Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PANCURON BRONO AMP 20MG 1ML

Facility

$195.85

Hospital Charge Code	6006787
Hospital Revenue Code	250
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$29.38
Rate for Payer: Qualcare PPO/HMO/WC	$29.38

PANCURON BRONO AMP 20MG 1ML

Facility

$195.85

Hospital Charge Code	6006787
Hospital Revenue Code	250
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$97.92
Rate for Payer: Aetna Commercial	$74.42
Rate for Payer: Aetna Medicare Advantage	$58.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$97.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.76
Rate for Payer: Oxford Commercial	$39.17
Rate for Payer: Qualcare PPO/HMO/WC	$29.38
Rate for Payer: UnitedHealthcare Commercial	$39.17
Rate for Payer: UnitedHealthcare Community & State	$4.72
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

PANCURONIUM BROMIDE/1MG/1

Facility

$9.38

Service Code	NDC 409464601
Hospital Charge Code	60633607
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.69
Rate for Payer: Aetna Commercial	$3.56
Rate for Payer: Aetna Medicare Advantage	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.81
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$1.88
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

PANCURONIUM BROMIDE/1MG/1

Facility

$9.38

Service Code	NDC 409464601
Hospital Charge Code	60633607
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.41

PANCURONIUM BROMIDE VL 2ML

Facility

$9.00

Hospital Charge Code	6023360
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

PANCURONIUM BROMIDE VL 2ML

Facility

$9.00

Hospital Charge Code	6023360
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

PANEL 1

Facility

$667.59

Service Code	HCPCS 86146
Hospital Charge Code	39708028A
Hospital Revenue Code	302
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PANEL 1

Facility

$667.59

Service Code	HCPCS 86146
Hospital Charge Code	39708028A
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PANEL 2

Facility

$667.59

Service Code	HCPCS 86146
Hospital Charge Code	39708028B
Hospital Revenue Code	302
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PANEL 2

Facility

$667.59

Service Code	HCPCS 86146
Hospital Charge Code	39708028B
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PANEL 3

Facility

$667.59

Service Code	HCPCS 86146
Hospital Charge Code	39708028C
Hospital Revenue Code	302
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PANEL 3

Facility

$667.59

Service Code	HCPCS 86146
Hospital Charge Code	39708028C
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PANEL 3

Facility

$390.00

Service Code	HCPCS 86146
Hospital Charge Code	366886146
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PANEL 3

Facility

$390.00

Service Code	HCPCS 86146
Hospital Charge Code	366886146
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
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	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PANEL 4

Facility

$667.59

Service Code	HCPCS 86147
Hospital Charge Code	39708028D
Hospital Revenue Code	302
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PANEL 4

Facility

$667.59

Service Code	HCPCS 86147
Hospital Charge Code	39708028D
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PANEL 5

Facility

$667.59

Service Code	HCPCS 86147
Hospital Charge Code	39708028E
Hospital Revenue Code	302
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PANEL 5

Facility

$667.59

Service Code	HCPCS 86147
Hospital Charge Code	39708028E
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PANEL 6

Facility

$667.59

Service Code	HCPCS 86147
Hospital Charge Code	39708028F
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PANEL 6

Facility

$667.59

Service Code	HCPCS 86147
Hospital Charge Code	39708028F
Hospital Revenue Code	302
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PANEL 7

Facility

$667.59

Service Code	HCPCS 86148
Hospital Charge Code	39708028G
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PANEL 7

Facility

$667.59

Service Code	HCPCS 86148
Hospital Charge Code	39708028G
Hospital Revenue Code	302
Min. Negotiated Rate	$12.86
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PANEL 8

Facility

$667.59

Service Code	HCPCS 86148
Hospital Charge Code	39708028H
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PANEL 8

Facility

$667.59

Service Code	HCPCS 86148
Hospital Charge Code	39708028H
Hospital Revenue Code	302
Min. Negotiated Rate	$12.86
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PANEL 9

Facility

$667.59

Service Code	HCPCS 86148
Hospital Charge Code	39708028I
Hospital Revenue Code	302
Min. Negotiated Rate	$12.86
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

Know your out-of-pocket cost for care.

All Charges