Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$41,049.37

Service Code	MSDRG 822
Min. Negotiated Rate	$12,499.01
Max. Negotiated Rate	$41,049.37
Rate for Payer: Aetna Commercial	$28,462.92
Rate for Payer: Aetna Medicare Advantage	$41,049.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,843.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,843.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,156.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,843.64
Rate for Payer: Cigna Commercial	$22,531.66
Rate for Payer: Cigna Medicare Advantage	$13,156.85
Rate for Payer: Clover Medicare Advantage	$12,499.01
Rate for Payer: EmblemHealth Commercial	$39,470.55
Rate for Payer: Humana Medicare Advantage	$13,551.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,156.85
Rate for Payer: Oxford Commercial	$16,193.80
Rate for Payer: UnitedHealthcare Commercial	$28,396.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,156.85
Rate for Payer: Wellcare Medicare Advantage	$13,156.85

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC

Facility

$54,863.61

Service Code	MSDRG 841
Min. Negotiated Rate	$16,705.27
Max. Negotiated Rate	$54,863.61
Rate for Payer: Aetna Commercial	$37,954.88
Rate for Payer: Aetna Medicare Advantage	$54,863.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,519.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,519.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,584.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,519.77
Rate for Payer: Cigna Commercial	$30,530.02
Rate for Payer: Cigna Medicare Advantage	$17,584.49
Rate for Payer: Clover Medicare Advantage	$16,705.27
Rate for Payer: EmblemHealth Commercial	$52,753.47
Rate for Payer: Humana Medicare Advantage	$18,112.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,584.49
Rate for Payer: Oxford Commercial	$21,942.33
Rate for Payer: UnitedHealthcare Commercial	$38,476.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,584.49
Rate for Payer: Wellcare Medicare Advantage	$17,584.49

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC

Facility

$106,691.43

Service Code	MSDRG 840
Min. Negotiated Rate	$32,486.17
Max. Negotiated Rate	$106,691.43
Rate for Payer: Aetna Commercial	$73,566.49
Rate for Payer: Aetna Medicare Advantage	$106,691.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72,806.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72,806.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34,195.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72,806.93
Rate for Payer: Cigna Commercial	$60,537.92
Rate for Payer: Cigna Medicare Advantage	$34,195.97
Rate for Payer: Clover Medicare Advantage	$32,486.17
Rate for Payer: EmblemHealth Commercial	$102,587.91
Rate for Payer: Humana Medicare Advantage	$35,221.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34,195.97
Rate for Payer: Oxford Commercial	$43,509.40
Rate for Payer: UnitedHealthcare Commercial	$76,295.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$34,195.97
Rate for Payer: Wellcare Medicare Advantage	$34,195.97

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC

Facility

$75,362.04

Service Code	MSDRG 824
Min. Negotiated Rate	$22,946.78
Max. Negotiated Rate	$75,362.04
Rate for Payer: Aetna Commercial	$52,039.64
Rate for Payer: Aetna Medicare Advantage	$75,362.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,872.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,872.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,154.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,872.03
Rate for Payer: Cigna Commercial	$42,398.44
Rate for Payer: Cigna Medicare Advantage	$24,154.50
Rate for Payer: Clover Medicare Advantage	$22,946.78
Rate for Payer: EmblemHealth Commercial	$72,463.50
Rate for Payer: Humana Medicare Advantage	$24,879.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,154.50
Rate for Payer: Oxford Commercial	$30,472.32
Rate for Payer: UnitedHealthcare Commercial	$53,434.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,154.50
Rate for Payer: Wellcare Medicare Advantage	$24,154.50

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC

Facility

$150,322.41

Service Code	MSDRG 823
Min. Negotiated Rate	$45,771.25
Max. Negotiated Rate	$150,322.41
Rate for Payer: Aetna Commercial	$103,545.97
Rate for Payer: Aetna Medicare Advantage	$150,322.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104,674.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104,674.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$48,180.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104,674.50
Rate for Payer: Cigna Commercial	$85,799.95
Rate for Payer: Cigna Medicare Advantage	$48,180.26
Rate for Payer: Clover Medicare Advantage	$45,771.25
Rate for Payer: EmblemHealth Commercial	$144,540.78
Rate for Payer: Humana Medicare Advantage	$49,625.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$48,180.26
Rate for Payer: Oxford Commercial	$61,665.56
Rate for Payer: UnitedHealthcare Commercial	$108,132.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$48,180.26
Rate for Payer: Wellcare Medicare Advantage	$48,180.26

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$45,748.93

Service Code	MSDRG 825
Min. Negotiated Rate	$13,929.96
Max. Negotiated Rate	$45,748.93
Rate for Payer: Aetna Commercial	$31,692.05
Rate for Payer: Aetna Medicare Advantage	$45,748.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,006.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,006.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,663.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,006.69
Rate for Payer: Cigna Commercial	$25,252.67
Rate for Payer: Cigna Medicare Advantage	$14,663.12
Rate for Payer: Clover Medicare Advantage	$13,929.96
Rate for Payer: EmblemHealth Commercial	$43,989.36
Rate for Payer: Humana Medicare Advantage	$15,103.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,663.12
Rate for Payer: Oxford Commercial	$18,149.43
Rate for Payer: UnitedHealthcare Commercial	$31,825.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,663.12
Rate for Payer: Wellcare Medicare Advantage	$14,663.12

LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$34,791.90

Service Code	MSDRG 842
Min. Negotiated Rate	$10,593.69
Max. Negotiated Rate	$34,791.90
Rate for Payer: Aetna Commercial	$24,163.32
Rate for Payer: Aetna Medicare Advantage	$34,791.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,889.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,889.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,889.27
Rate for Payer: Cigna Commercial	$18,908.63
Rate for Payer: Cigna Medicare Advantage	$11,151.25
Rate for Payer: Clover Medicare Advantage	$10,593.69
Rate for Payer: EmblemHealth Commercial	$33,453.75
Rate for Payer: Humana Medicare Advantage	$11,485.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,151.25
Rate for Payer: Oxford Commercial	$13,589.88
Rate for Payer: UnitedHealthcare Commercial	$23,830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,151.25
Rate for Payer: Wellcare Medicare Advantage	$11,151.25

LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$14,013.16

Service Code	APR-DRG 6912
Min. Negotiated Rate	$13,738.39
Max. Negotiated Rate	$14,013.16
Rate for Payer: UnitedHealthcare Community & State	$13,738.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,013.16
Rate for Payer: Wellpoint Medicaid Managed Care	$13,738.39

LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$20,722.24

Service Code	APR-DRG 6913
Min. Negotiated Rate	$20,315.92
Max. Negotiated Rate	$20,722.24
Rate for Payer: UnitedHealthcare Community & State	$20,315.92
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,722.24
Rate for Payer: Wellpoint Medicaid Managed Care	$20,315.92

LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$10,592.87

Service Code	APR-DRG 6911
Min. Negotiated Rate	$10,385.17
Max. Negotiated Rate	$10,592.87
Rate for Payer: UnitedHealthcare Community & State	$10,385.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,592.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10,385.17

LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$39,755.48

Service Code	APR-DRG 6914
Min. Negotiated Rate	$38,975.96
Max. Negotiated Rate	$39,755.48
Rate for Payer: UnitedHealthcare Community & State	$38,975.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$39,755.48
Rate for Payer: Wellpoint Medicaid Managed Care	$38,975.96

LYPRESSIN NASL 185MCG/ML

Facility

$281.60

Hospital Charge Code	6003388
Hospital Revenue Code	252
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.80
Rate for Payer: Aetna Commercial	$107.01
Rate for Payer: Aetna Medicare Advantage	$84.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.81
Rate for Payer: Cigna Commercial	$140.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.48
Rate for Payer: Oxford Commercial	$56.32
Rate for Payer: Qualcare PPO/HMO/WC	$42.24
Rate for Payer: UnitedHealthcare Commercial	$56.32
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

LYPRESSIN NASL 185MCG/ML

Facility

$281.60

Hospital Charge Code	6003388
Hospital Revenue Code	252
Min. Negotiated Rate	$42.24
Max. Negotiated Rate	$42.24
Rate for Payer: Qualcare PPO/HMO/WC	$42.24

LYRICA 50MG CAPSULE

Facility

$9.00

Hospital Charge Code	60635630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

LYRICA 50MG CAPSULE

Facility

$9.00

Hospital Charge Code	60635630
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

LYRICA 75MG

Facility

$12.00

Hospital Charge Code	60635622
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

LYRICA 75MG

Facility

$12.00

Hospital Charge Code	60635622
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

LYSIS ADHESIONS, MULTI 2DAYS

Facility

$4,344.06

Service Code	HCPCS 62263
Hospital Charge Code	1600000758
Hospital Revenue Code	360
Min. Negotiated Rate	$651.61
Max. Negotiated Rate	$651.61
Rate for Payer: Qualcare PPO/HMO/WC	$651.61

LYSIS ADHESIONS, MULTI 2DAYS

Facility

$4,344.06

Service Code	HCPCS 62263
Hospital Charge Code	1600000758
Hospital Revenue Code	360
Min. Negotiated Rate	$104.69
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,303.22
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$651.61
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$104.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$115.12

LYSIS OF LABIAL LESION (S)

Facility

$14,977.64

Service Code	HCPCS 56441
Hospital Charge Code	1600000536
Hospital Revenue Code	360
Min. Negotiated Rate	$360.96
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	$862.00
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	$4,493.29
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.65
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$360.96
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	$396.91

LYSIS OF LABIAL LESION (S)

Facility

$14,977.64

Service Code	HCPCS 56441
Hospital Charge Code	1600000536
Hospital Revenue Code	360
Min. Negotiated Rate	$2,246.65
Max. Negotiated Rate	$2,246.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.65

LYSIS PENIL CIRCUMIC LESION

Facility

$12,062.25

Service Code	HCPCS 54162
Hospital Charge Code	1600000583
Hospital Revenue Code	360
Min. Negotiated Rate	$1,809.34
Max. Negotiated Rate	$1,809.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,809.34

LYSIS PENIL CIRCUMIC LESION

Facility

$12,062.25

Service Code	HCPCS 54162
Hospital Charge Code	1600000583
Hospital Revenue Code	360
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,618.68
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,809.34
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$290.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$319.65

LYSOZYME, Lactofferin Liquid

Facility

$37.80

Hospital Charge Code	60628758
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

LYSOZYME, Lactofferin Liquid

Facility

$37.80

Hospital Charge Code	60628758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

Know your out-of-pocket cost for care.

All Charges