Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM GASTROINTESTINAL OTHER

Facility

$1,336.60

Service Code	HCPCS 78299
Hospital Charge Code	4500959
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM GASTROINTESTINAL OTHER

Facility

$1,336.60

Service Code	HCPCS 78299
Hospital Charge Code	4500959
Hospital Revenue Code	341
Min. Negotiated Rate	$32.21
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.98
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$32.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.42

NM GATED CARDIAC SGL W RV EF

Facility

$3,351.25

Service Code	HCPCS 78496
Hospital Charge Code	4500926
Hospital Revenue Code	341
Min. Negotiated Rate	$54.07
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,273.47
Rate for Payer: Aetna Medicare Advantage	$1,005.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$854.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$854.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$854.57
Rate for Payer: Cigna Commercial	$1,675.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,005.38
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$502.69
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$80.77
Rate for Payer: Wellpoint Medicaid Managed Care	$88.81

NM GATED CARDIAC SGL W RV EF

Facility

$3,351.25

Service Code	HCPCS 78496
Hospital Charge Code	4500926
Hospital Revenue Code	341
Min. Negotiated Rate	$502.69
Max. Negotiated Rate	$502.69
Rate for Payer: Qualcare PPO/HMO/WC	$502.69

NM GATED CARDIAC SPEC WM & EF

Facility

$3,351.25

Service Code	HCPCS 78494
Hospital Charge Code	4500924
Hospital Revenue Code	341
Min. Negotiated Rate	$80.77
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$304.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,005.38
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$502.69
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$80.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$88.81

NM GATED CARDIAC SPEC WM & EF

Facility

$3,351.25

Service Code	HCPCS 78494
Hospital Charge Code	4500924
Hospital Revenue Code	341
Min. Negotiated Rate	$502.69
Max. Negotiated Rate	$502.69
Rate for Payer: Qualcare PPO/HMO/WC	$502.69

NM GENITOURINARY OTHER

Facility

$1,296.25

Service Code	HCPCS 78799
Hospital Charge Code	4500961
Hospital Revenue Code	341
Min. Negotiated Rate	$31.24
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.88
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.44
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$31.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$34.35

NM GENITOURINARY OTHER

Facility

$1,296.25

Service Code	HCPCS 78799
Hospital Charge Code	4500961
Hospital Revenue Code	341
Min. Negotiated Rate	$194.44
Max. Negotiated Rate	$194.44
Rate for Payer: Qualcare PPO/HMO/WC	$194.44

NM GEN.OF AUTOMATED DATA<30MIN

Facility

$156.85

Hospital Charge Code	4500724
Hospital Revenue Code	340
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$23.53
Rate for Payer: Qualcare PPO/HMO/WC	$23.53

NM GEN.OF AUTOMATED DATA<30MIN

Facility

$156.85

Hospital Charge Code	4500724
Hospital Revenue Code	340
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$59.60
Rate for Payer: Aetna Medicare Advantage	$47.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.00
Rate for Payer: Cigna Commercial	$78.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.05
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.53
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

NM GEN.OF AUTOMATED DATA>30MIN

Facility

$272.85

Hospital Charge Code	4500716
Hospital Revenue Code	340
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$103.68
Rate for Payer: Aetna Medicare Advantage	$81.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.58
Rate for Payer: Cigna Commercial	$136.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.86
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.93
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$6.58
Rate for Payer: Wellpoint Medicaid Managed Care	$7.23

NM GEN.OF AUTOMATED DATA>30MIN

Facility

$272.85

Hospital Charge Code	4500716
Hospital Revenue Code	340
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$40.93
Rate for Payer: Qualcare PPO/HMO/WC	$40.93

NM HEART INFARCT PLANAR W EFF

Facility

$1,768.00

Service Code	HCPCS 78468
Hospital Charge Code	4500918
Hospital Revenue Code	341
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$265.20
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$46.85

NM HEART INFARCT PLANAR W EFF

Facility

$1,768.00

Service Code	HCPCS 78468
Hospital Charge Code	4500918
Hospital Revenue Code	341
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$265.20
Rate for Payer: Qualcare PPO/HMO/WC	$265.20

NM HEART INFRACT PLANAR SPECT

Facility

$2,513.65

Service Code	HCPCS 78469
Hospital Charge Code	4500920
Hospital Revenue Code	341
Min. Negotiated Rate	$377.05
Max. Negotiated Rate	$377.05
Rate for Payer: Qualcare PPO/HMO/WC	$377.05

NM HEART INFRACT PLANAR SPECT

Facility

$2,513.65

Service Code	HCPCS 78469
Hospital Charge Code	4500920
Hospital Revenue Code	341
Min. Negotiated Rate	$60.58
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$226.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$754.10
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$377.05
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$60.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$66.61

NM HEMOTOPOIETIC UNLISTED PROC

Facility

$1,388.55

Service Code	HCPCS 78199
Hospital Charge Code	4500962
Hospital Revenue Code	341
Min. Negotiated Rate	$33.46
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$416.56
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$208.28
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$36.80

NM HEMOTOPOIETIC UNLISTED PROC

Facility

$1,388.55

Service Code	HCPCS 78199
Hospital Charge Code	4500962
Hospital Revenue Code	341
Min. Negotiated Rate	$208.28
Max. Negotiated Rate	$208.28
Rate for Payer: Qualcare PPO/HMO/WC	$208.28

NM HEPATOBIL IMAG W GALLBALLAD

Facility

$12,000.00

Service Code	HCPCS 78226
Hospital Charge Code	4500910
Hospital Revenue Code	341
Min. Negotiated Rate	$284.20
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$284.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM HEPATOBIL IMAG W GALLBALLAD

Facility

$12,000.00

Service Code	HCPCS 78226
Hospital Charge Code	4500910
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM HEPATO W GALL W PHAMA INTER

Facility

$12,000.00

Service Code	HCPCS 78227
Hospital Charge Code	4500336
Hospital Revenue Code	341
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM HEPATO W GALL W PHAMA INTER

Facility

$12,000.00

Service Code	HCPCS 78227
Hospital Charge Code	4500336
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM I-123 EA 100 UCI UP TO 999U

Facility

$215.25

Hospital Charge Code	4500807
Hospital Revenue Code	343
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$107.62
Rate for Payer: Aetna Commercial	$81.80
Rate for Payer: Aetna Medicare Advantage	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.89
Rate for Payer: Cigna Commercial	$107.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.58
Rate for Payer: Qualcare PPO/HMO/WC	$32.29
Rate for Payer: UnitedHealthcare Community & State	$5.19
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

NM I-123 EA 100 UCI UP TO 999U

Facility

$215.25

Hospital Charge Code	4500807
Hospital Revenue Code	343
Min. Negotiated Rate	$32.29
Max. Negotiated Rate	$32.29
Rate for Payer: Qualcare PPO/HMO/WC	$32.29

NM I-123 MIBG PER 10 MCI

Facility

$9,923.00

Service Code	HCPCS A9582
Hospital Charge Code	4509045
Hospital Revenue Code	344
Min. Negotiated Rate	$239.14
Max. Negotiated Rate	$8,365.48
Rate for Payer: Aetna Commercial	$6,303.60
Rate for Payer: Aetna Medicare Advantage	$7,508.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,365.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,365.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,086.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,365.48
Rate for Payer: Cigna Medicare Advantage	$1,622.25
Rate for Payer: Clover Medicare Advantage	$2,201.62
Rate for Payer: EmblemHealth Commercial	$6,952.50
Rate for Payer: Humana Medicare Advantage	$2,387.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,317.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,976.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.45
Rate for Payer: UnitedHealthcare Community & State	$239.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,317.50
Rate for Payer: Wellcare Medicare Advantage	$2,317.50
Rate for Payer: Wellpoint Medicaid Managed Care	$262.96

Know your out-of-pocket cost for care.

All Charges