Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SERTRALINE 25 MG TAB

Facility

$19.10

Service Code	NDC 68180035106
Hospital Charge Code	60629304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.55
Rate for Payer: Aetna Commercial	$7.26
Rate for Payer: Aetna Medicare Advantage	$5.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.87
Rate for Payer: Cigna Commercial	$9.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.73
Rate for Payer: Oxford Commercial	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.87
Rate for Payer: UnitedHealthcare Commercial	$3.82
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

SERTRALINE 25 MG TAB

Facility

$19.10

Service Code	NDC 68180035106
Hospital Charge Code	60629304
Hospital Revenue Code	250
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$2.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.87

SERTRALINE 50 MG TAB

Facility

$50.38

Service Code	NDC 58151057588
Hospital Charge Code	60627781
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.19
Rate for Payer: Aetna Commercial	$19.14
Rate for Payer: Aetna Medicare Advantage	$15.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.85
Rate for Payer: Cigna Commercial	$25.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.11
Rate for Payer: Oxford Commercial	$10.08
Rate for Payer: Qualcare PPO/HMO/WC	$7.56
Rate for Payer: UnitedHealthcare Commercial	$10.08
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

SERTRALINE 50 MG TAB

Facility

$50.38

Service Code	NDC 58151057588
Hospital Charge Code	60627781
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$7.56

SERUM BACTERICIDAL TITER

Facility

$82.00

Service Code	HCPCS 87197
Hospital Charge Code	38477103
Hospital Revenue Code	309
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

SERUM BACTERICIDAL TITER

Facility

$82.00

Service Code	HCPCS 87197
Hospital Charge Code	38477103
Hospital Revenue Code	309
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare Advantage	$48.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.22
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: Cigna Medicare Advantage	$15.02
Rate for Payer: Clover Medicare Advantage	$14.27
Rate for Payer: EmblemHealth Commercial	$45.06
Rate for Payer: Humana Medicare Advantage	$15.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.02
Rate for Payer: Wellcare Medicare Advantage	$15.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

SERUM FREE CORTISOL I

Facility

$139.25

Service Code	HCPCS 82533
Hospital Charge Code	3038537A
Hospital Revenue Code	301
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$20.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

SERUM FREE CORTISOL I

Facility

$139.25

Service Code	HCPCS 82533
Hospital Charge Code	3038537A
Hospital Revenue Code	301
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.34
Rate for Payer: Aetna Medicare Advantage	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.84
Rate for Payer: Cigna Commercial	$69.62
Rate for Payer: Cigna Medicare Advantage	$16.30
Rate for Payer: Clover Medicare Advantage	$15.48
Rate for Payer: EmblemHealth Commercial	$48.90
Rate for Payer: Humana Medicare Advantage	$16.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.30
Rate for Payer: Wellcare Medicare Advantage	$16.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

SERUM FREE CORTISOL II

Facility

$123.70

Service Code	HCPCS 84449
Hospital Charge Code	3038537B
Hospital Revenue Code	301
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$18.55
Rate for Payer: Qualcare PPO/HMO/WC	$18.55

SERUM FREE CORTISOL II

Facility

$123.70

Service Code	HCPCS 84449
Hospital Charge Code	3038537B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.96
Rate for Payer: Aetna Medicare Advantage	$58.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.97
Rate for Payer: Cigna Commercial	$61.85
Rate for Payer: Cigna Medicare Advantage	$18.00
Rate for Payer: Clover Medicare Advantage	$17.10
Rate for Payer: EmblemHealth Commercial	$54.00
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00
Rate for Payer: Wellcare Medicare Advantage	$18.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3.28

SERUM LEISHMANIA ANTIBODY

Facility

$157.30

Service Code	HCPCS 86717
Hospital Charge Code	401382724
Hospital Revenue Code	306
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna Medicare Advantage	$39.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.22
Rate for Payer: Cigna Commercial	$78.65
Rate for Payer: Cigna Medicare Advantage	$12.25
Rate for Payer: Clover Medicare Advantage	$11.64
Rate for Payer: EmblemHealth Commercial	$36.75
Rate for Payer: Humana Medicare Advantage	$12.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.19
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.59
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.25
Rate for Payer: Wellcare Medicare Advantage	$12.25
Rate for Payer: Wellpoint Medicaid Managed Care	$4.17

