Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

X-PLATE VA LCKG 2.4/2.7MM MED

Facility

$4,347.60

Service Code	HCPCS C1713
Hospital Charge Code	270683072
Hospital Revenue Code	278
Min. Negotiated Rate	$652.14
Max. Negotiated Rate	$1,052.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$869.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,052.12
Rate for Payer: Qualcare PPO/HMO/WC	$652.14

X-PLATE VA LCKG 2.4/2.7MM MED

Facility

$4,347.60

Service Code	HCPCS C1713
Hospital Charge Code	270683072
Hospital Revenue Code	278
Min. Negotiated Rate	$123.47
Max. Negotiated Rate	$2,173.80
Rate for Payer: Aetna Commercial	$1,652.09
Rate for Payer: Aetna Medicare Advantage	$1,304.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,108.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,108.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$869.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,108.64
Rate for Payer: Cigna Commercial	$2,173.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,052.12
Rate for Payer: Qualcare PPO/HMO/WC	$652.14
Rate for Payer: UnitedHealthcare Community & State	$137.38
Rate for Payer: Wellpoint Medicaid Managed Care	$123.47

X-PLATE VA LCKG 3.7MM MED

Facility

$670.80

Service Code	HCPCS C1713
Hospital Charge Code	270689594
Hospital Revenue Code	278
Min. Negotiated Rate	$100.62
Max. Negotiated Rate	$162.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.33
Rate for Payer: Qualcare PPO/HMO/WC	$100.62

X-PLATE VA LCKG 3.7MM MED

Facility

$670.80

Service Code	HCPCS C1713
Hospital Charge Code	270689594
Hospital Revenue Code	278
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$335.40
Rate for Payer: Aetna Commercial	$254.90
Rate for Payer: Aetna Medicare Advantage	$201.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.05
Rate for Payer: Cigna Commercial	$335.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.33
Rate for Payer: Qualcare PPO/HMO/WC	$100.62
Rate for Payer: UnitedHealthcare Community & State	$21.20
Rate for Payer: Wellpoint Medicaid Managed Care	$19.05

XPS CONSLE& MICRODEBRIDER RENT

Facility

$2,640.00

Hospital Charge Code	270337856
Hospital Revenue Code	272
Min. Negotiated Rate	$74.98
Max. Negotiated Rate	$1,320.00
Rate for Payer: Aetna Commercial	$1,003.20
Rate for Payer: Aetna Medicare Advantage	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$673.20
Rate for Payer: Cigna Commercial	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$686.40
Rate for Payer: Oxford Commercial	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$396.00
Rate for Payer: UnitedHealthcare Commercial	$528.00
Rate for Payer: UnitedHealthcare Community & State	$83.42
Rate for Payer: Wellpoint Medicaid Managed Care	$74.98

XPS CONSLE& MICRODEBRIDER RENT

Facility

$2,640.00

Hospital Charge Code	270337856
Hospital Revenue Code	272
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$396.00
Rate for Payer: Qualcare PPO/HMO/WC	$396.00

XR ABDOMEN 1 VIEW PORTABLE

Facility

$5,100.00

Service Code	HCPCS 74018
Hospital Charge Code	2002780
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ABDOMEN 1 VIEW PORTABLE

Facility

$5,100.00

Service Code	HCPCS 74018
Hospital Charge Code	2002780
Hospital Revenue Code	320
Min. Negotiated Rate	$26.93
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR ABDOMEN 2 VWS W DECUB ERECT

Facility

$556.00

Service Code	HCPCS 74020
Hospital Charge Code	2000206
Hospital Revenue Code	320
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$211.28
Rate for Payer: Aetna Medicare Advantage	$166.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.78
Rate for Payer: Cigna Commercial	$278.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.56
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.40
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$17.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$15.79

XR ABDOMEN 2 VWS W DECUB ERECT

Facility

$556.00

Service Code	HCPCS 74020
Hospital Charge Code	2000206
Hospital Revenue Code	320
Min. Negotiated Rate	$83.40
Max. Negotiated Rate	$83.40
Rate for Payer: Qualcare PPO/HMO/WC	$83.40

XR ABDOMEN MULT VIEWS

Facility

$6,601.19

Service Code	HCPCS 74022
Hospital Charge Code	2000214
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ABDOMEN MULT VIEWS

