Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

COMMUNITY/WORK REINTERGRATI

Facility

$161.00

Service Code	HCPCS 97537GO
Hospital Charge Code	74203065
Hospital Revenue Code	430
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

COMMUNITY/WORK REINTERGRATI

Facility

$161.00

Service Code	HCPCS 97537GO
Hospital Charge Code	74203065
Hospital Revenue Code	430
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$61.18
Rate for Payer: Aetna Medicare Advantage	$48.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.05
Rate for Payer: Cigna Commercial	$80.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.86
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.57

COMMUN WORK/REINT EA 15MIN CQ

Facility

$161.00

Service Code	HCPCS 97537GP
Hospital Charge Code	409197537Q
Hospital Revenue Code	420
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

COMMUN WORK/REINT EA 15MIN CQ

Facility

$161.00

Service Code	HCPCS 97537GP
Hospital Charge Code	409197537Q
Hospital Revenue Code	420
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$61.18
Rate for Payer: Aetna Medicare Advantage	$48.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.05
Rate for Payer: Cigna Commercial	$80.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.86
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.57

COMP ARTICULAR 2.5MMX4.MM

Facility

$15,030.00

Service Code	HCPCS C1776
Hospital Charge Code	270692682
Hospital Revenue Code	278
Min. Negotiated Rate	$2,254.50
Max. Negotiated Rate	$3,637.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50

COMP ARTICULAR 2.5MMX4.MM

Facility

$15,030.00

Service Code	HCPCS C1776
Hospital Charge Code	270692682
Hospital Revenue Code	278
Min. Negotiated Rate	$426.85
Max. Negotiated Rate	$7,515.00
Rate for Payer: Aetna Commercial	$5,711.40
Rate for Payer: Aetna Medicare Advantage	$4,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,832.65
Rate for Payer: Cigna Commercial	$7,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50
Rate for Payer: UnitedHealthcare Community & State	$474.95
Rate for Payer: Wellpoint Medicaid Managed Care	$426.85

COMPAZINE/5MG/5ML

Facility

$4.00

Service Code	NDC 440819012
Hospital Charge Code	60632732
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

COMPAZINE/5MG/5ML

Facility

$4.00

Service Code	NDC 440819012
Hospital Charge Code	60632732
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

COMP FEMORAL 62.5mm 183126

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270638691
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

COMP FEMORAL 62.5mm 183126

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270638691
Hospital Revenue Code	278
Min. Negotiated Rate	$489.33
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$6,547.40
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50
Rate for Payer: UnitedHealthcare Community & State	$544.47
Rate for Payer: Wellpoint Medicaid Managed Care	$489.33

COMPLEMENT ANTIGEN

Facility

$120.00

Service Code	HCPCS 86160
Hospital Charge Code	401386160C
Hospital Revenue Code	302
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3.41

COMPLEMENT ANTIGEN

Facility

$120.00

Service Code	HCPCS 86160
Hospital Charge Code	401386160C
Hospital Revenue Code	302
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

COMPLEMENT C1 PANEL A

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COMPLEMENT C1 PANEL A

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

COMPLEMENT C1 PANEL B

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COMPLEMENT C1 PANEL B

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

COMPLEMENT C1 PANEL C

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

COMPLEMENT C1 PANEL C

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	3008182C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COMPLEMENT,C1Q

Facility

$235.00

Service Code	HCPCS 86160
Hospital Charge Code	38476217
Hospital Revenue Code	302
Min. Negotiated Rate	$6.67
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$6.67

COMPLEMENT,C1Q

Facility

$235.00

Service Code	HCPCS 86160
Hospital Charge Code	38476217
Hospital Revenue Code	302
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

COMPLEMENT C2

Facility

$341.00

Service Code	HCPCS 86160
Hospital Charge Code	38476252
Hospital Revenue Code	302
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$51.15
Rate for Payer: Qualcare PPO/HMO/WC	$51.15

COMPLEMENT C2

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39900462
Hospital Revenue Code	302
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

COMPLEMENT C2

Facility

$341.00

Service Code	HCPCS 86160
Hospital Charge Code	38476252
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$170.50
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$170.50
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$9.68

COMPLEMENT C2

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39900462
Hospital Revenue Code	302
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

COMPLEMENT C3

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39900423
Hospital Revenue Code	302
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

Know your out-of-pocket cost for care.

All Charges