Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANZEMET100MG VIAL INJ 5ML

Facility

$779.00

Hospital Charge Code	60635300
Hospital Revenue Code	636
Min. Negotiated Rate	$18.77
Max. Negotiated Rate	$389.50
Rate for Payer: Aetna Commercial	$296.02
Rate for Payer: Aetna Medicare Advantage	$233.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.65
Rate for Payer: Cigna Commercial	$389.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.52
Rate for Payer: Qualcare PPO/HMO/WC	$116.85
Rate for Payer: UnitedHealthcare Community & State	$18.77
Rate for Payer: Wellpoint Medicaid Managed Care	$20.64

ANZEMET 50MG TAB U/D

Facility

$261.00

Hospital Charge Code	60635301
Hospital Revenue Code	250
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna Commercial	$99.18
Rate for Payer: Aetna Medicare Advantage	$78.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.56
Rate for Payer: Cigna Commercial	$130.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.30
Rate for Payer: Oxford Commercial	$52.20
Rate for Payer: Qualcare PPO/HMO/WC	$39.15
Rate for Payer: UnitedHealthcare Commercial	$52.20
Rate for Payer: UnitedHealthcare Community & State	$6.29
Rate for Payer: Wellpoint Medicaid Managed Care	$6.92

ANZEMET 50MG TAB U/D

Facility

$261.00

Hospital Charge Code	60635301
Hospital Revenue Code	250
Min. Negotiated Rate	$39.15
Max. Negotiated Rate	$39.15
Rate for Payer: Qualcare PPO/HMO/WC	$39.15

ANZEMET TAB 100MG U/D

Facility

$318.00

Hospital Charge Code	60635299
Hospital Revenue Code	250
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$120.84
Rate for Payer: Aetna Medicare Advantage	$95.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.09
Rate for Payer: Cigna Commercial	$159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.40
Rate for Payer: Oxford Commercial	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Commercial	$63.60
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: Wellpoint Medicaid Managed Care	$8.43

ANZEMET TAB 100MG U/D

Facility

$318.00

Hospital Charge Code	60635299
Hospital Revenue Code	250
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$47.70

AO CANNULATED HANDLE

Facility

$705.55

Service Code	HCPCS C1713
Hospital Charge Code	270704190
Hospital Revenue Code	278
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$352.77
Rate for Payer: Aetna Commercial	$268.11
Rate for Payer: Aetna Medicare Advantage	$211.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.92
Rate for Payer: Cigna Commercial	$352.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$155.22
Rate for Payer: Qualcare PPO/HMO/WC	$105.83
Rate for Payer: UnitedHealthcare Community & State	$17.00
Rate for Payer: Wellpoint Medicaid Managed Care	$18.70

AO CANNULATED HANDLE

Facility

$705.55

Service Code	HCPCS C1713
Hospital Charge Code	270704190
Hospital Revenue Code	278
Min. Negotiated Rate	$105.83
Max. Negotiated Rate	$170.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$155.22
Rate for Payer: Qualcare PPO/HMO/WC	$105.83

A-OK SLIT KNIVES 3.2MM

Facility

$365.00

Hospital Charge Code	270330823
Hospital Revenue Code	272
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$54.75
Rate for Payer: Qualcare PPO/HMO/WC	$54.75

A-OK SLIT KNIVES 3.2MM

Facility

$365.00

Hospital Charge Code	270330823
Hospital Revenue Code	272
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$182.50
Rate for Payer: Aetna Commercial	$138.70
Rate for Payer: Aetna Medicare Advantage	$109.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.08
Rate for Payer: Cigna Commercial	$182.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.50
Rate for Payer: Oxford Commercial	$73.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.75
Rate for Payer: UnitedHealthcare Commercial	$73.00
Rate for Payer: UnitedHealthcare Community & State	$8.80
Rate for Payer: Wellpoint Medicaid Managed Care	$9.67

AORTA&ILIAC ARTER DUP LTD

Facility

$17,200.00

Service Code	HCPCS 93979
Hospital Charge Code	74115054
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

AORTA&ILIAC ARTER DUP LTD

Facility

$17,200.00

Service Code	HCPCS 93979
Hospital Charge Code	74115054
Hospital Revenue Code	921
Min. Negotiated Rate	$117.99
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$371.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,160.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$414.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$455.80

AORTA&ILIAC ARTER DUP LTD

Facility

$789.00

Service Code	HCPCS 93979
Hospital Charge Code	74116054
Hospital Revenue Code	921
Min. Negotiated Rate	$19.01
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$371.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.70
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$19.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.91

AORTA&ILIAC ARTER DUP LTD

Facility

$789.00

Service Code	HCPCS 93979
Hospital Charge Code	74116054
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

