Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

REMOVE EXTRA SPINE SEGMENT

Facility

$15,178.00

Service Code	HCPCS 22116
Hospital Charge Code	24001253
Hospital Revenue Code	360
Min. Negotiated Rate	$2,276.70
Max. Negotiated Rate	$2,276.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,276.70

REMOVE EXTRA SPINE SEGMENT

Facility

$15,178.00

Service Code	HCPCS 22116
Hospital Charge Code	1600000682
Hospital Revenue Code	360
Min. Negotiated Rate	$2,276.70
Max. Negotiated Rate	$2,276.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,276.70

REMOVE FECAL IMPACTION OR FB

Facility

$21,472.19

Service Code	HCPCS 45915
Hospital Charge Code	16000486
Hospital Revenue Code	360
Min. Negotiated Rate	$517.48
Max. Negotiated Rate	$6,441.66
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,131.69
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,441.66
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,220.83
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$517.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$569.01

REMOVE FECAL IMPACTION OR FB

Facility

$21,472.19

Service Code	HCPCS 45915
Hospital Charge Code	16000486
Hospital Revenue Code	360
Min. Negotiated Rate	$3,220.83
Max. Negotiated Rate	$3,220.83
Rate for Payer: Qualcare PPO/HMO/WC	$3,220.83

REMOVE GROIN LYMPH NODES

Facility

$22,569.14

Service Code	HCPCS 38760
Hospital Charge Code	16000958
Hospital Revenue Code	360
Min. Negotiated Rate	$3,385.37
Max. Negotiated Rate	$3,385.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,385.37

REMOVE GROIN LYMPH NODES

Facility

$22,569.14

Service Code	HCPCS 38760
Hospital Charge Code	16000958
Hospital Revenue Code	360
Min. Negotiated Rate	$543.92
Max. Negotiated Rate	$28,475.80
Rate for Payer: Aetna Commercial	$21,457.24
Rate for Payer: Aetna Medicare Advantage	$25,559.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,888.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,475.80
Rate for Payer: Cigna Commercial	$15,812.86
Rate for Payer: Cigna Medicare Advantage	$7,888.69
Rate for Payer: Clover Medicare Advantage	$7,494.26
Rate for Payer: EmblemHealth Commercial	$23,666.07
Rate for Payer: Humana Medicare Advantage	$8,125.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,888.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,770.74
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,385.37
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$543.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,888.69
Rate for Payer: Wellcare Medicare Advantage	$7,888.69
Rate for Payer: Wellpoint Medicaid Managed Care	$598.08

REMOVE IMPACTED EAR WAX UNI

Facility

$229.14

Service Code	HCPCS 69210
Hospital Charge Code	1600000283
Hospital Revenue Code	360
Min. Negotiated Rate	$34.37
Max. Negotiated Rate	$34.37
Rate for Payer: Qualcare PPO/HMO/WC	$34.37

REMOVE IMPACTED EAR WAX UNI

Facility

$229.14

Service Code	HCPCS 69210
Hospital Charge Code	1600000283
Hospital Revenue Code	360
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
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	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.74
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.37
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$5.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37
Rate for Payer: Wellpoint Medicaid Managed Care	$193.50

REMOVE IN/EX HEM GROUPS 2+

Facility

$32,333.10

Service Code	HCPCS 46260
Hospital Charge Code	16000172
Hospital Revenue Code	360
Min. Negotiated Rate	$4,849.97
Max. Negotiated Rate	$4,849.97
Rate for Payer: Qualcare PPO/HMO/WC	$4,849.97

REMOVE IN/EX HEM GROUPS 2+

Facility

$32,333.10

Service Code	HCPCS 46260
Hospital Charge Code	16000172
Hospital Revenue Code	360
Min. Negotiated Rate	$779.23
Max. Negotiated Rate	$11,903.20
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,903.20
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,699.93
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,849.97
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$779.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56
Rate for Payer: Wellpoint Medicaid Managed Care	$856.83

