St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AIR CAST

Facility

$65.56

Service Code	HCPCS 99070
Hospital Charge Code	40202800
Hospital Revenue Code	270
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$52.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.26
Rate for Payer: Aetna Government	$10.26
Rate for Payer: Brighton Health Commercial	$49.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.58
Rate for Payer: Group Health Inc Commercial	$32.78
Rate for Payer: Group Health Inc Medicare	$22.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.78
Rate for Payer: Hamaspik Choice Inc Medicare	$32.78

AIR MATTRESS

Facility

$113.40

Hospital Charge Code	40200810
Hospital Revenue Code	270
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$90.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.70
Rate for Payer: Aetna Government	$56.70
Rate for Payer: Brighton Health Commercial	$85.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.11
Rate for Payer: Group Health Inc Commercial	$56.70
Rate for Payer: Group Health Inc Medicare	$39.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$56.70

AIRWAY BERMAN MEDIUM 90MM

Facility

$2.67

Hospital Charge Code	64901942
Hospital Revenue Code	270
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$2.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.34
Rate for Payer: Aetna Government	$1.34
Rate for Payer: Brighton Health Commercial	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.82
Rate for Payer: Group Health Inc Commercial	$1.34
Rate for Payer: Group Health Inc Medicare	$0.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1.34

AIRWAY BERMAN SMALL 80MM

Facility

$1.13

Hospital Charge Code	64901945
Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$0.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.77
Rate for Payer: Group Health Inc Commercial	$0.57
Rate for Payer: Group Health Inc Medicare	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.57
Rate for Payer: Hamaspik Choice Inc Medicare	$0.57

AIRWAY GUEDEL 50MM COLOR CODED

Facility

$2.69

Hospital Charge Code	64904498
Hospital Revenue Code	270
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$2.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.34
Rate for Payer: Aetna Government	$1.34
Rate for Payer: Brighton Health Commercial	$2.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.83
Rate for Payer: Group Health Inc Commercial	$1.34
Rate for Payer: Group Health Inc Medicare	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.34
Rate for Payer: Hamaspik Choice Inc Medicare	$1.34

AIRWAY GUEDEL 70MM COLOR CODED

Facility

$1.69

Hospital Charge Code	64904312
Hospital Revenue Code	270
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	$0.85
Rate for Payer: Aetna Government	$0.85
Rate for Payer: Brighton Health Commercial	$1.27
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	$0.85
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.85
Rate for Payer: Hamaspik Choice Inc Medicare	$0.85

AIRWAY INHALATION EACH ADD'L TX

Facility

$557.18

Service Code	HCPCS 94640 76
Hospital Charge Code	30103319
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

AIRWAY INHALATION EACH ADD'L TX

Facility

$557.18

Service Code	HCPCS 94640 76
Hospital Charge Code	30103319
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

AIRWAY INHALATION TREATMENT

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	30103324
Hospital Revenue Code	412
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

AIRWAY INHALATION TREATMENT

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	30103324
Hospital Revenue Code	412
Rate for Payer: Cash Price	$246.65

AIRWAY NASAL 16FR

Facility

$12.95

Hospital Charge Code	64905006
Hospital Revenue Code	270
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$10.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$9.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.81
Rate for Payer: Group Health Inc Commercial	$6.48
Rate for Payer: Group Health Inc Medicare	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.48
Rate for Payer: Hamaspik Choice Inc Medicare	$6.48

AIRWAY NASAL 18FR

Facility

$12.95

Hospital Charge Code	64905008
Hospital Revenue Code	270
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$10.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$9.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.81
Rate for Payer: Group Health Inc Commercial	$6.48
Rate for Payer: Group Health Inc Medicare	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.48
Rate for Payer: Hamaspik Choice Inc Medicare	$6.48

AIRWAY NASAL 20FR

Facility

$12.95

Hospital Charge Code	64905010
Hospital Revenue Code	270
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$10.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$9.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.81
Rate for Payer: Group Health Inc Commercial	$6.48
Rate for Payer: Group Health Inc Medicare	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.48
Rate for Payer: Hamaspik Choice Inc Medicare	$6.48

