Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM CTRL CV HMDYNMIC W/W/O EXER

Facility

$1,490.50

Service Code	HCPCS 78414
Hospital Charge Code	4500950
Hospital Revenue Code	341
Min. Negotiated Rate	$223.57
Max. Negotiated Rate	$223.57
Rate for Payer: Qualcare PPO/HMO/WC	$223.57

NM CUREA C-13 H PYLORI

Facility

$587.25

Service Code	HCPCS 83013
Hospital Charge Code	4500882
Hospital Revenue Code	301
Min. Negotiated Rate	$88.09
Max. Negotiated Rate	$88.09
Rate for Payer: Qualcare PPO/HMO/WC	$88.09

NM CUREA C-13 H PYLORI

Facility

$587.25

Service Code	HCPCS 83013
Hospital Charge Code	4500882
Hospital Revenue Code	301
Min. Negotiated Rate	$15.56
Max. Negotiated Rate	$293.62
Rate for Payer: Aetna Commercial	$183.22
Rate for Payer: Aetna Medicare Advantage	$218.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$67.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.15
Rate for Payer: Cigna Commercial	$293.62
Rate for Payer: Cigna Medicare Advantage	$67.36
Rate for Payer: Clover Medicare Advantage	$63.99
Rate for Payer: EmblemHealth Commercial	$202.08
Rate for Payer: Humana Medicare Advantage	$69.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$67.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$53.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.36
Rate for Payer: Wellcare Medicare Advantage	$67.36
Rate for Payer: Wellpoint Medicaid Managed Care	$15.56

NM DACRYOCYSTOGRAPHY

Facility

$1,241.55

Service Code	HCPCS 78660
Hospital Charge Code	4500955
Hospital Revenue Code	341
Min. Negotiated Rate	$186.23
Max. Negotiated Rate	$186.23
Rate for Payer: Qualcare PPO/HMO/WC	$186.23

NM DACRYOCYSTOGRAPHY

Facility

$1,241.55

Service Code	HCPCS 78660
Hospital Charge Code	4500955
Hospital Revenue Code	341
Min. Negotiated Rate	$29.92
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.46
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.23
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$29.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$32.90

NMDA RECEPTOR AB TEST

Facility

$2,650.00

Service Code	HCPCS 86255
Hospital Charge Code	39990240
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$1,325.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$1,325.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$795.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$397.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$70.22

NMDA RECEPTOR AB TEST

Facility

$2,650.00

Service Code	HCPCS 86255
Hospital Charge Code	39990240
Hospital Revenue Code	302
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$397.50
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

NM ENDOCRINE OTHER

Facility

$874.50

Service Code	HCPCS 78099
Hospital Charge Code	4500956
Hospital Revenue Code	341
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.35
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.18
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$21.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$23.17

NM ENDOCRINE OTHER

Facility

$874.50

Service Code	HCPCS 78099
Hospital Charge Code	4500956
Hospital Revenue Code	341
Min. Negotiated Rate	$131.18
Max. Negotiated Rate	$131.18
Rate for Payer: Qualcare PPO/HMO/WC	$131.18

NM ESOPHAGEAL MOTILITY

Facility

$1,336.60

Service Code	HCPCS 78258
Hospital Charge Code	4500957
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM ESOPHAGEAL MOTILITY

Facility

$1,336.60

Service Code	HCPCS 78258
Hospital Charge Code	4500957
Hospital Revenue Code	341
Min. Negotiated Rate	$32.21
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.98
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$32.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.42

NM GALLIUM 67 PER mCi

Facility

$72.85

Service Code	HCPCS A9556
Hospital Charge Code	4500823
Hospital Revenue Code	343
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

NM GALLIUM 67 PER mCi

Facility

$72.85

Service Code	HCPCS A9556
Hospital Charge Code	4500823
Hospital Revenue Code	343
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$149.07
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$149.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

NM GALLUIM SPECT

Facility

$2,090.45

Service Code	HCPCS 78807
Hospital Charge Code	4500518
Hospital Revenue Code	341
Min. Negotiated Rate	$50.38
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$794.37
Rate for Payer: Aetna Medicare Advantage	$627.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.06
Rate for Payer: Cigna Commercial	$1,045.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$627.13
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$313.57
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$50.38
Rate for Payer: Wellpoint Medicaid Managed Care	$55.40

NM GALLUIM SPECT

Facility

$2,090.45

Service Code	HCPCS 78807
Hospital Charge Code	4500518
Hospital Revenue Code	341
Min. Negotiated Rate	$313.57
Max. Negotiated Rate	$313.57
Rate for Payer: Qualcare PPO/HMO/WC	$313.57

NM GASTRIC EMPTYING STUDY

Facility

$12,000.00

Service Code	HCPCS 78264
Hospital Charge Code	4500732
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM GASTRIC EMPTYING STUDY

Facility

$12,000.00

Service Code	HCPCS 78264
Hospital Charge Code	4500732
Hospital Revenue Code	341
Min. Negotiated Rate	$65.82
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

NM GASTRIC MUCOSA IMAGING

Facility

$1,336.60

Service Code	HCPCS 78261
Hospital Charge Code	4500958
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM GASTRIC MUCOSA IMAGING

Facility

$1,336.60

Service Code	HCPCS 78261
Hospital Charge Code	4500958
Hospital Revenue Code	341
Min. Negotiated Rate	$32.21
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.98
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$32.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.42

NM GASTRINTESTNAL PROTEIN LOSS

Facility

$1,336.60

Service Code	HCPCS 78282
Hospital Charge Code	4500960
Hospital Revenue Code	341
Min. Negotiated Rate	$32.21
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.98
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$32.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.42

NM GASTRINTESTNAL PROTEIN LOSS

Facility

$1,336.60

Service Code	HCPCS 78282
Hospital Charge Code	4500960
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM GASTROESOPH REFLUX

Facility

$349.65

Service Code	HCPCS 78262
Hospital Charge Code	4500419
Hospital Revenue Code	341
Min. Negotiated Rate	$52.45
Max. Negotiated Rate	$52.45
Rate for Payer: Qualcare PPO/HMO/WC	$52.45

NM GASTROESOPH REFLUX

Facility

$349.65

Service Code	HCPCS 78262
Hospital Charge Code	4500419
Hospital Revenue Code	341
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.89
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.45
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$8.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$9.27

NM GASTROINTES BLOOD LOSS

Facility

$12,000.00

Service Code	HCPCS 78278
Hospital Charge Code	4500328
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM GASTROINTES BLOOD LOSS

Facility

$12,000.00

Service Code	HCPCS 78278
Hospital Charge Code	4500328
Hospital Revenue Code	341
Min. Negotiated Rate	$94.86
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

Know your out-of-pocket cost for care.

All Charges