St. Barnabas Hospital

All Charges

Charge

Type

Price

BENZOCAINE + BUTAMBEN + TETRACAINE TOPIC

Facility OP

$44.24

Hospital Charge Code	41644258
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$35.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.12
Rate for Payer: Aetna Government	$22.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.08
Rate for Payer: Group Health Inc Commercial	$22.12
Rate for Payer: Group Health Inc Medicare	$15.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.12
Rate for Payer: Hamaspik Choice Inc Medicare	$22.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.76

BENZOCAINE + BUTAMBEN + TETRACAINE TOPIC

Facility OP

$44.24

Hospital Charge Code	41654258
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$35.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.12
Rate for Payer: Aetna Government	$22.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.08
Rate for Payer: Group Health Inc Commercial	$22.12
Rate for Payer: Group Health Inc Medicare	$15.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.12
Rate for Payer: Hamaspik Choice Inc Medicare	$22.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.76

BENZOCAINE-MENTHOL 15-3.6MG LOZ

Facility OP

$0.14

Hospital Charge Code	41657045
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: 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

BENZOCAINE-MENTHOL 15-3.6MG LOZ

Facility OP

$0.14

Hospital Charge Code	41647045
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: 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

BENZOCAINE MENTHOL LOZENGE 15/4

Facility OP

$1.00

Hospital Charge Code	41656042
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: 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

BENZOCAINE MENTHOL LOZENGE 15MG

Facility OP

$1.00

Hospital Charge Code	41646042
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: 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

BENZOCAINE TOPICAL SPRAY 20%

Facility OP

$5.02

Hospital Charge Code	41651419
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.41
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.26

BENZOCAINE TOPICAL SPRAY 20%

Facility OP

$5.02

Hospital Charge Code	41641419
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.41
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.26

BENZODIAZEPINES, 1-12

Facility OP

$33.95

Service Code	HCPCS 80346
Hospital Charge Code	40609728
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$27.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.09
Rate for Payer: Group Health Inc Commercial	$16.98
Rate for Payer: Group Health Inc Medicare	$11.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.98
Rate for Payer: Hamaspik Choice Inc Medicare	$16.98

BENZODIAZEPINES, 13 OR MORE

Facility OP

$37.35

Service Code	HCPCS 80347
Hospital Charge Code	40601022
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$29.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.40
Rate for Payer: Group Health Inc Commercial	$18.68
Rate for Payer: Group Health Inc Medicare	$13.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.68
Rate for Payer: Hamaspik Choice Inc Medicare	$18.68

BENZOIN COMPOUND TINCTURE 30 ML

Facility OP

$49.04

Hospital Charge Code	41655232
Hospital Revenue Code	250
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$39.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.52
Rate for Payer: Aetna Government	$24.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.35
Rate for Payer: Group Health Inc Commercial	$24.52
Rate for Payer: Group Health Inc Medicare	$17.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.52
Rate for Payer: Hamaspik Choice Inc Medicare	$24.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.88

BENZOIN COMPOUND TINCTURE 30 ML

Facility OP

$49.04

Hospital Charge Code	41645232
Hospital Revenue Code	250
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$39.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.52
Rate for Payer: Aetna Government	$24.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.35
Rate for Payer: Group Health Inc Commercial	$24.52
Rate for Payer: Group Health Inc Medicare	$17.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.52
Rate for Payer: Hamaspik Choice Inc Medicare	$24.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.88

BENZOYL PEROXIDE 10% GEL 45 GRAMS

Facility OP

$4.00

Hospital Charge Code	41650584
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

BENZOYL PEROXIDE 10% GEL 45 GRAMS

Facility OP

$4.00

Hospital Charge Code	41640584
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

BENZOYL PEROXIDE 5% GEL 45 GRAMS

Facility OP

$4.00

Hospital Charge Code	41640387
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

BENZOYL PEROXIDE 5% GEL 45 GRAMS

Facility OP

$4.00

Hospital Charge Code	41650387
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

BENZTROPINE 0.5 MG TAB

Facility OP

$1.00

Hospital Charge Code	41643515
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: 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

BENZTROPINE 0.5 MG TAB

Facility OP

$1.00

Hospital Charge Code	41653515
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: 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

BENZTROPINE 1 MG/ML INJ

Facility OP

$43.73

Service Code	HCPCS J0515
Hospital Charge Code	41644393
Hospital Revenue Code	636
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$28.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.51
Rate for Payer: Aetna Government	$19.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.59
Rate for Payer: Group Health Inc Commercial	$21.86
Rate for Payer: Group Health Inc Medicare	$15.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.86
Rate for Payer: Hamaspik Choice Inc Medicare	$21.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.43
Rate for Payer: SOMOS Essential	$17.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.42

BENZTROPINE 1 MG/ML INJ

Facility IP

$43.73

Service Code	HCPCS J0515
Hospital Charge Code	41654393
Hospital Revenue Code	636
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$21.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.86
Rate for Payer: Hamaspik Choice Inc Medicare	$21.86

BENZTROPINE 1 MG/ML INJ

Facility IP

$43.73

Service Code	HCPCS J0515
Hospital Charge Code	41644393
Hospital Revenue Code	636
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$21.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.86
Rate for Payer: Hamaspik Choice Inc Medicare	$21.86

BENZTROPINE 1 MG/ML INJ

Facility OP

$43.73

Service Code	HCPCS J0515
Hospital Charge Code	41654393
Hospital Revenue Code	636
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$28.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.51
Rate for Payer: Aetna Government	$19.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.59
Rate for Payer: Group Health Inc Commercial	$21.86
Rate for Payer: Group Health Inc Medicare	$15.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.86
Rate for Payer: Hamaspik Choice Inc Medicare	$21.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.43
Rate for Payer: SOMOS Essential	$17.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.42

BENZTROPINE 1 MG TAB

Facility OP

$1.00

Hospital Charge Code	41653516
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: 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

BENZTROPINE 1 MG TAB

Facility OP

$1.00

Hospital Charge Code	41643516
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: 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

BENZTROPINE 2 MG TAB

Facility OP

$1.00

Hospital Charge Code	41650545
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: 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

Price Transparency.

All Charges