Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLUCOSE TOLERANCE EA ADD SPEC.

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38472325
Hospital Revenue Code	301
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$201.50
Rate for Payer: Aetna Commercial	$10.66
Rate for Payer: Aetna Medicare Advantage	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.15
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: Cigna Medicare Advantage	$3.92
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Medicare Advantage	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

GLUCOSE TOLERANCE EA ADD SPEC.

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38472325
Hospital Revenue Code	301
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

GLUCOSE,URINE

Facility

$233.00

Service Code	HCPCS 82947
Hospital Charge Code	38472305
Hospital Revenue Code	301
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.69
Rate for Payer: Aetna Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.19
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: Cigna Medicare Advantage	$3.93
Rate for Payer: Clover Medicare Advantage	$3.73
Rate for Payer: EmblemHealth Commercial	$11.79
Rate for Payer: Humana Medicare Advantage	$4.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.93
Rate for Payer: Wellcare Medicare Advantage	$3.93
Rate for Payer: Wellpoint Medicaid Managed Care	$6.17

GLUCOSE,URINE

Facility

$233.00

Service Code	HCPCS 82947
Hospital Charge Code	38472305
Hospital Revenue Code	301
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

GLUCOSE, URINE, QUALITATIVE

Facility

$268.50

Service Code	HCPCS 81003
Hospital Charge Code	3003381
Hospital Revenue Code	307
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$134.25
Rate for Payer: Aetna Commercial	$6.12
Rate for Payer: Aetna Medicare Advantage	$7.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.12
Rate for Payer: Cigna Commercial	$134.25
Rate for Payer: Cigna Medicare Advantage	$2.25
Rate for Payer: Clover Medicare Advantage	$2.14
Rate for Payer: EmblemHealth Commercial	$6.75
Rate for Payer: Humana Medicare Advantage	$2.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.27
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.25
Rate for Payer: Wellcare Medicare Advantage	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7.12

GLUCOSE, URINE, QUALITATIVE

Facility

$268.50

Service Code	HCPCS 81003
Hospital Charge Code	3003381
Hospital Revenue Code	307
Min. Negotiated Rate	$40.27
Max. Negotiated Rate	$40.27
Rate for Payer: Qualcare PPO/HMO/WC	$40.27

GLUCOTROL/10MG/TAB

Facility

$7.00

Hospital Charge Code	60633049
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

GLUCOTROL/10MG/TAB

Facility

$7.00

Hospital Charge Code	60633049
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

GLUCOTROL/5MG/TAB

Facility

$4.00

Service Code	NDC 49411066
Hospital Charge Code	60633047
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GLUCOTROL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633048
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

GLUCOTROL/5MG/TAB

Facility

$4.00

Service Code	NDC 49411066
Hospital Charge Code	60633047
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

GLUCOTROL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60633048
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

GLUC TOLERANCE TEST

Facility

$304.85

Service Code	HCPCS 82951
Hospital Charge Code	3008547A
Hospital Revenue Code	301
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$45.73
Rate for Payer: Qualcare PPO/HMO/WC	$45.73

GLUC TOLERANCE TEST

Facility

$304.85

Service Code	HCPCS 82951
Hospital Charge Code	3008547A
Hospital Revenue Code	301
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$152.43
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.46
Rate for Payer: Cigna Commercial	$152.43
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$8.08

GLUC TOLERANCE TEST 3HR

Facility

$390.00

Service Code	HCPCS 82951
Hospital Charge Code	3001401A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GLUC TOLERANCE TEST 3HR

Facility

$390.00

Service Code	HCPCS 82951
Hospital Charge Code	3001401A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

GLUC TOLERANCE TEST 3HR PANEL

Facility

$304.85

Service Code	HCPCS 82951
Hospital Charge Code	3001401
Hospital Revenue Code	301
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$45.73
Rate for Payer: Qualcare PPO/HMO/WC	$45.73

GLUC TOLERANCE TEST 3HR PANEL

Facility

$304.85

Service Code	HCPCS 82951
Hospital Charge Code	3001401
Hospital Revenue Code	301
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$152.43
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.46
Rate for Payer: Cigna Commercial	$152.43
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$8.08

GLUC TOLERANCE TEST 5HR

Facility

$304.85

Service Code	HCPCS 82951
Hospital Charge Code	3001419A
Hospital Revenue Code	301
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$152.43
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.46
Rate for Payer: Cigna Commercial	$152.43
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$8.08

GLUC TOLERANCE TEST 5HR

Facility

$304.85

Service Code	HCPCS 82951
Hospital Charge Code	3001419A
Hospital Revenue Code	301
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$45.73
Rate for Payer: Qualcare PPO/HMO/WC	$45.73

GLUC TOLERANCE TEST 5HR PANEL

Facility

$243.85

Service Code	HCPCS 82951
Hospital Charge Code	3001419
Hospital Revenue Code	301
Min. Negotiated Rate	$36.58
Max. Negotiated Rate	$36.58
Rate for Payer: Qualcare PPO/HMO/WC	$36.58

GLUC TOLERANCE TEST 5HR PANEL

Facility

$243.85

Service Code	HCPCS 82951
Hospital Charge Code	3001419
Hospital Revenue Code	301
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.46
Rate for Payer: Cigna Commercial	$121.92
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.58
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$6.46

GLUC TOLERANCE TEST EACH ADDI

Facility

$390.00

Service Code	HCPCS 82952
Hospital Charge Code	3001402
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GLUC TOLERANCE TEST EACH ADDI

Facility

$390.00

Service Code	HCPCS 82952
Hospital Charge Code	3001402
Hospital Revenue Code	301
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$10.66
Rate for Payer: Aetna Medicare Advantage	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.15
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.92
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Medicare Advantage	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

GLUE MASTISOL VIAL

Facility

$13.65

Hospital Charge Code	270600756
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

Know your out-of-pocket cost for care.

All Charges