St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AMPHOTERICIN B LIPOSOME 50 MG IV SUSR

Facility

$305.70

Service Code	HCPCS J0289
Hospital Charge Code	5515036501
Hospital Revenue Code	258
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$244.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.48
Rate for Payer: Aetna Government	$21.48
Rate for Payer: Affinity Essential Plan 1&2	$15.04
Rate for Payer: Affinity Essential Plan 3&4	$15.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.04
Rate for Payer: Brighton Health Commercial	$229.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$244.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.88
Rate for Payer: Elderplan Medicare Advantage	$21.48
Rate for Payer: EmblemHealth Commercial	$21.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.33
Rate for Payer: Fidelis Essential Plan Aliesa	$18.26
Rate for Payer: Fidelis Essential Plan QHP	$19.12
Rate for Payer: Fidelis Medicare Advantage	$21.48
Rate for Payer: Fidelis Qualified Health Plan	$19.12
Rate for Payer: Group Health Inc Commercial	$21.48
Rate for Payer: Group Health Inc Medicare	$21.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.48
Rate for Payer: Hamaspik Choice Inc Medicare	$21.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.48
Rate for Payer: Healthfirst Medicare Advantage	$18.26
Rate for Payer: Healthfirst QHP	$21.48
Rate for Payer: Humana Medicare	$21.91
Rate for Payer: Senior Whole Health Medicare Advantage	$21.48
Rate for Payer: United Healthcare Medicare Advantage	$21.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$198.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.41
Rate for Payer: Wellcare Medicare	$20.41

AMPHOTERICIN B LIPOSOME 50 MG IV SUSR

Facility

$305.70

Service Code	HCPCS J0289
Hospital Charge Code	6275695401
Hospital Revenue Code	258
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$244.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$168.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.48
Rate for Payer: Aetna Government	$21.48
Rate for Payer: Affinity Essential Plan 1&2	$15.04
Rate for Payer: Affinity Essential Plan 3&4	$15.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.04
Rate for Payer: Brighton Health Commercial	$229.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$244.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.88
Rate for Payer: Elderplan Medicare Advantage	$21.48
Rate for Payer: EmblemHealth Commercial	$21.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.33
Rate for Payer: Fidelis Essential Plan Aliesa	$18.26
Rate for Payer: Fidelis Essential Plan QHP	$19.12
Rate for Payer: Fidelis Medicare Advantage	$21.48
Rate for Payer: Fidelis Qualified Health Plan	$19.12
Rate for Payer: Group Health Inc Commercial	$21.48
Rate for Payer: Group Health Inc Medicare	$21.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.48
Rate for Payer: Hamaspik Choice Inc Medicare	$21.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.48
Rate for Payer: Healthfirst Medicare Advantage	$18.26
Rate for Payer: Healthfirst QHP	$21.48
Rate for Payer: Humana Medicare	$21.91
Rate for Payer: Senior Whole Health Medicare Advantage	$21.48
Rate for Payer: United Healthcare Medicare Advantage	$21.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$198.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.41
Rate for Payer: Wellcare Medicare	$20.41

AMPHOTERICIN B LIPOSOME 50 MG IV SUSR

Facility

$370.85

Service Code	HCPCS J0289
Hospital Charge Code	0469305130
Hospital Revenue Code	258
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$296.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$203.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.48
Rate for Payer: Aetna Government	$21.48
Rate for Payer: Affinity Essential Plan 1&2	$15.04
Rate for Payer: Affinity Essential Plan 3&4	$15.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.04
Rate for Payer: Brighton Health Commercial	$278.14
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$296.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.18
Rate for Payer: Elderplan Medicare Advantage	$21.48
Rate for Payer: EmblemHealth Commercial	$21.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.33
Rate for Payer: Fidelis Essential Plan Aliesa	$18.26
Rate for Payer: Fidelis Essential Plan QHP	$19.12
Rate for Payer: Fidelis Medicare Advantage	$21.48
Rate for Payer: Fidelis Qualified Health Plan	$19.12
Rate for Payer: Group Health Inc Commercial	$21.48
Rate for Payer: Group Health Inc Medicare	$21.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.48
Rate for Payer: Hamaspik Choice Inc Medicare	$21.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.48
Rate for Payer: Healthfirst Medicare Advantage	$18.26
Rate for Payer: Healthfirst QHP	$21.48
Rate for Payer: Humana Medicare	$21.91
Rate for Payer: Senior Whole Health Medicare Advantage	$21.48
Rate for Payer: United Healthcare Medicare Advantage	$21.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$241.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.41
Rate for Payer: Wellcare Medicare	$20.41

AMPHOTERICIN B LIPOSOME 50 MG IV SUSR

Facility

$305.70

Service Code	HCPCS J0289
Hospital Charge Code	5515036501
Hospital Revenue Code	258
Min. Negotiated Rate	$152.85
Max. Negotiated Rate	$152.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.85

AMPICILLIN 500 MG PO CAPS

Facility

$0.65

Service Code	NDC 0781214501
Hospital Charge Code	0781214501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32

AMPICILLIN 500 MG PO CAPS

Facility

$0.65

Service Code	NDC 0781214501
Hospital Charge Code	0781214501
Hospital Revenue Code	250
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	$0.32
Rate for Payer: Aetna Government	$0.32
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: EmblemHealth Commercial	$0.32
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

AMPICILLIN DESENSITIZATION SOLN B (2 MG/ML) - COMPOUNDED

Facility

$1.00

Service Code	NDC 9999720756
Hospital Charge Code	9999720756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: EmblemHealth Commercial	$0.50
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

AMPICILLIN DESENSITIZATION SOLN B (2 MG/ML) - COMPOUNDED

Facility

$1.00

Service Code	NDC 9999720756
Hospital Charge Code	9999720756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

