Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CYPROHEPTADINE/4MG/TAB

Facility

$4.00

Hospital Charge Code	60632764
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
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	$1.20
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	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CYPROHEPTADINE/4MG/TAB

Facility

$4.00

Hospital Charge Code	60632764
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CYPROHEPTADINE SYRP 2MG/5ML

Facility

$4.56

Service Code	NDC 64980050448
Hospital Charge Code	60629033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

CYPROHEPTADINE SYRP 2MG/5ML

Facility

$4.56

Service Code	NDC 64980050448
Hospital Charge Code	60629033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.28
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna Medicare Advantage	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.16
Rate for Payer: Cigna Commercial	$2.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.37
Rate for Payer: Oxford Commercial	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.91
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

CYSTAIN C

Facility

$390.00

Service Code	HCPCS 82610
Hospital Charge Code	38479749
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CYSTAIN C

Facility

$390.00

Service Code	HCPCS 82610
Hospital Charge Code	38479749
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.37
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.52
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.52
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	$14.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Medicare Advantage	$18.52
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CYST ASP BREAST EA ADDL CYST

Facility

$669.90

Service Code	HCPCS 19001
Hospital Charge Code	75190105
Hospital Revenue Code	510
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$334.95
Rate for Payer: Aetna Commercial	$254.56
Rate for Payer: Aetna Medicare Advantage	$200.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.82
Rate for Payer: Cigna Commercial	$334.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.97
Rate for Payer: Qualcare PPO/HMO/WC	$100.48
Rate for Payer: UnitedHealthcare Community & State	$16.14
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

CYST ASP BREAST EA ADDL CYST

Facility

$669.90

Service Code	HCPCS 19001
Hospital Charge Code	75190105
Hospital Revenue Code	510
Min. Negotiated Rate	$100.48
Max. Negotiated Rate	$100.48
Rate for Payer: Qualcare PPO/HMO/WC	$100.48

CYST ASP BREAST INITIAL CYST

Facility

$1,901.69

Service Code	HCPCS 19000
Hospital Charge Code	75190100
Hospital Revenue Code	510
Min. Negotiated Rate	$285.25
Max. Negotiated Rate	$285.25
Rate for Payer: Qualcare PPO/HMO/WC	$285.25

CYST ASP BREAST INITIAL CYST

Facility

$1,901.69

Service Code	HCPCS 19000
Hospital Charge Code	75190100
Hospital Revenue Code	510
Min. Negotiated Rate	$45.83
Max. Negotiated Rate	$3,036.77
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$570.51
Rate for Payer: Qualcare PPO/HMO/WC	$285.25
Rate for Payer: UnitedHealthcare Community & State	$45.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$50.39

CYSTATIN C

Facility

$96.00

Service Code	HCPCS 82610
Hospital Charge Code	38477117
Hospital Revenue Code	301
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

CYSTATIN C

Facility

$96.00

Service Code	HCPCS 82610
Hospital Charge Code	38477117
Hospital Revenue Code	301
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.37
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.85
Rate for Payer: Cigna Commercial	$48.00
Rate for Payer: Cigna Medicare Advantage	$18.52
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Medicare Advantage	$18.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.54

CYSTICERCOSIS ANTIBODY

Facility

$128.00

Service Code	HCPCS 86682
Hospital Charge Code	38479421
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CYSTICERCOSIS ANTIBODY

Facility

$128.00

Service Code	HCPCS 86682
Hospital Charge Code	38479421
Hospital Revenue Code	302
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.39
Rate for Payer: Aetna Medicare Advantage	$42.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.96
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: Cigna Medicare Advantage	$13.01
Rate for Payer: Clover Medicare Advantage	$12.36
Rate for Payer: EmblemHealth Commercial	$39.03
Rate for Payer: Humana Medicare Advantage	$13.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.01
Rate for Payer: Wellcare Medicare Advantage	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

CYSTICERCOSIS ANTIBODY

Facility

$128.00

Service Code	HCPCS 86682
Hospital Charge Code	38476225
Hospital Revenue Code	302
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CYSTICERCOSIS ANTIBODY

Facility

$128.00

Service Code	HCPCS 86682
Hospital Charge Code	38476225
Hospital Revenue Code	302
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.39
Rate for Payer: Aetna Medicare Advantage	$42.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.96
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: Cigna Medicare Advantage	$13.01
Rate for Payer: Clover Medicare Advantage	$12.36
Rate for Payer: EmblemHealth Commercial	$39.03
Rate for Payer: Humana Medicare Advantage	$13.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.01
Rate for Payer: Wellcare Medicare Advantage	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

