Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NAIL FEM TROCH RT 10.5x440mm

Facility

$11,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270673235
Hospital Revenue Code	278
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$288.00
Rate for Payer: Wellpoint Medicaid Managed Care	$316.68

NAIL FEM TROCH RT 9x440mm

Facility

$11,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270673236
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

NAIL FEM TROCH RT 9x440mm

Facility

$11,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270673236
Hospital Revenue Code	278
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$288.00
Rate for Payer: Wellpoint Medicaid Managed Care	$316.68

NAIL FEMUR 125D 11X420MM

Facility

$9,825.00

Service Code	HCPCS C1713
Hospital Charge Code	270696276
Hospital Revenue Code	278
Min. Negotiated Rate	$1,473.75
Max. Negotiated Rate	$2,377.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,161.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75

NAIL FEMUR 125D 11X420MM

Facility

$9,825.00

Service Code	HCPCS C1713
Hospital Charge Code	270696276
Hospital Revenue Code	278
Min. Negotiated Rate	$236.78
Max. Negotiated Rate	$4,912.50
Rate for Payer: Aetna Commercial	$3,733.50
Rate for Payer: Aetna Medicare Advantage	$2,947.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,505.38
Rate for Payer: Cigna Commercial	$4,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,161.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75
Rate for Payer: UnitedHealthcare Community & State	$236.78
Rate for Payer: Wellpoint Medicaid Managed Care	$260.36

NAIL FEMUR TFNA TI 11X235MM RT

Facility

$20,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270699468
Hospital Revenue Code	278
Min. Negotiated Rate	$3,149.25
Max. Negotiated Rate	$5,080.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,080.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,618.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,149.25

NAIL FEMUR TFNA TI 11X235MM RT

Facility

$20,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270699468
Hospital Revenue Code	278
Min. Negotiated Rate	$505.98
Max. Negotiated Rate	$10,497.50
Rate for Payer: Aetna Commercial	$7,978.10
Rate for Payer: Aetna Medicare Advantage	$6,298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,353.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,353.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,353.73
Rate for Payer: Cigna Commercial	$10,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,080.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,618.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,149.25
Rate for Payer: UnitedHealthcare Community & State	$505.98
Rate for Payer: Wellpoint Medicaid Managed Care	$556.37

NAIL FEXIBLE 2.0 X 300MM

Facility

$1,900.00

Hospital Charge Code	270667218
Hospital Revenue Code	278
Min. Negotiated Rate	$45.79
Max. Negotiated Rate	$950.00
Rate for Payer: Aetna Commercial	$722.00
Rate for Payer: Aetna Medicare Advantage	$570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.50
Rate for Payer: Cigna Commercial	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$418.00
Rate for Payer: Qualcare PPO/HMO/WC	$285.00
Rate for Payer: UnitedHealthcare Community & State	$45.79
Rate for Payer: Wellpoint Medicaid Managed Care	$50.35

NAIL FEXIBLE 2.0 X 300MM

Facility

$1,900.00

Hospital Charge Code	270667218
Hospital Revenue Code	278
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$459.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$418.00
Rate for Payer: Qualcare PPO/HMO/WC	$285.00

NAIL FIB REM LG CANN RT 3.2MM

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	270698394
Hospital Revenue Code	278
Min. Negotiated Rate	$121.88
Max. Negotiated Rate	$196.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$121.88

NAIL FIB REM LG CANN RT 3.2MM

Facility

$812.50

Service Code	HCPCS C1713
Hospital Charge Code	270698394
Hospital Revenue Code	278
Min. Negotiated Rate	$19.58
Max. Negotiated Rate	$406.25
Rate for Payer: Aetna Commercial	$308.75
Rate for Payer: Aetna Medicare Advantage	$243.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.19
Rate for Payer: Cigna Commercial	$406.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$178.75
Rate for Payer: Qualcare PPO/HMO/WC	$121.88
Rate for Payer: UnitedHealthcare Community & State	$19.58
Rate for Payer: Wellpoint Medicaid Managed Care	$21.53

NAIL FIBULA 3.0X130MM RT

Facility

$14,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694195
Hospital Revenue Code	278
Min. Negotiated Rate	$360.90
Max. Negotiated Rate	$7,487.50
Rate for Payer: Aetna Commercial	$5,690.50
Rate for Payer: Aetna Medicare Advantage	$4,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,818.62
Rate for Payer: Cigna Commercial	$7,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,294.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25
Rate for Payer: UnitedHealthcare Community & State	$360.90
Rate for Payer: Wellpoint Medicaid Managed Care	$396.84

