St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$0.66

Service Code	HCPCS J3290
Hospital Charge Code	8128461100
Hospital Revenue Code	258
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$1.44

Service Code	HCPCS J3290
Hospital Charge Code	2315516631
Hospital Revenue Code	258
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$1.44

Service Code	HCPCS J3290
Hospital Charge Code	2315516631
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
Rate for Payer: EmblemHealth Commercial	$0.72
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.94

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$0.72

Service Code	HCPCS J3290
Hospital Charge Code	5515018810
Hospital Revenue Code	258
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$0.65

Service Code	HCPCS J3290
Hospital Charge Code	2315552431
Hospital Revenue Code	258
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$0.65

Service Code	HCPCS J3290
Hospital Charge Code	2315552431
Hospital Revenue Code	258
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.32
Rate for Payer: Aetna Government	$0.32
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.44
Rate for Payer: EmblemHealth Commercial	$0.32
Rate for Payer: Group Health Inc Commercial	$0.32
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.32
Rate for Payer: Hamaspik Choice Inc Medicare	$0.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.42

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$0.72

Service Code	HCPCS J3290
Hospital Charge Code	5515018810
Hospital Revenue Code	258
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: EmblemHealth Commercial	$0.36
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

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$2.52

Service Code	HCPCS J3290
Hospital Charge Code	6050561690
Hospital Revenue Code	258
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.26

TRANEXAMIC ACID 1000 MG/10ML IV SOLN

Facility

$2.52

Service Code	HCPCS J3290
Hospital Charge Code	6050561690
Hospital Revenue Code	258
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$2.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.26
Rate for Payer: Aetna Government	$1.26
Rate for Payer: Brighton Health Commercial	$1.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.71
Rate for Payer: EmblemHealth Commercial	$1.26
Rate for Payer: Group Health Inc Commercial	$1.26
Rate for Payer: Group Health Inc Medicare	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.64

TRANEXAMIC ACID 650 MG PO TABS

Facility

$5.15

Service Code	NDC 6068775021
Hospital Charge Code	6068775021
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$4.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.58
Rate for Payer: Aetna Government	$2.58
Rate for Payer: Brighton Health Commercial	$3.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.50
Rate for Payer: EmblemHealth Commercial	$2.58
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.35

TRANEXAMIC ACID 650 MG PO TABS

Facility

$5.15

Service Code	NDC 6068775021
Hospital Charge Code	6068775021
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58

TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN

Facility

$0.25

Service Code	HCPCS J3290
Hospital Charge Code	5175401081
Hospital Revenue Code	258
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN

Facility

$0.25

Service Code	HCPCS J3290
Hospital Charge Code	5175401083
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN

Facility

$0.25

Service Code	HCPCS J3290
Hospital Charge Code	5175401083
Hospital Revenue Code	258
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN

Facility

$0.25

Service Code	HCPCS J3290
Hospital Charge Code	8083023291
Hospital Revenue Code	258
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.12
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN

Facility

$0.25

Service Code	HCPCS J3290
Hospital Charge Code	8083023291
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12

TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN

Facility

$0.25

Service Code	HCPCS J3290
Hospital Charge Code	5175401081
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

Transient ischemia

Facility

$43,147.78

Service Code	APR-DRG 0472
Min. Negotiated Rate	$6,944.00
Max. Negotiated Rate	$43,147.78
Rate for Payer: Affinity Essential Plan 1&2	$43,147.78
Rate for Payer: Affinity Essential Plan 3&4	$43,147.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,176.79
Rate for Payer: Amida Care Medicaid	$19,176.79
Rate for Payer: EmblemHealth Essential Plan 1&2	$43,147.78
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,176.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,176.79
Rate for Payer: Fidelis Qualified Health Plan	$23,012.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,176.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,176.79
Rate for Payer: Healthfirst Commercial	$11,892.00
Rate for Payer: Healthfirst Essential Plan	$43,147.78
Rate for Payer: Healthfirst QHP	$6,944.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,176.79
Rate for Payer: SOMOS Essential	$43,147.78
Rate for Payer: United Healthcare Essential Plan 1&2	$43,147.78
Rate for Payer: United Healthcare Essential Plan 3&4	$43,147.78
Rate for Payer: United Healthcare Medicaid	$19,176.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,176.79

Transient ischemia

Facility

$41,046.07

Service Code	APR-DRG 0471
Min. Negotiated Rate	$6,161.00
Max. Negotiated Rate	$41,046.07
Rate for Payer: Affinity Essential Plan 1&2	$41,046.07
Rate for Payer: Affinity Essential Plan 3&4	$41,046.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,242.70
Rate for Payer: Amida Care Medicaid	$18,242.70
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,046.07
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,242.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,242.70
Rate for Payer: Fidelis Qualified Health Plan	$21,891.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,242.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,242.70
Rate for Payer: Healthfirst Commercial	$10,076.00
Rate for Payer: Healthfirst Essential Plan	$41,046.07
Rate for Payer: Healthfirst QHP	$6,161.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,242.70
Rate for Payer: SOMOS Essential	$41,046.07
Rate for Payer: United Healthcare Essential Plan 1&2	$41,046.07
Rate for Payer: United Healthcare Essential Plan 3&4	$41,046.07
Rate for Payer: United Healthcare Medicaid	$18,242.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,242.70