CYSTICERCUS IGG AB,WB

Facility

$390.00

Service Code	HCPCS 86682
Hospital Charge Code	38479748
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.39
Rate for Payer: Aetna Medicare Advantage	$42.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.96
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.01
Rate for Payer: Clover Medicare Advantage	$12.36
Rate for Payer: EmblemHealth Commercial	$39.03
Rate for Payer: Humana Medicare Advantage	$13.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.01
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	$10.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.01
Rate for Payer: Wellcare Medicare Advantage	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CYSTICERCUS IGG AB,WB

Facility

$390.00

Service Code	HCPCS 86682
Hospital Charge Code	38479748
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CYSTICERCUS IgG AB,WB(SER

Facility

$89.40

Service Code	HCPCS 86682
Hospital Charge Code	39900238
Hospital Revenue Code	302
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.39
Rate for Payer: Aetna Medicare Advantage	$42.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.96
Rate for Payer: Cigna Commercial	$44.70
Rate for Payer: Cigna Medicare Advantage	$13.01
Rate for Payer: Clover Medicare Advantage	$12.36
Rate for Payer: EmblemHealth Commercial	$39.03
Rate for Payer: Humana Medicare Advantage	$13.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.41
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.01
Rate for Payer: Wellcare Medicare Advantage	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$2.37

CYSTICERCUS IgG AB,WB(SER

Facility

$89.40

Service Code	HCPCS 86682
Hospital Charge Code	39900238
Hospital Revenue Code	302
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$13.41
Rate for Payer: Qualcare PPO/HMO/WC	$13.41

CYSTICEROSIS ANTIBODY

Facility

$131.25

Service Code	HCPCS 86317
Hospital Charge Code	3009339
Hospital Revenue Code	302
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.77
Rate for Payer: Aetna Medicare Advantage	$48.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.11
Rate for Payer: Cigna Commercial	$65.62
Rate for Payer: Cigna Medicare Advantage	$14.99
Rate for Payer: Clover Medicare Advantage	$14.24
Rate for Payer: EmblemHealth Commercial	$44.97
Rate for Payer: Humana Medicare Advantage	$15.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.99
Rate for Payer: Wellcare Medicare Advantage	$14.99
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

CYSTICEROSIS ANTIBODY

Facility

$131.25

Service Code	HCPCS 86317
Hospital Charge Code	3009339
Hospital Revenue Code	302
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

CYSTIC FIBROSIS DNA

Facility

$395.00

Service Code	HCPCS 81220
Hospital Charge Code	39900015
Hospital Revenue Code	310
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$59.25
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

CYSTIC FIBROSIS DNA

Facility

$395.00

Service Code	HCPCS 81220
Hospital Charge Code	39900015
Hospital Revenue Code	310
Min. Negotiated Rate	$10.47
Max. Negotiated Rate	$2,009.16
Rate for Payer: Aetna Commercial	$1,513.95
Rate for Payer: Aetna Medicare Advantage	$1,803.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,009.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,009.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,009.16
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: Cigna Medicare Advantage	$556.60
Rate for Payer: Clover Medicare Advantage	$528.77
Rate for Payer: EmblemHealth Commercial	$1,669.80
Rate for Payer: Humana Medicare Advantage	$573.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$556.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$445.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$556.60
Rate for Payer: Wellcare Medicare Advantage	$556.60
Rate for Payer: Wellpoint Medicaid Managed Care	$10.47

CYSTIC FIBROSIS EXPANDED SCRN

Facility

$6,000.00

Service Code	HCPCS 81220
Hospital Charge Code	3038551
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$1,513.95
Rate for Payer: Aetna Medicare Advantage	$1,803.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,009.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,009.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,009.16
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: Cigna Medicare Advantage	$556.60
Rate for Payer: Clover Medicare Advantage	$528.77
Rate for Payer: EmblemHealth Commercial	$1,669.80
Rate for Payer: Humana Medicare Advantage	$573.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$556.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,800.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$445.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$556.60
Rate for Payer: Wellcare Medicare Advantage	$556.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

Know your out-of-pocket cost for care.

All Charges