Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CT ANGIO LOW EXT W/WO CON

Facility

$9,500.00

Service Code	HCPCS 73706
Hospital Charge Code	2209001
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ANGIO LOW EXT W/WO CON

Facility

$9,500.00

Service Code	HCPCS 73706
Hospital Charge Code	2209001
Hospital Revenue Code	352
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$958.88
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT ANGIO PELVIS W CONTRAST

Facility

$9,500.00

Service Code	HCPCS 72191
Hospital Charge Code	2250408
Hospital Revenue Code	352
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT ANGIO PELVIS W CONTRAST

Facility

$9,500.00

Service Code	HCPCS 72191
Hospital Charge Code	2250408
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ANGIO UPPER EXT LEFT

Facility

$1,770.90

Service Code	HCPCS 73206LT
Hospital Charge Code	2205450
Hospital Revenue Code	352
Min. Negotiated Rate	$42.68
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$672.94
Rate for Payer: Aetna Medicare Advantage	$531.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.58
Rate for Payer: Cigna Commercial	$885.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$531.27
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$265.63
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$42.68
Rate for Payer: Wellpoint Medicaid Managed Care	$46.93

CT ANGIO UPPER EXT LEFT

Facility

$1,770.90

Service Code	HCPCS 73206LT
Hospital Charge Code	2205450
Hospital Revenue Code	352
Min. Negotiated Rate	$265.63
Max. Negotiated Rate	$265.63
Rate for Payer: Qualcare PPO/HMO/WC	$265.63

CT ANGIO UPPER EXT RIGHT

Facility

$1,770.90

Service Code	HCPCS 73206RT
Hospital Charge Code	2205451
Hospital Revenue Code	352
Min. Negotiated Rate	$42.68
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$672.94
Rate for Payer: Aetna Medicare Advantage	$531.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.58
Rate for Payer: Cigna Commercial	$885.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$531.27
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$265.63
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$42.68
Rate for Payer: Wellpoint Medicaid Managed Care	$46.93

CT ANGIO UPPER EXT RIGHT

Facility

$1,770.90

Service Code	HCPCS 73206RT
Hospital Charge Code	2205451
Hospital Revenue Code	352
Min. Negotiated Rate	$265.63
Max. Negotiated Rate	$265.63
Rate for Payer: Qualcare PPO/HMO/WC	$265.63

CT ANGIO UPR EXTRM W/WO DYE

Facility

$9,500.00

Service Code	HCPCS 73206
Hospital Charge Code	2205293
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ANGIO UPR EXTRM W/WO DYE

Facility

$9,500.00

Service Code	HCPCS 73206
Hospital Charge Code	2205293
Hospital Revenue Code	352
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT ANKLE W/ CONTRAST BILATERAL

Facility

$1,521.90

Service Code	HCPCS 73701
Hospital Charge Code	2205315
Hospital Revenue Code	352
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.57
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$228.28
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$36.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$958.88
Rate for Payer: Wellpoint Medicaid Managed Care	$40.33

CT ANKLE W/ CONTRAST BILATERAL

Facility

$1,521.90

Service Code	HCPCS 73701
Hospital Charge Code	2205315
Hospital Revenue Code	352
Min. Negotiated Rate	$228.28
Max. Negotiated Rate	$228.28
Rate for Payer: Qualcare PPO/HMO/WC	$228.28

CT ANKLE W/ CONTRAST LEFT

Facility

$1,521.90

Service Code	HCPCS 73701
Hospital Charge Code	2205316
Hospital Revenue Code	352
Min. Negotiated Rate	$228.28
Max. Negotiated Rate	$228.28
Rate for Payer: Qualcare PPO/HMO/WC	$228.28

CT ANKLE W/ CONTRAST LEFT

Facility

$1,521.90

Service Code	HCPCS 73701
Hospital Charge Code	2205316
Hospital Revenue Code	352
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.57
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$228.28
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$36.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$958.88
Rate for Payer: Wellpoint Medicaid Managed Care	$40.33

CT ANKLE W/ CONTRAST RIGHT

Facility

$1,810.20

Service Code	HCPCS 73701RT
Hospital Charge Code	2205317
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT ANKLE W/ CONTRAST RIGHT

Facility

$1,810.20

Service Code	HCPCS 73701RT
Hospital Charge Code	2205317
Hospital Revenue Code	352
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$687.88
Rate for Payer: Aetna Medicare Advantage	$543.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.60
Rate for Payer: Cigna Commercial	$905.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.06
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.53
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$43.63
Rate for Payer: Wellpoint Medicaid Managed Care	$47.97

CT ANKLE W/O CONTRAST BILTERAL

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205318
Hospital Revenue Code	352
Min. Negotiated Rate	$27.01
Max. Negotiated Rate	$3,354.00
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	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
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	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
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	$336.23
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.11
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$27.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.70

CT ANKLE W/O CONTRAST BILTERAL

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205318
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT ANKLE W/O CONTRAST LEFT

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205319
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT ANKLE W/O CONTRAST LEFT

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205319
Hospital Revenue Code	352
Min. Negotiated Rate	$27.01
Max. Negotiated Rate	$3,354.00
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	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
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	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
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	$336.23
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.11
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$27.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.70

CT ANKLE W/O CONTRAST RIGHT

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205320
Hospital Revenue Code	352
Min. Negotiated Rate	$27.01
Max. Negotiated Rate	$3,354.00
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	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
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	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
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	$336.23
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.11
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$27.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.70

CT ANKLE W/O CONTRAST RIGHT

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205320
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT ANKLE W/&W/O CONTRAST BLTRL

Facility

$3,620.40

Service Code	HCPCS 7370250
Hospital Charge Code	2205452
Hospital Revenue Code	352
Min. Negotiated Rate	$87.25
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,375.75
Rate for Payer: Aetna Medicare Advantage	$1,086.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$923.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$923.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$923.20
Rate for Payer: Cigna Commercial	$1,810.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,086.12
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$543.06
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$87.25
Rate for Payer: Wellpoint Medicaid Managed Care	$95.94

CT ANKLE W/&W/O CONTRAST BLTRL

Facility

$3,620.40

Service Code	HCPCS 7370250
Hospital Charge Code	2205452
Hospital Revenue Code	352
Min. Negotiated Rate	$543.06
Max. Negotiated Rate	$543.06
Rate for Payer: Qualcare PPO/HMO/WC	$543.06

CT ANKLE W/&W/O CONTRAST LEFT

Facility

$1,810.20

Service Code	HCPCS 73702LT
Hospital Charge Code	2205453
Hospital Revenue Code	352
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$687.88
Rate for Payer: Aetna Medicare Advantage	$543.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.60
Rate for Payer: Cigna Commercial	$905.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.06
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.53
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$43.63
Rate for Payer: Wellpoint Medicaid Managed Care	$47.97

Know your out-of-pocket cost for care.

All Charges