St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INJECT TRIGGER POINT 3 OR MORE

Facility

$792.83

Service Code	HCPCS 20553
Hospital Charge Code	30303067
Hospital Revenue Code	510
Rate for Payer: Cash Price	$342.51

INJ FENTANYL CITRATE, 1 MG

Facility

$13.00

Service Code	HCPCS J3010
Hospital Charge Code	41647105
Hospital Revenue Code	636
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50

INJ FENTANYL CITRATE, 1 MG

Facility

$13.00

Service Code	HCPCS J3010
Hospital Charge Code	41657105
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$8.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$7.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.05
Rate for Payer: SOMOS Essential	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

INJ FENTANYL CITRATE, 1 MG

Facility

$13.00

Service Code	HCPCS J3010
Hospital Charge Code	41647105
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$8.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$7.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.05
Rate for Payer: SOMOS Essential	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

INJ FENTANYL CITRATE, 1 MG

Facility

$13.00

Service Code	HCPCS J3010
Hospital Charge Code	41657105
Hospital Revenue Code	636
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50

INJ FETANYL CITRATE, .1 MG

Facility

$13.00

Service Code	HCPCS J3010
Hospital Charge Code	41655456
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$8.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$7.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.05
Rate for Payer: SOMOS Essential	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

INJ FETANYL CITRATE, .1 MG

Facility

$13.00

Service Code	HCPCS J3010
Hospital Charge Code	41645456
Hospital Revenue Code	636
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50

INJ FETANYL CITRATE, .1 MG

Facility

$13.00

Service Code	HCPCS J3010
Hospital Charge Code	41655456
Hospital Revenue Code	636
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50

INJ FETANYL CITRATE, .1 MG

Facility

$13.00

Service Code	HCPCS J3010
Hospital Charge Code	41645456
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$8.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$7.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.05
Rate for Payer: SOMOS Essential	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

INJ, FOSPHENYTOIN 1000MG/NS 50MG

Facility

$16.00

Service Code	HCPCS Q2009
Hospital Charge Code	41657107
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

INJ, FOSPHENYTOIN 1000MG/NS 50MG

Facility

$16.00

Service Code	HCPCS Q2009
Hospital Charge Code	41657107
Hospital Revenue Code	636
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Affinity Essential Plan 1&2	$3.36
Rate for Payer: Affinity Essential Plan 3&4	$3.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.36
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Elderplan Medicare Advantage	$4.80
Rate for Payer: EmblemHealth Commercial	$4.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.80
Rate for Payer: Fidelis Essential Plan Aliesa	$4.80
Rate for Payer: Fidelis Essential Plan QHP	$5.04
Rate for Payer: Fidelis Medicare Advantage	$4.80
Rate for Payer: Fidelis Qualified Health Plan	$5.04
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: Healthfirst Medicare Advantage	$4.08
Rate for Payer: Healthfirst QHP	$4.80
Rate for Payer: Humana Medicare	$4.90
Rate for Payer: Senior Whole Health Medicare Advantage	$4.80
Rate for Payer: United Healthcare Medicare Advantage	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.84
Rate for Payer: Wellcare Medicare	$4.56

INJ, FOSPHENYTOIN 1000NG/NS 50MG

Facility

$16.00

Service Code	HCPCS Q2009
Hospital Charge Code	41647107
Hospital Revenue Code	636
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00

INJ, FOSPHENYTOIN 1000NG/NS 50MG

Facility

$16.00

Service Code	HCPCS Q2009
Hospital Charge Code	41647107
Hospital Revenue Code	636
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Affinity Essential Plan 1&2	$3.36
Rate for Payer: Affinity Essential Plan 3&4	$3.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.36
Rate for Payer: Brighton Health Commercial	$9.60
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.20
Rate for Payer: Elderplan Medicare Advantage	$4.80
Rate for Payer: EmblemHealth Commercial	$4.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.80
Rate for Payer: Fidelis Essential Plan Aliesa	$4.80
Rate for Payer: Fidelis Essential Plan QHP	$5.04
Rate for Payer: Fidelis Medicare Advantage	$4.80
Rate for Payer: Fidelis Qualified Health Plan	$5.04
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: Healthfirst Medicare Advantage	$4.08
Rate for Payer: Healthfirst QHP	$4.80
Rate for Payer: Humana Medicare	$4.90
Rate for Payer: Senior Whole Health Medicare Advantage	$4.80
Rate for Payer: United Healthcare Medicare Advantage	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.84
Rate for Payer: Wellcare Medicare	$4.56

