Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PHOSPHATE24HR URINE WO CREATIN

Facility

$65.24

Service Code	HCPCS 84105
Hospital Charge Code	401184105
Hospital Revenue Code	301
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$9.79
Rate for Payer: Qualcare PPO/HMO/WC	$9.79

PHOSPHATIDY GLYCEROL

Facility

$130.00

Service Code	HCPCS 84999
Hospital Charge Code	38478103
Hospital Revenue Code	301
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

PHOSPHATIDY GLYCEROL

Facility

$130.00

Service Code	HCPCS 84999
Hospital Charge Code	38478103
Hospital Revenue Code	301
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

PHOSPHATIDYLGLYCEROL,AMNIOTIC

Facility

$348.00

Service Code	HCPCS 84081
Hospital Charge Code	38473118
Hospital Revenue Code	301
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$52.20
Rate for Payer: Qualcare PPO/HMO/WC	$52.20

PHOSPHATIDYLGLYCEROL,AMNIOTIC

Facility

$348.00

Service Code	HCPCS 84081
Hospital Charge Code	38473118
Hospital Revenue Code	301
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$174.00
Rate for Payer: Aetna Commercial	$44.93
Rate for Payer: Aetna Medicare Advantage	$53.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.93
Rate for Payer: Cigna Commercial	$174.00
Rate for Payer: Cigna Medicare Advantage	$16.52
Rate for Payer: Clover Medicare Advantage	$15.69
Rate for Payer: EmblemHealth Commercial	$49.56
Rate for Payer: Humana Medicare Advantage	$17.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.48
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.52
Rate for Payer: Wellcare Medicare Advantage	$16.52
Rate for Payer: Wellpoint Medicaid Managed Care	$9.88

PHOSPHOHEXOSE ISOMERASE

Facility

$73.00

Service Code	HCPCS 84087
Hospital Charge Code	38477067
Hospital Revenue Code	301
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

PHOSPHOHEXOSE ISOMERASE

Facility

$73.00

Service Code	HCPCS 84087
Hospital Charge Code	38477067
Hospital Revenue Code	301
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$29.19
Rate for Payer: Aetna Medicare Advantage	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.92
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: Cigna Medicare Advantage	$10.73
Rate for Payer: Clover Medicare Advantage	$10.19
Rate for Payer: EmblemHealth Commercial	$32.19
Rate for Payer: Humana Medicare Advantage	$11.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.73
Rate for Payer: Wellcare Medicare Advantage	$10.73
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

PHOSPHOLIPASE A2 RECEP AB IFA

Facility

$198.10

Service Code	HCPCS 86255
Hospital Charge Code	401186255A
Hospital Revenue Code	302
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$99.05
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.51
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.71
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.63

PHOSPHOLIPASE A2 RECEP AB IFA

Facility

$198.10

Service Code	HCPCS 86255
Hospital Charge Code	401186255A
Hospital Revenue Code	302
Min. Negotiated Rate	$29.71
Max. Negotiated Rate	$29.71
Rate for Payer: Qualcare PPO/HMO/WC	$29.71

PHOSPHOLIPIDS

Facility

$390.00

Service Code	HCPCS 84311
Hospital Charge Code	39900135
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$22.03
Rate for Payer: Aetna Medicare Advantage	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.38
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.10
Rate for Payer: Clover Medicare Advantage	$7.70
Rate for Payer: EmblemHealth Commercial	$24.30
Rate for Payer: Humana Medicare Advantage	$8.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.10
Rate for Payer: Wellcare Medicare Advantage	$8.10
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PHOSPHOLIPIDS

Facility

$390.00

Service Code	HCPCS 84311
Hospital Charge Code	39900135
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHOSPHOROUS URINE

Facility

$390.00

Service Code	HCPCS 84105
Hospital Charge Code	39990241H
Hospital Revenue Code	301
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.97
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PHOSPHOROUS URINE

Facility

$390.00

Service Code	HCPCS 84105
Hospital Charge Code	39990241H
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHOSPHORUS INORGANIC

Facility

$64.00

Service Code	HCPCS 84100
Hospital Charge Code	38472539
Hospital Revenue Code	301
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$12.89
Rate for Payer: Aetna Medicare Advantage	$15.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.19
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: Cigna Medicare Advantage	$4.74
Rate for Payer: Clover Medicare Advantage	$4.50
Rate for Payer: EmblemHealth Commercial	$14.22
Rate for Payer: Humana Medicare Advantage	$4.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.74
Rate for Payer: Wellcare Medicare Advantage	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

PHOSPHORUS INORGANIC

Facility

$64.00

Service Code	HCPCS 84100
Hospital Charge Code	38472539
Hospital Revenue Code	301
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

PHOSPHORUS RANDOM UR

Facility

$163.00

Service Code	HCPCS 84105
Hospital Charge Code	38479041
Hospital Revenue Code	301
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.97
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.38
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

PHOSPHORUS RANDOM UR

Facility

$163.00

Service Code	HCPCS 84105
Hospital Charge Code	38479041
Hospital Revenue Code	301
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PHOSPHORUS, SERUM

Facility

$656.14

Service Code	HCPCS 84100
Hospital Charge Code	3002094
Hospital Revenue Code	301
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$328.07
Rate for Payer: Aetna Commercial	$12.89
Rate for Payer: Aetna Medicare Advantage	$15.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.19
Rate for Payer: Cigna Commercial	$328.07
Rate for Payer: Cigna Medicare Advantage	$4.74
Rate for Payer: Clover Medicare Advantage	$4.50
Rate for Payer: EmblemHealth Commercial	$14.22
Rate for Payer: Humana Medicare Advantage	$4.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.42
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.74
Rate for Payer: Wellcare Medicare Advantage	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$18.63

PHOSPHORUS, SERUM

Facility

$656.14

Service Code	HCPCS 84100
Hospital Charge Code	3002094
Hospital Revenue Code	301
Min. Negotiated Rate	$98.42
Max. Negotiated Rate	$98.42
Rate for Payer: Qualcare PPO/HMO/WC	$98.42

PHOSPHORUS SUPPLEMENT TABLET

Facility

$5.70

Service Code	NDC 486112501
Hospital Charge Code	60632341
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Commercial	$2.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.48
Rate for Payer: Oxford Commercial	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.14
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

PHOSPHORUS SUPPLEMENT TABLET

Facility

$5.70

Service Code	NDC 486112501
Hospital Charge Code	60632341
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

PHOSPHORUS URINE

Facility

$390.00

Service Code	HCPCS 84105
Hospital Charge Code	3030855
Hospital Revenue Code	301
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.97
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PHOSPHORUS URINE

Facility

$390.00

Service Code	HCPCS 84105
Hospital Charge Code	3030855
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHOSPHORUS, URINE

Facility

$163.00

Service Code	HCPCS 84105
Hospital Charge Code	38472542
Hospital Revenue Code	301
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PHOSPHORUS, URINE

Facility

$163.00

Service Code	HCPCS 84105
Hospital Charge Code	38472542
Hospital Revenue Code	301
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.97
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.38
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

Know your out-of-pocket cost for care.

All Charges