St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

EMTRICITABINE-TENOFOVIR DF 200-300 MG PO TABS [39255]

Facility

$70.01

Service Code	NDC 42385095330
Hospital Charge Code	42385095330
Hospital Revenue Code	250
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$56.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.00
Rate for Payer: Aetna Government	$35.00
Rate for Payer: Brighton Health Commercial	$52.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.60
Rate for Payer: Group Health Inc Commercial	$35.00
Rate for Payer: Group Health Inc Medicare	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.50

EMTRICITAB-RILPIVIR-TENOFOV AF 200-25-25 MG PO TABS [132062]

Facility

$144.93

Service Code	NDC 61958210101
Hospital Charge Code	61958210101
Hospital Revenue Code	250
Min. Negotiated Rate	$50.72
Max. Negotiated Rate	$115.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.46
Rate for Payer: Aetna Government	$72.46
Rate for Payer: Brighton Health Commercial	$108.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.55
Rate for Payer: Group Health Inc Commercial	$72.46
Rate for Payer: Group Health Inc Medicare	$50.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.46
Rate for Payer: Hamaspik Choice Inc Medicare	$72.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.20

EMTRICITAB-RILPIVIR-TENOFOV DF 200-25-300 MG PO TABS [111273]

Facility

$144.93

Service Code	NDC 61958110101
Hospital Charge Code	61958110101
Hospital Revenue Code	250
Min. Negotiated Rate	$50.72
Max. Negotiated Rate	$115.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.46
Rate for Payer: Aetna Government	$72.46
Rate for Payer: Brighton Health Commercial	$108.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$115.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.55
Rate for Payer: Group Health Inc Commercial	$72.46
Rate for Payer: Group Health Inc Medicare	$50.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.46
Rate for Payer: Hamaspik Choice Inc Medicare	$72.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.20

EMTRICITAB/TENOFOVIR ALAF 200-25

Facility

$122.13

Hospital Charge Code	41656639
Hospital Revenue Code	250
Min. Negotiated Rate	$42.75
Max. Negotiated Rate	$97.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.06
Rate for Payer: Aetna Government	$61.06
Rate for Payer: Brighton Health Commercial	$91.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$97.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.05
Rate for Payer: Group Health Inc Commercial	$61.06
Rate for Payer: Group Health Inc Medicare	$42.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.06
Rate for Payer: Hamaspik Choice Inc Medicare	$61.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$79.38

EMTRICITAB/TENOFOVIR ALAF 200-25

Facility

$122.13

Hospital Charge Code	41646639
Hospital Revenue Code	250
Min. Negotiated Rate	$42.75
Max. Negotiated Rate	$97.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.06
Rate for Payer: Aetna Government	$61.06
Rate for Payer: Brighton Health Commercial	$91.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$97.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$83.05
Rate for Payer: Group Health Inc Commercial	$61.06
Rate for Payer: Group Health Inc Medicare	$42.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.06
Rate for Payer: Hamaspik Choice Inc Medicare	$61.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$79.38

EMTRI/RILP/TENO 200-25-300MG TAB

Facility

$120.89

Hospital Charge Code	41657048
Hospital Revenue Code	250
Min. Negotiated Rate	$42.31
Max. Negotiated Rate	$96.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.44
Rate for Payer: Aetna Government	$60.44
Rate for Payer: Brighton Health Commercial	$90.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.21
Rate for Payer: Group Health Inc Commercial	$60.44
Rate for Payer: Group Health Inc Medicare	$42.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.44
Rate for Payer: Hamaspik Choice Inc Medicare	$60.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.58

EMTRI/TENOF/EFAV 200/300/600MGTAB

Facility

$114.40

Hospital Charge Code	41657004
Hospital Revenue Code	250
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$91.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.20
Rate for Payer: Aetna Government	$57.20
Rate for Payer: Brighton Health Commercial	$85.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.79
Rate for Payer: Group Health Inc Commercial	$57.20
Rate for Payer: Group Health Inc Medicare	$40.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.20
Rate for Payer: Hamaspik Choice Inc Medicare	$57.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.36

ENALAPRIL 10 MG TAB

Facility

$0.11

Hospital Charge Code	41652936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

ENALAPRIL 10 MG TAB

Facility

$0.11

Hospital Charge Code	41642936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

ENALAPRIL 20 MG TAB

Facility

$0.14

Hospital Charge Code	41652891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

ENALAPRIL 20 MG TAB

Facility

$0.14

Hospital Charge Code	41642891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

ENALAPRIL 2.5 MG TAB

Facility

$1.00

Hospital Charge Code	41650258
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

ENALAPRIL 2.5 MG TAB

Facility

$1.00

Hospital Charge Code	41640258
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

ENALAPRIL 5 MG TAB

Facility

$1.00

Hospital Charge Code	41642937
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

ENALAPRIL 5 MG TAB

Facility

$1.00

Hospital Charge Code	41652937
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

ENALAPRILAT 1.25MG/ML INJ 1ML

Facility

$2.47

Hospital Charge Code	41654522
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.61

ENALAPRILAT 1.25MG/ML INJ 1ML

Facility

$2.47

Hospital Charge Code	41644522
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.61

ENALAPRILAT 1.25MG/ML INJ 2ML

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41647029
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ENALAPRILAT 1.25MG/ML INJ 2ML

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41657029
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

ENALAPRILAT 1.25MG/ML INJ 2ML

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41647029
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

ENALAPRILAT 1.25MG/ML INJ 2ML

Facility

$0.01

Service Code	HCPCS J3490
Hospital Charge Code	41657029
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ENALAPRILAT 1.25 MG/ML IV INJ [9929]

Facility

$5.69

Service Code	NDC 00143978601
Hospital Charge Code	00143978601
Hospital Revenue Code	278
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$5.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.84
Rate for Payer: Aetna Government	$2.84
Rate for Payer: Brighton Health Commercial	$3.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.27
Rate for Payer: EmblemHealth Commercial	$2.84
Rate for Payer: Fidelis Medicare Advantage	$5.97
Rate for Payer: Group Health Inc Commercial	$2.84
Rate for Payer: Group Health Inc Medicare	$1.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.70

ENALAPRILAT 1.25 MG/ML IV INJ [9929]

Facility

$6.37

Service Code	NDC 00143978701
Hospital Charge Code	00143978701
Hospital Revenue Code	278
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$3.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.18
Rate for Payer: Hamaspik Choice Inc Medicare	$3.18

ENALAPRILAT 1.25 MG/ML IV INJ [9929]

Facility

$6.37

Service Code	NDC 00143978710
Hospital Charge Code	00143978710
Hospital Revenue Code	278
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$6.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.19
Rate for Payer: Aetna Government	$3.19
Rate for Payer: Brighton Health Commercial	$3.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.66
Rate for Payer: EmblemHealth Commercial	$3.19
Rate for Payer: Fidelis Medicare Advantage	$6.69
Rate for Payer: Group Health Inc Commercial	$3.19
Rate for Payer: Group Health Inc Medicare	$2.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.19
Rate for Payer: Hamaspik Choice Inc Medicare	$3.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.14

ENALAPRILAT 1.25 MG/ML IV INJ [9929]

Facility

$5.69

Service Code	NDC 00143978610
Hospital Charge Code	00143978610
Hospital Revenue Code	278
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.84
Rate for Payer: Hamaspik Choice Inc Medicare	$2.84

Know your out-of-pocket cost for care.

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