Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CL TX WB DSTL TIB FX W MANIP

Facility

$15,476.60

Service Code	HCPCS 27825
Hospital Charge Code	16000480
Hospital Revenue Code	360
Min. Negotiated Rate	$2,321.49
Max. Negotiated Rate	$2,321.49
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.49

CLUB HOUSE GROUP THERAPY NON M

Facility

$433.40

Service Code	HCPCS 90849
Hospital Charge Code	87504160
Hospital Revenue Code	913
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.68
Rate for Payer: Qualcare PPO/HMO/WC	$65.01
Rate for Payer: UnitedHealthcare Community & State	$13.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$12.31

CLUB HOUSE GROUP THERAPY NON M

Facility

$433.40

Service Code	HCPCS 90849
Hospital Charge Code	87504160
Hospital Revenue Code	913
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$65.01
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

CL,URINE RANDOM

Facility

$517.00

Service Code	HCPCS 82340
Hospital Charge Code	38479032
Hospital Revenue Code	301
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$258.50
Rate for Payer: Aetna Commercial	$16.40
Rate for Payer: Aetna Medicare Advantage	$19.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.87
Rate for Payer: Cigna Commercial	$258.50
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$5.73
Rate for Payer: EmblemHealth Commercial	$18.09
Rate for Payer: Humana Medicare Advantage	$6.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.42
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.03
Rate for Payer: Wellcare Medicare Advantage	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$14.68

CL,URINE RANDOM

Facility

$517.00

Service Code	HCPCS 82340
Hospital Charge Code	38479032
Hospital Revenue Code	301
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$77.55

CMFLG TAILORSPLNT 3/32 2.4MM

Facility

$410.75

Hospital Charge Code	270663150
Hospital Revenue Code	270
Min. Negotiated Rate	$61.61
Max. Negotiated Rate	$61.61
Rate for Payer: Qualcare PPO/HMO/WC	$61.61

CMFLG TAILORSPLNT 3/32 2.4MM

Facility

$410.75

Hospital Charge Code	270663150
Hospital Revenue Code	270
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$205.38
Rate for Payer: Aetna Commercial	$156.09
Rate for Payer: Aetna Medicare Advantage	$123.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.74
Rate for Payer: Cigna Commercial	$205.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.80
Rate for Payer: Oxford Commercial	$82.15
Rate for Payer: Qualcare PPO/HMO/WC	$61.61
Rate for Payer: UnitedHealthcare Commercial	$82.15
Rate for Payer: UnitedHealthcare Community & State	$12.98
Rate for Payer: Wellpoint Medicaid Managed Care	$11.67

C MOTOR EVOKED UPPR&LWR LIMBS

Facility

$5,325.60

Service Code	HCPCS 95939
Hospital Charge Code	321095939
Hospital Revenue Code	920
Min. Negotiated Rate	$798.84
Max. Negotiated Rate	$798.84
Rate for Payer: Qualcare PPO/HMO/WC	$798.84

C MOTOR EVOKED UPPR&LWR LIMBS

Facility

$5,325.60

Service Code	HCPCS 95939
Hospital Charge Code	321095939
Hospital Revenue Code	920
Min. Negotiated Rate	$151.25
Max. Negotiated Rate	$3,700.81
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,700.81
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.66
Rate for Payer: Oxford Commercial	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$798.84
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$168.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$151.25

CMPLX REPAIR TRUNK 2.6-7.5 cm

Facility

$5,105.84

Service Code	HCPCS 13101
Hospital Charge Code	16000198
Hospital Revenue Code	360
Min. Negotiated Rate	$765.88
Max. Negotiated Rate	$765.88
Rate for Payer: Qualcare PPO/HMO/WC	$765.88

CMPLX REPAIR TRUNK 2.6-7.5 cm

Facility

$5,105.84

Service Code	HCPCS 13101
Hospital Charge Code	16000198
Hospital Revenue Code	360
Min. Negotiated Rate	$145.01
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
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	$3,185.09
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,327.52
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.88
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$161.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$145.01

CMPLX RPR TRUNK ADDL 5CM/<

Facility

$4,899.30

Service Code	HCPCS 13102
Hospital Charge Code	16000261
Hospital Revenue Code	360
Min. Negotiated Rate	$139.14
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,861.73
Rate for Payer: Aetna Medicare Advantage	$1,469.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.32
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	$1,249.32
Rate for Payer: Cigna Commercial	$2,449.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,273.82
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$734.89
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$154.82
Rate for Payer: Wellpoint Medicaid Managed Care	$139.14

CMPLX RPR TRUNK ADDL 5CM/<

Facility

$4,899.30

Service Code	HCPCS 13102
Hospital Charge Code	16000261
Hospital Revenue Code	360
Min. Negotiated Rate	$734.89
Max. Negotiated Rate	$734.89
Rate for Payer: Qualcare PPO/HMO/WC	$734.89

C MRSA SCREEN

Facility

$735.08

Service Code	HCPCS 87081
Hospital Charge Code	3008878
Hospital Revenue Code	309
Min. Negotiated Rate	$110.26
Max. Negotiated Rate	$110.26
Rate for Payer: Qualcare PPO/HMO/WC	$110.26

C MRSA SCREEN

Facility

$735.08

Service Code	HCPCS 87081
Hospital Charge Code	3008878
Hospital Revenue Code	309
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$367.54
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: Aetna Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.05
Rate for Payer: Cigna Commercial	$367.54
Rate for Payer: Cigna Medicare Advantage	$6.63
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.12
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$110.26
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Medicare Advantage	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$20.88

CMV AB (IGG)

Facility

$390.00

Service Code	HCPCS 86644
Hospital Charge Code	39900231
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.20
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
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	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CMV AB (IGG)

Facility

$390.00

Service Code	HCPCS 86644
Hospital Charge Code	39900231
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CMV AB (IGG,IGM) I

Facility

$667.59

Service Code	HCPCS 86644
Hospital Charge Code	39990092A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.20
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CMV AB (IGG,IGM) I

Facility

$667.59

Service Code	HCPCS 86644
Hospital Charge Code	39990092A
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CMV AB (IGG,IGM) II

Facility

$667.59

Service Code	HCPCS 86645
Hospital Charge Code	39990092B
Hospital Revenue Code	302
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.12
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CMV AB (IGG,IGM) II

Facility

$667.59

Service Code	HCPCS 86645
Hospital Charge Code	39990092B
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CMV AB (IGM)

Facility

$390.00

Service Code	HCPCS 86645
Hospital Charge Code	39900232
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$45.83
Rate for Payer: Aetna Medicare Advantage	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.12
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$16.01
Rate for Payer: EmblemHealth Commercial	$50.55
Rate for Payer: Humana Medicare Advantage	$17.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.85
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	$13.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.85
Rate for Payer: Wellcare Medicare Advantage	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CMV AB (IGM)

Facility

$390.00

Service Code	HCPCS 86645
Hospital Charge Code	39900232
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CMV CONVENT., RAPID CULT 1

Facility

$390.00

Service Code	HCPCS 87252
Hospital Charge Code	3990162A
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CMV CONVENT., RAPID CULT 1

Facility

$390.00

Service Code	HCPCS 87252
Hospital Charge Code	3990162A
Hospital Revenue Code	309
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
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	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges