Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSN FEM CNT CCR STD SZ 11 RT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697604
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.48
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,282.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1,410.20

PSN FEM CR CMT CCR STD SZ9 L

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699914
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

PSN FEM CR CMT CCR STD SZ9 L

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PSN FEM CR CMT CCR STD SZ 9 R

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694235
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

PSN FEM CR CMT CCR STD SZ 9 R

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694235
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PSN FEM CR CMT COCR NRW SZ 5

Facility

$10,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270699556
Hospital Revenue Code	278
Min. Negotiated Rate	$248.23
Max. Negotiated Rate	$5,150.00
Rate for Payer: Aetna Commercial	$3,914.00
Rate for Payer: Aetna Medicare Advantage	$3,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,626.50
Rate for Payer: Cigna Commercial	$5,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,492.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,266.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,545.00
Rate for Payer: UnitedHealthcare Community & State	$248.23
Rate for Payer: Wellpoint Medicaid Managed Care	$272.95

PSN FEM CR CMT COCR NRW SZ 5

Facility

$10,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270699556
Hospital Revenue Code	278
Min. Negotiated Rate	$1,545.00
Max. Negotiated Rate	$2,492.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,492.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,266.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,545.00

PSN FEM CR CMT COCR NRW SZ 6

Facility

$10,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270699203
Hospital Revenue Code	278
Min. Negotiated Rate	$1,545.00
Max. Negotiated Rate	$2,492.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,492.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,266.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,545.00

PSN FEM CR CMT COCR NRW SZ 6

Facility

$10,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270699203
Hospital Revenue Code	278
Min. Negotiated Rate	$248.23
Max. Negotiated Rate	$5,150.00
Rate for Payer: Aetna Commercial	$3,914.00
Rate for Payer: Aetna Medicare Advantage	$3,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,626.50
Rate for Payer: Cigna Commercial	$5,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,492.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,266.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,545.00
Rate for Payer: UnitedHealthcare Community & State	$248.23
Rate for Payer: Wellpoint Medicaid Managed Care	$272.95

PSN FEM CR CMT COCR STD 10 L

Facility

$10,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270699909
Hospital Revenue Code	278
Min. Negotiated Rate	$248.23
Max. Negotiated Rate	$5,150.00
Rate for Payer: Aetna Commercial	$3,914.00
Rate for Payer: Aetna Medicare Advantage	$3,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,626.50
Rate for Payer: Cigna Commercial	$5,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,492.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,266.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,545.00
Rate for Payer: UnitedHealthcare Community & State	$248.23
Rate for Payer: Wellpoint Medicaid Managed Care	$272.95

PSN FEM CR CMT COCR STD 10 L

Facility

$10,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270699909
Hospital Revenue Code	278
Min. Negotiated Rate	$1,545.00
Max. Negotiated Rate	$2,492.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,492.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,266.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,545.00

PSN FEM CR POR CCR STD SZ11

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270699477
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

PSN FEM CR POR CCR STD SZ11

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270699477
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM CR POR CCR STD SZ 12

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270698700
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM CR POR CCR STD SZ 12

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270698700
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

PSN FEM CR POR CCR STD SZ 7 LT

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270698588
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

PSN FEM CR POR CCR STD SZ 7 LT

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270698588
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM CR POR CCR STD SZ8 L

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694747
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM CR POR CCR STD SZ8 L

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694747
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

PSN FEM CR POR CCR STD SZ E LT

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270694796
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$3,346.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

PSN FEM CR POR CCR STD SZ E LT

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270694796
Hospital Revenue Code	278
Min. Negotiated Rate	$333.30
Max. Negotiated Rate	$6,915.00
Rate for Payer: Aetna Commercial	$5,255.40
Rate for Payer: Aetna Medicare Advantage	$4,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,526.65
Rate for Payer: Cigna Commercial	$6,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,042.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50
Rate for Payer: UnitedHealthcare Community & State	$333.30
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

PSN FEM POR CCR NRM SZ 9R

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270695089
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

PSN FEM POR CCR NRM SZ 9R

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270695089
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN FEM PS CMT CCR NRW SZ 10L

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696438
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PSN FEM PS CMT CCR NRW SZ 10L

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696438
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

Know your out-of-pocket cost for care.

All Charges