Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANTIPHOSPHOLIPID AB PRO

Facility

$302.45

Service Code	HCPCS 86146
Hospital Charge Code	3035068B
Hospital Revenue Code	302
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$45.37
Rate for Payer: Qualcare PPO/HMO/WC	$45.37

ANTIPHOSPHOLIPID AB PRO

Facility

$58.90

Service Code	HCPCS 86148
Hospital Charge Code	3035068E
Hospital Revenue Code	302
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$29.45
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.84
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

ANTIPHOSPHOLIPID AB PRO

Facility

$358.45

Service Code	HCPCS 8614791
Hospital Charge Code	3035068I
Hospital Revenue Code	302
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$179.22
Rate for Payer: Aetna Commercial	$136.21
Rate for Payer: Aetna Medicare Advantage	$107.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.40
Rate for Payer: Cigna Commercial	$179.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.50

ANTIPHOSPHOLIPID AB PRO

Facility

$58.90

Service Code	HCPCS 86148
Hospital Charge Code	3035068D
Hospital Revenue Code	302
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$8.84
Rate for Payer: Qualcare PPO/HMO/WC	$8.84

ANTIPHOSPHOLIPID AB PRO

Facility

$302.45

Service Code	HCPCS 86146
Hospital Charge Code	3035068B
Hospital Revenue Code	302
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$151.22
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$151.22
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$8.01

ANTIPHOSPHOLIPID AB PRO

Facility

$358.45

Service Code	HCPCS 8614791
Hospital Charge Code	3035068G
Hospital Revenue Code	302
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$179.22
Rate for Payer: Aetna Commercial	$136.21
Rate for Payer: Aetna Medicare Advantage	$107.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.40
Rate for Payer: Cigna Commercial	$179.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.50

ANTIPHOSPHOLIPID AB PRO

Facility

$58.90

Service Code	HCPCS 86148
Hospital Charge Code	3035068F
Hospital Revenue Code	302
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$29.45
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.84
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

ANTIPHOSPHOLIPID AB PRO

Facility

$358.45

Service Code	HCPCS 8614791
Hospital Charge Code	3035068H
Hospital Revenue Code	302
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$179.22
Rate for Payer: Aetna Commercial	$136.21
Rate for Payer: Aetna Medicare Advantage	$107.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.40
Rate for Payer: Cigna Commercial	$179.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.50

ANTIPHOSPHOLIPID AB PRO

Facility

$58.90

Service Code	HCPCS 86148
Hospital Charge Code	3035068E
Hospital Revenue Code	302
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$8.84
Rate for Payer: Qualcare PPO/HMO/WC	$8.84

ANTIPHOSPHOLIPID AB PRO

Facility

$58.90

Service Code	HCPCS 86148
Hospital Charge Code	3035068D
Hospital Revenue Code	302
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$29.45
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.84
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

ANTIPHOSPHOLIPID AB PRO

Facility

$302.45

Service Code	HCPCS 86146
Hospital Charge Code	3035068A
Hospital Revenue Code	302
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$151.22
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$151.22
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$8.01

ANTIPHOSPHOLIPID AB PRO

Facility

$358.45

Service Code	HCPCS 8614791
Hospital Charge Code	3035068H
Hospital Revenue Code	302
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

ANTIPHOSPHOLIPID AB PRO

Facility

$358.45

Service Code	HCPCS 8614791
Hospital Charge Code	3035068G
Hospital Revenue Code	302
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

ANTIPHOSPHOLIPID AB PRO

Facility

$58.90

Service Code	HCPCS 86148
Hospital Charge Code	3035068F
Hospital Revenue Code	302
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$8.84
Rate for Payer: Qualcare PPO/HMO/WC	$8.84

ANTIPHOSPHOLIPID AB PRO

Facility

$302.45

Service Code	HCPCS 86146
Hospital Charge Code	3035068A
Hospital Revenue Code	302
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$45.37
Rate for Payer: Qualcare PPO/HMO/WC	$45.37

ANTIPHOSPHOLIPID AB PRO

Facility

$358.45

Service Code	HCPCS 8614791
Hospital Charge Code	3035068I
Hospital Revenue Code	302
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

ANTI PLATELET ANTIBODIES

Facility

$493.65

Service Code	HCPCS 86022
Hospital Charge Code	3006517
Hospital Revenue Code	302
Min. Negotiated Rate	$74.05
Max. Negotiated Rate	$74.05
Rate for Payer: Qualcare PPO/HMO/WC	$74.05

ANTI PLATELET ANTIBODIES

Facility

$493.65

Service Code	HCPCS 86022
Hospital Charge Code	3006517
Hospital Revenue Code	302
Min. Negotiated Rate	$13.08
Max. Negotiated Rate	$246.82
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$59.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.31
Rate for Payer: Cigna Commercial	$246.82
Rate for Payer: Cigna Medicare Advantage	$18.37
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Medicare Advantage	$18.37
Rate for Payer: Wellpoint Medicaid Managed Care	$13.08

ANTI-PLATELET ANTIBODIES

Facility

$567.00

Service Code	HCPCS 86022
Hospital Charge Code	38476060
Hospital Revenue Code	302
Min. Negotiated Rate	$85.05
Max. Negotiated Rate	$85.05
Rate for Payer: Qualcare PPO/HMO/WC	$85.05

ANTI-PLATELET ANTIBODIES

Facility

$567.00

Service Code	HCPCS 86022
Hospital Charge Code	38476060
Hospital Revenue Code	302
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$59.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.31
Rate for Payer: Cigna Commercial	$283.50
Rate for Payer: Cigna Medicare Advantage	$18.37
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Medicare Advantage	$18.37
Rate for Payer: Wellpoint Medicaid Managed Care	$15.03

ANTI PM 1 ANTIBODY

Facility

$388.00

Service Code	HCPCS 86331
Hospital Charge Code	38476251
Hospital Revenue Code	302
Min. Negotiated Rate	$58.20
Max. Negotiated Rate	$58.20
Rate for Payer: Qualcare PPO/HMO/WC	$58.20

ANTI PM 1 ANTIBODY

Facility

$388.00

Service Code	HCPCS 86331
Hospital Charge Code	38476251
Hospital Revenue Code	302
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$194.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$194.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.28

ANTI-PM/SCL-100AB (EIA)

Facility

$667.59

Service Code	HCPCS 86235
Hospital Charge Code	3847977
Hospital Revenue Code	302
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

ANTI-PM/SCL-100AB (EIA)

Facility

$667.59

Service Code	HCPCS 86235
Hospital Charge Code	3847977
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	39990222
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

Know your out-of-pocket cost for care.

All Charges