Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FP 1ST DEGREE INITIAL TREAT

Facility

$1,083.25

Service Code	HCPCS 16000
Hospital Charge Code	87502510
Hospital Revenue Code	761
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$864.65
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.64
Rate for Payer: Oxford Commercial	$216.65
Rate for Payer: Qualcare PPO/HMO/WC	$162.49
Rate for Payer: UnitedHealthcare Commercial	$216.65
Rate for Payer: UnitedHealthcare Community & State	$34.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$554.01
Rate for Payer: Wellpoint Medicaid Managed Care	$30.76

FP ARTHROCENTESIS INTER JOINT

Facility

$186.04

Service Code	HCPCS 20605
Hospital Charge Code	87502535
Hospital Revenue Code	761
Min. Negotiated Rate	$27.91
Max. Negotiated Rate	$27.91
Rate for Payer: Qualcare PPO/HMO/WC	$27.91

FP ARTHROCENTESIS INTER JOINT

Facility

$186.04

Service Code	HCPCS 20605
Hospital Charge Code	87502535
Hospital Revenue Code	761
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$1,322.84
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.37
Rate for Payer: Oxford Commercial	$37.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.91
Rate for Payer: UnitedHealthcare Commercial	$37.21
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$5.28

FP ARTHROCENTESIS INTER. JOINT

Facility

$329.00

Service Code	HCPCS 20605
Hospital Charge Code	83652095
Hospital Revenue Code	761
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

FP ARTHROCENTESIS INTER. JOINT

Facility

$329.00

Service Code	HCPCS 20605
Hospital Charge Code	83652095
Hospital Revenue Code	761
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$1,322.84
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.54
Rate for Payer: Oxford Commercial	$65.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$65.80
Rate for Payer: UnitedHealthcare Community & State	$10.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$9.34

FP ARTHROCENTESIS SM JOINT

Facility

$175.91

Service Code	HCPCS 20600
Hospital Charge Code	87502540
Hospital Revenue Code	761
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$1,322.84
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.74
Rate for Payer: Oxford Commercial	$35.18
Rate for Payer: Qualcare PPO/HMO/WC	$26.39
Rate for Payer: UnitedHealthcare Commercial	$35.18
Rate for Payer: UnitedHealthcare Community & State	$5.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$5.00

FP ARTHROCENTESIS SM JOINT

Facility

$175.91

Service Code	HCPCS 20600
Hospital Charge Code	87502540
Hospital Revenue Code	761
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$26.39
Rate for Payer: Qualcare PPO/HMO/WC	$26.39

FP AUDIOMETRY

Facility

$101.70

Service Code	HCPCS 92552
Hospital Charge Code	87502715
Hospital Revenue Code	471
Min. Negotiated Rate	$15.26
Max. Negotiated Rate	$15.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.26

FP AUDIOMETRY

Facility

$101.70

Service Code	HCPCS 92552
Hospital Charge Code	87502715
Hospital Revenue Code	471
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$1,823.00
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	$64.90
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	$26.44
Rate for Payer: Oxford Commercial	$1,606.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.26
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

FP AVULSION & ADDTL NAIL PL

Facility

$495.25

Service Code	HCPCS 11732
Hospital Charge Code	87502485
Hospital Revenue Code	761
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$247.62
Rate for Payer: Aetna Commercial	$188.19
Rate for Payer: Aetna Medicare Advantage	$148.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.29
Rate for Payer: Cigna Commercial	$247.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.76
Rate for Payer: Oxford Commercial	$99.05
Rate for Payer: Qualcare PPO/HMO/WC	$74.29
Rate for Payer: UnitedHealthcare Commercial	$99.05
Rate for Payer: UnitedHealthcare Community & State	$15.65
Rate for Payer: Wellpoint Medicaid Managed Care	$14.07

FP AVULSION & ADDTL NAIL PL

Facility

$495.25

Service Code	HCPCS 11732
Hospital Charge Code	87502485
Hospital Revenue Code	761
Min. Negotiated Rate	$74.29
Max. Negotiated Rate	$74.29
Rate for Payer: Qualcare PPO/HMO/WC	$74.29

