Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ER COM REP TRUNK >7.6EA ADDL 5

Facility

$1,898.00

Service Code	HCPCS 13102
Hospital Charge Code	5700716
Hospital Revenue Code	450
Min. Negotiated Rate	$284.70
Max. Negotiated Rate	$284.70
Rate for Payer: Qualcare PPO/HMO/WC	$284.70

ER CONTROL NOSEBLD ANT COMPLEX

Facility

$463.00

Service Code	HCPCS 30903
Hospital Charge Code	5700432
Hospital Revenue Code	450
Min. Negotiated Rate	$69.45
Max. Negotiated Rate	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

ER CONTROL NOSEBLD ANT COMPLEX

Facility

$463.00

Service Code	HCPCS 30903
Hospital Charge Code	5700432
Hospital Revenue Code	450
Min. Negotiated Rate	$13.15
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.38
Rate for Payer: Qualcare PPO/HMO/WC	$69.45
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$13.15

ER CONTROL NOSEBLD ANT SIMPLE

Facility

$982.00

Service Code	HCPCS 30901
Hospital Charge Code	5700430
Hospital Revenue Code	450
Min. Negotiated Rate	$27.89
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.32
Rate for Payer: Qualcare PPO/HMO/WC	$147.30
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$27.89

ER CONTROL NOSEBLD ANT SIMPLE

Facility

$982.00

Service Code	HCPCS 30901
Hospital Charge Code	5700430
Hospital Revenue Code	450
Min. Negotiated Rate	$147.30
Max. Negotiated Rate	$147.30
Rate for Payer: Qualcare PPO/HMO/WC	$147.30

ER CONTROL NOSEBLD POST INITAL

Facility

$654.00

Service Code	HCPCS 30905
Hospital Charge Code	5700435
Hospital Revenue Code	450
Min. Negotiated Rate	$98.10
Max. Negotiated Rate	$98.10
Rate for Payer: Qualcare PPO/HMO/WC	$98.10

ER CONTROL NOSEBLD POST INITAL

Facility

$654.00

Service Code	HCPCS 30905
Hospital Charge Code	5700435
Hospital Revenue Code	450
Min. Negotiated Rate	$18.57
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.04
Rate for Payer: Qualcare PPO/HMO/WC	$98.10
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$18.57

ER CONTROL NOSEBLD POST SUBSEQ

Facility

$463.00

Service Code	HCPCS 30906
Hospital Charge Code	5700437
Hospital Revenue Code	450
Min. Negotiated Rate	$13.15
Max. Negotiated Rate	$1,020.71
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.71
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.38
Rate for Payer: Qualcare PPO/HMO/WC	$69.45
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$13.15

ER CONTROL NOSEBLD POST SUBSEQ

Facility

$463.00

Service Code	HCPCS 30906
Hospital Charge Code	5700437
Hospital Revenue Code	450
Min. Negotiated Rate	$69.45
Max. Negotiated Rate	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

ERCP FOR SPHINCT/PAPILLOTOMY

Facility

$9,500.80

Service Code	HCPCS 43262
Hospital Charge Code	16000823
Hospital Revenue Code	360
Min. Negotiated Rate	$269.82
Max. Negotiated Rate	$16,615.40
Rate for Payer: Aetna Commercial	$12,458.69
Rate for Payer: Aetna Medicare Advantage	$14,840.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,615.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,615.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,580.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,615.40
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: Cigna Medicare Advantage	$4,580.40
Rate for Payer: Clover Medicare Advantage	$4,351.38
Rate for Payer: EmblemHealth Commercial	$13,741.20
Rate for Payer: Humana Medicare Advantage	$4,717.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,580.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.21
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.12
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$300.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,580.40
Rate for Payer: Wellcare Medicare Advantage	$4,580.40
Rate for Payer: Wellpoint Medicaid Managed Care	$269.82

ERCP FOR SPHINCT/PAPILLOTOMY

Facility

$9,500.80

Service Code	HCPCS 43262
Hospital Charge Code	16000823
Hospital Revenue Code	360
Min. Negotiated Rate	$1,425.12
Max. Negotiated Rate	$1,425.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.12

ERCP HYDRATOME CATH

Facility

$1,386.00

Hospital Charge Code	270325682
Hospital Revenue Code	272
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$207.90
Rate for Payer: Qualcare PPO/HMO/WC	$207.90

ERCP HYDRATOME CATH

Facility

$1,386.00

Hospital Charge Code	270325682
Hospital Revenue Code	272
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$693.00
Rate for Payer: Aetna Commercial	$526.68
Rate for Payer: Aetna Medicare Advantage	$415.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$353.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$353.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$353.43
Rate for Payer: Cigna Commercial	$693.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.36
Rate for Payer: Oxford Commercial	$277.20
Rate for Payer: Qualcare PPO/HMO/WC	$207.90
Rate for Payer: UnitedHealthcare Commercial	$277.20
Rate for Payer: UnitedHealthcare Community & State	$43.80
Rate for Payer: Wellpoint Medicaid Managed Care	$39.36

ER CPR

Facility

$968.00

Service Code	HCPCS 92950
Hospital Charge Code	5700255
Hospital Revenue Code	480
Min. Negotiated Rate	$145.20
Max. Negotiated Rate	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$145.20

