St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DIGOXIN 0.25 MG/ML IJ SOLN [2442]

Facility

$3.30

Service Code	HCPCS J1160
Hospital Charge Code	00641141035
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$14.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.42
Rate for Payer: Aetna Government	$14.42
Rate for Payer: Brighton Health Commercial	$2.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.24
Rate for Payer: Group Health Inc Commercial	$1.65
Rate for Payer: Group Health Inc Medicare	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.65
Rate for Payer: Hamaspik Choice Inc Medicare	$1.65
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$9.06
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$9.61
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$9.61
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$9.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.14

DIGOXIN 0.25 MG/ML IJ SOLN [2442]

Facility

$3.74

Service Code	HCPCS J1160
Hospital Charge Code	00781305972
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$14.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.42
Rate for Payer: Aetna Government	$14.42
Rate for Payer: Brighton Health Commercial	$2.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.54
Rate for Payer: Group Health Inc Commercial	$1.87
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$9.06
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$9.61
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$9.61
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$9.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.43

DIGOXIN 100 MCG/ML INJ PEDIATRIC

Facility

$12.00

Service Code	HCPCS J1160
Hospital Charge Code	41652959
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

DIGOXIN 100 MCG/ML INJ PEDIATRIC

Facility

$12.00

Service Code	HCPCS J1160
Hospital Charge Code	41652959
Hospital Revenue Code	636
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$14.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.42
Rate for Payer: Aetna Government	$14.42
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.61
Rate for Payer: SOMOS Essential	$9.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

DIGOXIN 100 MCG/ML INJ PEDIATRIC

Facility

$12.00

Service Code	HCPCS J1160
Hospital Charge Code	41642959
Hospital Revenue Code	636
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$14.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.42
Rate for Payer: Aetna Government	$14.42
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.61
Rate for Payer: SOMOS Essential	$9.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

DIGOXIN 100 MCG/ML INJ PEDIATRIC

Facility

$12.00

Service Code	HCPCS J1160
Hospital Charge Code	41642959
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

DIGOXIN 125 MCG PO TABS [2444]

Facility

$1.69

Service Code	NDC 00904592161
Hospital Charge Code	00904592161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.10

DIGOXIN 125 MCG PO TABS [2444]

Facility

$19.86

Service Code	NDC 59212024256
Hospital Charge Code	59212024256
Hospital Revenue Code	250
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$15.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.93
Rate for Payer: Aetna Government	$9.93
Rate for Payer: Brighton Health Commercial	$14.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.50
Rate for Payer: Group Health Inc Commercial	$9.93
Rate for Payer: Group Health Inc Medicare	$6.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.93
Rate for Payer: Hamaspik Choice Inc Medicare	$9.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.91

DIGOXIN 125 MCG PO TABS [2444]

Facility

$2.30

Service Code	NDC 00143124001
Hospital Charge Code	00143124001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.56
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.50

DIGOXIN 125 MCG TAB

Facility

$1.00

Hospital Charge Code	41652956
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: 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

DIGOXIN 125 MCG TAB

Facility

$1.00

Hospital Charge Code	41642956
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: 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

DIGOXIN 20 MCG/ML INJ NEONATAL

Facility

$11.00

Service Code	HCPCS J1160
Hospital Charge Code	41643138
Hospital Revenue Code	636
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.42
Rate for Payer: Aetna Government	$14.42
Rate for Payer: Brighton Health Commercial	$6.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.32
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.61
Rate for Payer: SOMOS Essential	$9.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

DIGOXIN 20 MCG/ML INJ NEONATAL

Facility

$11.00

Service Code	HCPCS J1160
Hospital Charge Code	41653138
Hospital Revenue Code	636
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.42
Rate for Payer: Aetna Government	$14.42
Rate for Payer: Brighton Health Commercial	$6.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.32
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.61
Rate for Payer: SOMOS Essential	$9.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

DIGOXIN 20 MCG/ML INJ NEONATAL

Facility

$11.00

Service Code	HCPCS J1160
Hospital Charge Code	41653138
Hospital Revenue Code	636
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50

DIGOXIN 20 MCG/ML INJ NEONATAL

Facility

$11.00

Service Code	HCPCS J1160
Hospital Charge Code	41643138
Hospital Revenue Code	636
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50

DIGOXIN 250 MCG/ML INJ

Facility

$373.00

Service Code	HCPCS J1160
Hospital Charge Code	41652958
Hospital Revenue Code	636
Min. Negotiated Rate	$186.50
Max. Negotiated Rate	$186.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.50
Rate for Payer: Hamaspik Choice Inc Medicare	$186.50

DIGOXIN 250 MCG/ML INJ

Facility

$373.00

Service Code	HCPCS J1160
Hospital Charge Code	41652958
Hospital Revenue Code	636
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$242.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.42
Rate for Payer: Aetna Government	$14.42
Rate for Payer: Brighton Health Commercial	$223.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$186.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$214.48
Rate for Payer: Group Health Inc Commercial	$186.50
Rate for Payer: Group Health Inc Medicare	$130.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.50
Rate for Payer: Hamaspik Choice Inc Medicare	$186.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.61
Rate for Payer: SOMOS Essential	$9.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$242.45

DIGOXIN 250 MCG/ML INJ

Facility

$373.00

Service Code	HCPCS J1160
Hospital Charge Code	41642958
Hospital Revenue Code	636
Min. Negotiated Rate	$186.50
Max. Negotiated Rate	$186.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.50
Rate for Payer: Hamaspik Choice Inc Medicare	$186.50

DIGOXIN 250 MCG/ML INJ

Facility

$373.00

Service Code	HCPCS J1160
Hospital Charge Code	41642958
Hospital Revenue Code	636
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$242.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.42
Rate for Payer: Aetna Government	$14.42
Rate for Payer: Brighton Health Commercial	$223.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$186.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$214.48
Rate for Payer: Group Health Inc Commercial	$186.50
Rate for Payer: Group Health Inc Medicare	$130.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$186.50
Rate for Payer: Hamaspik Choice Inc Medicare	$186.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.61
Rate for Payer: SOMOS Essential	$9.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$242.45

DIGOXIN 250 MCG PO TABS [2445]

Facility

$1.69

Service Code	NDC 00904592261
Hospital Charge Code	00904592261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.10

DIGOXIN 250 MCG PO TABS [2445]

Facility

$2.30

Service Code	NDC 00143124101
Hospital Charge Code	00143124101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.15
Rate for Payer: Aetna Government	$1.15
Rate for Payer: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.56
Rate for Payer: Group Health Inc Commercial	$1.15
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.50

DIGOXIN 250 MCG TAB

Facility

$0.72

Hospital Charge Code	41652957
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

DIGOXIN 250 MCG TAB

Facility

$0.72

Hospital Charge Code	41642957
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

DIGOXIN 50 MCG/ML ELIXIR 2.5 ML UDC

Facility

$2.00

Hospital Charge Code	41654331
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

DIGOXIN 50 MCG/ML ELIXIR 2.5 ML UDC

Facility

$2.00

Hospital Charge Code	41644331
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

Know your out-of-pocket cost for care.

All Charges