St. Barnabas Hospital

All Charges

Charge

Type

Price

ENOXAPARIN 30 MG/0.3 ML INJ

Facility OP

$1.71

Service Code	HCPCS J1650
Hospital Charge Code	41640151
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.61
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.66
Rate for Payer: SOMOS Essential	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.11

ENOXAPARIN 30 MG/0.3 ML INJ

Facility IP

$1.71

Service Code	HCPCS J1650
Hospital Charge Code	41650151
Hospital Revenue Code	636
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86

ENOXAPARIN 30 MG/0.3 ML INJ

Facility OP

$1.71

Service Code	HCPCS J1650
Hospital Charge Code	41650151
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.61
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.66
Rate for Payer: SOMOS Essential	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.11

ENOXAPARIN 40 MG/0.4 ML INJ

Facility IP

$3.41

Service Code	HCPCS J1650
Hospital Charge Code	41652482
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70

ENOXAPARIN 40 MG/0.4 ML INJ

Facility OP

$3.41

Service Code	HCPCS J1650
Hospital Charge Code	41642482
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$2.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.61
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.66
Rate for Payer: SOMOS Essential	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

ENOXAPARIN 40 MG/0.4 ML INJ

Facility OP

$3.41

Service Code	HCPCS J1650
Hospital Charge Code	41652482
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$2.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.61
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.66
Rate for Payer: SOMOS Essential	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

ENOXAPARIN 40 MG/0.4 ML INJ

Facility IP

$3.41

Service Code	HCPCS J1650
Hospital Charge Code	41642482
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70

ENOXAPARIN 60 MG/0.6 ML INJ

Facility IP

$14.89

Service Code	HCPCS J1650
Hospital Charge Code	41642483
Hospital Revenue Code	636
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$7.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.44
Rate for Payer: Hamaspik Choice Inc Medicare	$7.44

ENOXAPARIN 60 MG/0.6 ML INJ

Facility IP

$14.89

Service Code	HCPCS J1650
Hospital Charge Code	41652483
Hospital Revenue Code	636
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$7.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.44
Rate for Payer: Hamaspik Choice Inc Medicare	$7.44

ENOXAPARIN 60 MG/0.6 ML INJ

Facility OP

$14.89

Service Code	HCPCS J1650
Hospital Charge Code	41652483
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$9.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.61
Rate for Payer: Group Health Inc Commercial	$7.44
Rate for Payer: Group Health Inc Medicare	$5.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.44
Rate for Payer: Hamaspik Choice Inc Medicare	$7.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.66
Rate for Payer: SOMOS Essential	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.68

ENOXAPARIN 60 MG/0.6 ML INJ

Facility OP

$14.89

Service Code	HCPCS J1650
Hospital Charge Code	41642483
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$9.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.61
Rate for Payer: Group Health Inc Commercial	$7.44
Rate for Payer: Group Health Inc Medicare	$5.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.44
Rate for Payer: Hamaspik Choice Inc Medicare	$7.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.66
Rate for Payer: SOMOS Essential	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.68

ENOXAPARIN 80 MG/0.8 ML INJ

Facility IP

$6.27

Service Code	HCPCS J1650
Hospital Charge Code	41652074
Hospital Revenue Code	636
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3.14

ENOXAPARIN 80 MG/0.8 ML INJ

Facility IP

$6.27

Service Code	HCPCS J1650
Hospital Charge Code	41642074
Hospital Revenue Code	636
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3.14

ENOXAPARIN 80 MG/0.8 ML INJ

Facility OP

$6.27

Service Code	HCPCS J1650
Hospital Charge Code	41652074
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$4.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.61
Rate for Payer: Group Health Inc Commercial	$3.14
Rate for Payer: Group Health Inc Medicare	$2.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.66
Rate for Payer: SOMOS Essential	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.08

ENOXAPARIN 80 MG/0.8 ML INJ

Facility OP

$6.27

Service Code	HCPCS J1650
Hospital Charge Code	41642074
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$4.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.76
Rate for Payer: Aetna Government	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.61
Rate for Payer: Group Health Inc Commercial	$3.14
Rate for Payer: Group Health Inc Medicare	$2.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.66
Rate for Payer: SOMOS Essential	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.08

ENTECAVIR 0.5MG TABLET

Facility OP

$4.05

Hospital Charge Code	41643893
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$3.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.02
Rate for Payer: Aetna Government	$2.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.75
Rate for Payer: Group Health Inc Commercial	$2.02
Rate for Payer: Group Health Inc Medicare	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.02
Rate for Payer: Hamaspik Choice Inc Medicare	$2.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.63

ENTECAVIR 0.5MG TABLET

Facility OP

$4.05

Hospital Charge Code	41653893
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$3.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.02
Rate for Payer: Aetna Government	$2.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.75
Rate for Payer: Group Health Inc Commercial	$2.02
Rate for Payer: Group Health Inc Medicare	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.02
Rate for Payer: Hamaspik Choice Inc Medicare	$2.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.63

