St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ILR DEVICE INTERROGATE - CRD DVC IMP/POST-PROC LOOP RCRDR ILR W PROG

Facility

$69.00

Service Code	CPT 93291
Hospital Charge Code	4809329108
Hospital Revenue Code	480
Min. Negotiated Rate	$20.94
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.92
Rate for Payer: Aetna Government	$29.92
Rate for Payer: Affinity Essential Plan 1&2	$20.94
Rate for Payer: Affinity Essential Plan 3&4	$20.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$20.94
Rate for Payer: Brighton Health Commercial	$51.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.92
Rate for Payer: Elderplan Medicare Advantage	$29.92
Rate for Payer: EmblemHealth Commercial	$29.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.93
Rate for Payer: Fidelis Essential Plan Aliesa	$25.43
Rate for Payer: Fidelis Essential Plan QHP	$26.63
Rate for Payer: Fidelis Medicare Advantage	$29.92
Rate for Payer: Fidelis Qualified Health Plan	$26.63
Rate for Payer: Group Health Inc Commercial	$29.92
Rate for Payer: Group Health Inc Medicare	$29.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.92
Rate for Payer: Hamaspik Choice Inc Medicare	$29.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$54.74
Rate for Payer: Healthfirst Medicare Advantage	$25.43
Rate for Payer: Healthfirst QHP	$29.92
Rate for Payer: Humana Medicare	$30.52
Rate for Payer: Senior Whole Health Medicare Advantage	$29.92
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$29.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.42
Rate for Payer: Wellcare Medicare	$28.42

HC ILR DEVICE INTERROGATE - CRD DVC IMP/POST-PROC LOOP RCRDR ILR W PROG

Facility

$69.00

Service Code	CPT 93291
Hospital Charge Code	4809329108
Hospital Revenue Code	480
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$34.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.50

HC ILR DEVICE INTERROGAT REMOTE - CARD DEVICE REMOTE - LOOP RECORDER

Facility

$84.00

Service Code	CPT 93298 TC
Hospital Charge Code	4809329802
Hospital Revenue Code	480
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.68
Rate for Payer: Aetna Government	$22.68
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.12
Rate for Payer: EmblemHealth Commercial	$42.00
Rate for Payer: Group Health Inc Commercial	$42.00
Rate for Payer: Group Health Inc Medicare	$29.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$42.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.35
Rate for Payer: United Healthcare Commercial	$316.00

HC ILR DEVICE INTERROGAT REMOTE - CARD DEVICE REMOTE - LOOP RECORDER

Facility

$84.00

Service Code	CPT 93298 TC
Hospital Charge Code	4809329802
Hospital Revenue Code	480
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00

HC ILR DEVICE INTERROGAT REMOTE - CARDIAC DEVICE CHECK CHECK - REMOTE

Facility

$84.00

Service Code	CPT 93298 TC
Hospital Charge Code	4809329801
Hospital Revenue Code	480
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.68
Rate for Payer: Aetna Government	$22.68
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.12
Rate for Payer: EmblemHealth Commercial	$42.00
Rate for Payer: Group Health Inc Commercial	$42.00
Rate for Payer: Group Health Inc Medicare	$29.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$42.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.35
Rate for Payer: United Healthcare Commercial	$316.00

HC ILR DEVICE INTERROGAT REMOTE - CARDIAC DEVICE CHECK CHECK - REMOTE

Facility

$84.00

Service Code	CPT 93298 TC
Hospital Charge Code	4809329801
Hospital Revenue Code	480
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00

HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL

Facility

$4,157.00

Service Code	CPT 49407 TC
Hospital Charge Code	3614940701
Hospital Revenue Code	361
Min. Negotiated Rate	$708.28
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$833.63
Rate for Payer: Aetna Government	$833.63
Rate for Payer: Brighton Health Commercial	$3,117.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$2,078.50
Rate for Payer: Group Health Inc Commercial	$2,078.50
Rate for Payer: Group Health Inc Medicare	$1,454.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicare	$708.28
Rate for Payer: United Healthcare Commercial	$1,409.00

HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL

Facility

$4,157.00

Service Code	CPT 49407 TC
Hospital Charge Code	3614940701
Hospital Revenue Code	361
Min. Negotiated Rate	$2,078.50
Max. Negotiated Rate	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50

HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE

Facility

$1,847.00

Service Code	CPT 10030
Hospital Charge Code	3611003001
Hospital Revenue Code	361
Min. Negotiated Rate	$149.54
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$859.66
Rate for Payer: Aetna Government	$859.66
Rate for Payer: Affinity Essential Plan 1&2	$601.76
Rate for Payer: Affinity Essential Plan 3&4	$601.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$601.76
Rate for Payer: Brighton Health Commercial	$1,385.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$859.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$859.66
Rate for Payer: EmblemHealth Commercial	$859.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$773.69
Rate for Payer: Fidelis Essential Plan Aliesa	$730.71
Rate for Payer: Fidelis Essential Plan QHP	$765.10
Rate for Payer: Fidelis Medicare Advantage	$859.66
Rate for Payer: Fidelis Qualified Health Plan	$765.10
Rate for Payer: Group Health Inc Commercial	$859.66
Rate for Payer: Group Health Inc Medicare	$859.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$859.66
Rate for Payer: Hamaspik Choice Inc Medicare	$377.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$149.54
Rate for Payer: Healthfirst Medicare Advantage	$730.71
Rate for Payer: Healthfirst QHP	$859.66
Rate for Payer: Humana Medicare	$876.85
Rate for Payer: Senior Whole Health Medicare Advantage	$859.66
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$859.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$859.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$816.68
Rate for Payer: Wellcare Medicare	$816.68

HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE

Facility

$1,847.00

Service Code	CPT 10030
Hospital Charge Code	3611003001
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ

Facility

$4,157.00

Service Code	CPT 49405 TC
Hospital Charge Code	3614940501
Hospital Revenue Code	361
Min. Negotiated Rate	$239.11
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$239.11
Rate for Payer: Aetna Government	$239.11
Rate for Payer: Brighton Health Commercial	$3,117.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$2,078.50
Rate for Payer: Group Health Inc Commercial	$2,078.50
Rate for Payer: Group Health Inc Medicare	$1,454.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,078.50
Rate for Payer: United Healthcare Commercial	$1,409.00

HC IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ

Facility

$4,157.00

Service Code	CPT 49405 TC
Hospital Charge Code	3614940501
Hospital Revenue Code	361
Min. Negotiated Rate	$2,078.50
Max. Negotiated Rate	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50

HC IMDEVIMAB INFUSION ADMINISTRATION

Facility

$1,357.00

Service Code	CPT M0243
Hospital Charge Code	260M024301
Hospital Revenue Code	260
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$1,085.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$746.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$1,017.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,085.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$922.76
Rate for Payer: EmblemHealth Commercial	$678.50
Rate for Payer: Group Health Inc Commercial	$678.50
Rate for Payer: Group Health Inc Medicare	$474.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$678.50
Rate for Payer: Hamaspik Choice Inc Medicare	$678.50
Rate for Payer: United Healthcare Commercial	$76.00

HC IMDEVIMAB INFUSION ADMINISTRATION

Facility

$1,357.00

Service Code	CPT M0243
Hospital Charge Code	260M024301
Hospital Revenue Code	260
Min. Negotiated Rate	$678.50
Max. Negotiated Rate	$678.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$678.50

HC IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ

Facility

$4,157.00

Service Code	CPT 49406 TC
Hospital Charge Code	3614940601
Hospital Revenue Code	361
Min. Negotiated Rate	$239.11
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$239.11
Rate for Payer: Aetna Government	$239.11
Rate for Payer: Brighton Health Commercial	$3,117.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$2,078.50
Rate for Payer: Group Health Inc Commercial	$2,078.50
Rate for Payer: Group Health Inc Medicare	$1,454.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicare	$708.28
Rate for Payer: United Healthcare Commercial	$1,409.00

HC IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ

Facility

$4,157.00

Service Code	CPT 49406 TC
Hospital Charge Code	3614940601
Hospital Revenue Code	361
Min. Negotiated Rate	$2,078.50
Max. Negotiated Rate	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50

HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE - BUNDLED CHARGE

Facility

$434.00

Service Code	CPT 88341
Hospital Charge Code	3128834102
Hospital Revenue Code	312
Min. Negotiated Rate	$217.00
Max. Negotiated Rate	$217.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.00

HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE - BUNDLED CHARGE

Facility

$434.00

Service Code	CPT 88341
Hospital Charge Code	3128834102
Hospital Revenue Code	312
Min. Negotiated Rate	$25.62
Max. Negotiated Rate	$347.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.35
Rate for Payer: Aetna Government	$56.35
Rate for Payer: Brighton Health Commercial	$325.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$347.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$295.12
Rate for Payer: EmblemHealth Commercial	$109.96
Rate for Payer: Group Health Inc Commercial	$217.00
Rate for Payer: Group Health Inc Medicare	$151.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.00
Rate for Payer: Hamaspik Choice Inc Medicare	$217.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.62
Rate for Payer: Healthfirst Essential Plan	$57.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.62

HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - BUNDLED CHARGE

Facility

$434.00

Service Code	CPT 88342
Hospital Charge Code	3128834201
Hospital Revenue Code	312
Min. Negotiated Rate	$217.00
Max. Negotiated Rate	$217.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.00

HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - BUNDLED CHARGE

Facility

$434.00

Service Code	CPT 88342
Hospital Charge Code	3128834201
Hospital Revenue Code	312
Min. Negotiated Rate	$25.62
Max. Negotiated Rate	$238.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.37
Rate for Payer: Aetna Government	$209.37
Rate for Payer: Affinity Essential Plan 1&2	$146.56
Rate for Payer: Affinity Essential Plan 3&4	$146.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.56
Rate for Payer: Brighton Health Commercial	$209.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$209.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.91
Rate for Payer: Elderplan Medicare Advantage	$209.37
Rate for Payer: EmblemHealth Commercial	$128.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$188.43
Rate for Payer: Fidelis Essential Plan Aliesa	$177.96
Rate for Payer: Fidelis Essential Plan QHP	$186.34
Rate for Payer: Fidelis Medicare Advantage	$209.37
Rate for Payer: Fidelis Qualified Health Plan	$186.34
Rate for Payer: Group Health Inc Commercial	$209.37
Rate for Payer: Group Health Inc Medicare	$209.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.37
Rate for Payer: Hamaspik Choice Inc Medicare	$209.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.62
Rate for Payer: Healthfirst Essential Plan	$57.65
Rate for Payer: Healthfirst Medicare Advantage	$209.37
Rate for Payer: Healthfirst QHP	$209.37
Rate for Payer: Humana Medicare	$213.56
Rate for Payer: Senior Whole Health Medicare Advantage	$209.37
Rate for Payer: United Healthcare Medicare Advantage	$209.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$209.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.62
Rate for Payer: Wellcare Medicare	$188.43

HC IMM ADMINBY INTRAMUSCULAR INJ OF SEVERE ACUTE RESPIRATORY SYNDROME COVID SINGLE DOSE

Facility

$109.00

Service Code	CPT 90480
Hospital Charge Code	7719048001
Hospital Revenue Code	771
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50

HC IMM ADMINBY INTRAMUSCULAR INJ OF SEVERE ACUTE RESPIRATORY SYNDROME COVID SINGLE DOSE

Facility

$109.00

Service Code	CPT 90480
Hospital Charge Code	7719048001
Hospital Revenue Code	771
Min. Negotiated Rate	$35.51
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.73
Rate for Payer: Aetna Government	$50.73
Rate for Payer: Affinity Essential Plan 1&2	$35.51
Rate for Payer: Affinity Essential Plan 3&4	$35.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$35.51
Rate for Payer: Brighton Health Commercial	$81.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$50.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.12
Rate for Payer: Elderplan Medicare Advantage	$50.73
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45.66
Rate for Payer: Fidelis Essential Plan Aliesa	$43.12
Rate for Payer: Fidelis Essential Plan QHP	$45.15
Rate for Payer: Fidelis Medicare Advantage	$50.73
Rate for Payer: Fidelis Qualified Health Plan	$45.15
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.73
Rate for Payer: Hamaspik Choice Inc Medicare	$50.73
Rate for Payer: Healthfirst Medicare Advantage	$43.12
Rate for Payer: Healthfirst QHP	$50.73
Rate for Payer: Humana Medicare	$51.74
Rate for Payer: Senior Whole Health Medicare Advantage	$50.73
Rate for Payer: United Healthcare Commercial	$44.00
Rate for Payer: United Healthcare Medicare Advantage	$50.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48.19
Rate for Payer: Wellcare Medicare	$48.19

HC IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 3RD DOSE

Facility

$102.00

Service Code	CPT 0083A
Hospital Charge Code	7710083A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 3RD DOSE

Facility

$102.00

Service Code	CPT 0083A
Hospital Charge Code	7710083A01
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC IMMM ADMIN SARSCOV2 BOOSTER DOSE

Facility

$102.00

Service Code	CPT 0034A
Hospital Charge Code	7710034A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

Know your out-of-pocket cost for care.

All Charges