AIRWAY NASAL 22FR

Facility

$12.95

Hospital Charge Code	64905012
Hospital Revenue Code	270
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$10.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$9.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.81
Rate for Payer: Group Health Inc Commercial	$6.48
Rate for Payer: Group Health Inc Medicare	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.48
Rate for Payer: Hamaspik Choice Inc Medicare	$6.48

AIRWAY NASAL 24FR

Facility

$12.95

Hospital Charge Code	64905014
Hospital Revenue Code	270
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$10.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$9.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.81
Rate for Payer: Group Health Inc Commercial	$6.48
Rate for Payer: Group Health Inc Medicare	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.48
Rate for Payer: Hamaspik Choice Inc Medicare	$6.48

AIRWAY NASAL FLANGE

Facility

$19.01

Hospital Charge Code	64906828
Hospital Revenue Code	270
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$15.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.50
Rate for Payer: Aetna Government	$9.50
Rate for Payer: Brighton Health Commercial	$14.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.93
Rate for Payer: Group Health Inc Commercial	$9.50
Rate for Payer: Group Health Inc Medicare	$6.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50
Rate for Payer: Hamaspik Choice Inc Medicare	$9.50

AIRWAY NASAL PEDIATRIC 18 FR

Facility

$42.00

Hospital Charge Code	40201021
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.00
Rate for Payer: Aetna Government	$21.00
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.56
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00

AIRWAY NASLA PEDIATRIC 16 FR

Facility

$42.00

Hospital Charge Code	40201020
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.00
Rate for Payer: Aetna Government	$21.00
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.56
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00

AIRWAY,NASOPHARYNGEAL,6MM ID,8MM

Facility

$7.67

Hospital Charge Code	64901956
Hospital Revenue Code	270
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$6.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Brighton Health Commercial	$5.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.22
Rate for Payer: Group Health Inc Commercial	$3.84
Rate for Payer: Group Health Inc Medicare	$2.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.84
Rate for Payer: Hamaspik Choice Inc Medicare	$3.84

AIRWAY,NASOPHARYNGEAL,7MM ID,9.5

Facility

$8.14

Hospital Charge Code	64901958
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$6.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.07
Rate for Payer: Aetna Government	$4.07
Rate for Payer: Brighton Health Commercial	$6.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.54
Rate for Payer: Group Health Inc Commercial	$4.07
Rate for Payer: Group Health Inc Medicare	$2.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.07
Rate for Payer: Hamaspik Choice Inc Medicare	$4.07

AIRWAY,NASOPHARYNGEAL,8MMID,10,5

Facility

$8.14

Hospital Charge Code	64901893
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$6.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.07
Rate for Payer: Aetna Government	$4.07
Rate for Payer: Brighton Health Commercial	$6.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.54
Rate for Payer: Group Health Inc Commercial	$4.07
Rate for Payer: Group Health Inc Medicare	$2.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.07
Rate for Payer: Hamaspik Choice Inc Medicare	$4.07

AIRWAY,NASOPHARYNGEAL,9MM ID,12

Facility

$8.14

Hospital Charge Code	64901964
Hospital Revenue Code	270
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$6.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.07
Rate for Payer: Aetna Government	$4.07
Rate for Payer: Brighton Health Commercial	$6.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.54
Rate for Payer: Group Health Inc Commercial	$4.07
Rate for Payer: Group Health Inc Medicare	$2.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.07
Rate for Payer: Hamaspik Choice Inc Medicare	$4.07

AIRWAY ORAL 40MM

Facility

$0.46

Hospital Charge Code	64902425
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

AIRWAY ORAL 60MM

Facility

$0.76

Hospital Charge Code	64902427
Hospital Revenue Code	270
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38

AIRWAY ORAL PEDS SIZE 000 L/F

Facility

$42.50

Hospital Charge Code	64901725
Hospital Revenue Code	270
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$34.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.25
Rate for Payer: Aetna Government	$21.25
Rate for Payer: Brighton Health Commercial	$31.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.90
Rate for Payer: Group Health Inc Commercial	$21.25
Rate for Payer: Group Health Inc Medicare	$14.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.25
Rate for Payer: Hamaspik Choice Inc Medicare	$21.25

Know your out-of-pocket cost for care.

All Charges