ENTEROVIRUS RT-PCR

Facility OP

$87.73

Service Code	HCPCS 87498
Hospital Charge Code	40619200
Hospital Revenue Code	300
Min. Negotiated Rate	$28.07
Max. Negotiated Rate	$55.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.09
Rate for Payer: Aetna Government	$35.09
Rate for Payer: Cash Price	$35.09
Rate for Payer: Cash Price	$35.09
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.20
Rate for Payer: Elderplan Medicare Advantage	$35.09
Rate for Payer: EmblemHealth Commercial	$35.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.58
Rate for Payer: Fidelis Essential Plan Aliesa	$29.83
Rate for Payer: Fidelis Essential Plan QHP	$31.23
Rate for Payer: Fidelis Medicare Advantage	$35.09
Rate for Payer: Fidelis Qualified Health Plan	$31.23
Rate for Payer: Group Health Inc Commercial	$35.09
Rate for Payer: Group Health Inc Medicare	$35.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.86
Rate for Payer: Hamaspik Choice Inc Medicare	$35.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35.09
Rate for Payer: Healthfirst Medicare Advantage	$35.09
Rate for Payer: Healthfirst QHP	$35.09
Rate for Payer: Senior Whole Health Medicare Advantage	$35.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.07
Rate for Payer: Wellcare Medicare	$31.58

ENTRY PORTAL

Facility IP

$1,376.00

Service Code	HCPCS C1713
Hospital Charge Code	40006118
Hospital Revenue Code	278
Min. Negotiated Rate	$688.00
Max. Negotiated Rate	$688.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$688.00
Rate for Payer: Hamaspik Choice Inc Medicare	$688.00

ENTRY PORTAL

Facility OP

$1,376.00

Service Code	HCPCS C1713
Hospital Charge Code	40006118
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,444.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$688.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$791.20
Rate for Payer: Fidelis Medicare Advantage	$1,444.80
Rate for Payer: Group Health Inc Commercial	$688.00
Rate for Payer: Group Health Inc Medicare	$481.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$688.00
Rate for Payer: Hamaspik Choice Inc Medicare	$688.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$894.40

ENTRY REAMER FLEXIBLE SHAFT

Facility IP

$2,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40006117
Hospital Revenue Code	278
Min. Negotiated Rate	$1,040.00
Max. Negotiated Rate	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,040.00

ENTRY REAMER FLEXIBLE SHAFT

Facility OP

$2,080.00

Service Code	HCPCS C1713
Hospital Charge Code	40006117
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,184.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,144.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,040.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,196.00
Rate for Payer: Fidelis Medicare Advantage	$2,184.00
Rate for Payer: Group Health Inc Commercial	$1,040.00
Rate for Payer: Group Health Inc Medicare	$728.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,040.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,040.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,352.00

ENTRY REAMER SOLID SHAFT

Facility OP

$960.00

Service Code	HCPCS C1713
Hospital Charge Code	40006116
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,008.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$528.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$480.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.00
Rate for Payer: Fidelis Medicare Advantage	$1,008.00
Rate for Payer: Group Health Inc Commercial	$480.00
Rate for Payer: Group Health Inc Medicare	$336.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$480.00
Rate for Payer: Hamaspik Choice Inc Medicare	$480.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$624.00

ENTRY REAMER SOLID SHAFT

Facility IP

$960.00

Service Code	HCPCS C1713
Hospital Charge Code	40006116
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$480.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$480.00
Rate for Payer: Hamaspik Choice Inc Medicare	$480.00

ENUCLEATION - EYE

Facility OP

$9,471.08

Service Code	HCPCS 65101
Hospital Charge Code	40072490
Hospital Revenue Code	360
Min. Negotiated Rate	$921.47
Max. Negotiated Rate	$4,735.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,471.17
Rate for Payer: Aetna Government	$4,471.17
Rate for Payer: Cash Price	$4,471.17
Rate for Payer: Cash Price	$4,471.17
Rate for Payer: Cash Price	$4,471.17
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,471.17
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	$4,471.17
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$921.47
Rate for Payer: Fidelis Essential Plan Aliesa	$3,800.49
Rate for Payer: Fidelis Essential Plan QHP	$3,979.34
Rate for Payer: Fidelis Medicare Advantage	$4,471.17
Rate for Payer: Fidelis Qualified Health Plan	$3,979.34
Rate for Payer: Group Health Inc Commercial	$4,471.17
Rate for Payer: Group Health Inc Medicare	$4,471.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,735.54
Rate for Payer: Hamaspik Choice Inc Medicare	$4,471.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,023.86
Rate for Payer: Healthfirst Medicare Advantage	$3,800.49
Rate for Payer: Healthfirst QHP	$4,471.17
Rate for Payer: Senior Whole Health Medicare Advantage	$4,471.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,471.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,576.94
Rate for Payer: Wellcare Medicare	$4,247.61

Price Transparency.

All Charges