St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SIMVASTATIN 40 MG TAB

Facility

$0.20

Hospital Charge Code	41652920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

SIMVASTATIN 40 MG TAB

Facility

$0.20

Hospital Charge Code	41642920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

SINCALIDE 5 MCG IJ SOLR [11368]

Facility

$156.56

Service Code	HCPCS J2805
Hospital Charge Code	00270055615
Hospital Revenue Code	250
Min. Negotiated Rate	$54.79
Max. Negotiated Rate	$137.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.08
Rate for Payer: Aetna Government	$121.08
Rate for Payer: Brighton Health Commercial	$117.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$106.46
Rate for Payer: Group Health Inc Commercial	$78.28
Rate for Payer: Group Health Inc Medicare	$54.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.28
Rate for Payer: Hamaspik Choice Inc Medicare	$78.28
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$129.74
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$137.53
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$137.53
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$137.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$101.76

SINCALIDE 5 MCG INJ

Facility

$56.00

Service Code	HCPCS J2805
Hospital Charge Code	41651796
Hospital Revenue Code	636
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00
Rate for Payer: Hamaspik Choice Inc Medicare	$28.00

SINCALIDE 5 MCG INJ

Facility

$56.00

Service Code	HCPCS J2805
Hospital Charge Code	41641796
Hospital Revenue Code	636
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$137.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.08
Rate for Payer: Aetna Government	$121.08
Rate for Payer: Brighton Health Commercial	$33.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.20
Rate for Payer: Group Health Inc Commercial	$28.00
Rate for Payer: Group Health Inc Medicare	$19.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00
Rate for Payer: Hamaspik Choice Inc Medicare	$28.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.53
Rate for Payer: SOMOS Essential	$137.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.40

SINCALIDE 5 MCG INJ

Facility

$56.00

Service Code	HCPCS J2805
Hospital Charge Code	41641796
Hospital Revenue Code	636
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00
Rate for Payer: Hamaspik Choice Inc Medicare	$28.00

SINCALIDE 5 MCG INJ

Facility

$56.00

Service Code	HCPCS J2805
Hospital Charge Code	41651796
Hospital Revenue Code	636
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$137.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.08
Rate for Payer: Aetna Government	$121.08
Rate for Payer: Brighton Health Commercial	$33.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.20
Rate for Payer: Group Health Inc Commercial	$28.00
Rate for Payer: Group Health Inc Medicare	$19.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00
Rate for Payer: Hamaspik Choice Inc Medicare	$28.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.53
Rate for Payer: SOMOS Essential	$137.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.40

SINGLE ACTION PUMP SYSTEM

Facility

$224.00

Hospital Charge Code	40205957
Hospital Revenue Code	270
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$179.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$112.00
Rate for Payer: Aetna Government	$112.00
Rate for Payer: Brighton Health Commercial	$168.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$152.32
Rate for Payer: Group Health Inc Commercial	$112.00
Rate for Payer: Group Health Inc Medicare	$78.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.00
Rate for Payer: Hamaspik Choice Inc Medicare	$112.00

SINGLE CHAMBER PCMKR CHECK

Facility

$109.80

Service Code	HCPCS 93279 TC
Hospital Charge Code	40804104
Hospital Revenue Code	480
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$87.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.90
Rate for Payer: Aetna Government	$54.90
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Group Health Inc Commercial	$54.90
Rate for Payer: Group Health Inc Medicare	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$54.90

SINGLE CHAMBER PCMKR CHECK

Facility

$109.80

Service Code	HCPCS 93279 TC
Hospital Charge Code	40804104
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

SINGLE CR 3/4 CAST HIGH NOBLE MET

Facility

$1,000.00

Service Code	HCPCS D2780
Hospital Charge Code	42303292
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

SINGLE CR 3/4 CAST HIGH NOBLE MET

Facility

$1,000.00

Service Code	HCPCS D2780
Hospital Charge Code	42303292
Hospital Revenue Code	361
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$750.00
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

SINGLE CROWN 3/4 CAST BASE METAL

Facility

$1,000.00

Service Code	HCPCS D2781
Hospital Charge Code	42303293
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

SINGLE CROWN 3/4 CAST BASE METAL

Facility

$1,000.00

Service Code	HCPCS D2781
Hospital Charge Code	42303293
Hospital Revenue Code	361
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$750.00
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

SINGLE CROWN 3/4 CAST NOBLE METAL

Facility

$1,000.00

Service Code	HCPCS D2782
Hospital Charge Code	42303294
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

SINGLE CROWN 3/4 CAST NOBLE METAL

Facility

$1,000.00

Service Code	HCPCS D2782
Hospital Charge Code	42303294
Hospital Revenue Code	361
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$750.00
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

SINGLE CROWN 3/4 PORC/CERAM

Facility

$1,300.00

Service Code	HCPCS D2783
Hospital Charge Code	42303295
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

SINGLE CROWN 3/4 PORC/CERAM

Facility

$1,300.00

Service Code	HCPCS D2783
Hospital Charge Code	42303295
Hospital Revenue Code	361
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$715.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$975.00
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$650.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

SINGLE/DUAL ICD

Facility

$109.80

Service Code	HCPCS 93289 TC
Hospital Charge Code	30305067
Hospital Revenue Code	480
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$87.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.90
Rate for Payer: Aetna Government	$54.90
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Group Health Inc Commercial	$54.90
Rate for Payer: Group Health Inc Medicare	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$54.90

SINGLE/DUAL ICD

Facility

$109.80

Service Code	HCPCS 93289 TC
Hospital Charge Code	30305067
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

SINGLE LEAD ICD W/REPROGRAM

Facility

$109.80

Service Code	HCPCS 93282 TC
Hospital Charge Code	30305064
Hospital Revenue Code	480
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$87.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.90
Rate for Payer: Aetna Government	$54.90
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Group Health Inc Commercial	$54.90
Rate for Payer: Group Health Inc Medicare	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$54.90

SINGLE LEAD ICD W/REPROGRAM

Facility

$109.80

Service Code	HCPCS 93282 TC
Hospital Charge Code	30305064
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

SINGLE LEAD PACE W/REPROGRAM

Facility

$109.80

Service Code	HCPCS 93279 TC
Hospital Charge Code	30305061
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

SINGLE LEAD PACE W/REPROGRAM

Facility

$109.80

Service Code	HCPCS 93279 TC
Hospital Charge Code	30305061
Hospital Revenue Code	480
Min. Negotiated Rate	$38.43
Max. Negotiated Rate	$87.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.90
Rate for Payer: Aetna Government	$54.90
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Group Health Inc Commercial	$54.90
Rate for Payer: Group Health Inc Medicare	$38.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$54.90

SINGLE ONLAY MET 4 OR MORE SURF.

Facility

$1,169.44

Service Code	HCPCS D2544
Hospital Charge Code	42303285
Hospital Revenue Code	361
Min. Negotiated Rate	$584.72
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$643.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Brighton Health Commercial	$877.08
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$584.72
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

Know your out-of-pocket cost for care.

All Charges