St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TRIDENT 0 POLYETHYLENE INSERT36MM

Facility

$4,590.00

Service Code	HCPCS C1776
Hospital Charge Code	40205023
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,819.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,524.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,754.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,295.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,639.25
Rate for Payer: EmblemHealth Commercial	$2,295.00
Rate for Payer: Fidelis Medicare Advantage	$4,819.50
Rate for Payer: Group Health Inc Commercial	$2,295.00
Rate for Payer: Group Health Inc Medicare	$1,606.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,295.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,983.50

TRIDENT 0 POLYETHYLENE INSERT36MM

Facility

$4,590.00

Service Code	HCPCS C1776
Hospital Charge Code	40205023
Hospital Revenue Code	278
Min. Negotiated Rate	$2,295.00
Max. Negotiated Rate	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,295.00

TRIDENT 10 POLY INSERT 36MM

Facility

$4,590.00

Service Code	HCPCS C1776
Hospital Charge Code	40205021
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,819.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,524.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,754.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,295.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,639.25
Rate for Payer: EmblemHealth Commercial	$2,295.00
Rate for Payer: Fidelis Medicare Advantage	$4,819.50
Rate for Payer: Group Health Inc Commercial	$2,295.00
Rate for Payer: Group Health Inc Medicare	$1,606.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,295.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,983.50

TRIDENT 10 POLY INSERT 36MM

Facility

$4,590.00

Service Code	HCPCS C1776
Hospital Charge Code	40205021
Hospital Revenue Code	278
Min. Negotiated Rate	$2,295.00
Max. Negotiated Rate	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,295.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,295.00

TRIDENT II TRI MULTIHOLE

Facility

$12,084.38

Service Code	HCPCS C1776
Hospital Charge Code	64907273
Hospital Revenue Code	278
Min. Negotiated Rate	$6,042.19
Max. Negotiated Rate	$6,042.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,042.19
Rate for Payer: Hamaspik Choice Inc Medicare	$6,042.19

TRIDENT II TRI MULTIHOLE

Facility

$12,084.38

Service Code	HCPCS C1776
Hospital Charge Code	64907273
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$12,688.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,646.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$7,250.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,042.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,948.52
Rate for Payer: EmblemHealth Commercial	$6,042.19
Rate for Payer: Fidelis Medicare Advantage	$12,688.60
Rate for Payer: Group Health Inc Commercial	$6,042.19
Rate for Payer: Group Health Inc Medicare	$4,229.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,042.19
Rate for Payer: Hamaspik Choice Inc Medicare	$6,042.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,854.85

TRIDENT TRITANIUM HEMI SHELL 54MM

Facility

$8,320.00

Service Code	HCPCS C1776
Hospital Charge Code	40205025
Hospital Revenue Code	278
Min. Negotiated Rate	$4,160.00
Max. Negotiated Rate	$4,160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,160.00

TRIDENT TRITANIUM HEMI SHELL 54MM

Facility

$8,320.00

Service Code	HCPCS C1776
Hospital Charge Code	40205025
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,736.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,576.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,992.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,784.00
Rate for Payer: EmblemHealth Commercial	$4,160.00
Rate for Payer: Fidelis Medicare Advantage	$8,736.00
Rate for Payer: Group Health Inc Commercial	$4,160.00
Rate for Payer: Group Health Inc Medicare	$2,912.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,408.00

TRIDENT TRITANIUM HEMI SHELL 56MM

Facility

$8,320.00

Service Code	HCPCS C1776
Hospital Charge Code	40205024
Hospital Revenue Code	278
Min. Negotiated Rate	$4,160.00
Max. Negotiated Rate	$4,160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,160.00

TRIDENT TRITANIUM HEMI SHELL 56MM

Facility

$8,320.00

Service Code	HCPCS C1776
Hospital Charge Code	40205024
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,736.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,576.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,992.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,784.00
Rate for Payer: EmblemHealth Commercial	$4,160.00
Rate for Payer: Fidelis Medicare Advantage	$8,736.00
Rate for Payer: Group Health Inc Commercial	$4,160.00
Rate for Payer: Group Health Inc Medicare	$2,912.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,408.00