ER CPR

Facility

$968.00

Service Code	HCPCS 92950
Hospital Charge Code	5700255
Hospital Revenue Code	480
Min. Negotiated Rate	$27.49
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$930.53
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.68
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$145.20
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$30.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$27.49

ERCP REMOVE DUCT CALCULI

Facility

$22,967.20

Service Code	HCPCS 43264
Hospital Charge Code	16000965
Hospital Revenue Code	360
Min. Negotiated Rate	$652.27
Max. Negotiated Rate	$16,615.40
Rate for Payer: Aetna Commercial	$12,458.69
Rate for Payer: Aetna Medicare Advantage	$14,840.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,615.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,615.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,580.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,615.40
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: Cigna Medicare Advantage	$4,580.40
Rate for Payer: Clover Medicare Advantage	$4,351.38
Rate for Payer: EmblemHealth Commercial	$13,741.20
Rate for Payer: Humana Medicare Advantage	$4,717.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,580.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,971.47
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,445.08
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$725.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,580.40
Rate for Payer: Wellcare Medicare Advantage	$4,580.40
Rate for Payer: Wellpoint Medicaid Managed Care	$652.27

ERCP REMOVE DUCT CALCULI

Facility

$22,967.20

Service Code	HCPCS 43264
Hospital Charge Code	16000965
Hospital Revenue Code	360
Min. Negotiated Rate	$3,445.08
Max. Negotiated Rate	$3,445.08
Rate for Payer: Qualcare PPO/HMO/WC	$3,445.08

ERCP W/SPECIMEN COLLECTION

Facility

$10,176.05

Service Code	HCPCS 43260
Hospital Charge Code	1600000613
Hospital Revenue Code	360
Min. Negotiated Rate	$1,526.41
Max. Negotiated Rate	$1,526.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,526.41

ERCP W/SPECIMEN COLLECTION

Facility

$10,176.05

Service Code	HCPCS 43260
Hospital Charge Code	1600000613
Hospital Revenue Code	360
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$16,615.40
Rate for Payer: Aetna Commercial	$12,458.69
Rate for Payer: Aetna Medicare Advantage	$14,840.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,615.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,615.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,580.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,615.40
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: Cigna Medicare Advantage	$4,580.40
Rate for Payer: Clover Medicare Advantage	$4,351.38
Rate for Payer: EmblemHealth Commercial	$13,741.20
Rate for Payer: Humana Medicare Advantage	$4,717.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,580.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,645.77
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,526.41
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$321.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,580.40
Rate for Payer: Wellcare Medicare Advantage	$4,580.40
Rate for Payer: Wellpoint Medicaid Managed Care	$289.00

ER CRITICAL CARE 1ST HR WO MF

Facility

$17,139.05

Service Code	HCPCS 99291
Hospital Charge Code	5700029
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$4,456.15
Rate for Payer: Aetna Commercial	$2,669.24
Rate for Payer: Aetna Medicare Advantage	$3,179.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,559.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,559.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$981.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,054.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,559.81
Rate for Payer: Cigna Commercial	$1,967.11
Rate for Payer: Cigna Medicare Advantage	$981.34
Rate for Payer: Clover Medicare Advantage	$932.27
Rate for Payer: EmblemHealth Commercial	$2,944.02
Rate for Payer: Humana Medicare Advantage	$1,010.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$981.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,456.15
Rate for Payer: Oxford Commercial	$3,377.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,570.86
Rate for Payer: UnitedHealthcare Commercial	$3,833.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$981.34
Rate for Payer: Wellcare Medicare Advantage	$981.34
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER CRITICAL CARE 1ST HR WO MF

Facility

$17,139.05

Service Code	HCPCS 99291
Hospital Charge Code	5700029
Hospital Revenue Code	450
Min. Negotiated Rate	$2,570.86
Max. Negotiated Rate	$2,570.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,570.86

ER CRITICAL CARE ADDL 30 MINS

Facility

$1,731.00

Service Code	HCPCS 99292
Hospital Charge Code	5700031
Hospital Revenue Code	450
Min. Negotiated Rate	$259.65
Max. Negotiated Rate	$259.65
Rate for Payer: Qualcare PPO/HMO/WC	$259.65

ER CRITICAL CARE ADDL 30 MINS

Facility

$1,731.00

Service Code	HCPCS 99292
Hospital Charge Code	5700031
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$865.50
Rate for Payer: Aetna Commercial	$657.78
Rate for Payer: Aetna Medicare Advantage	$519.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$441.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$441.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$441.40
Rate for Payer: Cigna Commercial	$865.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.06
Rate for Payer: Qualcare PPO/HMO/WC	$259.65
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER DEBRID ECZEMA INFECTED 10%

Facility

$1,117.00

Service Code	HCPCS 11000
Hospital Charge Code	5700701
Hospital Revenue Code	450
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

ER DEBRID ECZEMA INFECTED 10%

Facility

$1,117.00

Service Code	HCPCS 11000
Hospital Charge Code	5700701
Hospital Revenue Code	450
Min. Negotiated Rate	$30.78
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.42
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,639.38
Rate for Payer: Wellpoint Medicaid Managed Care	$31.72

Know your out-of-pocket cost for care.

All Charges