Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLACE CATH CAROTID/INOM ART

Facility

$15,468.50

Service Code	HCPCS 36222
Hospital Charge Code	5600222
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

PLACE CATH CAROTID/INOM ART

Facility

$25,628.45

Service Code	HCPCS 36223
Hospital Charge Code	5600223
Hospital Revenue Code	361
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

PLACE CATH CAROTID/INOM ART

Facility

$25,628.45

Service Code	HCPCS 36223
Hospital Charge Code	5600223
Hospital Revenue Code	361
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,688.53
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$617.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$679.15

PLACE CATH CAROTID/INOM ART

Facility

$25,628.45

Service Code	HCPCS 36223
Hospital Charge Code	321036223
Hospital Revenue Code	361
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,688.53
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$617.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$679.15

PLACE CATH CAROTID/INOM ART

Facility

$13,077.63

Service Code	HCPCS 36222
Hospital Charge Code	411036222
Hospital Revenue Code	361
Min. Negotiated Rate	$315.17
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,923.29
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.64
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$315.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$346.56

PLACE CATH CAROTID/INOM ART

Facility

$13,077.63

Service Code	HCPCS 36222
Hospital Charge Code	74110102
Hospital Revenue Code	361
Min. Negotiated Rate	$1,961.64
Max. Negotiated Rate	$1,961.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.64

PLACE CATH CAROTID/INOM ART

Facility

$13,077.63

Service Code	HCPCS 36223
Hospital Charge Code	74110103
Hospital Revenue Code	361
Min. Negotiated Rate	$1,961.64
Max. Negotiated Rate	$1,961.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.64

PLACE CATH CAROTID/INOM ART

Facility

$13,077.63

Service Code	HCPCS 36222
Hospital Charge Code	74110102
Hospital Revenue Code	361
Min. Negotiated Rate	$315.17
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,923.29
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.64
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$315.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$346.56

PLACE CATH CAROTID/INOM ART

Facility

$13,077.63

Service Code	HCPCS 36222
Hospital Charge Code	5100809
Hospital Revenue Code	361
Min. Negotiated Rate	$315.17
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,923.29
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.64
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$315.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$346.56

PLACE CATH CAROTID/INOM ART

Facility

$13,077.63

Service Code	HCPCS 36222
Hospital Charge Code	5100809
Hospital Revenue Code	361
Min. Negotiated Rate	$1,961.64
Max. Negotiated Rate	$1,961.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.64

PLACE CATH CAROTID/INOM ART

Facility

$13,077.63

Service Code	HCPCS 36223
Hospital Charge Code	411036223
Hospital Revenue Code	361
Min. Negotiated Rate	$1,961.64
Max. Negotiated Rate	$1,961.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.64

PLACE CATH CAROTID/INOM ART

Facility

$15,468.50

Service Code	HCPCS 36222
Hospital Charge Code	5600222
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

PLACE CATH CAROTID/INOM ART

Facility

$13,077.63

Service Code	HCPCS 36223
Hospital Charge Code	5100810
Hospital Revenue Code	361
Min. Negotiated Rate	$1,961.64
Max. Negotiated Rate	$1,961.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.64

PLACE CATH CAROTID/INOM ART

Facility

$13,077.63

Service Code	HCPCS 36223
Hospital Charge Code	74110103
Hospital Revenue Code	361
Min. Negotiated Rate	$315.17
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,923.29
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.64
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$315.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$346.56

PLACE CATH CAROTID/INOM ART BI

Facility

$38,442.70

Service Code	HCPCS 3622350
Hospital Charge Code	411036223B
Hospital Revenue Code	361
Min. Negotiated Rate	$5,766.40
Max. Negotiated Rate	$5,766.40
Rate for Payer: Qualcare PPO/HMO/WC	$5,766.40

PLACE CATH CAROTID/INOM ART BI

Facility

$38,442.70

Service Code	HCPCS 3622350
Hospital Charge Code	411036223B
Hospital Revenue Code	361
Min. Negotiated Rate	$926.47
Max. Negotiated Rate	$19,221.35
Rate for Payer: Aetna Commercial	$14,608.23
Rate for Payer: Aetna Medicare Advantage	$11,532.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,802.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,802.89
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	$9,802.89
Rate for Payer: Cigna Commercial	$19,221.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,532.81
Rate for Payer: Qualcare PPO/HMO/WC	$5,766.40
Rate for Payer: UnitedHealthcare Community & State	$926.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1,018.73

PLACE CATH COMM ILI,CONTRLATRL

Facility

$331.55

Service Code	HCPCS 36245
Hospital Charge Code	5100555
Hospital Revenue Code	361
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

PLACE CATH COMM ILI,CONTRLATRL

Facility

$331.55

Service Code	HCPCS 36245
Hospital Charge Code	5100555
Hospital Revenue Code	361
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$125.99
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
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	$84.55
Rate for Payer: Cigna Commercial	$165.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

PLACE CATHETER IN ARTERY

Facility

$403.00

Service Code	HCPCS 36216
Hospital Charge Code	3668362162
Hospital Revenue Code	361
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$153.14
Rate for Payer: Aetna Medicare Advantage	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.77
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	$102.77
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

PLACE CATHETER IN ARTERY

Facility

$403.00

Service Code	HCPCS 36216
Hospital Charge Code	3668362162
Hospital Revenue Code	361
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

PLACE CATHETER IN ARTERY

Facility

$486.00

Service Code	HCPCS 36217
Hospital Charge Code	411036217
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PLACE CATHETER IN ARTERY

Facility

$403.00

Service Code	HCPCS 36216
Hospital Charge Code	366836216
Hospital Revenue Code	361
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$153.14
Rate for Payer: Aetna Medicare Advantage	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.77
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	$102.77
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

PLACE CATHETER IN ARTERY

Facility

$486.00

Service Code	HCPCS 36218
Hospital Charge Code	366836218
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

PLACE CATHETER IN ARTERY

Facility

$486.00

Service Code	HCPCS 36218
Hospital Charge Code	366836218
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PLACE CATHETER IN ARTERY

Facility

$486.00

Service Code	HCPCS 36217
Hospital Charge Code	411036217
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

Know your out-of-pocket cost for care.

All Charges