St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SP FNA BX W/FLUOR GDN 1ST LES

Facility

$1,847.58

Service Code	HCPCS 10007
Hospital Charge Code	41546542
Hospital Revenue Code	361
Min. Negotiated Rate	$650.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
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: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$813.63
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

SP FNA BX W/FLUOR GDN 1ST LES

Facility

$1,847.58

Service Code	HCPCS 10007
Hospital Charge Code	41546542
Hospital Revenue Code	361
Rate for Payer: Cash Price	$813.63

SP FNA BX W/FLUOR GDN EA ADDL

Facility

$923.79

Service Code	HCPCS 10008
Hospital Charge Code	41546543
Hospital Revenue Code	361
Min. Negotiated Rate	$52.04
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.04
Rate for Payer: Aetna Government	$52.04
Rate for Payer: Brighton Health Commercial	$692.84
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	$461.90
Rate for Payer: Group Health Inc Medicare	$323.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.90
Rate for Payer: Hamaspik Choice Inc Medicare	$461.90

SP FNA BX W/MR GDN 1ST LES

Facility

$1,847.58

Service Code	HCPCS 10011
Hospital Charge Code	41546546
Hospital Revenue Code	361
Min. Negotiated Rate	$650.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
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: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$813.63
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

SP FNA BX W/MR GDN 1ST LES

Facility

$1,847.58

Service Code	HCPCS 10011
Hospital Charge Code	41546546
Hospital Revenue Code	361
Rate for Payer: Cash Price	$813.63

SP FNA BX W/MR GDN EA ADDL

Facility

$923.79

Service Code	HCPCS 10012
Hospital Charge Code	41546547
Hospital Revenue Code	361
Min. Negotiated Rate	$234.84
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$234.84
Rate for Payer: Aetna Government	$234.84
Rate for Payer: Brighton Health Commercial	$692.84
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	$461.90
Rate for Payer: Group Health Inc Medicare	$323.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.90
Rate for Payer: Hamaspik Choice Inc Medicare	$461.90

SP FNA BX W/US GDN 1ST LES

Facility

$1,847.58

Service Code	HCPCS 10005
Hospital Charge Code	41546540
Hospital Revenue Code	361
Min. Negotiated Rate	$650.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Brighton Health Commercial	$1,385.68
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
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: Elderplan Medicare Advantage	$813.63
Rate for Payer: EmblemHealth Commercial	$813.63
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
Rate for Payer: Group Health Inc Commercial	$813.63
Rate for Payer: Group Health Inc Medicare	$813.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

SP FNA BX W/US GDN 1ST LES

Facility

$1,847.58

Service Code	HCPCS 10005
Hospital Charge Code	41546540
Hospital Revenue Code	361
Rate for Payer: Cash Price	$813.63

SP FNA BX W/US GDN EA ADDL

Facility

$923.79

Service Code	HCPCS 10006
Hospital Charge Code	41546541
Hospital Revenue Code	361
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.17
Rate for Payer: Aetna Government	$42.17
Rate for Payer: Brighton Health Commercial	$692.84
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	$461.90
Rate for Payer: Group Health Inc Medicare	$323.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.90
Rate for Payer: Hamaspik Choice Inc Medicare	$461.90

SP F/UP ANGIOGRAPHY EXISTING CATH

Facility

$4,940.28

Service Code	HCPCS 75898 TC
Hospital Charge Code	41543351
Hospital Revenue Code	361
Min. Negotiated Rate	$1,729.10
Max. Negotiated Rate	$3,705.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,470.14
Rate for Payer: Aetna Government	$2,470.14
Rate for Payer: Brighton Health Commercial	$3,705.21
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
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	$2,470.14
Rate for Payer: Group Health Inc Medicare	$1,729.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.14

SP F/UP ANGIOGRAPHY EXISTING CATH

Facility

$4,940.28

Service Code	HCPCS 75898 TC
Hospital Charge Code	41543351
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,686.08

SP GALACTOGRAM MULTIPLE

Facility

$473.48

Service Code	HCPCS 19030 TC
Hospital Charge Code	41542813
Hospital Revenue Code	361
Min. Negotiated Rate	$165.72
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$260.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$236.74
Rate for Payer: Aetna Government	$236.74
Rate for Payer: Brighton Health Commercial	$355.11
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	$236.74
Rate for Payer: Group Health Inc Medicare	$165.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.74
Rate for Payer: Hamaspik Choice Inc Medicare	$236.74

SP GALACTOGRAM SINGLE

Facility

$258.64

Service Code	HCPCS 19030 TC
Hospital Charge Code	41542812
Hospital Revenue Code	361
Min. Negotiated Rate	$90.52
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$129.32
Rate for Payer: Aetna Government	$129.32
Rate for Payer: Brighton Health Commercial	$193.98
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	$129.32
Rate for Payer: Group Health Inc Medicare	$90.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.32
Rate for Payer: Hamaspik Choice Inc Medicare	$129.32

SP GASTRO CATHER CHECK

Facility

$705.83

Service Code	HCPCS 49465 TC
Hospital Charge Code	41547450
Hospital Revenue Code	361
Rate for Payer: Cash Price	$283.37

SP GASTRO CATHER CHECK

Facility

$705.83

Service Code	HCPCS 49465 TC
Hospital Charge Code	41547450
Hospital Revenue Code	361
Min. Negotiated Rate	$247.04
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Brighton Health Commercial	$529.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
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	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92

