Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPACER MIS TI 7D 6MM 14X16MM

Facility

$31,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270695460
Hospital Revenue Code	278
Min. Negotiated Rate	$4,782.00
Max. Negotiated Rate	$7,714.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,013.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00

SPACER MIS TI 7D 6MM 14X16MM

Facility

$31,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270695460
Hospital Revenue Code	278
Min. Negotiated Rate	$768.31
Max. Negotiated Rate	$15,940.00
Rate for Payer: Aetna Commercial	$12,114.40
Rate for Payer: Aetna Medicare Advantage	$9,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,129.40
Rate for Payer: Cigna Commercial	$15,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,013.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00
Rate for Payer: UnitedHealthcare Community & State	$768.31
Rate for Payer: Wellpoint Medicaid Managed Care	$844.82

SPACER MOD TLIF-O 8D 8X10X25MM

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693670
Hospital Revenue Code	278
Min. Negotiated Rate	$783.25
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Community & State	$783.25
Rate for Payer: Wellpoint Medicaid Managed Care	$861.25

SPACER MOD TLIF-O 8D 8X10X25MM

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693670
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

SPACER NANO 6D SM 6MM

Facility

$38,653.75

Service Code	HCPCS C1889
Hospital Charge Code	270697819
Hospital Revenue Code	278
Min. Negotiated Rate	$5,798.06
Max. Negotiated Rate	$9,354.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,730.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,354.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,503.83
Rate for Payer: Qualcare PPO/HMO/WC	$5,798.06

SPACER NANO 6D SM 6MM

Facility

$38,653.75

Service Code	HCPCS C1889
Hospital Charge Code	270697819
Hospital Revenue Code	278
Min. Negotiated Rate	$931.56
Max. Negotiated Rate	$19,326.88
Rate for Payer: Aetna Commercial	$14,688.42
Rate for Payer: Aetna Medicare Advantage	$11,596.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,856.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,856.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,730.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,856.71
Rate for Payer: Cigna Commercial	$19,326.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,354.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,503.83
Rate for Payer: Qualcare PPO/HMO/WC	$5,798.06
Rate for Payer: UnitedHealthcare Community & State	$931.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1,024.32

SPACER NANO TC 6D SM 7MM

Facility

$38,653.75

Service Code	HCPCS C1889
Hospital Charge Code	270697822
Hospital Revenue Code	278
Min. Negotiated Rate	$5,798.06
Max. Negotiated Rate	$9,354.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,730.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,354.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,503.83
Rate for Payer: Qualcare PPO/HMO/WC	$5,798.06

SPACER NANO TC 6D SM 7MM

Facility

$38,653.75

Service Code	HCPCS C1889
Hospital Charge Code	270697822
Hospital Revenue Code	278
Min. Negotiated Rate	$931.56
Max. Negotiated Rate	$19,326.88
Rate for Payer: Aetna Commercial	$14,688.42
Rate for Payer: Aetna Medicare Advantage	$11,596.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,856.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,856.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,730.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,856.71
Rate for Payer: Cigna Commercial	$19,326.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,354.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,503.83
Rate for Payer: Qualcare PPO/HMO/WC	$5,798.06
Rate for Payer: UnitedHealthcare Community & State	$931.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1,024.32

SPACER NANO TI 7D 21X32X12MM

Facility

$105,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270696607
Hospital Revenue Code	278
Min. Negotiated Rate	$15,821.25
Max. Negotiated Rate	$25,524.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,524.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$15,821.25

SPACER NANO TI 7D 21X32X12MM

Facility

$105,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270696607
Hospital Revenue Code	278
Min. Negotiated Rate	$2,541.95
Max. Negotiated Rate	$52,737.50
Rate for Payer: Aetna Commercial	$40,080.50
Rate for Payer: Aetna Medicare Advantage	$31,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,896.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,896.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,896.12
Rate for Payer: Cigna Commercial	$52,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,524.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$15,821.25
Rate for Payer: UnitedHealthcare Community & State	$2,541.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2,795.09

SPACER PEEK 12x15x7 6DEG

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270677681
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

SPACER PEEK 12x15x7 6DEG

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270677681
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

SPACER PEEK 7D 16X14X6MM

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694921
Hospital Revenue Code	278
Min. Negotiated Rate	$584.42
Max. Negotiated Rate	$12,125.00
Rate for Payer: Aetna Commercial	$9,215.00
Rate for Payer: Aetna Medicare Advantage	$7,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,183.75
Rate for Payer: Cigna Commercial	$12,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50
Rate for Payer: UnitedHealthcare Community & State	$584.42
Rate for Payer: Wellpoint Medicaid Managed Care	$642.62

SPACER PEEK 7D 16X14X6MM

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694921
Hospital Revenue Code	278
Min. Negotiated Rate	$3,637.50
Max. Negotiated Rate	$5,868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50

SPACER PEEK IMPLANT 11X11X7

Facility

$10,675.00

Service Code	HCPCS L8699
Hospital Charge Code	270648860
Hospital Revenue Code	278
Min. Negotiated Rate	$257.27
Max. Negotiated Rate	$5,337.50
Rate for Payer: Aetna Commercial	$4,056.50
Rate for Payer: Aetna Medicare Advantage	$3,202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,722.12
Rate for Payer: Cigna Commercial	$5,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,348.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25
Rate for Payer: UnitedHealthcare Community & State	$257.27
Rate for Payer: Wellpoint Medicaid Managed Care	$282.89

SPACER PEEK IMPLANT 11X11X7

Facility

$10,675.00

Service Code	HCPCS L8699
Hospital Charge Code	270648860
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$2,583.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,348.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

SPACER PEEK INTERB 7X13X16MM7D

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695374
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

SPACER PEEK INTERB 7X13X16MM7D

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695374
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

SPACER PEEK OPT TI 14X12X7MM

Facility

$5,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699546
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SPACER PEEK OPT TI 14X12X7MM

Facility

$5,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699546
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

SPACER PLIF 11X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694810
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$4,961.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,510.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF 11X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694810
Hospital Revenue Code	278
Min. Negotiated Rate	$494.05
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$7,790.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,510.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00
Rate for Payer: UnitedHealthcare Community & State	$494.05
Rate for Payer: Wellpoint Medicaid Managed Care	$543.25

SPACER PLIF 13X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694811
Hospital Revenue Code	278
Min. Negotiated Rate	$494.05
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$7,790.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,510.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00
Rate for Payer: UnitedHealthcare Community & State	$494.05
Rate for Payer: Wellpoint Medicaid Managed Care	$543.25

SPACER PLIF 13X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694811
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$4,961.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,510.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER PLIF ZFUZE 12X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695411
Hospital Revenue Code	278
Min. Negotiated Rate	$494.05
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$7,790.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,510.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00
Rate for Payer: UnitedHealthcare Community & State	$494.05
Rate for Payer: Wellpoint Medicaid Managed Care	$543.25

Know your out-of-pocket cost for care.

All Charges