Facility

$6,601.19

Service Code	HCPCS 74022
Hospital Charge Code	2000214
Hospital Revenue Code	320
Min. Negotiated Rate	$45.38
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

XR ABDOMEN ONE VIEW

Facility

$6,601.19

Service Code	HCPCS 74018
Hospital Charge Code	2000198
Hospital Revenue Code	320
Min. Negotiated Rate	$26.93
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

XR ABDOMEN ONE VIEW

Facility

$6,601.19

Service Code	HCPCS 74018
Hospital Charge Code	2000198
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ABDOMEN TWO VIEWS PORTABLE

Facility

$5,100.00

Service Code	HCPCS 74019
Hospital Charge Code	2003051
Hospital Revenue Code	320
Min. Negotiated Rate	$32.87
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR ABDOMEN TWO VIEWS PORTABLE

Facility

$5,100.00

Service Code	HCPCS 74019
Hospital Charge Code	2003051
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ABLATE BONE TUMOR(S) PERQ

Facility

$33,376.25

Service Code	HCPCS 20982
Hospital Charge Code	5600102
Hospital Revenue Code	361
Min. Negotiated Rate	$947.89
Max. Negotiated Rate	$75,563.15
Rate for Payer: Aetna Commercial	$56,659.34
Rate for Payer: Aetna Medicare Advantage	$67,491.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,563.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,563.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,830.64
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	$75,563.15
Rate for Payer: Cigna Commercial	$41,754.94
Rate for Payer: Cigna Medicare Advantage	$20,830.64
Rate for Payer: Clover Medicare Advantage	$19,789.11
Rate for Payer: EmblemHealth Commercial	$62,491.92
Rate for Payer: Humana Medicare Advantage	$21,455.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,830.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,677.83
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,006.44
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$1,054.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,830.64
Rate for Payer: Wellcare Medicare Advantage	$20,830.64
Rate for Payer: Wellpoint Medicaid Managed Care	$947.89

XR ABLATE BONE TUMOR(S) PERQ

Facility

$33,376.25

Service Code	HCPCS 20982
Hospital Charge Code	321020982
Hospital Revenue Code	361
Min. Negotiated Rate	$5,006.44
Max. Negotiated Rate	$5,006.44
Rate for Payer: Qualcare PPO/HMO/WC	$5,006.44

XR ABLATE BONE TUMOR(S) PERQ

Facility

$33,376.25

Service Code	HCPCS 20982
Hospital Charge Code	5600102
Hospital Revenue Code	361
Min. Negotiated Rate	$5,006.44
Max. Negotiated Rate	$5,006.44
Rate for Payer: Qualcare PPO/HMO/WC	$5,006.44

XR ABLATE BONE TUMOR(S) PERQ

Facility

$33,376.25

Service Code	HCPCS 20982
Hospital Charge Code	321020982
Hospital Revenue Code	361
Min. Negotiated Rate	$947.89
Max. Negotiated Rate	$75,563.15
Rate for Payer: Aetna Commercial	$56,659.34
Rate for Payer: Aetna Medicare Advantage	$67,491.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,563.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,563.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,830.64
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	$75,563.15
Rate for Payer: Cigna Commercial	$41,754.94
Rate for Payer: Cigna Medicare Advantage	$20,830.64
Rate for Payer: Clover Medicare Advantage	$19,789.11
Rate for Payer: EmblemHealth Commercial	$62,491.92
Rate for Payer: Humana Medicare Advantage	$21,455.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,830.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,677.83
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,006.44
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$1,054.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,830.64
Rate for Payer: Wellcare Medicare Advantage	$20,830.64
Rate for Payer: Wellpoint Medicaid Managed Care	$947.89

XR ACROMIOCL JNTS BI

Facility

$5,100.00

Service Code	HCPCS 73050
Hospital Charge Code	2000099
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ACROMIOCL JNTS BI

Facility

$5,100.00

Service Code	HCPCS 73050
Hospital Charge Code	2000099
Hospital Revenue Code	320
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR ANKLE 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7360050
Hospital Charge Code	2011307
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ANKLE 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7360050
Hospital Charge Code	2011307
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR ANKLE COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7361050
Hospital Charge Code	2011308
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

Know your out-of-pocket cost for care.

All Charges