SERUM LEISHMANIA ANTIBODY

Facility

$157.30

Service Code	HCPCS 86717
Hospital Charge Code	401382724
Hospital Revenue Code	306
Min. Negotiated Rate	$23.59
Max. Negotiated Rate	$23.59
Rate for Payer: Qualcare PPO/HMO/WC	$23.59

SERUM LIVER ANTIGEN LC-1 CYTOS

Facility

$220.00

Service Code	HCPCS 86376
Hospital Charge Code	401386377
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

SERUM LIVER ANTIGEN LC-1 CYTOS

Facility

$220.00

Service Code	HCPCS 86376
Hospital Charge Code	401386377
Hospital Revenue Code	302
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.58
Rate for Payer: Aetna Medicare Advantage	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.52
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: Cigna Medicare Advantage	$14.55
Rate for Payer: Clover Medicare Advantage	$13.82
Rate for Payer: EmblemHealth Commercial	$43.65
Rate for Payer: Humana Medicare Advantage	$14.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.55
Rate for Payer: Wellcare Medicare Advantage	$14.55
Rate for Payer: Wellpoint Medicaid Managed Care	$5.83

SERUM OXYCODONE QUART

Facility

$121.26

Service Code	HCPCS 80365
Hospital Charge Code	39900532
Hospital Revenue Code	301
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.08
Rate for Payer: Aetna Medicare Advantage	$36.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.92
Rate for Payer: Cigna Commercial	$60.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.19
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

SERUM OXYCODONE QUART

Facility

$121.26

Service Code	HCPCS 80365
Hospital Charge Code	39900532
Hospital Revenue Code	301
Min. Negotiated Rate	$18.19
Max. Negotiated Rate	$18.19
Rate for Payer: Qualcare PPO/HMO/WC	$18.19

SERUM PROTEIN ELECTROPHORESES

Facility

$73.80

Service Code	HCPCS 84165
Hospital Charge Code	3990131B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.77
Rate for Payer: Cigna Commercial	$36.90
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.07
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.96

SERUM PROTEIN ELECTROPHORESES

Facility

$73.80

Service Code	HCPCS 84165
Hospital Charge Code	3990131B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$11.07
Rate for Payer: Qualcare PPO/HMO/WC	$11.07

SERUM PROTEIN ELECTROPHORESIS

Facility

$667.59

Service Code	HCPCS 84165
Hospital Charge Code	39990131B
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SERUM PROTEIN ELECTROPHORESIS

Facility

$667.59

Service Code	HCPCS 84165
Hospital Charge Code	39990131B
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.77
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
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	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

SERUM PROTEIN ELECTROPHORESIS

Facility

$667.59

Service Code	HCPCS 84155
Hospital Charge Code	39990131A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$9.98
Rate for Payer: Aetna Medicare Advantage	$11.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.25
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$3.67
Rate for Payer: Clover Medicare Advantage	$3.49
Rate for Payer: EmblemHealth Commercial	$11.01
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.67
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	$2.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.67
Rate for Payer: Wellcare Medicare Advantage	$3.67
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

SERUM PROTEIN ELECTROPHORESIS

Facility

$667.59

Service Code	HCPCS 84155
Hospital Charge Code	39990131A
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SERUM VISCOSITY

Facility

$390.00

Service Code	HCPCS 85810
Hospital Charge Code	39900427
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SERUM VISCOSITY

Facility

$390.00

Service Code	HCPCS 85810
Hospital Charge Code	39900427
Hospital Revenue Code	305
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.74
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.13
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.67
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.67
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	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Medicare Advantage	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SERZONE 100MG

Facility

$7.00

Hospital Charge Code	60635098
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

Know your out-of-pocket cost for care.

All Charges