Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-MYELOGRAM INJECTION

Facility

$678.00

Service Code	HCPCS 62284
Hospital Charge Code	2670220
Hospital Revenue Code	361
Min. Negotiated Rate	$101.70
Max. Negotiated Rate	$101.70
Rate for Payer: Qualcare PPO/HMO/WC	$101.70

IR MYELOGRAM LUMBAR

Facility

$3,939.00

Service Code	HCPCS 62304
Hospital Charge Code	7411656
Hospital Revenue Code	361
Min. Negotiated Rate	$590.85
Max. Negotiated Rate	$590.85
Rate for Payer: Qualcare PPO/HMO/WC	$590.85

IR MYELOGRAM LUMBAR

Facility

$3,939.00

Hospital Charge Code	2692124
Hospital Revenue Code	361
Min. Negotiated Rate	$590.85
Max. Negotiated Rate	$590.85
Rate for Payer: Qualcare PPO/HMO/WC	$590.85

IR MYELOGRAM LUMBAR

Facility

$3,939.00

Hospital Charge Code	2692124
Hospital Revenue Code	361
Min. Negotiated Rate	$94.93
Max. Negotiated Rate	$1,969.50
Rate for Payer: Aetna Commercial	$1,496.82
Rate for Payer: Aetna Medicare Advantage	$1,181.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,004.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,004.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,004.45
Rate for Payer: Cigna Commercial	$1,969.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.85
Rate for Payer: UnitedHealthcare Community & State	$94.93
Rate for Payer: Wellpoint Medicaid Managed Care	$104.38

IR MYELOGRAM LUMBAR

Facility

$3,939.00

Service Code	HCPCS 62304
Hospital Charge Code	7411656
Hospital Revenue Code	361
Min. Negotiated Rate	$94.93
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,533.19
Rate for Payer: Aetna Medicare Advantage	$3,017.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$931.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,361.79
Rate for Payer: Cigna Commercial	$1,866.82
Rate for Payer: Cigna Medicare Advantage	$931.32
Rate for Payer: Clover Medicare Advantage	$884.75
Rate for Payer: EmblemHealth Commercial	$2,793.96
Rate for Payer: Humana Medicare Advantage	$959.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$931.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.70
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$590.85
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$94.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$931.32
Rate for Payer: Wellcare Medicare Advantage	$931.32
Rate for Payer: Wellpoint Medicaid Managed Care	$104.38

IR MYELOGRAM THORACIC

Facility

$3,939.00

Hospital Charge Code	2692123
Hospital Revenue Code	361
Min. Negotiated Rate	$94.93
Max. Negotiated Rate	$1,969.50
Rate for Payer: Aetna Commercial	$1,496.82
Rate for Payer: Aetna Medicare Advantage	$1,181.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,004.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,004.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,004.45
Rate for Payer: Cigna Commercial	$1,969.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.85
Rate for Payer: UnitedHealthcare Community & State	$94.93
Rate for Payer: Wellpoint Medicaid Managed Care	$104.38

IR MYELOGRAM THORACIC

Facility

$3,939.00

Service Code	HCPCS 62303
Hospital Charge Code	7411655
Hospital Revenue Code	361
Min. Negotiated Rate	$590.85
Max. Negotiated Rate	$590.85
Rate for Payer: Qualcare PPO/HMO/WC	$590.85

IR MYELOGRAM THORACIC

Facility

$3,939.00

Hospital Charge Code	2692123
Hospital Revenue Code	361
Min. Negotiated Rate	$590.85
Max. Negotiated Rate	$590.85
Rate for Payer: Qualcare PPO/HMO/WC	$590.85

IR MYELOGRAM THORACIC

Facility

$3,939.00

Service Code	HCPCS 62303
Hospital Charge Code	7411655
Hospital Revenue Code	361
Min. Negotiated Rate	$94.93
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,533.19
Rate for Payer: Aetna Medicare Advantage	$3,017.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$931.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,361.79
Rate for Payer: Cigna Commercial	$1,866.82
Rate for Payer: Cigna Medicare Advantage	$931.32
Rate for Payer: Clover Medicare Advantage	$884.75
Rate for Payer: EmblemHealth Commercial	$2,793.96
Rate for Payer: Humana Medicare Advantage	$959.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$931.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.70
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$590.85
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$94.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$931.32
Rate for Payer: Wellcare Medicare Advantage	$931.32
Rate for Payer: Wellpoint Medicaid Managed Care	$104.38

IR NDL BIOPSY BONE DEEP PERC

Facility

$7,219.95

Service Code	HCPCS 20225
Hospital Charge Code	7411342
Hospital Revenue Code	361
Min. Negotiated Rate	$1,082.99
Max. Negotiated Rate	$1,082.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,082.99