NAIL FIBULA 3.0X130MM RT

Facility

$14,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270694195
Hospital Revenue Code	278
Min. Negotiated Rate	$2,246.25
Max. Negotiated Rate	$3,623.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,294.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25

NAIL FIBULA 3.0X180MM RT

Facility

$16,224.00

Service Code	HCPCS C1713
Hospital Charge Code	270698395
Hospital Revenue Code	278
Min. Negotiated Rate	$2,433.60
Max. Negotiated Rate	$3,926.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,244.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,926.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,569.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,433.60

NAIL FIBULA 3.0X180MM RT

Facility

$16,224.00

Service Code	HCPCS C1713
Hospital Charge Code	270698395
Hospital Revenue Code	278
Min. Negotiated Rate	$391.00
Max. Negotiated Rate	$8,112.00
Rate for Payer: Aetna Commercial	$6,165.12
Rate for Payer: Aetna Medicare Advantage	$4,867.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,137.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,137.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,137.12
Rate for Payer: Cigna Commercial	$8,112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,926.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,569.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,433.60
Rate for Payer: UnitedHealthcare Community & State	$391.00
Rate for Payer: Wellpoint Medicaid Managed Care	$429.94

NAIL FIBULA LEFT 3.0X130MM

Facility

$14,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694818
Hospital Revenue Code	278
Min. Negotiated Rate	$2,246.25
Max. Negotiated Rate	$3,623.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,294.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25

NAIL FIBULA LEFT 3.0X130MM

Facility

$14,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694818
Hospital Revenue Code	278
Min. Negotiated Rate	$360.90
Max. Negotiated Rate	$7,487.50
Rate for Payer: Aetna Commercial	$5,690.50
Rate for Payer: Aetna Medicare Advantage	$4,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,818.62
Rate for Payer: Cigna Commercial	$7,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,294.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25
Rate for Payer: UnitedHealthcare Community & State	$360.90
Rate for Payer: Wellpoint Medicaid Managed Care	$396.84

NAIL FIXAT TRIM SYST 2.4X30MM

Facility

$11,685.00

Service Code	HCPCS C1713
Hospital Charge Code	270694442
Hospital Revenue Code	278
Min. Negotiated Rate	$1,752.75
Max. Negotiated Rate	$2,827.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,337.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,827.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,570.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,752.75

NAIL FIXAT TRIM SYST 2.4X30MM

Facility

$11,685.00

Service Code	HCPCS C1713
Hospital Charge Code	270694442
Hospital Revenue Code	278
Min. Negotiated Rate	$281.61
Max. Negotiated Rate	$5,842.50
Rate for Payer: Aetna Commercial	$4,440.30
Rate for Payer: Aetna Medicare Advantage	$3,505.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,979.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,979.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,337.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,979.68
Rate for Payer: Cigna Commercial	$5,842.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,827.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,570.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,752.75
Rate for Payer: UnitedHealthcare Community & State	$281.61
Rate for Payer: Wellpoint Medicaid Managed Care	$309.65

NAIL FLEX 3.5MM WIN PED 240703

Facility

$900.00

Hospital Charge Code	270640895
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

NAIL FLEX 3.5MM WIN PED 240703

Facility

$900.00

Hospital Charge Code	270640895
Hospital Revenue Code	278
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

NAIL FMRL 9x80 TRCH RT14443238

Facility

$11,955.00

Hospital Charge Code	270647828
Hospital Revenue Code	278
Min. Negotiated Rate	$288.12
Max. Negotiated Rate	$5,977.50
Rate for Payer: Aetna Commercial	$4,542.90
Rate for Payer: Aetna Medicare Advantage	$3,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,048.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,048.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,391.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,048.53
Rate for Payer: Cigna Commercial	$5,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,893.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,630.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,793.25
Rate for Payer: UnitedHealthcare Community & State	$288.12
Rate for Payer: Wellpoint Medicaid Managed Care	$316.81

NAIL FMRL 9x80 TRCH RT14443238

Facility

$11,955.00

Hospital Charge Code	270647828
Hospital Revenue Code	278
Min. Negotiated Rate	$1,793.25
Max. Negotiated Rate	$2,893.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,391.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,893.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,630.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,793.25

NAIL FRACTURE HIP 125 DEG 9X18

Facility

$6,750.00

Service Code	HCPCS C1716
Hospital Charge Code	270698453
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

NAIL FRACTURE HIP 125 DEG 9X18

Facility

$6,750.00

Service Code	HCPCS C1716
Hospital Charge Code	270698453
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$2,155.71
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,155.71
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

Know your out-of-pocket cost for care.

All Charges