Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEL C SEC W/ TUBAL EA ADD HR

Facility

$10,100.00

Hospital Charge Code	73190143
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEL C SEC W/TUBAL EA ADD HR

Facility

$6,141.59

Hospital Charge Code	73190151
Hospital Revenue Code	720
Min. Negotiated Rate	$148.01
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$2,333.80
Rate for Payer: Aetna Medicare Advantage	$1,842.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,566.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,566.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,566.11
Rate for Payer: Cigna Commercial	$3,070.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,842.48
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$921.24
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$148.01
Rate for Payer: Wellpoint Medicaid Managed Care	$162.75

DEL C SEC W/TUBAL EA ADD HR

Facility

$6,141.59

Hospital Charge Code	73190151
Hospital Revenue Code	720
Min. Negotiated Rate	$921.24
Max. Negotiated Rate	$921.24
Rate for Payer: Qualcare PPO/HMO/WC	$921.24

DEL D&C

Facility

$10,100.00

Service Code	HCPCS 59160
Hospital Charge Code	73190025
Hospital Revenue Code	720
Min. Negotiated Rate	$195.15
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,030.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$243.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$267.65

DEL D&C

Facility

$10,100.00

Service Code	HCPCS 59160
Hospital Charge Code	73190025
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEL DELIVER PLACENTA

Facility

$10,100.00

Service Code	HCPCS 59414
Hospital Charge Code	73190037
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEL DELIVER PLACENTA

Facility

$10,100.00

Service Code	HCPCS 59414
Hospital Charge Code	73190037
Hospital Revenue Code	720
Min. Negotiated Rate	$81.31
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,030.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$243.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$267.65

DEL ECHO EXAM OF FETAL HEART

Facility

$587.00

Service Code	HCPCS 76827
Hospital Charge Code	73190079
Hospital Revenue Code	402
Min. Negotiated Rate	$88.05
Max. Negotiated Rate	$88.05
Rate for Payer: Qualcare PPO/HMO/WC	$88.05

DEL ECHO EXAM OF FETAL HEART

Facility

$587.00

Service Code	HCPCS 76827
Hospital Charge Code	73190079
Hospital Revenue Code	402
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.10
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.05
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$14.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$15.56

DEL EPIS OR VAGINAL REPAIR

Facility

$10,100.00

Service Code	HCPCS 59300
Hospital Charge Code	73190027
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEL EPIS OR VAGINAL REPAIR

Facility

$10,100.00

Service Code	HCPCS 59300
Hospital Charge Code	73190027
Hospital Revenue Code	720
Min. Negotiated Rate	$174.24
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$174.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,030.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$243.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$267.65

DEL EVACUATION OF HEMATOMA

Facility

$1,671.00

Service Code	HCPCS 10160
Hospital Charge Code	73190001
Hospital Revenue Code	361
Min. Negotiated Rate	$250.65
Max. Negotiated Rate	$250.65
Rate for Payer: Qualcare PPO/HMO/WC	$250.65

DEL EVACUATION OF HEMATOMA

Facility

$1,671.00

Service Code	HCPCS 10160
Hospital Charge Code	73190001
Hospital Revenue Code	361
Min. Negotiated Rate	$40.27
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$501.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$40.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

DEL EXAM UNDER ANESTHESIA

Facility

$10,100.00

Service Code	HCPCS 57410
Hospital Charge Code	73190007
Hospital Revenue Code	720
Min. Negotiated Rate	$74.54
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,030.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$243.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$267.65

DEL EXAM UNDER ANESTHESIA

Facility

$10,100.00

Service Code	HCPCS 57410
Hospital Charge Code	73190007
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEL EXTERNAL VERSION

Facility

$10,100.00

Service Code	HCPCS 59412
Hospital Charge Code	73190035
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEL EXTERNAL VERSION

Facility

$10,100.00

Service Code	HCPCS 59412
Hospital Charge Code	73190035
Hospital Revenue Code	720
Min. Negotiated Rate	$91.94
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,030.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$243.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$267.65

DEL FETAL BIOPHY PRFILE W/NST

Facility

$555.00

Service Code	HCPCS 76818
Hospital Charge Code	73190075
Hospital Revenue Code	402
Min. Negotiated Rate	$83.25
Max. Negotiated Rate	$83.25
Rate for Payer: Qualcare PPO/HMO/WC	$83.25

DEL FETAL BIOPHY PRFILE W/NST

Facility

$555.00

Service Code	HCPCS 76818
Hospital Charge Code	73190075
Hospital Revenue Code	402
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.25
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$13.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$14.71

DEL FETAL DOPPLER-UMBIL ART

Facility

$721.00

Service Code	HCPCS 76820
Hospital Charge Code	73190077
Hospital Revenue Code	402
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$108.15
Rate for Payer: Qualcare PPO/HMO/WC	$108.15

DEL FETAL DOPPLER-UMBIL ART

Facility

$721.00

Service Code	HCPCS 76820
Hospital Charge Code	73190077
Hospital Revenue Code	402
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.30
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.15
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$19.11

DEL FETAL MONITOR - EXTERNAL

Facility

$1,005.20

Hospital Charge Code	73190021
Hospital Revenue Code	720
Min. Negotiated Rate	$150.78
Max. Negotiated Rate	$150.78
Rate for Payer: Qualcare PPO/HMO/WC	$150.78

DEL FETAL MONITOR - EXTERNAL

Facility

$1,005.20

Hospital Charge Code	73190021
Hospital Revenue Code	720
Min. Negotiated Rate	$24.23
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$381.98
Rate for Payer: Aetna Medicare Advantage	$301.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.33
Rate for Payer: Cigna Commercial	$502.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.56
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.78
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$24.23
Rate for Payer: Wellpoint Medicaid Managed Care	$26.64

DEL FINGERSTICK

Facility

$14.00

Service Code	HCPCS 36416
Hospital Charge Code	73190003
Hospital Revenue Code	300
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

DEL FINGERSTICK

Facility

$14.00

Service Code	HCPCS 36416
Hospital Charge Code	73190003
Hospital Revenue Code	300
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

Know your out-of-pocket cost for care.

All Charges