St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]

Facility

$0.04

Service Code	HCPCS J1644
Hospital Charge Code	63323052301
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.04
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]

Facility

$0.04

Service Code	HCPCS J1644
Hospital Charge Code	63323052374
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.04
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]

Facility

$0.05

Service Code	HCPCS J1644
Hospital Charge Code	00409452030
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]

Facility

$0.05

Service Code	HCPCS J1644
Hospital Charge Code	00409452030
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]

Facility

$0.05

Service Code	HCPCS J1644
Hospital Charge Code	00409452002
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]

Facility

$0.04

Service Code	HCPCS J1644
Hospital Charge Code	63323052301
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]

Facility

$0.07

Service Code	HCPCS J1644
Hospital Charge Code	00264958720
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Fidelis Medicare Advantage	$0.08
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]

Facility

$0.07

Service Code	HCPCS J1644
Hospital Charge Code	00264958720
Hospital Revenue Code	278
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04

HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]

Facility

$0.05

Service Code	HCPCS J1644
Hospital Charge Code	00409452002
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03

HEPARIN SOD (PORK) LOCK FLUSH 100 UNIT/ML IV SOLN [105387]

Facility

$0.50

Service Code	HCPCS J1642
Hospital Charge Code	63323054505
Hospital Revenue Code	278
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25

HEPARIN SOD (PORK) LOCK FLUSH 100 UNIT/ML IV SOLN [105387]

Facility

$1.93

Service Code	HCPCS J1642
Hospital Charge Code	63323054501
Hospital Revenue Code	278
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97

HEPARIN SOD (PORK) LOCK FLUSH 100 UNIT/ML IV SOLN [105387]

Facility

$1.93

Service Code	HCPCS J1642
Hospital Charge Code	63323054501
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$2.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$1.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.11
Rate for Payer: EmblemHealth Commercial	$0.97
Rate for Payer: Fidelis Medicare Advantage	$2.03
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

HEPARIN SOD (PORK) LOCK FLUSH 100 UNIT/ML IV SOLN [105387]

Facility

$0.50

Service Code	HCPCS J1642
Hospital Charge Code	63323054505
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Fidelis Medicare Advantage	$0.52
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

HEPATIC FUNCTION PANEL

Facility

$20.43

Service Code	HCPCS 80076
Hospital Charge Code	40602511
Hospital Revenue Code	301
Rate for Payer: Cash Price	$8.17

HEPATIC FUNCTION PANEL

Facility

$20.43

Service Code	HCPCS 80076
Hospital Charge Code	40602511
Hospital Revenue Code	301
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$15.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.17
Rate for Payer: Aetna Government	$8.17
Rate for Payer: Affinity Essential Plan 1&2	$5.72
Rate for Payer: Affinity Essential Plan 3&4	$5.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.72
Rate for Payer: Brighton Health Commercial	$15.32
Rate for Payer: Cash Price	$8.17
Rate for Payer: Cash Price	$8.17
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.98
Rate for Payer: Elderplan Medicare Advantage	$8.17
Rate for Payer: EmblemHealth Commercial	$8.17
Rate for Payer: Fidelis Essential Plan Aliesa	$6.94
Rate for Payer: Fidelis Essential Plan QHP	$7.27
Rate for Payer: Fidelis Medicare Advantage	$8.17
Rate for Payer: Fidelis Qualified Health Plan	$7.27
Rate for Payer: Group Health Inc Commercial	$8.17
Rate for Payer: Group Health Inc Medicare	$8.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.22
Rate for Payer: Hamaspik Choice Inc Medicare	$8.17
Rate for Payer: Healthfirst Medicare Advantage	$8.17
Rate for Payer: Healthfirst QHP	$8.17
Rate for Payer: Humana Medicare	$8.33
Rate for Payer: Senior Whole Health Medicare Advantage	$8.17
Rate for Payer: United Healthcare Commercial	$10.34
Rate for Payer: United Healthcare Medicare Advantage	$8.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.54
Rate for Payer: Wellcare Medicare	$7.35

HEPATITIS A AB W/REFLEX

Facility

$30.98

Service Code	HCPCS 86708
Hospital Charge Code	40718176
Hospital Revenue Code	302
Rate for Payer: Cash Price	$12.39

HEPATITIS A AB W/REFLEX

Facility

$30.98

Service Code	HCPCS 86708
Hospital Charge Code	40718176
Hospital Revenue Code	302
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$23.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.39
Rate for Payer: Aetna Government	$12.39
Rate for Payer: Affinity Essential Plan 1&2	$8.67
Rate for Payer: Affinity Essential Plan 3&4	$8.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.67
Rate for Payer: Brighton Health Commercial	$23.24
Rate for Payer: Cash Price	$12.39
Rate for Payer: Cash Price	$12.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.66
Rate for Payer: Elderplan Medicare Advantage	$12.39
Rate for Payer: EmblemHealth Commercial	$12.39
Rate for Payer: Fidelis Essential Plan Aliesa	$10.53
Rate for Payer: Fidelis Essential Plan QHP	$11.03
Rate for Payer: Fidelis Medicare Advantage	$12.39
Rate for Payer: Fidelis Qualified Health Plan	$11.03
Rate for Payer: Group Health Inc Commercial	$12.39
Rate for Payer: Group Health Inc Medicare	$12.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.49
Rate for Payer: Hamaspik Choice Inc Medicare	$12.39
Rate for Payer: Healthfirst Medicare Advantage	$12.39
Rate for Payer: Healthfirst QHP	$12.39
Rate for Payer: Humana Medicare	$12.64
Rate for Payer: Senior Whole Health Medicare Advantage	$12.39
Rate for Payer: United Healthcare Commercial	$15.69
Rate for Payer: United Healthcare Medicare Advantage	$12.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.91
Rate for Payer: Wellcare Medicare	$11.15

HEPATITIS A ANTIBODY

Facility

$30.98

Service Code	HCPCS 86708
Hospital Charge Code	40717549
Hospital Revenue Code	302
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$23.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.39
Rate for Payer: Aetna Government	$12.39
Rate for Payer: Affinity Essential Plan 1&2	$8.67
Rate for Payer: Affinity Essential Plan 3&4	$8.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.67
Rate for Payer: Brighton Health Commercial	$23.24
Rate for Payer: Cash Price	$12.39
Rate for Payer: Cash Price	$12.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.66
Rate for Payer: Elderplan Medicare Advantage	$12.39
Rate for Payer: EmblemHealth Commercial	$12.39
Rate for Payer: Fidelis Essential Plan Aliesa	$10.53
Rate for Payer: Fidelis Essential Plan QHP	$11.03
Rate for Payer: Fidelis Medicare Advantage	$12.39
Rate for Payer: Fidelis Qualified Health Plan	$11.03
Rate for Payer: Group Health Inc Commercial	$12.39
Rate for Payer: Group Health Inc Medicare	$12.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.49
Rate for Payer: Hamaspik Choice Inc Medicare	$12.39
Rate for Payer: Healthfirst Medicare Advantage	$12.39
Rate for Payer: Healthfirst QHP	$12.39
Rate for Payer: Humana Medicare	$12.64
Rate for Payer: Senior Whole Health Medicare Advantage	$12.39
Rate for Payer: United Healthcare Commercial	$15.69
Rate for Payer: United Healthcare Medicare Advantage	$12.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.91
Rate for Payer: Wellcare Medicare	$11.15

HEPATITIS A ANTIBODY

Facility

$30.98

Service Code	HCPCS 86708
Hospital Charge Code	40717549
Hospital Revenue Code	302
Rate for Payer: Cash Price	$12.39

HEPATITIS A + HEPATITIS B VACCINE INJ

Facility

$173.00

Service Code	HCPCS 90636
Hospital Charge Code	41654780
Hospital Revenue Code	636
Min. Negotiated Rate	$86.50
Max. Negotiated Rate	$86.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.50
Rate for Payer: Hamaspik Choice Inc Medicare	$86.50

HEPATITIS A + HEPATITIS B VACCINE INJ

Facility

$173.00

Service Code	HCPCS 90636
Hospital Charge Code	41644780
Hospital Revenue Code	636
Min. Negotiated Rate	$86.50
Max. Negotiated Rate	$86.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.50
Rate for Payer: Hamaspik Choice Inc Medicare	$86.50

HEPATITIS A + HEPATITIS B VACCINE INJ

Facility

$173.00

Service Code	HCPCS 90636
Hospital Charge Code	41644780
Hospital Revenue Code	636
Min. Negotiated Rate	$60.55
Max. Negotiated Rate	$114.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.35
Rate for Payer: Aetna Government	$114.35
Rate for Payer: Brighton Health Commercial	$103.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.48
Rate for Payer: Group Health Inc Commercial	$86.50
Rate for Payer: Group Health Inc Medicare	$60.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.50
Rate for Payer: Hamaspik Choice Inc Medicare	$86.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$112.45

HEPATITIS A + HEPATITIS B VACCINE INJ

Facility

$173.00

Service Code	HCPCS 90636
Hospital Charge Code	41654780
Hospital Revenue Code	636
Min. Negotiated Rate	$60.55
Max. Negotiated Rate	$114.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.35
Rate for Payer: Aetna Government	$114.35
Rate for Payer: Brighton Health Commercial	$103.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.48
Rate for Payer: Group Health Inc Commercial	$86.50
Rate for Payer: Group Health Inc Medicare	$60.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.50
Rate for Payer: Hamaspik Choice Inc Medicare	$86.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$112.45

HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY [166255]

Facility

$151.14

Service Code	NDC 58160081552
Hospital Charge Code	58160081552
Hospital Revenue Code	250
Min. Negotiated Rate	$52.90
Max. Negotiated Rate	$120.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.57
Rate for Payer: Aetna Government	$75.57
Rate for Payer: Brighton Health Commercial	$113.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.77
Rate for Payer: Group Health Inc Commercial	$75.57
Rate for Payer: Group Health Inc Medicare	$52.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.57
Rate for Payer: Hamaspik Choice Inc Medicare	$75.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.24

HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY [166255]

Facility

$151.14

Service Code	NDC 58160081543
Hospital Charge Code	58160081543
Hospital Revenue Code	250
Min. Negotiated Rate	$52.90
Max. Negotiated Rate	$120.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.57
Rate for Payer: Aetna Government	$75.57
Rate for Payer: Brighton Health Commercial	$113.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$120.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.77
Rate for Payer: Group Health Inc Commercial	$75.57
Rate for Payer: Group Health Inc Medicare	$52.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.57
Rate for Payer: Hamaspik Choice Inc Medicare	$75.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$98.24

Know your out-of-pocket cost for care.

All Charges