FP AVULSION&ADDTN'L NAIL PL

Facility

$372.00

Service Code	HCPCS 11732
Hospital Charge Code	83652053
Hospital Revenue Code	761
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$141.36
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.72
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$11.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.56

FP AVULSION&ADDTN'L NAIL PL

Facility

$372.00

Service Code	HCPCS 11732
Hospital Charge Code	83652053
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

FP AVULSION OF NAIL PL

Facility

$372.00

Service Code	HCPCS 11730
Hospital Charge Code	87502480
Hospital Revenue Code	761
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$864.65
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.72
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$11.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.56

FP AVULSION OF NAIL PL

Facility

$372.00

Service Code	HCPCS 11730
Hospital Charge Code	87502480
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

FP BX SKIN & ADDTL LESION

Facility

$344.17

Service Code	HCPCS 11101
Hospital Charge Code	87502460
Hospital Revenue Code	761
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$172.09
Rate for Payer: Aetna Commercial	$130.78
Rate for Payer: Aetna Medicare Advantage	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.76
Rate for Payer: Cigna Commercial	$172.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.48
Rate for Payer: Oxford Commercial	$68.83
Rate for Payer: Qualcare PPO/HMO/WC	$51.63
Rate for Payer: UnitedHealthcare Commercial	$68.83
Rate for Payer: UnitedHealthcare Community & State	$10.88
Rate for Payer: Wellpoint Medicaid Managed Care	$9.77

FP BX SKIN & ADDTL LESION

Facility

$344.17

Service Code	HCPCS 11101
Hospital Charge Code	87502460
Hospital Revenue Code	761
Min. Negotiated Rate	$51.63
Max. Negotiated Rate	$51.63
Rate for Payer: Qualcare PPO/HMO/WC	$51.63

FP BX SKIN & ADDTN'L LESION

Facility

$185.00

Service Code	HCPCS 11101
Hospital Charge Code	83652029
Hospital Revenue Code	761
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.10
Rate for Payer: Oxford Commercial	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$37.00
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: Wellpoint Medicaid Managed Care	$5.25

FP BX SKIN & ADDTN'L LESION

Facility

$185.00

Service Code	HCPCS 11101
Hospital Charge Code	83652029
Hospital Revenue Code	761
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

FP CERUMEN REMOVAL

Facility

$167.24

Service Code	HCPCS 69210
Hospital Charge Code	87502530
Hospital Revenue Code	761
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$254.22
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.48
Rate for Payer: Oxford Commercial	$33.45
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$33.45
Rate for Payer: UnitedHealthcare Community & State	$5.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

FP CERUMEN REMOVAL

Facility

$167.24

Service Code	HCPCS 69210
Hospital Charge Code	87502530
Hospital Revenue Code	761
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

FP CHEM CAUT GRAN TISSUE

Facility

$1,083.25

Service Code	HCPCS 17250
Hospital Charge Code	87502525
Hospital Revenue Code	761
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$864.65
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.64
Rate for Payer: Oxford Commercial	$216.65
Rate for Payer: Qualcare PPO/HMO/WC	$162.49
Rate for Payer: UnitedHealthcare Commercial	$216.65
Rate for Payer: UnitedHealthcare Community & State	$34.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$30.76

FP CHEM CAUT GRAN TISSUE

Facility

$1,083.25

Service Code	HCPCS 17250
Hospital Charge Code	87502525
Hospital Revenue Code	761
Min. Negotiated Rate	$162.49
Max. Negotiated Rate	$162.49
Rate for Payer: Qualcare PPO/HMO/WC	$162.49

FP CIRCUMCISION>28 DAYS OF AG

Professional

Both

$2,888.00

Service Code	HCPCS 54161
Hospital Charge Code	83652117
Hospital Revenue Code	975
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$16.33
Rate for Payer: Aetna Medicare Advantage	$16.33
Rate for Payer: Fidelis All Plans	$16.33

FP COLLECTION CAP BLOOD SPECIM

Facility

$58.00

Service Code	HCPCS 36416
Hospital Charge Code	83652103
Hospital Revenue Code	300
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$22.04
Rate for Payer: Aetna Medicare Advantage	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.79
Rate for Payer: Cigna Commercial	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.08
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

Know your out-of-pocket cost for care.

All Charges