Transient ischemia

Facility

$47,416.25

Service Code	APR-DRG 0473
Min. Negotiated Rate	$9,078.00
Max. Negotiated Rate	$47,416.25
Rate for Payer: Affinity Essential Plan 1&2	$47,416.25
Rate for Payer: Affinity Essential Plan 3&4	$47,416.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,073.89
Rate for Payer: Amida Care Medicaid	$21,073.89
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,416.25
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,073.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,073.89
Rate for Payer: Fidelis Qualified Health Plan	$25,288.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,073.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,073.89
Rate for Payer: Healthfirst Commercial	$16,513.00
Rate for Payer: Healthfirst Essential Plan	$47,416.25
Rate for Payer: Healthfirst QHP	$9,078.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,073.89
Rate for Payer: SOMOS Essential	$47,416.25
Rate for Payer: United Healthcare Essential Plan 1&2	$47,416.25
Rate for Payer: United Healthcare Essential Plan 3&4	$47,416.25
Rate for Payer: United Healthcare Medicaid	$21,073.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,073.89

Transient ischemia

Facility

$47,783.83

Service Code	APR-DRG 0474
Min. Negotiated Rate	$15,811.00
Max. Negotiated Rate	$47,783.83
Rate for Payer: Affinity Essential Plan 1&2	$47,783.83
Rate for Payer: Affinity Essential Plan 3&4	$47,783.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,237.26
Rate for Payer: Amida Care Medicaid	$21,237.26
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,783.83
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,237.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,237.26
Rate for Payer: Fidelis Qualified Health Plan	$25,484.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,237.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,237.26
Rate for Payer: Healthfirst Commercial	$16,914.00
Rate for Payer: Healthfirst Essential Plan	$47,783.83
Rate for Payer: Healthfirst QHP	$15,811.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,237.26
Rate for Payer: SOMOS Essential	$47,783.83
Rate for Payer: United Healthcare Essential Plan 1&2	$47,783.83
Rate for Payer: United Healthcare Essential Plan 3&4	$47,783.83
Rate for Payer: United Healthcare Medicaid	$21,237.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,237.26

TRANSIENT ISCHEMIA

Facility

$212.19

Service Code	EAPG 00526
Min. Negotiated Rate	$155.06
Max. Negotiated Rate	$212.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.06
Rate for Payer: Healthfirst Commercial	$212.19

Transurethral prostatectomy

Facility

$42,657.07

Service Code	APR-DRG 4821
Min. Negotiated Rate	$6,795.00
Max. Negotiated Rate	$42,657.07
Rate for Payer: Affinity Essential Plan 1&2	$42,657.07
Rate for Payer: Affinity Essential Plan 3&4	$42,657.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,958.70
Rate for Payer: Amida Care Medicaid	$18,958.70
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,657.07
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,958.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,958.70
Rate for Payer: Fidelis Qualified Health Plan	$22,750.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,958.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,958.70
Rate for Payer: Healthfirst Commercial	$11,501.00
Rate for Payer: Healthfirst Essential Plan	$42,657.07
Rate for Payer: Healthfirst QHP	$6,795.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,958.70
Rate for Payer: SOMOS Essential	$42,657.07
Rate for Payer: United Healthcare Essential Plan 1&2	$42,657.07
Rate for Payer: United Healthcare Essential Plan 3&4	$42,657.07
Rate for Payer: United Healthcare Medicaid	$18,958.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,958.70

Transurethral prostatectomy

Facility

$46,927.33

Service Code	APR-DRG 4822
Min. Negotiated Rate	$8,033.00
Max. Negotiated Rate	$46,927.33
Rate for Payer: Affinity Essential Plan 1&2	$46,927.33
Rate for Payer: Affinity Essential Plan 3&4	$46,927.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,856.59
Rate for Payer: Amida Care Medicaid	$20,856.59
Rate for Payer: EmblemHealth Essential Plan 1&2	$46,927.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,856.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,856.59
Rate for Payer: Fidelis Qualified Health Plan	$25,027.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,856.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,856.59
Rate for Payer: Healthfirst Commercial	$15,997.00
Rate for Payer: Healthfirst Essential Plan	$46,927.33
Rate for Payer: Healthfirst QHP	$8,033.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,856.59
Rate for Payer: SOMOS Essential	$46,927.33
Rate for Payer: United Healthcare Essential Plan 1&2	$46,927.33
Rate for Payer: United Healthcare Essential Plan 3&4	$46,927.33
Rate for Payer: United Healthcare Medicaid	$20,856.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,856.59

Transurethral prostatectomy

Facility

$73,415.79

Service Code	APR-DRG 4823
Min. Negotiated Rate	$16,520.00
Max. Negotiated Rate	$73,415.79
Rate for Payer: Affinity Essential Plan 1&2	$73,415.79
Rate for Payer: Affinity Essential Plan 3&4	$73,415.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,629.24
Rate for Payer: Amida Care Medicaid	$32,629.24
Rate for Payer: EmblemHealth Essential Plan 1&2	$73,415.79
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,629.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,629.24
Rate for Payer: Fidelis Qualified Health Plan	$39,155.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,629.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,629.24
Rate for Payer: Healthfirst Commercial	$38,248.00
Rate for Payer: Healthfirst Essential Plan	$73,415.79
Rate for Payer: Healthfirst QHP	$16,520.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,629.24
Rate for Payer: SOMOS Essential	$73,415.79
Rate for Payer: United Healthcare Essential Plan 1&2	$73,415.79
Rate for Payer: United Healthcare Essential Plan 3&4	$73,415.79
Rate for Payer: United Healthcare Medicaid	$32,629.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,629.24

Know your out-of-pocket cost for care.

All Charges