Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EEG COMA OR SLEEP ONLY

Facility

$1,004.00

Service Code	HCPCS 95822
Hospital Charge Code	90000050
Hospital Revenue Code	740
Min. Negotiated Rate	$150.60
Max. Negotiated Rate	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$150.60

EEG CONT REC W VID EEG TECH

Facility

$1,481.95

Service Code	HCPCS 95700
Hospital Charge Code	403395700
Hospital Revenue Code	740
Min. Negotiated Rate	$35.71
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.58
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.29
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$35.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$39.27

EEG CONT REC W VID EEG TECH

Facility

$1,481.95

Service Code	HCPCS 95700
Hospital Charge Code	403395700
Hospital Revenue Code	740
Min. Negotiated Rate	$222.29
Max. Negotiated Rate	$222.29
Rate for Payer: Qualcare PPO/HMO/WC	$222.29

EEG DIGITAL ANALYSIS

Facility

$2,539.78

Service Code	HCPCS 95957
Hospital Charge Code	5500024
Hospital Revenue Code	920
Min. Negotiated Rate	$61.21
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$965.12
Rate for Payer: Aetna Medicare Advantage	$761.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$647.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$647.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,012.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$647.64
Rate for Payer: Cigna Commercial	$1,269.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$761.93
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$380.97
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$61.21
Rate for Payer: Wellpoint Medicaid Managed Care	$67.30

EEG DIGITAL ANALYSIS

Facility

$2,539.78

Service Code	HCPCS 95957
Hospital Charge Code	5500024
Hospital Revenue Code	920
Min. Negotiated Rate	$380.97
Max. Negotiated Rate	$380.97
Rate for Payer: Qualcare PPO/HMO/WC	$380.97

EEG ELECTROCEREBRAL SILENCE

Facility

$548.00

Service Code	HCPCS 95824
Hospital Charge Code	5400064
Hospital Revenue Code	740
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.40
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.20
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$13.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$14.52

EEG ELECTROCEREBRAL SILENCE

Facility

$548.00

Service Code	HCPCS 95824
Hospital Charge Code	5400064
Hospital Revenue Code	740
Min. Negotiated Rate	$82.20
Max. Negotiated Rate	$82.20
Rate for Payer: Qualcare PPO/HMO/WC	$82.20

EEG FOR ECT

Facility

$1,290.00

Service Code	HCPCS 95816
Hospital Charge Code	84033005
Hospital Revenue Code	740
Min. Negotiated Rate	$193.50
Max. Negotiated Rate	$193.50
Rate for Payer: Qualcare PPO/HMO/WC	$193.50

EEG FOR ECT

Facility

$1,290.00

Service Code	HCPCS 95816
Hospital Charge Code	84033005
Hospital Revenue Code	740
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.00
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.50
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$31.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$34.19

EEG PORTABLE

Facility

$576.00

Service Code	HCPCS 95816
Hospital Charge Code	5400072
Hospital Revenue Code	740
Min. Negotiated Rate	$13.88
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.80
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.40
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$13.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$15.26

EEG PORTABLE

Facility

$576.00

Service Code	HCPCS 95816
Hospital Charge Code	5400072
Hospital Revenue Code	740
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$86.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.40

EEG ROUTINE

Facility

$1,491.00

Service Code	HCPCS 95816
Hospital Charge Code	36540014
Hospital Revenue Code	740
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$223.65
Rate for Payer: Qualcare PPO/HMO/WC	$223.65

EEG ROUTINE

Facility

$1,491.00

Service Code	HCPCS 95816
Hospital Charge Code	36540014
Hospital Revenue Code	740
Min. Negotiated Rate	$35.93
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$447.30
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.65
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$35.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$39.51

EEG ROUTINE > 1 HR

Facility

$1,477.50

Service Code	HCPCS 95813
Hospital Charge Code	5500030
Hospital Revenue Code	740
Min. Negotiated Rate	$221.62
Max. Negotiated Rate	$221.62
Rate for Payer: Qualcare PPO/HMO/WC	$221.62

EEG ROUTINE > 1 HR

Facility

$1,477.50

Service Code	HCPCS 95813
Hospital Charge Code	5500030
Hospital Revenue Code	740
Min. Negotiated Rate	$35.61
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$443.25
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.62
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$35.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$39.15

EEG ROUTINE UP TO 1 HR

Facility

$2,762.45

Service Code	HCPCS 95812
Hospital Charge Code	5500032
Hospital Revenue Code	740
Min. Negotiated Rate	$66.58
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$482.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$828.74
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$414.37
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$66.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$73.20

EEG ROUTINE UP TO 1 HR

Facility

$2,762.45

Service Code	HCPCS 95812
Hospital Charge Code	5500032
Hospital Revenue Code	740
Min. Negotiated Rate	$414.37
Max. Negotiated Rate	$414.37
Rate for Payer: Qualcare PPO/HMO/WC	$414.37

EEG SLEEP ******

Facility

$289.30

Service Code	HCPCS 95819
Hospital Charge Code	5400056
Hospital Revenue Code	749
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$43.40
Rate for Payer: Qualcare PPO/HMO/WC	$43.40

EEG SLEEP ******

Facility

$289.30

Service Code	HCPCS 95819
Hospital Charge Code	5400056
Hospital Revenue Code	749
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$925.96
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$466.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Qualcare PPO/HMO/WC	$43.40
Rate for Payer: UnitedHealthcare Community & State	$6.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$7.67

EEG SLEEP DEPRIVED

Facility

$2,804.90

Service Code	HCPCS 95819
Hospital Charge Code	36540016
Hospital Revenue Code	740
Min. Negotiated Rate	$67.60
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$466.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$841.47
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.74
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$67.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$74.33

EEG SLEEP DEPRIVED

Facility

$2,804.90

Service Code	HCPCS 95819
Hospital Charge Code	36540016
Hospital Revenue Code	740
Min. Negotiated Rate	$420.74
Max. Negotiated Rate	$420.74
Rate for Payer: Qualcare PPO/HMO/WC	$420.74

EEG SLEEP ONLY

Facility

$576.00

Service Code	HCPCS 95822
Hospital Charge Code	5500020
Hospital Revenue Code	740
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$86.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.40

EEG SLEEP ONLY

Facility

$576.00

Service Code	HCPCS 95822
Hospital Charge Code	5500020
Hospital Revenue Code	740
Min. Negotiated Rate	$13.88
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$453.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.80
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.40
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$13.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$15.26

EEG/VIDEO MON/RECORD </= 12 HR

Facility

$2,647.00

Service Code	HCPCS 9595152
Hospital Charge Code	403395951P
Hospital Revenue Code	740
Min. Negotiated Rate	$397.05
Max. Negotiated Rate	$397.05
Rate for Payer: Qualcare PPO/HMO/WC	$397.05

EEG/VIDEO MON/RECORD </= 12 HR

Facility

$2,647.00

Service Code	HCPCS 9595152
Hospital Charge Code	403395951P
Hospital Revenue Code	740
Min. Negotiated Rate	$63.79
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$1,005.86
Rate for Payer: Aetna Medicare Advantage	$794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$674.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$674.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$674.99
Rate for Payer: Cigna Commercial	$1,323.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$794.10
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$397.05
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$63.79
Rate for Payer: Wellpoint Medicaid Managed Care	$70.15

Know your out-of-pocket cost for care.

All Charges