AMPICILLIN SODIUM 1 G IJ SOLR

Facility

$8.64

Service Code	HCPCS J0290
Hospital Charge Code	0781340495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$6.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$6.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.87
Rate for Payer: EmblemHealth Commercial	$4.32
Rate for Payer: Group Health Inc Commercial	$4.32
Rate for Payer: Group Health Inc Medicare	$3.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.32
Rate for Payer: Hamaspik Choice Inc Medicare	$4.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.61

AMPICILLIN SODIUM 1 G IJ SOLR

Facility

$8.64

Service Code	HCPCS J0290
Hospital Charge Code	0781340485
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.32

AMPICILLIN SODIUM 1 G IJ SOLR

Facility

$8.64

Service Code	HCPCS J0290
Hospital Charge Code	0781340485
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$6.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$6.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.88
Rate for Payer: EmblemHealth Commercial	$4.32
Rate for Payer: Group Health Inc Commercial	$4.32
Rate for Payer: Group Health Inc Medicare	$3.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.32
Rate for Payer: Hamaspik Choice Inc Medicare	$4.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.62

AMPICILLIN SODIUM 1 G IJ SOLR

Facility

$8.21

Service Code	HCPCS J0290
Hospital Charge Code	5515011310
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.10

AMPICILLIN SODIUM 1 G IJ SOLR

Facility

$8.64

Service Code	HCPCS J0290
Hospital Charge Code	0781340495
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.32

AMPICILLIN SODIUM 1 G IJ SOLR

Facility

$5.81

Service Code	HCPCS J0290
Hospital Charge Code	7248542101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.90

AMPICILLIN SODIUM 1 G IJ SOLR

Facility

$8.21

Service Code	HCPCS J0290
Hospital Charge Code	5515011310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$6.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$6.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.58
Rate for Payer: EmblemHealth Commercial	$4.10
Rate for Payer: Group Health Inc Commercial	$4.10
Rate for Payer: Group Health Inc Medicare	$2.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.10
Rate for Payer: Hamaspik Choice Inc Medicare	$4.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.33

AMPICILLIN SODIUM 1 G IJ SOLR

Facility

$5.81

Service Code	HCPCS J0290
Hospital Charge Code	7248542101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$4.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$4.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.95
Rate for Payer: EmblemHealth Commercial	$2.90
Rate for Payer: Group Health Inc Commercial	$2.90
Rate for Payer: Group Health Inc Medicare	$2.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.90
Rate for Payer: Hamaspik Choice Inc Medicare	$2.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.78

AMPICILLIN SODIUM 250 MG IJ SOLR

Facility

$4.19

Service Code	HCPCS J0290
Hospital Charge Code	0781340295
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$3.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$3.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.85
Rate for Payer: EmblemHealth Commercial	$2.09
Rate for Payer: Group Health Inc Commercial	$2.09
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.09
Rate for Payer: Hamaspik Choice Inc Medicare	$2.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.72

AMPICILLIN SODIUM 250 MG IJ SOLR

Facility

$4.19

Service Code	HCPCS J0290
Hospital Charge Code	0781340278
Hospital Revenue Code	250
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.09

AMPICILLIN SODIUM 250 MG IJ SOLR

Facility

$4.19

Service Code	HCPCS J0290
Hospital Charge Code	0781340278
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$3.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$3.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.85
Rate for Payer: EmblemHealth Commercial	$2.09
Rate for Payer: Group Health Inc Commercial	$2.09
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.09
Rate for Payer: Hamaspik Choice Inc Medicare	$2.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.72

AMPICILLIN SODIUM 250 MG IJ SOLR

Facility

$4.19

Service Code	HCPCS J0290
Hospital Charge Code	0781340295
Hospital Revenue Code	250
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.09

AMPICILLIN SODIUM 2 G IJ SOLR (WRAPPED)

Facility

$16.75

Service Code	HCPCS J0290
Hospital Charge Code	0781340880
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$13.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$12.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.39
Rate for Payer: EmblemHealth Commercial	$8.38
Rate for Payer: Group Health Inc Commercial	$8.38
Rate for Payer: Group Health Inc Medicare	$5.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.38
Rate for Payer: Hamaspik Choice Inc Medicare	$8.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.89

AMPICILLIN SODIUM 2 G IJ SOLR (WRAPPED)

Facility

$15.92

Service Code	HCPCS J0290
Hospital Charge Code	5515011420
Hospital Revenue Code	250
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$7.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.96

AMPICILLIN SODIUM 2 G IJ SOLR (WRAPPED)

Facility

$16.75

Service Code	HCPCS J0290
Hospital Charge Code	0781340880
Hospital Revenue Code	250
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$8.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.38

AMPICILLIN SODIUM 2 G IJ SOLR (WRAPPED)

Facility

$8.53

Service Code	HCPCS J0290
Hospital Charge Code	7248542201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$6.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$6.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.80
Rate for Payer: EmblemHealth Commercial	$4.27
Rate for Payer: Group Health Inc Commercial	$4.27
Rate for Payer: Group Health Inc Medicare	$2.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.27
Rate for Payer: Hamaspik Choice Inc Medicare	$4.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.55

AMPICILLIN SODIUM 2 G IJ SOLR (WRAPPED)

Facility

$15.92

Service Code	HCPCS J0290
Hospital Charge Code	5515011420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$12.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$11.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.82
Rate for Payer: EmblemHealth Commercial	$7.96
Rate for Payer: Group Health Inc Commercial	$7.96
Rate for Payer: Group Health Inc Medicare	$5.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.96
Rate for Payer: Hamaspik Choice Inc Medicare	$7.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.34

Know your out-of-pocket cost for care.

All Charges