Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEP B SURFACE AB QN

Facility

$559.00

Service Code	HCPCS 86706
Hospital Charge Code	38479104
Hospital Revenue Code	302
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$279.50
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.77
Rate for Payer: Cigna Commercial	$279.50
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$14.81

HEP B SURFACE ANTIBODY

Facility

$559.00

Service Code	HCPCS 86706
Hospital Charge Code	38479489
Hospital Revenue Code	302
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$279.50
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.77
Rate for Payer: Cigna Commercial	$279.50
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$14.81

HEP B SURFACE ANTIBODY

Facility

$559.00

Service Code	HCPCS 86706
Hospital Charge Code	38479489
Hospital Revenue Code	302
Min. Negotiated Rate	$83.85
Max. Negotiated Rate	$83.85
Rate for Payer: Qualcare PPO/HMO/WC	$83.85

HEP B SURF ANTIBODY

Facility

$311.00

Service Code	HCPCS 86706
Hospital Charge Code	38479492
Hospital Revenue Code	302
Min. Negotiated Rate	$8.24
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.77
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

HEP B SURF ANTIBODY

Facility

$311.00

Service Code	HCPCS 86706
Hospital Charge Code	38479492
Hospital Revenue Code	302
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

HEP B SURF ANTIG

Facility

$311.00

Service Code	HCPCS 86706
Hospital Charge Code	38479488
Hospital Revenue Code	302
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

HEP B SURF ANTIG

Facility

$311.00

Service Code	HCPCS 86706
Hospital Charge Code	38479488
Hospital Revenue Code	302
Min. Negotiated Rate	$8.24
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.77
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

HEP B VIRUSDRUGRESIST GENO BCP

Facility

$399.96

Service Code	HCPCS 87912
Hospital Charge Code	397080003
Hospital Revenue Code	306
Min. Negotiated Rate	$59.99
Max. Negotiated Rate	$59.99
Rate for Payer: Qualcare PPO/HMO/WC	$59.99

HEP B VIRUSDRUGRESIST GENO BCP

Facility

$399.96

Service Code	HCPCS 87912
Hospital Charge Code	397080003
Hospital Revenue Code	306
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$929.32
Rate for Payer: Aetna Commercial	$700.26
Rate for Payer: Aetna Medicare Advantage	$834.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$929.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$929.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$657.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$929.32
Rate for Payer: Cigna Commercial	$199.98
Rate for Payer: Cigna Medicare Advantage	$257.45
Rate for Payer: Clover Medicare Advantage	$244.58
Rate for Payer: EmblemHealth Commercial	$772.35
Rate for Payer: Humana Medicare Advantage	$265.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$257.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.99
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$205.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.45
Rate for Payer: Wellcare Medicare Advantage	$257.45
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

HEP C AB W RFL HCV,RNA QNT PCR

Facility

$97.20

Hospital Charge Code	39708041
Hospital Revenue Code	306
Min. Negotiated Rate	$14.58
Max. Negotiated Rate	$14.58
Rate for Payer: Qualcare PPO/HMO/WC	$14.58

HEP C AB W RFL HCV,RNA QNT PCR

Facility

$97.20

Hospital Charge Code	39708041
Hospital Revenue Code	306
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.94
Rate for Payer: Aetna Medicare Advantage	$29.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.79
Rate for Payer: Cigna Commercial	$48.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.58
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

HEP C GENO

Facility

$495.25

Hospital Charge Code	3032738
Hospital Revenue Code	301
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$247.62
Rate for Payer: Aetna Commercial	$188.19
Rate for Payer: Aetna Medicare Advantage	$148.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.29
Rate for Payer: Cigna Commercial	$247.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.29
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.94
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

HEP C GENO

Facility

$495.25

Hospital Charge Code	3032738
Hospital Revenue Code	301
Min. Negotiated Rate	$74.29
Max. Negotiated Rate	$74.29
Rate for Payer: Qualcare PPO/HMO/WC	$74.29

HEP-C VIRUS AB (HCV)

Facility

$141.65

Service Code	HCPCS 86803
Hospital Charge Code	3032737
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.51
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

HEP-C VIRUS AB (HCV)

Facility

$141.65

Service Code	HCPCS 86803
Hospital Charge Code	3032737
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

HEP-LOCK/10U/1ML

Facility

$7.00

Hospital Charge Code	60633082
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

HEP-LOCK/10U/1ML

Facility

$7.00

Hospital Charge Code	60633082
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

HEP STEIN BAR ANTI VCA

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38479495
Hospital Revenue Code	302
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

HEP STEIN BAR ANTI VCA

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38479495
Hospital Revenue Code	302
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

HER-2/NEU QUANT ELISA

Facility

$442.70

Service Code	HCPCS 83950
Hospital Charge Code	3038127
Hospital Revenue Code	300
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$175.20
Rate for Payer: Aetna Medicare Advantage	$208.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.50
Rate for Payer: Cigna Commercial	$221.35
Rate for Payer: Cigna Medicare Advantage	$64.41
Rate for Payer: Clover Medicare Advantage	$61.19
Rate for Payer: EmblemHealth Commercial	$193.23
Rate for Payer: Humana Medicare Advantage	$66.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.81
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.41
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.41
Rate for Payer: Wellcare Medicare Advantage	$64.41
Rate for Payer: Wellpoint Medicaid Managed Care	$11.73

HER-2/NEU QUANT ELISA

Facility

$442.70

Service Code	HCPCS 83950
Hospital Charge Code	3038127
Hospital Revenue Code	300
Min. Negotiated Rate	$66.41
Max. Negotiated Rate	$66.41
Rate for Payer: Qualcare PPO/HMO/WC	$66.41

HER2 PARAFFIN BLOCK 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061081
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

HER2 PARAFFIN BLOCK 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061081
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

HERBERT BONE SCREW

Facility

$681.00

Hospital Charge Code	270335016
Hospital Revenue Code	278
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$340.50
Rate for Payer: Aetna Commercial	$258.78
Rate for Payer: Aetna Medicare Advantage	$204.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.66
Rate for Payer: Cigna Commercial	$340.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.82
Rate for Payer: Qualcare PPO/HMO/WC	$102.15
Rate for Payer: UnitedHealthcare Community & State	$16.41
Rate for Payer: Wellpoint Medicaid Managed Care	$18.05

HERBERT BONE SCREW

Facility

$681.00

Hospital Charge Code	270335016
Hospital Revenue Code	278
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$164.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.82
Rate for Payer: Qualcare PPO/HMO/WC	$102.15

Know your out-of-pocket cost for care.

All Charges