Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT AFX MAIN BODY 25x90

Facility

$65,795.00

Hospital Charge Code	270677832
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

GRAFT AFX MAIN BODY 25X90

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270680103
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFX MAIN BODY 25X90

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270680103
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

GRAFT AFX MAIN BODY 25X90MM

Facility

$57,900.00

Hospital Charge Code	270665612
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 25X90MM

Facility

$57,900.00

Hospital Charge Code	270667712
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 25X90MM

Facility

$57,900.00

Hospital Charge Code	270667712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 25X90MM

Facility

$57,900.00

Hospital Charge Code	270665612
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x100mm

Facility

$57,900.00

Hospital Charge Code	270673845
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 28x100mm

Facility

$57,900.00

Hospital Charge Code	270673845O
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x100mm

Facility

$57,900.00

Hospital Charge Code	270673845O
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 28x100mm

Facility

$57,900.00

Hospital Charge Code	270673845
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x60mm

Facility

$57,900.00

Hospital Charge Code	270646485
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28x60mm

Facility

$57,900.00

Hospital Charge Code	270646485
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 28x70

Facility

$65,795.00

Hospital Charge Code	270677830
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFX MAIN BODY 28x70

Facility

$65,795.00

Hospital Charge Code	270677830
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

GRAFT AFX MAIN BODY 28x70mm

Facility

$57,900.00

Hospital Charge Code	270646239
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 28x70mm

Facility

$57,900.00

Hospital Charge Code	270646239
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28X70MM

Facility

$57,900.00

Hospital Charge Code	270667713
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28X70MM

Facility

$57,900.00

Hospital Charge Code	270667713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 28X90MM

Facility

$57,900.00

Hospital Charge Code	270666861
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 28X90MM

Facility

$57,900.00

Hospital Charge Code	270666861
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AG PRIMATRIX 8x12cm

Facility

$15,695.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673606
Hospital Revenue Code	278
Min. Negotiated Rate	$2,354.25
Max. Negotiated Rate	$3,798.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,139.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,798.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,452.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,354.25

GRAFT AG PRIMATRIX 8x12cm

Facility

$15,695.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673606
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,798.19
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,798.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,452.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,354.25
Rate for Payer: UnitedHealthcare Community & State	$378.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$415.92

GRAFT ALDERM NON-MH 200 201010

Facility

$41.20

Service Code	HCPCS Q4116
Hospital Charge Code	270633030
Hospital Revenue Code	636
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$9.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.18

GRAFT ALDERM NON-MH 200 201010

Facility

$41.20

Service Code	HCPCS Q4116
Hospital Charge Code	270633030
Hospital Revenue Code	636
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$533.66
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.18
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

Know your out-of-pocket cost for care.

All Charges