Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH DESIPRAMINE

Facility

$302.00

Service Code	HCPCS 80335
Hospital Charge Code	397071353
Hospital Revenue Code	301
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$45.30
Rate for Payer: Qualcare PPO/HMO/WC	$45.30

CH DESIPRAMINE

Facility

$302.00

Service Code	HCPCS 80335
Hospital Charge Code	397071353
Hospital Revenue Code	301
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$151.00
Rate for Payer: Aetna Commercial	$114.76
Rate for Payer: Aetna Medicare Advantage	$90.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.01
Rate for Payer: Cigna Commercial	$151.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$8.00

CH DESMOGLEIN ABS

Facility

$258.00

Service Code	HCPCS 83520
Hospital Charge Code	397073683
Hospital Revenue Code	301
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

CH DESMOGLEIN ABS

Facility

$258.00

Service Code	HCPCS 83520
Hospital Charge Code	397073683
Hospital Revenue Code	301
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

CH DHEA S

Facility

$462.00

Service Code	HCPCS 82627
Hospital Charge Code	397072056
Hospital Revenue Code	301
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$231.00
Rate for Payer: Aetna Commercial	$60.47
Rate for Payer: Aetna Medicare Advantage	$72.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.24
Rate for Payer: Cigna Commercial	$231.00
Rate for Payer: Cigna Medicare Advantage	$22.23
Rate for Payer: Clover Medicare Advantage	$21.12
Rate for Payer: EmblemHealth Commercial	$66.69
Rate for Payer: Humana Medicare Advantage	$22.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.23
Rate for Payer: Wellcare Medicare Advantage	$22.23
Rate for Payer: Wellpoint Medicaid Managed Care	$12.24

CH DHEA S

Facility

$462.00

Service Code	HCPCS 82627
Hospital Charge Code	397072056
Hospital Revenue Code	301
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$69.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.30

CH DHEA URINE 24 HR

Facility

$603.00

Service Code	HCPCS 82626
Hospital Charge Code	397073017
Hospital Revenue Code	301
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$301.50
Rate for Payer: Aetna Commercial	$68.73
Rate for Payer: Aetna Medicare Advantage	$81.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.22
Rate for Payer: Cigna Commercial	$301.50
Rate for Payer: Cigna Medicare Advantage	$25.27
Rate for Payer: Clover Medicare Advantage	$24.01
Rate for Payer: EmblemHealth Commercial	$75.81
Rate for Payer: Humana Medicare Advantage	$26.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.27
Rate for Payer: Wellcare Medicare Advantage	$25.27
Rate for Payer: Wellpoint Medicaid Managed Care	$15.98

CH DHEA URINE 24 HR

Facility

$603.00

Service Code	HCPCS 82626
Hospital Charge Code	397073017
Hospital Revenue Code	301
Min. Negotiated Rate	$90.45
Max. Negotiated Rate	$90.45
Rate for Payer: Qualcare PPO/HMO/WC	$90.45

CH DIAZEPAM

Facility

$226.00

Service Code	HCPCS 80346
Hospital Charge Code	397073119
Hospital Revenue Code	301
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$33.90
Rate for Payer: Qualcare PPO/HMO/WC	$33.90

CH DIAZEPAM

Facility

$226.00

Service Code	HCPCS 80346
Hospital Charge Code	397073119
Hospital Revenue Code	301
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$85.88
Rate for Payer: Aetna Medicare Advantage	$67.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.63
Rate for Payer: Cigna Commercial	$113.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.99

CH DIBUCAINE NUMBER

Facility

$201.00

Service Code	HCPCS 82638
Hospital Charge Code	397072057
Hospital Revenue Code	301
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna Medicare Advantage	$39.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.22
Rate for Payer: Cigna Commercial	$100.50
Rate for Payer: Cigna Medicare Advantage	$12.25
Rate for Payer: Clover Medicare Advantage	$11.64
Rate for Payer: EmblemHealth Commercial	$36.75
Rate for Payer: Humana Medicare Advantage	$12.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.25
Rate for Payer: Wellcare Medicare Advantage	$12.25
Rate for Payer: Wellpoint Medicaid Managed Care	$5.33

CH DIBUCAINE NUMBER

Facility

$201.00

Service Code	HCPCS 82638
Hospital Charge Code	397072057
Hospital Revenue Code	301
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

CH DIFFERENTIAL AUTO

Facility

$390.00

Service Code	HCPCS 85004
Hospital Charge Code	397021026
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH DIFFERENTIAL AUTO

Facility

$390.00

Service Code	HCPCS 85004
Hospital Charge Code	397021026
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH DIGITOXIN

Facility

$131.00

Service Code	HCPCS 80299
Hospital Charge Code	397071206
Hospital Revenue Code	301
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

CH DIGITOXIN

Facility

$131.00

Service Code	HCPCS 80299
Hospital Charge Code	397071206
Hospital Revenue Code	301
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

CH DIGOXIN

Facility

$83.00

Service Code	HCPCS 80162
Hospital Charge Code	397071149
Hospital Revenue Code	301
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.12
Rate for Payer: Aetna Medicare Advantage	$43.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.94
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: Cigna Medicare Advantage	$13.28
Rate for Payer: Clover Medicare Advantage	$12.62
Rate for Payer: EmblemHealth Commercial	$39.84
Rate for Payer: Humana Medicare Advantage	$13.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.28
Rate for Payer: Wellcare Medicare Advantage	$13.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.20

CH DIGOXIN

Facility

$83.00

Service Code	HCPCS 80162
Hospital Charge Code	397071149
Hospital Revenue Code	301
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

CH DIHYDROTESTOSTERONE SERUM

Facility

$132.00

Service Code	HCPCS 80327
Hospital Charge Code	397070006
Hospital Revenue Code	301
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.16
Rate for Payer: Aetna Medicare Advantage	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.66
Rate for Payer: Cigna Commercial	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$3.50

CH DIHYDROTESTOSTERONE SERUM

Facility

$132.00

Service Code	HCPCS 80327
Hospital Charge Code	397070006
Hospital Revenue Code	301
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.80

CH DILANTIN

Facility

$118.00

Service Code	HCPCS 80185
Hospital Charge Code	397071297
Hospital Revenue Code	301
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.83
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

CH DILANTIN

Facility

$118.00

Service Code	HCPCS 80185
Hospital Charge Code	397071297
Hospital Revenue Code	301
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

CH DIPHTHERIA AB TITER

Facility

$249.00

Service Code	HCPCS 86648
Hospital Charge Code	397073628
Hospital Revenue Code	302
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$37.35
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

CH DIPHTHERIA AB TITER

Facility

$249.00

Service Code	HCPCS 86648
Hospital Charge Code	397073628
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$124.50
Rate for Payer: Aetna Commercial	$41.37
Rate for Payer: Aetna Medicare Advantage	$49.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.90
Rate for Payer: Cigna Commercial	$124.50
Rate for Payer: Cigna Medicare Advantage	$15.21
Rate for Payer: Clover Medicare Advantage	$14.45
Rate for Payer: EmblemHealth Commercial	$45.63
Rate for Payer: Humana Medicare Advantage	$15.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.21
Rate for Payer: Wellcare Medicare Advantage	$15.21
Rate for Payer: Wellpoint Medicaid Managed Care	$6.60

CH DIRECT COOMBS (DAT)

Facility

$59.00

Service Code	HCPCS 86880
Hospital Charge Code	397031026
Hospital Revenue Code	300
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

Know your out-of-pocket cost for care.

All Charges