Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DETECT BY NUC ACD STAPHYLOCOCC

Facility

$248.54

Service Code	HCPCS 87640
Hospital Charge Code	38477197
Hospital Revenue Code	306
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$126.66
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$124.27
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.59

DETECT BY NUC ACID CYTOMEGALOV

Facility

$141.99

Service Code	HCPCS 87495
Hospital Charge Code	38477160
Hospital Revenue Code	306
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

DETECT BY NUC ACID CYTOMEGALOV

Facility

$141.99

Service Code	HCPCS 87495
Hospital Charge Code	38477160
Hospital Revenue Code	306
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$81.68
Rate for Payer: Aetna Medicare Advantage	$97.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.40
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$30.03
Rate for Payer: Clover Medicare Advantage	$28.53
Rate for Payer: EmblemHealth Commercial	$90.09
Rate for Payer: Humana Medicare Advantage	$30.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.03
Rate for Payer: Wellcare Medicare Advantage	$30.03
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

DETECT BY NUC ACID GARDNERELLA

Facility

$141.99

Service Code	HCPCS 87510
Hospital Charge Code	38477161
Hospital Revenue Code	306
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

DETECT BY NUC ACID GARDNERELLA

Facility

$141.99

Service Code	HCPCS 87510
Hospital Charge Code	38477161
Hospital Revenue Code	306
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.37
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

DETECT BY NUC ACID MULT ORG AM

Facility

$497.99

Service Code	HCPCS 87801
Hospital Charge Code	38477229
Hospital Revenue Code	306
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$253.40
Rate for Payer: Aetna Commercial	$190.94
Rate for Payer: Aetna Medicare Advantage	$227.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.40
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: Cigna Medicare Advantage	$70.20
Rate for Payer: Clover Medicare Advantage	$66.69
Rate for Payer: EmblemHealth Commercial	$210.60
Rate for Payer: Humana Medicare Advantage	$72.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$56.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20
Rate for Payer: Wellcare Medicare Advantage	$70.20
Rate for Payer: Wellpoint Medicaid Managed Care	$13.20

DETECT BY NUC ACID MULT ORG AM

Facility

$497.99

Service Code	HCPCS 87801
Hospital Charge Code	38477229
Hospital Revenue Code	306
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Qualcare PPO/HMO/WC	$74.70

DETECT BY NUCL ACD CLOSTRIDIUM

Facility

$248.54

Service Code	HCPCS 87493
Hospital Charge Code	38477193
Hospital Revenue Code	306
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$134.53
Rate for Payer: Aetna Commercial	$101.37
Rate for Payer: Aetna Medicare Advantage	$120.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.53
Rate for Payer: Cigna Commercial	$124.27
Rate for Payer: Cigna Medicare Advantage	$37.27
Rate for Payer: Clover Medicare Advantage	$35.41
Rate for Payer: EmblemHealth Commercial	$111.81
Rate for Payer: Humana Medicare Advantage	$38.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$29.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.27
Rate for Payer: Wellcare Medicare Advantage	$37.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.59

DETECT BY NUCL ACD CLOSTRIDIUM

Facility

$248.54

Service Code	HCPCS 87493
Hospital Charge Code	38477193
Hospital Revenue Code	306
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

DETECT BY NUCL ACD HEPATITIS B

Facility

$248.54

Service Code	HCPCS 87516
Hospital Charge Code	38477195
Hospital Revenue Code	306
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$126.66
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$124.27
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.59

DETECT BY NUCL ACD HEPATITIS B

Facility

$248.54

Service Code	HCPCS 87516
Hospital Charge Code	38477195
Hospital Revenue Code	306
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

DETECT BY NUCLEIC ACD ENTEROV

Facility

$248.54

Service Code	HCPCS 87498
Hospital Charge Code	38477194
Hospital Revenue Code	306
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$126.66
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$124.27
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.28
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.59

