Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LAP SLEEVE GASTRECTOMY

Facility

$10,973.76

Service Code	HCPCS 43775
Hospital Charge Code	16000273
Hospital Revenue Code	360
Min. Negotiated Rate	$1,646.06
Max. Negotiated Rate	$1,646.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.06

LAP SLEEVE GASTRECTOMY

Facility

$10,973.76

Service Code	HCPCS 43775
Hospital Charge Code	16000273
Hospital Revenue Code	360
Min. Negotiated Rate	$264.47
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$4,170.03
Rate for Payer: Aetna Medicare Advantage	$3,292.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,971.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,120.00
Rate for Payer: Cigna Commercial	$5,486.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,292.13
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.06
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$264.47
Rate for Payer: Wellpoint Medicaid Managed Care	$290.80

LAP SURG REMOVAL GAS&SUBCUTDEV

Facility

$144,581.09

Service Code	HCPCS 43774
Hospital Charge Code	1600180
Hospital Revenue Code	361
Min. Negotiated Rate	$3,484.40
Max. Negotiated Rate	$43,374.33
Rate for Payer: Aetna Commercial	$12,458.69
Rate for Payer: Aetna Medicare Advantage	$14,840.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,580.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,971.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,120.00
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: Cigna Medicare Advantage	$4,580.40
Rate for Payer: Clover Medicare Advantage	$4,351.38
Rate for Payer: EmblemHealth Commercial	$13,741.20
Rate for Payer: Humana Medicare Advantage	$4,717.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,580.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43,374.33
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$3,484.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,580.40
Rate for Payer: Wellcare Medicare Advantage	$4,580.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3,831.40

LAP SURG REMOVAL GAS&SUBCUTDEV

Facility

$144,581.09

Service Code	HCPCS 43774
Hospital Charge Code	1600180
Hospital Revenue Code	361
Min. Negotiated Rate	$21,687.16
Max. Negotiated Rate	$21,687.16
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16

LAP SURG REMOVAL&REPLACEGASDEV

Facility

$144,581.09

Service Code	HCPCS 43773
Hospital Charge Code	1600179
Hospital Revenue Code	361
Min. Negotiated Rate	$21,687.16
Max. Negotiated Rate	$21,687.16
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16

LAP SURG REMOVAL&REPLACEGASDEV

Facility

$144,581.09

Service Code	HCPCS 43773
Hospital Charge Code	1600179
Hospital Revenue Code	361
Min. Negotiated Rate	$3,484.40
Max. Negotiated Rate	$43,374.33
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,971.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,120.00
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43,374.33
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$21,687.16
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$3,484.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3,831.40

LAP TIP 2MM X 30CM & TUBESET

Facility

$6,000.00

Hospital Charge Code	270691645
Hospital Revenue Code	272
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,800.00
Rate for Payer: Oxford Commercial	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Commercial	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

LAP TIP 2MM X 30CM & TUBESET

Facility

$6,000.00

Hospital Charge Code	270691645
Hospital Revenue Code	272
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LAP TX ECT PREG WO SALPIN/OOPH

Facility

$43,334.60

Service Code	HCPCS 59150
Hospital Charge Code	1600000429
Hospital Revenue Code	360
Min. Negotiated Rate	$6,500.19
Max. Negotiated Rate	$6,500.19
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.19

LAP TX ECT PREG WO SALPIN/OOPH

Facility

$43,334.60

Service Code	HCPCS 59150
Hospital Charge Code	1600000429
Hospital Revenue Code	360
Min. Negotiated Rate	$1,044.36
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,000.38
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.19
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,044.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,148.37

LAP TX ECT PREG,W SALPIN/OOPHO

Facility

$44,604.40

Service Code	HCPCS 59151
Hospital Charge Code	1600000488
Hospital Revenue Code	360
Min. Negotiated Rate	$6,690.66
Max. Negotiated Rate	$6,690.66
Rate for Payer: Qualcare PPO/HMO/WC	$6,690.66

LAP TX ECT PREG,W SALPIN/OOPHO

Facility

$44,604.40

Service Code	HCPCS 59151
Hospital Charge Code	1600000488
Hospital Revenue Code	360
Min. Negotiated Rate	$1,074.97
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,381.32
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,690.66
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,074.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,182.02

