Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ASSAY OF LEAD

Facility

$390.00

Service Code	HCPCS 83655
Hospital Charge Code	401083655
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF LEAD

Facility

$390.00

Service Code	HCPCS 83655
Hospital Charge Code	401083655
Hospital Revenue Code	301
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
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	$43.71
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ASSAY OF MERCURY

Facility

$390.00

Service Code	HCPCS 83825
Hospital Charge Code	401083825
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.23
Rate for Payer: Aetna Medicare Advantage	$52.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.69
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.26
Rate for Payer: Clover Medicare Advantage	$15.45
Rate for Payer: EmblemHealth Commercial	$48.78
Rate for Payer: Humana Medicare Advantage	$16.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.26
Rate for Payer: Wellcare Medicare Advantage	$16.26
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ASSAY OF MERCURY

Facility

$390.00

Service Code	HCPCS 83825
Hospital Charge Code	401083825
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF TOTAL ESTRADIOL

Facility

$123.17

Service Code	HCPCS 82670
Hospital Charge Code	401182670
Hospital Revenue Code	300
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.94
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	$100.86
Rate for Payer: Cigna Commercial	$61.59
Rate for Payer: Cigna Medicare Advantage	$27.94
Rate for Payer: Clover Medicare Advantage	$26.54
Rate for Payer: EmblemHealth Commercial	$83.82
Rate for Payer: Humana Medicare Advantage	$28.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.48
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.94
Rate for Payer: Wellcare Medicare Advantage	$27.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

ASSAY OF TOTAL ESTRADIOL

Facility

$123.17

Service Code	HCPCS 82670
Hospital Charge Code	401182670
Hospital Revenue Code	300
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$18.48
Rate for Payer: Qualcare PPO/HMO/WC	$18.48

ASSAY OF TROPONIN QUANT

Facility

$650.82

Service Code	HCPCS 84484
Hospital Charge Code	402084484
Hospital Revenue Code	450
Min. Negotiated Rate	$97.62
Max. Negotiated Rate	$97.62
Rate for Payer: Qualcare PPO/HMO/WC	$97.62

ASSAY OF TROPONIN QUANT

Facility

$650.82

Service Code	HCPCS 84484
Hospital Charge Code	402084484
Hospital Revenue Code	450
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$33.92
Rate for Payer: Aetna Medicare Advantage	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.01
Rate for Payer: Cigna Commercial	$325.41
Rate for Payer: Cigna Medicare Advantage	$12.47
Rate for Payer: Clover Medicare Advantage	$11.85
Rate for Payer: EmblemHealth Commercial	$37.41
Rate for Payer: Humana Medicare Advantage	$12.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.62
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.47
Rate for Payer: Wellcare Medicare Advantage	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$17.25

ASSAY OF URINE CREATININE

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	401082570
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ASSAY OF URINE CREATININE

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	401082570B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF URINE CREATININE

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	401082570B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ASSAY OF URINE CREATININE

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	401082570
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY PROTEIN URINE

Facility

$390.00

Service Code	HCPCS 84166
Hospital Charge Code	401084166
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY PROTEIN URINE

Facility

$390.00

Service Code	HCPCS 84166
Hospital Charge Code	401084166
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.50
Rate for Payer: Aetna Medicare Advantage	$57.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.83
Rate for Payer: Clover Medicare Advantage	$16.94
Rate for Payer: EmblemHealth Commercial	$53.49
Rate for Payer: Humana Medicare Advantage	$18.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.83
Rate for Payer: Wellcare Medicare Advantage	$17.83
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ASSEMBL DEXTRUS SEAL CAP HAPO2

Facility

$2,366.25

Hospital Charge Code	270640477
Hospital Revenue Code	272
Min. Negotiated Rate	$57.03
Max. Negotiated Rate	$1,183.12
Rate for Payer: Aetna Commercial	$899.17
Rate for Payer: Aetna Medicare Advantage	$709.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$603.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$603.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$603.39
Rate for Payer: Cigna Commercial	$1,183.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$709.88
Rate for Payer: Oxford Commercial	$473.25
Rate for Payer: Qualcare PPO/HMO/WC	$354.94
Rate for Payer: UnitedHealthcare Commercial	$473.25
Rate for Payer: UnitedHealthcare Community & State	$57.03
Rate for Payer: Wellpoint Medicaid Managed Care	$62.71

ASSEMBL DEXTRUS SEAL CAP HAPO2

Facility

$2,366.25

Hospital Charge Code	270640477
Hospital Revenue Code	272
Min. Negotiated Rate	$354.94
Max. Negotiated Rate	$354.94
Rate for Payer: Qualcare PPO/HMO/WC	$354.94

