payer: Wellcare Medicare	$67.20

SPEECH/HEARING THERAPY

Facility

$228.65

Service Code	HCPCS 92507
Hospital Charge Code	30307901
Hospital Revenue Code	440
Min. Negotiated Rate	$52.82
Max. Negotiated Rate	$182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.82
Rate for Payer: Aetna Government	$52.82
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$114.32
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.32
Rate for Payer: Hamaspik Choice Inc Medicare	$114.32
Rate for Payer: Wellcare Medicare	$55.00

SPEECH-LANG THERAPY 31-45 MIN.

Facility

$228.65

Service Code	HCPCS 92507 GN
Hospital Charge Code	41904821
Hospital Revenue Code	440
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.32
Rate for Payer: Aetna Government	$114.32
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$114.32
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.32
Rate for Payer: Hamaspik Choice Inc Medicare	$114.32
Rate for Payer: Wellcare Medicare	$55.00

SP ELBOW ARTHROGRAM

Facility

$478.25

Service Code	HCPCS 24220 TC
Hospital Charge Code	41547465
Hospital Revenue Code	361
Min. Negotiated Rate	$167.39
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$263.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$239.12
Rate for Payer: Aetna Government	$239.12
Rate for Payer: Brighton Health Commercial	$358.69
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	$239.12
Rate for Payer: Group Health Inc Medicare	$167.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$239.12
Rate for Payer: Hamaspik Choice Inc Medicare	$239.12

Know your out-of-pocket cost for care.

All Charges