St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FILGRASTIM-AAFI 480 MCG/1.6ML IJ SOLN

Facility

$262.80

Service Code	HCPCS Q5110
Hospital Charge Code	0069029410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$210.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Affinity Essential Plan 1&2	$0.21
Rate for Payer: Affinity Essential Plan 3&4	$0.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.21
Rate for Payer: Brighton Health Commercial	$197.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$210.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$178.70
Rate for Payer: Elderplan Medicare Advantage	$0.30
Rate for Payer: EmblemHealth Commercial	$0.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.27
Rate for Payer: Fidelis Essential Plan Aliesa	$0.26
Rate for Payer: Fidelis Essential Plan QHP	$0.27
Rate for Payer: Fidelis Medicare Advantage	$0.30
Rate for Payer: Fidelis Qualified Health Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.30
Rate for Payer: Healthfirst Medicare Advantage	$0.26
Rate for Payer: Healthfirst QHP	$0.30
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Senior Whole Health Medicare Advantage	$0.30
Rate for Payer: United Healthcare Medicare Advantage	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$170.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.29
Rate for Payer: Wellcare Medicare	$0.29

FILGRASTIM-AAFI 480 MCG/1.6ML IJ SOLN

Facility

$262.80

Service Code	HCPCS Q5110
Hospital Charge Code	0069029410
Hospital Revenue Code	250
Min. Negotiated Rate	$131.40
Max. Negotiated Rate	$131.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.40

FILGRASTIM-AYOW 300 MCG/0.5ML SC SOSY

Facility

$381.60

Service Code	NDC 7012115681
Hospital Charge Code	7012115681
Hospital Revenue Code	250
Min. Negotiated Rate	$133.56
Max. Negotiated Rate	$305.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$190.80
Rate for Payer: Aetna Government	$190.80
Rate for Payer: Brighton Health Commercial	$286.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$305.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.49
Rate for Payer: EmblemHealth Commercial	$190.80
Rate for Payer: Group Health Inc Commercial	$190.80
Rate for Payer: Group Health Inc Medicare	$133.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.80
Rate for Payer: Hamaspik Choice Inc Medicare	$190.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$248.04

FILGRASTIM-AYOW 300 MCG/0.5ML SC SOSY

Facility

$381.60

Service Code	NDC 7012115681
Hospital Charge Code	7012115681
Hospital Revenue Code	250
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$190.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.80

FILGRASTIM-AYOW 300 MCG/0.5ML SC SOSY

Facility

$381.60

Service Code	NDC 7012115687
Hospital Charge Code	7012115687
Hospital Revenue Code	250
Min. Negotiated Rate	$133.56
Max. Negotiated Rate	$305.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$190.80
Rate for Payer: Aetna Government	$190.80
Rate for Payer: Brighton Health Commercial	$286.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$305.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.49
Rate for Payer: EmblemHealth Commercial	$190.80
Rate for Payer: Group Health Inc Commercial	$190.80
Rate for Payer: Group Health Inc Medicare	$133.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.80
Rate for Payer: Hamaspik Choice Inc Medicare	$190.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$248.04

FILGRASTIM-AYOW 300 MCG/0.5ML SC SOSY

Facility

$381.60

Service Code	NDC 7012115687
Hospital Charge Code	7012115687
Hospital Revenue Code	250
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$190.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.80

FILGRASTIM-AYOW 480 MCG/0.8ML SC SOSY

Facility

$381.60

Service Code	NDC 7012115707
Hospital Charge Code	7012115707
Hospital Revenue Code	250
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$190.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.80

FILGRASTIM-AYOW 480 MCG/0.8ML SC SOSY

Facility

$381.60

Service Code	NDC 7012115707
Hospital Charge Code	7012115707
Hospital Revenue Code	250
Min. Negotiated Rate	$133.56
Max. Negotiated Rate	$305.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$190.80
Rate for Payer: Aetna Government	$190.80
Rate for Payer: Brighton Health Commercial	$286.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$305.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.49
Rate for Payer: EmblemHealth Commercial	$190.80
Rate for Payer: Group Health Inc Commercial	$190.80
Rate for Payer: Group Health Inc Medicare	$133.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.80
Rate for Payer: Hamaspik Choice Inc Medicare	$190.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$248.04

FILGRASTIM-AYOW 480 MCG/0.8ML SC SOSY

Facility

$381.60

Service Code	NDC 7012115701
Hospital Charge Code	7012115701
Hospital Revenue Code	250
Min. Negotiated Rate	$133.56
Max. Negotiated Rate	$305.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$209.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$190.80
Rate for Payer: Aetna Government	$190.80
Rate for Payer: Brighton Health Commercial	$286.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$305.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.49
Rate for Payer: EmblemHealth Commercial	$190.80
Rate for Payer: Group Health Inc Commercial	$190.80
Rate for Payer: Group Health Inc Medicare	$133.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.80
Rate for Payer: Hamaspik Choice Inc Medicare	$190.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$248.04

FILGRASTIM-AYOW 480 MCG/0.8ML SC SOSY

Facility

$381.60

Service Code	NDC 7012115701
Hospital Charge Code	7012115701
Hospital Revenue Code	250
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$190.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$190.80

FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY

Facility

$658.46

Service Code	HCPCS Q5101
Hospital Charge Code	6131431801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$526.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$362.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.46
Rate for Payer: Aetna Government	$0.46
Rate for Payer: Affinity Essential Plan 1&2	$0.32
Rate for Payer: Affinity Essential Plan 3&4	$0.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.32
Rate for Payer: Brighton Health Commercial	$493.85
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$526.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$447.75
Rate for Payer: Elderplan Medicare Advantage	$0.46
Rate for Payer: EmblemHealth Commercial	$0.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.41
Rate for Payer: Fidelis Essential Plan Aliesa	$0.39
Rate for Payer: Fidelis Essential Plan QHP	$0.41
Rate for Payer: Fidelis Medicare Advantage	$0.46
Rate for Payer: Fidelis Qualified Health Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.46
Rate for Payer: Healthfirst Medicare Advantage	$0.39
Rate for Payer: Healthfirst QHP	$0.46
Rate for Payer: Humana Medicare	$0.47
Rate for Payer: Senior Whole Health Medicare Advantage	$0.46
Rate for Payer: United Healthcare Medicare Advantage	$0.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$428.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.44
Rate for Payer: Wellcare Medicare	$0.44

FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY

Facility

$658.46

Service Code	HCPCS Q5101
Hospital Charge Code	6131431801
Hospital Revenue Code	250
Min. Negotiated Rate	$329.23
Max. Negotiated Rate	$329.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$329.23

FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY

Facility

$658.47

Service Code	HCPCS Q5101
Hospital Charge Code	6131431805
Hospital Revenue Code	250
Min. Negotiated Rate	$329.24
Max. Negotiated Rate	$329.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$329.24

FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY

Facility

$658.47

Service Code	HCPCS Q5101
Hospital Charge Code	6131431805
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$526.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$362.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.46
Rate for Payer: Aetna Government	$0.46
Rate for Payer: Affinity Essential Plan 1&2	$0.32
Rate for Payer: Affinity Essential Plan 3&4	$0.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.32
Rate for Payer: Brighton Health Commercial	$493.85
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$526.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$447.76
Rate for Payer: Elderplan Medicare Advantage	$0.46
Rate for Payer: EmblemHealth Commercial	$0.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.41
Rate for Payer: Fidelis Essential Plan Aliesa	$0.39
Rate for Payer: Fidelis Essential Plan QHP	$0.41
Rate for Payer: Fidelis Medicare Advantage	$0.46
Rate for Payer: Fidelis Qualified Health Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.46
Rate for Payer: Healthfirst Medicare Advantage	$0.39
Rate for Payer: Healthfirst QHP	$0.46
Rate for Payer: Humana Medicare	$0.47
Rate for Payer: Senior Whole Health Medicare Advantage	$0.46
Rate for Payer: United Healthcare Medicare Advantage	$0.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$428.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.44
Rate for Payer: Wellcare Medicare	$0.44

FILGRASTIM-SNDZ 480 MCG/0.8ML IJ SOSY

Facility

$658.48

Service Code	HCPCS Q5101
Hospital Charge Code	6131432601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$526.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$362.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.46
Rate for Payer: Aetna Government	$0.46
Rate for Payer: Affinity Essential Plan 1&2	$0.32
Rate for Payer: Affinity Essential Plan 3&4	$0.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.32
Rate for Payer: Brighton Health Commercial	$493.86
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$526.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$447.76
Rate for Payer: Elderplan Medicare Advantage	$0.46
Rate for Payer: EmblemHealth Commercial	$0.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.41
Rate for Payer: Fidelis Essential Plan Aliesa	$0.39
Rate for Payer: Fidelis Essential Plan QHP	$0.41
Rate for Payer: Fidelis Medicare Advantage	$0.46
Rate for Payer: Fidelis Qualified Health Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.46
Rate for Payer: Healthfirst Medicare Advantage	$0.39
Rate for Payer: Healthfirst QHP	$0.46
Rate for Payer: Humana Medicare	$0.47
Rate for Payer: Senior Whole Health Medicare Advantage	$0.46
Rate for Payer: United Healthcare Medicare Advantage	$0.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$428.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.44
Rate for Payer: Wellcare Medicare	$0.44

FILGRASTIM-SNDZ 480 MCG/0.8ML IJ SOSY

Facility

$658.48

Service Code	HCPCS Q5101
Hospital Charge Code	6131432601
Hospital Revenue Code	250
Min. Negotiated Rate	$329.24
Max. Negotiated Rate	$329.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$329.24

FINASTERIDE 5 MG PO TABS

Facility

$3.11

Service Code	NDC 1672909010
Hospital Charge Code	1672909010
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56

FINASTERIDE 5 MG PO TABS

Facility

$1.24

Service Code	NDC 0904683061
Hospital Charge Code	0904683061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.62
Rate for Payer: Aetna Government	$0.62
Rate for Payer: Brighton Health Commercial	$0.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: EmblemHealth Commercial	$0.62
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

FINASTERIDE 5 MG PO TABS

Facility

$3.13

Service Code	NDC 1672909016
Hospital Charge Code	1672909016
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.13
Rate for Payer: EmblemHealth Commercial	$1.56
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

FINASTERIDE 5 MG PO TABS

Facility

$3.13

Service Code	NDC 5026831411
Hospital Charge Code	5026831411
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.13
Rate for Payer: EmblemHealth Commercial	$1.56
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

FINASTERIDE 5 MG PO TABS

Facility

$3.13

Service Code	NDC 1672909015
Hospital Charge Code	1672909015
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56

FINASTERIDE 5 MG PO TABS

Facility

$3.13

Service Code	NDC 1672909016
Hospital Charge Code	1672909016
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56

FINASTERIDE 5 MG PO TABS

Facility

$3.11

Service Code	NDC 1672909010
Hospital Charge Code	1672909010
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.12
Rate for Payer: EmblemHealth Commercial	$1.56
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.02

FINASTERIDE 5 MG PO TABS

Facility

$0.96

Service Code	NDC 6068742865
Hospital Charge Code	6068742865
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

FINASTERIDE 5 MG PO TABS

Facility

$0.96

Service Code	NDC 6068742865
Hospital Charge Code	6068742865
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

Know your out-of-pocket cost for care.

All Charges