St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT SUPPORTED METAL CROWN

Facility

$2,000.00

Service Code	HCPCS D6067
Hospital Charge Code	42303342
Hospital Revenue Code	361
Min. Negotiated Rate	$360.01
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$360.01
Rate for Payer: Aetna Government	$360.01
Rate for Payer: Brighton Health Commercial	$1,500.00
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: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

IMPLANT SUPPORTED PFM

Facility

$2,000.00

Service Code	HCPCS D6066
Hospital Charge Code	42303341
Hospital Revenue Code	361
Min. Negotiated Rate	$370.92
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$370.92
Rate for Payer: Aetna Government	$370.92
Rate for Payer: Brighton Health Commercial	$1,500.00
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: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

IMPLANT SUPPORTED PORC/CERAM CRWN

Facility

$2,000.00

Service Code	HCPCS D6065
Hospital Charge Code	42303322
Hospital Revenue Code	361
Min. Negotiated Rate	$380.87
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.87
Rate for Payer: Aetna Government	$380.87
Rate for Payer: Brighton Health Commercial	$1,500.00
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: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

IMPLANT SUPPORTED RET/CERAMIC FPD

Facility

$1,559.00

Service Code	HCPCS D6075
Hospital Charge Code	42303350
Hospital Revenue Code	361
Min. Negotiated Rate	$380.87
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$857.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.87
Rate for Payer: Aetna Government	$380.87
Rate for Payer: Brighton Health Commercial	$1,169.25
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: Group Health Inc Commercial	$779.50
Rate for Payer: Group Health Inc Medicare	$545.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$779.50
Rate for Payer: Hamaspik Choice Inc Medicare	$779.50

IMPLANT SUPPORTED RET/PFM FPD

Facility

$1,276.00

Service Code	HCPCS D6076
Hospital Charge Code	42303351
Hospital Revenue Code	361
Min. Negotiated Rate	$370.92
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$701.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$370.92
Rate for Payer: Aetna Government	$370.92
Rate for Payer: Brighton Health Commercial	$957.00
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: Group Health Inc Commercial	$638.00
Rate for Payer: Group Health Inc Medicare	$446.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$638.00
Rate for Payer: Hamaspik Choice Inc Medicare	$638.00

IMPLANT SUPPORT RET/CAST MET FPD

Facility

$1,276.00

Service Code	HCPCS D6077
Hospital Charge Code	42303352
Hospital Revenue Code	361
Min. Negotiated Rate	$360.01
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$701.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$360.01
Rate for Payer: Aetna Government	$360.01
Rate for Payer: Brighton Health Commercial	$957.00
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: Group Health Inc Commercial	$638.00
Rate for Payer: Group Health Inc Medicare	$446.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$638.00
Rate for Payer: Hamaspik Choice Inc Medicare	$638.00

IMPLANT- SURGICAL/ENDOSTEAL

Facility

$2,500.00

Service Code	HCPCS D6010
Hospital Charge Code	42303317
Hospital Revenue Code	361
Min. Negotiated Rate	$672.43
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$672.43
Rate for Payer: Aetna Government	$672.43
Rate for Payer: Brighton Health Commercial	$1,875.00
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: Group Health Inc Commercial	$1,250.00
Rate for Payer: Group Health Inc Medicare	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,250.00

IMPLANT SYNDSMSIS KNTLSS S/S 8926

Facility

$1,760.00

Hospital Charge Code	64906655
Hospital Revenue Code	279
Min. Negotiated Rate	$616.00
Max. Negotiated Rate	$1,408.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$968.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$880.00
Rate for Payer: Aetna Government	$880.00
Rate for Payer: Brighton Health Commercial	$1,320.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,408.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,196.80
Rate for Payer: Group Health Inc Commercial	$880.00
Rate for Payer: Group Health Inc Medicare	$616.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$880.00
Rate for Payer: Hamaspik Choice Inc Medicare	$880.00

IMPLANT SYSTEM MPFL BIOCOMPOSITE

Facility

$5,312.50

Hospital Charge Code	64902858
Hospital Revenue Code	279
Min. Negotiated Rate	$1,859.38
Max. Negotiated Rate	$4,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,921.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,656.25
Rate for Payer: Aetna Government	$2,656.25
Rate for Payer: Brighton Health Commercial	$3,984.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,612.50
Rate for Payer: Group Health Inc Commercial	$2,656.25
Rate for Payer: Group Health Inc Medicare	$1,859.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,656.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,656.25

IMPLANT SYSTEM SWIVELOCK

Facility

$2,287.50

Hospital Charge Code	64903815
Hospital Revenue Code	279
Min. Negotiated Rate	$800.62
Max. Negotiated Rate	$1,830.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,258.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,143.75
Rate for Payer: Aetna Government	$1,143.75
Rate for Payer: Brighton Health Commercial	$1,715.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,830.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,555.50
Rate for Payer: Group Health Inc Commercial	$1,143.75
Rate for Payer: Group Health Inc Medicare	$800.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,143.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,143.75

IMPLANT SZR INFLT SM MOD+ 76991

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	64906368
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

IMPLANT SZR INFLT SM MOD+ 76991

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	64906368
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

IMPLANT SZR INFLT SM MOD+ 76992

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	64906369
Hospital Revenue Code	278
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$402.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$37.38
Rate for Payer: EmblemHealth Commercial	$32.50
Rate for Payer: Fidelis Medicare Advantage	$68.25
Rate for Payer: Group Health Inc Commercial	$32.50
Rate for Payer: Group Health Inc Medicare	$22.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.25

IMPLANT SZR INFLT SM MOD+ 76992

Facility

$65.00

Service Code	HCPCS C1789
Hospital Charge Code	64906369
Hospital Revenue Code	278
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50

IMPLANT TESTIC SALINE LG 2.9CM

Facility

$4,125.00

Hospital Charge Code	64902527
Hospital Revenue Code	272
Min. Negotiated Rate	$1,443.75
Max. Negotiated Rate	$3,300.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,268.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,062.50
Rate for Payer: Aetna Government	$2,062.50
Rate for Payer: Brighton Health Commercial	$3,093.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,805.00
Rate for Payer: Group Health Inc Commercial	$2,062.50
Rate for Payer: Group Health Inc Medicare	$1,443.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,062.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,062.50

IMPLANT TOE JOINT 0DEG NEUTRAL

Facility

$3,197.50

Service Code	HCPCS C1776
Hospital Charge Code	64903874
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,357.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,758.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,918.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,598.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,838.56
Rate for Payer: EmblemHealth Commercial	$1,598.75
Rate for Payer: Fidelis Medicare Advantage	$3,357.38
Rate for Payer: Group Health Inc Commercial	$1,598.75
Rate for Payer: Group Health Inc Medicare	$1,119.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,598.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,598.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,078.38

IMPLANT TOE JOINT 0DEG NEUTRAL

Facility

$3,197.50

Service Code	HCPCS C1776
Hospital Charge Code	64903874
Hospital Revenue Code	278
Min. Negotiated Rate	$1,598.75
Max. Negotiated Rate	$1,598.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,598.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,598.75

IMPLANT TOE JOINT NEUTRAL 0DEG

Facility

$3,422.50

Service Code	HCPCS C1776
Hospital Charge Code	64904916
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,593.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,882.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,053.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,711.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,967.94
Rate for Payer: EmblemHealth Commercial	$1,711.25
Rate for Payer: Fidelis Medicare Advantage	$3,593.62
Rate for Payer: Group Health Inc Commercial	$1,711.25
Rate for Payer: Group Health Inc Medicare	$1,197.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,711.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,711.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,224.62

IMPLANT TOE JOINT NEUTRAL 0DEG

Facility

$3,422.50

Service Code	HCPCS C1776
Hospital Charge Code	64904916
Hospital Revenue Code	278
Min. Negotiated Rate	$1,711.25
Max. Negotiated Rate	$1,711.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,711.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,711.25

IMPLANT TOE LG NPC

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	64902199
Hospital Revenue Code	278
Min. Negotiated Rate	$1,437.50
Max. Negotiated Rate	$1,437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,437.50

IMPLANT TOE LG NPC

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	64902199
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,018.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,581.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,725.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,653.12
Rate for Payer: EmblemHealth Commercial	$1,437.50
Rate for Payer: Fidelis Medicare Advantage	$3,018.75
Rate for Payer: Group Health Inc Commercial	$1,437.50
Rate for Payer: Group Health Inc Medicare	$1,006.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,868.75

IMPLANT TOE MS NPC

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64902197
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: EmblemHealth Commercial	$1,000.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

IMPLANT TOE MS NPC

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64902197
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

IMPLNT CRNIALPLASTY LRGE 101CM2

Facility

$25,828.12

Service Code	HCPCS 62120
Hospital Charge Code	64906299
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$19,371.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,205.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,958.84
Rate for Payer: Aetna Government	$1,958.84
Rate for Payer: Brighton Health Commercial	$19,371.09
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$12,914.06
Rate for Payer: Group Health Inc Medicare	$9,039.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,914.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12,914.06
Rate for Payer: United Healthcare Commercial	$1,496.00

IMPL SP/BR PUMP RFL & MAIN BY DOC

Facility

$792.83

Service Code	HCPCS 95991
Hospital Charge Code	40505006
Hospital Revenue Code	920
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$634.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$436.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Affinity Essential Plan 1&2	$239.76
Rate for Payer: Affinity Essential Plan 3&4	$239.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$239.76
Rate for Payer: Brighton Health Commercial	$594.62
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$634.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$539.12
Rate for Payer: Elderplan Medicare Advantage	$342.51
Rate for Payer: EmblemHealth Commercial	$342.51
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
Rate for Payer: Group Health Inc Commercial	$342.51
Rate for Payer: Group Health Inc Medicare	$342.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst Medicare Advantage	$291.13
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: Humana Medicare	$349.36
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: United Healthcare Commercial	$94.00
Rate for Payer: United Healthcare Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

Know your out-of-pocket cost for care.

All Charges