REMOVE IN/EX HEM GRP & FISS

Facility

$22,676.00

Service Code	HCPCS 46257
Hospital Charge Code	1600000628
Hospital Revenue Code	360
Min. Negotiated Rate	$3,401.40
Max. Negotiated Rate	$3,401.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,401.40

REMOVE IN/EX HEM GRP & FISS

Facility

$22,676.00

Service Code	HCPCS 46257
Hospital Charge Code	1600000628
Hospital Revenue Code	360
Min. Negotiated Rate	$546.49
Max. Negotiated Rate	$11,903.20
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,903.20
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,802.80
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,401.40
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$546.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56
Rate for Payer: Wellpoint Medicaid Managed Care	$600.91

REMOVE INT/EXT HEM 1 GROUP

Facility

$22,676.60

Service Code	HCPCS 46255
Hospital Charge Code	1600000384
Hospital Revenue Code	360
Min. Negotiated Rate	$546.51
Max. Negotiated Rate	$11,903.20
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,903.20
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,802.98
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,401.49
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$546.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56
Rate for Payer: Wellpoint Medicaid Managed Care	$600.93

REMOVE INT/EXT HEM 1 GROUP

Facility

$22,676.60

Service Code	HCPCS 46255
Hospital Charge Code	1600000384
Hospital Revenue Code	360
Min. Negotiated Rate	$3,401.49
Max. Negotiated Rate	$3,401.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,401.49

REMOVE INT/EXT HEM 2+GRPS & F

Facility

$22,676.60

Service Code	HCPCS 46261
Hospital Charge Code	1600000438
Hospital Revenue Code	360
Min. Negotiated Rate	$546.51
Max. Negotiated Rate	$11,903.20
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
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	$11,903.20
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,802.98
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,401.49
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$546.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56
Rate for Payer: Wellpoint Medicaid Managed Care	$600.93

REMOVE INT/EXT HEM 2+GRPS & F

Facility

$22,676.60

Service Code	HCPCS 46261
Hospital Charge Code	1600000438
Hospital Revenue Code	360
Min. Negotiated Rate	$3,401.49
Max. Negotiated Rate	$3,401.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,401.49

REMOVE INTRA AORTIC BALLN PERC

Facility

$180.00

Service Code	HCPCS 33968
Hospital Charge Code	5100314
Hospital Revenue Code	361
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

REMOVE INTRA AORTIC BALLN PERC

Facility

$180.00

Service Code	HCPCS 33968
Hospital Charge Code	74110038
Hospital Revenue Code	361
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

REMOVE INTRA AORTIC BALLN PERC

Facility

$180.00

Service Code	HCPCS 33968
Hospital Charge Code	74110038
Hospital Revenue Code	361
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$20,074.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
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	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

REMOVE INTRA AORTIC BALLN PERC

Facility

$180.00

Service Code	HCPCS 33968
Hospital Charge Code	5100314
Hospital Revenue Code	361
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$20,074.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
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	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

REMOVE INTRVAS FOREIGN BODY

Facility

$15,468.50

Service Code	HCPCS 37197
Hospital Charge Code	321037197
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

REMOVE INTRVAS FOREIGN BODY

Facility

$13,125.82

Service Code	HCPCS 37197
Hospital Charge Code	366837197
Hospital Revenue Code	361
Min. Negotiated Rate	$316.33
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	$3,937.75
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,968.87
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$316.33
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	$347.83

REMOVE INTRVAS FOREIGN BODY

Facility

$13,125.82

Service Code	HCPCS 37197
Hospital Charge Code	7411500
Hospital Revenue Code	361
Min. Negotiated Rate	$316.33
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	$3,937.75
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,968.87
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$316.33
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	$347.83

REMOVE INTRVAS FOREIGN BODY

Facility

$13,125.82

Service Code	HCPCS 37197
Hospital Charge Code	7411500
Hospital Revenue Code	361
Min. Negotiated Rate	$1,968.87
Max. Negotiated Rate	$1,968.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,968.87

REMOVE INTRVAS FOREIGN BODY

Facility

$15,468.50

Service Code	HCPCS 37197
Hospital Charge Code	5600228
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

Know your out-of-pocket cost for care.

All Charges