INJ, FOSPHENYTOIN 100MG/NS 50MG

Facility

$5.00

Service Code	HCPCS Q2009
Hospital Charge Code	41657106
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

INJ, FOSPHENYTOIN 100MG/NS 50MG

Facility

$5.00

Service Code	HCPCS Q2009
Hospital Charge Code	41657106
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Affinity Essential Plan 1&2	$3.36
Rate for Payer: Affinity Essential Plan 3&4	$3.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.36
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
Rate for Payer: Elderplan Medicare Advantage	$4.80
Rate for Payer: EmblemHealth Commercial	$4.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.80
Rate for Payer: Fidelis Essential Plan Aliesa	$4.80
Rate for Payer: Fidelis Essential Plan QHP	$5.04
Rate for Payer: Fidelis Medicare Advantage	$4.80
Rate for Payer: Fidelis Qualified Health Plan	$5.04
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: Healthfirst Medicare Advantage	$4.08
Rate for Payer: Healthfirst QHP	$4.80
Rate for Payer: Humana Medicare	$4.90
Rate for Payer: Senior Whole Health Medicare Advantage	$4.80
Rate for Payer: United Healthcare Medicare Advantage	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.84
Rate for Payer: Wellcare Medicare	$4.56

INJ, FOSPHENYTOIN 100/NS 50MG

Facility

$5.00

Service Code	HCPCS Q2009
Hospital Charge Code	41647106
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

INJ, FOSPHENYTOIN 100/NS 50MG

Facility

$5.00

Service Code	HCPCS Q2009
Hospital Charge Code	41647106
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.80
Rate for Payer: Aetna Government	$4.80
Rate for Payer: Affinity Essential Plan 1&2	$3.36
Rate for Payer: Affinity Essential Plan 3&4	$3.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.36
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
Rate for Payer: Elderplan Medicare Advantage	$4.80
Rate for Payer: EmblemHealth Commercial	$4.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.80
Rate for Payer: Fidelis Essential Plan Aliesa	$4.80
Rate for Payer: Fidelis Essential Plan QHP	$5.04
Rate for Payer: Fidelis Medicare Advantage	$4.80
Rate for Payer: Fidelis Qualified Health Plan	$5.04
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$4.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: Healthfirst Medicare Advantage	$4.08
Rate for Payer: Healthfirst QHP	$4.80
Rate for Payer: Humana Medicare	$4.90
Rate for Payer: Senior Whole Health Medicare Advantage	$4.80
Rate for Payer: United Healthcare Medicare Advantage	$4.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.84
Rate for Payer: Wellcare Medicare	$4.56

INJ, HYDROMORPHONE 2MG/1ML VIAL

Facility

$2.00

Service Code	HCPCS J1170
Hospital Charge Code	41657102
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

INJ, HYDROMORPHONE 2MG/1ML VIAL

Facility

$2.00

Service Code	HCPCS J1170
Hospital Charge Code	41647102
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

INJ, HYDROMORPHONE 2MG/1ML VIAL

Facility

$2.00

Service Code	HCPCS J1170
Hospital Charge Code	41657102
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

INJ, HYDROMORPHONE 2MG/1ML VIAL

Facility

$2.00

Service Code	HCPCS J1170
Hospital Charge Code	41647102
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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: SOMOS CHP/HARP/Medicaid	$5.04
Rate for Payer: SOMOS Essential	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

INJ LORAZEPAM 40MG/D5W 40ML-2MG

Facility

$28.00

Service Code	HCPCS J2060
Hospital Charge Code	41657142
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$18.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$16.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.10
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.02
Rate for Payer: SOMOS Essential	$1.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.20

INJ LORAZEPAM 40MG/D5W 40ML-2MG

Facility

$28.00

Service Code	HCPCS J2060
Hospital Charge Code	41657142
Hospital Revenue Code	636
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

INJ LORAZEPAM 40MG/D5W 40ML-2MG

Facility

$28.00

Service Code	HCPCS J2060
Hospital Charge Code	41647142
Hospital Revenue Code	636
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00

INJ LORAZEPAM 40MG/D5W 40ML-2MG

Facility

$28.00

Service Code	HCPCS J2060
Hospital Charge Code	41647142
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$18.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$16.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.10
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.02
Rate for Payer: SOMOS Essential	$1.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.20

Know your out-of-pocket cost for care.

All Charges