AORTA&ILIAC ARTER DUP LTD

Facility

$789.00

Service Code	HCPCS 93979
Hospital Charge Code	74117054
Hospital Revenue Code	921
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

AORTA&ILIAC ARTER DUP LTD

Facility

$17,200.00

Service Code	HCPCS 93979
Hospital Charge Code	2692095
Hospital Revenue Code	921
Min. Negotiated Rate	$117.99
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$371.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,160.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$414.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$455.80

AORTA&ILIAC ARTER DUP LTD

Facility

$563.15

Service Code	HCPCS 93979
Hospital Charge Code	94053220
Hospital Revenue Code	921
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

AORTA&ILIAC ARTER DUP LTD

Facility

$563.15

Service Code	HCPCS 93979
Hospital Charge Code	94053220
Hospital Revenue Code	921
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$371.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.94
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.47
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

AORTA&ILIAC ARTER DUP LTD

Facility

$17,200.00

Service Code	HCPCS 93979
Hospital Charge Code	2692095
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

AORTA&ILIAC ARTER DUP LTD

Facility

$789.00

Service Code	HCPCS 93979
Hospital Charge Code	74117054
Hospital Revenue Code	921
Min. Negotiated Rate	$19.01
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$371.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.70
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$19.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.91

AORT BDY SYS OVATN iX PMA 34MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270679784
Hospital Revenue Code	278
Min. Negotiated Rate	$1,359.12
Max. Negotiated Rate	$28,197.50
Rate for Payer: Aetna Commercial	$21,430.10
Rate for Payer: Aetna Medicare Advantage	$16,918.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,380.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,380.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,380.73
Rate for Payer: Cigna Commercial	$28,197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,647.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,406.90
Rate for Payer: Qualcare PPO/HMO/WC	$8,459.25
Rate for Payer: UnitedHealthcare Community & State	$1,359.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,494.47

AORT BDY SYS OVATN iX PMA 34MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270679784
Hospital Revenue Code	278
Min. Negotiated Rate	$8,459.25
Max. Negotiated Rate	$13,647.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,647.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,406.90
Rate for Payer: Qualcare PPO/HMO/WC	$8,459.25

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$224,439.17

Service Code	MSDRG 268
Min. Negotiated Rate	$68,338.85
Max. Negotiated Rate	$224,439.17
Rate for Payer: Aetna Commercial	$154,472.60
Rate for Payer: Aetna Medicare Advantage	$224,439.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159,337.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159,337.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$71,935.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159,337.85
Rate for Payer: Cigna Commercial	$128,713.02
Rate for Payer: Cigna Medicare Advantage	$71,935.63
Rate for Payer: Clover Medicare Advantage	$68,338.85
Rate for Payer: EmblemHealth Commercial	$215,806.89
Rate for Payer: Humana Medicare Advantage	$74,093.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$71,935.63
Rate for Payer: Oxford Commercial	$92,507.76
Rate for Payer: UnitedHealthcare Commercial	$162,215.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$71,935.63
Rate for Payer: Wellcare Medicare Advantage	$71,935.63

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$138,634.92

Service Code	MSDRG 269
Min. Negotiated Rate	$42,212.56
Max. Negotiated Rate	$138,634.92
Rate for Payer: Aetna Commercial	$95,515.31
Rate for Payer: Aetna Medicare Advantage	$138,634.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96,765.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96,765.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44,434.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96,765.76
Rate for Payer: Cigna Commercial	$79,032.96
Rate for Payer: Cigna Medicare Advantage	$44,434.27
Rate for Payer: Clover Medicare Advantage	$42,212.56
Rate for Payer: EmblemHealth Commercial	$133,302.81
Rate for Payer: Humana Medicare Advantage	$45,767.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44,434.27
Rate for Payer: Oxford Commercial	$56,802.04
Rate for Payer: UnitedHealthcare Commercial	$99,604.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$44,434.27
Rate for Payer: Wellcare Medicare Advantage	$44,434.27

AORTIC ARCH FLOURO

Facility

$3,032.40

Service Code	HCPCS 76000
Hospital Charge Code	7411163
Hospital Revenue Code	320
Min. Negotiated Rate	$454.86
Max. Negotiated Rate	$454.86
Rate for Payer: Qualcare PPO/HMO/WC	$454.86

AORTIC ARCH FLOURO

Facility

$3,032.40

Service Code	HCPCS 76000
Hospital Charge Code	7411163
Hospital Revenue Code	320
Min. Negotiated Rate	$73.08
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$909.72
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$454.86
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$73.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$80.36

Know your out-of-pocket cost for care.

All Charges