SP HEMO-DIALYSIS EVAL

Facility

$339.45

Service Code	HCPCS 93990 TC
Hospital Charge Code	41201178
Hospital Revenue Code	920
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72

SP HEMO-DIALYSIS EVAL

Facility

$339.45

Service Code	HCPCS 93990 TC
Hospital Charge Code	41201178
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

SPHERICAL RES 100CC (72404156)

Facility

$5,505.00

Service Code	HCPCS C1813
Hospital Charge Code	64904576
Hospital Revenue Code	278
Min. Negotiated Rate	$1,926.75
Max. Negotiated Rate	$5,780.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,027.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$3,303.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,752.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,165.38
Rate for Payer: EmblemHealth Commercial	$2,752.50
Rate for Payer: Fidelis Medicare Advantage	$5,780.25
Rate for Payer: Group Health Inc Commercial	$2,752.50
Rate for Payer: Group Health Inc Medicare	$1,926.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,752.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,752.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,578.25

SPHERICAL RES 100CC (72404156)

Facility

$5,505.00

Service Code	HCPCS C1813
Hospital Charge Code	64904576
Hospital Revenue Code	278
Min. Negotiated Rate	$2,752.50
Max. Negotiated Rate	$2,752.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,752.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,752.50

SPHINCTEROTOME AUTOTOME CANN 20MM

Facility

$697.50

Hospital Charge Code	64903912
Hospital Revenue Code	270
Min. Negotiated Rate	$244.12
Max. Negotiated Rate	$558.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$348.75
Rate for Payer: Aetna Government	$348.75
Rate for Payer: Brighton Health Commercial	$523.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$558.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$474.30
Rate for Payer: Group Health Inc Commercial	$348.75
Rate for Payer: Group Health Inc Medicare	$244.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.75
Rate for Payer: Hamaspik Choice Inc Medicare	$348.75

Sphincterotomy, anal, division of sphincter (separate procedure)

Facility

$3,246.99

Service Code	CPT 46080
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,246.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,246.99
Rate for Payer: Aetna Government	$3,246.99
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,246.99
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: Elderplan Medicare Advantage	$3,246.99
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,759.94
Rate for Payer: Fidelis Essential Plan QHP	$2,889.82
Rate for Payer: Fidelis Medicare Advantage	$3,246.99
Rate for Payer: Fidelis Qualified Health Plan	$2,889.82
Rate for Payer: Group Health Inc Commercial	$3,246.99
Rate for Payer: Group Health Inc Medicare	$3,246.99
Rate for Payer: Hamaspik Choice Inc Medicare	$3,246.99
Rate for Payer: Healthfirst Medicare Advantage	$2,759.94
Rate for Payer: Healthfirst QHP	$3,246.99
Rate for Payer: Senior Whole Health Medicare Advantage	$3,246.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,246.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,597.59
Rate for Payer: Wellcare Medicare	$3,084.64

SPHINETEROTOMY

Facility

$7,099.93

Service Code	HCPCS 46080
Hospital Charge Code	40011225
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$5,324.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,246.99
Rate for Payer: Aetna Government	$3,246.99
Rate for Payer: Brighton Health Commercial	$5,324.95
Rate for Payer: Cash Price	$3,246.99
Rate for Payer: Cash Price	$3,246.99
Rate for Payer: Cash Price	$3,246.99
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,246.99
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: Elderplan Medicare Advantage	$3,246.99
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,759.94
Rate for Payer: Fidelis Essential Plan QHP	$2,889.82
Rate for Payer: Fidelis Medicare Advantage	$3,246.99
Rate for Payer: Fidelis Qualified Health Plan	$2,889.82
Rate for Payer: Group Health Inc Commercial	$3,246.99
Rate for Payer: Group Health Inc Medicare	$3,246.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,549.96
Rate for Payer: Hamaspik Choice Inc Medicare	$3,246.99
Rate for Payer: Healthfirst Medicare Advantage	$2,759.94
Rate for Payer: Healthfirst QHP	$3,246.99
Rate for Payer: Senior Whole Health Medicare Advantage	$3,246.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,246.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,597.59
Rate for Payer: Wellcare Medicare	$3,084.64

SPHINETEROTOMY

Facility

$7,099.93

Service Code	HCPCS 46080
Hospital Charge Code	40011225
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,246.99

SP HIP ARTHOGRAM W/ANESTHESIA

Facility

$1,027.56

Service Code	HCPCS 27095 TC
Hospital Charge Code	41561911
Hospital Revenue Code	361
Min. Negotiated Rate	$359.65
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$565.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$513.78
Rate for Payer: Aetna Government	$513.78
Rate for Payer: Brighton Health Commercial	$770.67
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	$513.78
Rate for Payer: Group Health Inc Medicare	$359.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$513.78
Rate for Payer: Hamaspik Choice Inc Medicare	$513.78

SP HIP ARTHROGRAM

Facility

$864.39

Service Code	HCPCS 27093 TC
Hospital Charge Code	41547466
Hospital Revenue Code	361
Min. Negotiated Rate	$302.54
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$475.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$432.20
Rate for Payer: Aetna Government	$432.20
Rate for Payer: Brighton Health Commercial	$648.29
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	$432.20
Rate for Payer: Group Health Inc Medicare	$302.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$432.20
Rate for Payer: Hamaspik Choice Inc Medicare	$432.20

Know your out-of-pocket cost for care.

All Charges