TRIFLUOPERAZINE 10 MG TAB

Facility

$1.29

Hospital Charge Code	41644114
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.65
Rate for Payer: Aetna Government	$0.65
Rate for Payer: Brighton Health Commercial	$0.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.88
Rate for Payer: Group Health Inc Commercial	$0.65
Rate for Payer: Group Health Inc Medicare	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.65
Rate for Payer: Hamaspik Choice Inc Medicare	$0.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.84

TRIFLUOPERAZINE 10 MG TAB

Facility

$1.29

Hospital Charge Code	41654114
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.65
Rate for Payer: Aetna Government	$0.65
Rate for Payer: Brighton Health Commercial	$0.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.88
Rate for Payer: Group Health Inc Commercial	$0.65
Rate for Payer: Group Health Inc Medicare	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.65
Rate for Payer: Hamaspik Choice Inc Medicare	$0.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.84

TRIFLUOPERAZINE 1 MG TAB

Facility

$0.48

Hospital Charge Code	41644945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

TRIFLUOPERAZINE 1 MG TAB

Facility

$0.48

Hospital Charge Code	41654945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.33
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

TRIFLUOPERAZINE 2 MG TAB

Facility

$0.68

Hospital Charge Code	41644112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

TRIFLUOPERAZINE 2 MG TAB

Facility

$0.68

Hospital Charge Code	41654112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

TRIFLUOPERAZINE 5 MG TAB

Facility

$0.89

Hospital Charge Code	41654113
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

TRIFLUOPERAZINE 5 MG TAB

Facility

$0.89

Hospital Charge Code	41644113
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

TRIFLUOPERAZINE HCL 10 MG PO TABS [8162]

Facility

$2.45

Service Code	NDC 00378241001
Hospital Charge Code	00378241001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.22
Rate for Payer: Aetna Government	$1.22
Rate for Payer: Brighton Health Commercial	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.66
Rate for Payer: Group Health Inc Commercial	$1.22
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.59

TRIFLUOPERAZINE HCL 1 MG PO TABS [8161]

Facility

$0.88

Service Code	NDC 00378240101
Hospital Charge Code	00378240101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

TRIFLUOPERAZINE HCL 2 MG PO TABS [8163]

Facility

$2.00

Service Code	NDC 51079057320
Hospital Charge Code	51079057320
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

TRIFLUOPERAZINE HCL 5 MG PO TABS [8164]

Facility

$2.55

Service Code	NDC 51079057420
Hospital Charge Code	51079057420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$2.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.27
Rate for Payer: Aetna Government	$1.27
Rate for Payer: Brighton Health Commercial	$1.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.73
Rate for Payer: Group Health Inc Commercial	$1.27
Rate for Payer: Group Health Inc Medicare	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.27
Rate for Payer: Hamaspik Choice Inc Medicare	$1.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.66

TRIFLURIDINE 1% OPHTHALMIC SOLN

Facility

$243.82

Hospital Charge Code	41653372
Hospital Revenue Code	250
Min. Negotiated Rate	$85.34
Max. Negotiated Rate	$195.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.91
Rate for Payer: Aetna Government	$121.91
Rate for Payer: Brighton Health Commercial	$182.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.80
Rate for Payer: Group Health Inc Commercial	$121.91
Rate for Payer: Group Health Inc Medicare	$85.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.91
Rate for Payer: Hamaspik Choice Inc Medicare	$121.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$158.48

TRIFLURIDINE 1% OPHTHALMIC SOLN

Facility

$243.82

Hospital Charge Code	41643372
Hospital Revenue Code	250
Min. Negotiated Rate	$85.34
Max. Negotiated Rate	$195.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.91
Rate for Payer: Aetna Government	$121.91
Rate for Payer: Brighton Health Commercial	$182.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$195.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.80
Rate for Payer: Group Health Inc Commercial	$121.91
Rate for Payer: Group Health Inc Medicare	$85.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.91
Rate for Payer: Hamaspik Choice Inc Medicare	$121.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$158.48

TRIFLURIDINE 1 % OP SOLN [11595]

Facility

$29.73

Service Code	NDC 61314004475
Hospital Charge Code	61314004475
Hospital Revenue Code	250
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$23.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.86
Rate for Payer: Aetna Government	$14.86
Rate for Payer: Brighton Health Commercial	$22.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.21
Rate for Payer: Group Health Inc Commercial	$14.86
Rate for Payer: Group Health Inc Medicare	$10.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.86
Rate for Payer: Hamaspik Choice Inc Medicare	$14.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.32

Know your out-of-pocket cost for care.

All Charges