IR NDL BIOPSY BONE DEEP PERC

Facility

$8,054.80

Service Code	HCPCS 20225
Hospital Charge Code	2004596
Hospital Revenue Code	361
Min. Negotiated Rate	$194.12
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,416.44
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$194.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$213.45

IR NDL BIOPSY BONE DEEP PERC

Facility

$8,054.80

Service Code	HCPCS 20225
Hospital Charge Code	321020225
Hospital Revenue Code	361
Min. Negotiated Rate	$1,208.22
Max. Negotiated Rate	$1,208.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22

IR NDL BIOPSY BONE DEEP PERC

Facility

$8,054.80

Service Code	HCPCS 20225
Hospital Charge Code	321020225
Hospital Revenue Code	361
Min. Negotiated Rate	$194.12
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,416.44
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$194.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$213.45

IR NDL BIOPSY BONE DEEP PERC

Facility

$8,054.80

Service Code	HCPCS 20225
Hospital Charge Code	2004596
Hospital Revenue Code	361
Min. Negotiated Rate	$1,208.22
Max. Negotiated Rate	$1,208.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22

IR NDL BIOPSY BONE DEEP PERC

Facility

$7,219.95

Service Code	HCPCS 20225
Hospital Charge Code	7411342
Hospital Revenue Code	361
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,165.99
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,082.99
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$174.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$191.33

IR NDL BIOPSY BONE SUPERFIC

Facility

$3,749.80

Service Code	HCPCS 20220
Hospital Charge Code	7411341
Hospital Revenue Code	361
Min. Negotiated Rate	$562.47
Max. Negotiated Rate	$562.47
Rate for Payer: Qualcare PPO/HMO/WC	$562.47

IR NDL BIOPSY BONE SUPERFIC

Facility

$8,054.80

Service Code	HCPCS 20220
Hospital Charge Code	2004588
Hospital Revenue Code	361
Min. Negotiated Rate	$1,208.22
Max. Negotiated Rate	$1,208.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22

IR NDL BIOPSY BONE SUPERFIC

Facility

$8,054.80

Service Code	HCPCS 20220
Hospital Charge Code	2004588
Hospital Revenue Code	361
Min. Negotiated Rate	$194.12
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,416.44
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$194.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$213.45

IR NDL BIOPSY BONE SUPERFIC

Facility

$3,749.80

Service Code	HCPCS 20220
Hospital Charge Code	7411341
Hospital Revenue Code	361
Min. Negotiated Rate	$90.37
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,124.94
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.47
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$90.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$99.37

IR NDL BIOPSY BONE SUPERFIC

Facility

$8,054.80

Service Code	HCPCS 20220
Hospital Charge Code	321020220
Hospital Revenue Code	361
Min. Negotiated Rate	$194.12
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,416.44
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$194.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$213.45

IR NDL BIOPSY BONE SUPERFIC

Facility

$8,054.80

Service Code	HCPCS 20220
Hospital Charge Code	321020220
Hospital Revenue Code	361
Min. Negotiated Rate	$1,208.22
Max. Negotiated Rate	$1,208.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22

IR NEEDLE BIOPSY ABD/RETROPERI

Facility

$4,350.20

Service Code	HCPCS 49180
Hospital Charge Code	2004604
Hospital Revenue Code	361
Min. Negotiated Rate	$104.84
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.06
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$652.53
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$104.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$115.28

IR NEEDLE BIOPSY ABD/RETROPERI

Facility

$4,350.20

Service Code	HCPCS 49180
Hospital Charge Code	2004604
Hospital Revenue Code	361
Min. Negotiated Rate	$652.53
Max. Negotiated Rate	$652.53
Rate for Payer: Qualcare PPO/HMO/WC	$652.53

IR-NEEDLE BIOPSY CHEST-BI

Facility

$1,478.00

Service Code	HCPCS 3240050
Hospital Charge Code	7411780
Hospital Revenue Code	361
Min. Negotiated Rate	$221.70
Max. Negotiated Rate	$221.70
Rate for Payer: Qualcare PPO/HMO/WC	$221.70

IR-NEEDLE BIOPSY CHEST-BI

Facility

$1,478.00

Service Code	HCPCS 3240050
Hospital Charge Code	2690365
Hospital Revenue Code	361
Min. Negotiated Rate	$35.62
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$561.64
Rate for Payer: Aetna Medicare Advantage	$443.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.89
Rate for Payer: Cigna Commercial	$739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$443.40
Rate for Payer: Qualcare PPO/HMO/WC	$221.70
Rate for Payer: UnitedHealthcare Community & State	$35.62
Rate for Payer: Wellpoint Medicaid Managed Care	$39.17

Know your out-of-pocket cost for care.

All Charges