DETECT BY NUCLEIC ACD ENTEROV

Facility

$248.54

Service Code	HCPCS 87498
Hospital Charge Code	38477194
Hospital Revenue Code	306
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$37.28
Rate for Payer: Qualcare PPO/HMO/WC	$37.28

DETECT BY NUCLEIC ACID CHLAMYD

Facility

$141.99

Service Code	HCPCS 87490
Hospital Charge Code	38477159
Hospital Revenue Code	306
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$61.88
Rate for Payer: Aetna Medicare Advantage	$73.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.12
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$22.75
Rate for Payer: Clover Medicare Advantage	$21.61
Rate for Payer: EmblemHealth Commercial	$68.25
Rate for Payer: Humana Medicare Advantage	$23.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.75
Rate for Payer: Wellcare Medicare Advantage	$22.75
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

DETECT BY NUCLEIC ACID CHLAMYD

Facility

$141.99

Service Code	HCPCS 87490
Hospital Charge Code	38477159
Hospital Revenue Code	306
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

DETECT NUCLEIC ACID CANDIDA DI

Facility

$141.99

Service Code	HCPCS 87480
Hospital Charge Code	38477158
Hospital Revenue Code	306
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.37
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

DETECT NUCLEIC ACID CANDIDA DI

Facility

$141.99

Service Code	HCPCS 87480
Hospital Charge Code	38477158
Hospital Revenue Code	306
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

DETECTOR C02 ADULT

Facility

$37.50

Hospital Charge Code	270646412
Hospital Revenue Code	270
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna Commercial	$14.25
Rate for Payer: Aetna Medicare Advantage	$11.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.56
Rate for Payer: Cigna Commercial	$18.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.25
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.62
Rate for Payer: UnitedHealthcare Commercial	$7.50
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

DETECTOR C02 ADULT

Facility

$37.50

Hospital Charge Code	270646412
Hospital Revenue Code	270
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.62

DETECTOR CO2 DISP *****

Facility

$108.00

Hospital Charge Code	8003626
Hospital Revenue Code	279
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$41.04
Rate for Payer: Aetna Medicare Advantage	$32.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.54
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$21.60
Rate for Payer: UnitedHealthcare Community & State	$2.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

DETECTOR CO2 DISP *****

Facility

$108.00

Hospital Charge Code	8003626
Hospital Revenue Code	279
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

DETECTOR CO2 PEDIATRIC PEDICAP

Facility

$76.85

Hospital Charge Code	270608072
Hospital Revenue Code	272
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$38.42
Rate for Payer: Aetna Commercial	$29.20
Rate for Payer: Aetna Medicare Advantage	$23.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.60
Rate for Payer: Cigna Commercial	$38.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.05
Rate for Payer: Oxford Commercial	$15.37
Rate for Payer: Qualcare PPO/HMO/WC	$11.53
Rate for Payer: UnitedHealthcare Commercial	$15.37
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

DETECTOR CO2 PEDIATRIC PEDICAP

Facility

$76.85

Hospital Charge Code	270608072
Hospital Revenue Code	272
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$11.53
Rate for Payer: Qualcare PPO/HMO/WC	$11.53

DETECTOR CO2 STATCO2 END TIDAL

Facility

$71.84

Hospital Charge Code	270645180
Hospital Revenue Code	271
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$10.78
Rate for Payer: Qualcare PPO/HMO/WC	$10.78

DETECTOR CO2 STATCO2 END TIDAL

Facility

$71.84

Hospital Charge Code	270645180
Hospital Revenue Code	271
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$35.92
Rate for Payer: Aetna Commercial	$27.30
Rate for Payer: Aetna Medicare Advantage	$21.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.32
Rate for Payer: Cigna Commercial	$35.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.55
Rate for Payer: Oxford Commercial	$14.37
Rate for Payer: Qualcare PPO/HMO/WC	$10.78
Rate for Payer: UnitedHealthcare Commercial	$14.37
Rate for Payer: UnitedHealthcare Community & State	$1.73
Rate for Payer: Wellpoint Medicaid Managed Care	$1.90

Know your out-of-pocket cost for care.

All Charges