LAP TY ABS SUTURE CLIP APPLIER

Facility

$162.70

Hospital Charge Code	270685306
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$81.35
Rate for Payer: Aetna Commercial	$61.83
Rate for Payer: Aetna Medicare Advantage	$48.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.49
Rate for Payer: Cigna Commercial	$81.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.81
Rate for Payer: Oxford Commercial	$32.54
Rate for Payer: Qualcare PPO/HMO/WC	$24.41
Rate for Payer: UnitedHealthcare Commercial	$32.54
Rate for Payer: UnitedHealthcare Community & State	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$4.31

LAP TY ABS SUTURE CLIP APPLIER

Facility

$162.70

Hospital Charge Code	270685306
Hospital Revenue Code	272
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$24.41

LAP VENT/ABD HERNIA REPAIR

Facility

$66,282.45

Service Code	HCPCS 49652
Hospital Charge Code	16000647
Hospital Revenue Code	360
Min. Negotiated Rate	$9,942.37
Max. Negotiated Rate	$9,942.37
Rate for Payer: Qualcare PPO/HMO/WC	$9,942.37

LAP VENT/ABD HERNIA REPAIR

Facility

$66,282.45

Service Code	HCPCS 49652
Hospital Charge Code	16000647
Hospital Revenue Code	360
Min. Negotiated Rate	$1,597.41
Max. Negotiated Rate	$33,141.22
Rate for Payer: Aetna Commercial	$25,187.33
Rate for Payer: Aetna Medicare Advantage	$19,884.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,902.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,902.02
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	$16,902.02
Rate for Payer: Cigna Commercial	$33,141.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,884.74
Rate for Payer: Qualcare PPO/HMO/WC	$9,942.37
Rate for Payer: UnitedHealthcare Community & State	$1,597.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1,756.48

LAP W DESTRUCTIONS OF OVIDUCT

Facility

$58,549.97

Service Code	HCPCS 58670
Hospital Charge Code	1600000317
Hospital Revenue Code	360
Min. Negotiated Rate	$1,355.00
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,564.99
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,782.50
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,411.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,551.57

LAP W DESTRUCTIONS OF OVIDUCT

Facility

$58,549.97

Service Code	HCPCS 58670
Hospital Charge Code	1600000317
Hospital Revenue Code	360
Min. Negotiated Rate	$8,782.50
Max. Negotiated Rate	$8,782.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,782.50

LAP W/EXC DESTR OVARY PELVIC W

Facility

$58,549.97

Service Code	HCPCS 58662
Hospital Charge Code	16000765
Hospital Revenue Code	360
Min. Negotiated Rate	$8,782.50
Max. Negotiated Rate	$8,782.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,782.50

LAP W/EXC DESTR OVARY PELVIC W

Facility

$58,549.97

Service Code	HCPCS 58662
Hospital Charge Code	16000765
Hospital Revenue Code	360
Min. Negotiated Rate	$1,411.05
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,564.99
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,782.50
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,411.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,551.57

LAP,W REM ADNEXAL STRUCTURES

Facility

$44,604.40

Service Code	HCPCS 58661
Hospital Charge Code	16001009
Hospital Revenue Code	360
Min. Negotiated Rate	$1,074.97
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,381.32
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,690.66
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,074.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,182.02

LAP,W REM ADNEXAL STRUCTURES

Facility

$44,604.40

Service Code	HCPCS 58661
Hospital Charge Code	16001009
Hospital Revenue Code	360
Min. Negotiated Rate	$6,690.66
Max. Negotiated Rate	$6,690.66
Rate for Payer: Qualcare PPO/HMO/WC	$6,690.66

LARGE CAP BIOPSY ALLIGATOR

Facility

$24.75

Hospital Charge Code	270700337
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$9.40
Rate for Payer: Aetna Medicare Advantage	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.31
Rate for Payer: Cigna Commercial	$12.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.42
Rate for Payer: Oxford Commercial	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$3.71
Rate for Payer: UnitedHealthcare Commercial	$4.95
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

LARGE CAP BIOPSY ALLIGATOR

Facility

$24.75

Hospital Charge Code	270700337
Hospital Revenue Code	272
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$3.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.71

LARGE ID PLAQUE CLEAR

Facility

$30.15

Hospital Charge Code	270665602
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.07
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare Advantage	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.69
Rate for Payer: Cigna Commercial	$15.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: Oxford Commercial	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

Know your out-of-pocket cost for care.

All Charges