ASSEMBLY ANCHOR W/BOLT FA10485

Facility

$1,711.25

Hospital Charge Code	270629411
Hospital Revenue Code	278
Min. Negotiated Rate	$256.69
Max. Negotiated Rate	$414.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$342.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$376.48
Rate for Payer: Qualcare PPO/HMO/WC	$256.69

ASSEMBLY ANCHOR W/BOLT FA10485

Facility

$1,711.25

Hospital Charge Code	270629411
Hospital Revenue Code	278
Min. Negotiated Rate	$41.24
Max. Negotiated Rate	$855.62
Rate for Payer: Aetna Commercial	$650.27
Rate for Payer: Aetna Medicare Advantage	$513.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$342.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.37
Rate for Payer: Cigna Commercial	$855.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$376.48
Rate for Payer: Qualcare PPO/HMO/WC	$256.69
Rate for Payer: UnitedHealthcare Community & State	$41.24
Rate for Payer: Wellpoint Medicaid Managed Care	$45.35

ASSEMBLY BMT KNOB PULLR 472015

Facility

$973.65

Hospital Charge Code	270612167
Hospital Revenue Code	278
Min. Negotiated Rate	$23.46
Max. Negotiated Rate	$486.82
Rate for Payer: Aetna Commercial	$369.99
Rate for Payer: Aetna Medicare Advantage	$292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.28
Rate for Payer: Cigna Commercial	$486.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.20
Rate for Payer: Qualcare PPO/HMO/WC	$146.05
Rate for Payer: UnitedHealthcare Community & State	$23.46
Rate for Payer: Wellpoint Medicaid Managed Care	$25.80

ASSEMBLY BMT KNOB PULLR 472015

Facility

$973.65

Hospital Charge Code	270612167
Hospital Revenue Code	278
Min. Negotiated Rate	$146.05
Max. Negotiated Rate	$235.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.20
Rate for Payer: Qualcare PPO/HMO/WC	$146.05

ASSEMBLY DPY ANCH W/BOLT 10485

Facility

$2,740.85

Hospital Charge Code	270612437
Hospital Revenue Code	278
Min. Negotiated Rate	$411.13
Max. Negotiated Rate	$663.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$602.99
Rate for Payer: Qualcare PPO/HMO/WC	$411.13

ASSEMBLY DPY ANCH W/BOLT 10485

Facility

$2,740.85

Hospital Charge Code	270612437
Hospital Revenue Code	278
Min. Negotiated Rate	$66.05
Max. Negotiated Rate	$1,370.42
Rate for Payer: Aetna Commercial	$1,041.52
Rate for Payer: Aetna Medicare Advantage	$822.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$698.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$698.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$698.92
Rate for Payer: Cigna Commercial	$1,370.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$602.99
Rate for Payer: Qualcare PPO/HMO/WC	$411.13
Rate for Payer: UnitedHealthcare Community & State	$66.05
Rate for Payer: Wellpoint Medicaid Managed Care	$72.63

ASSEMBLY DPY DIST W/BOLT 10480

Facility

$2,570.45

Hospital Charge Code	270612436
Hospital Revenue Code	278
Min. Negotiated Rate	$385.57
Max. Negotiated Rate	$622.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.57

ASSEMBLY DPY DIST W/BOLT 10480

Facility

$2,570.45

Hospital Charge Code	270612436
Hospital Revenue Code	278
Min. Negotiated Rate	$61.95
Max. Negotiated Rate	$1,285.22
Rate for Payer: Aetna Commercial	$976.77
Rate for Payer: Aetna Medicare Advantage	$771.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.46
Rate for Payer: Cigna Commercial	$1,285.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.57
Rate for Payer: UnitedHealthcare Community & State	$61.95
Rate for Payer: Wellpoint Medicaid Managed Care	$68.12

ASSEMBLY HUML 8.0 REG 3281051

Facility

$12,439.75

Hospital Charge Code	270609044
Hospital Revenue Code	278
Min. Negotiated Rate	$299.80
Max. Negotiated Rate	$6,219.88
Rate for Payer: Aetna Commercial	$4,727.10
Rate for Payer: Aetna Medicare Advantage	$3,731.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,172.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,172.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,487.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,172.14
Rate for Payer: Cigna Commercial	$6,219.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,010.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,736.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,865.96
Rate for Payer: UnitedHealthcare Community & State	$299.80
Rate for Payer: Wellpoint Medicaid Managed Care	$329.65

Know your out-of-pocket cost for care.

All Charges