Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

REMOVE SELF-CONTD PENIS PROS

Facility

$29,904.60

Service Code	HCPCS 54415
Hospital Charge Code	1600000314
Hospital Revenue Code	360
Min. Negotiated Rate	$4,485.69
Max. Negotiated Rate	$4,485.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,485.69

REMOVE SPINAL LAMINA ADD-ON

Facility

$47,548.90

Service Code	HCPCS 63048
Hospital Charge Code	16000319
Hospital Revenue Code	360
Min. Negotiated Rate	$1,145.93
Max. Negotiated Rate	$23,774.45
Rate for Payer: Aetna Commercial	$18,068.58
Rate for Payer: Aetna Medicare Advantage	$14,264.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,124.97
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	$12,124.97
Rate for Payer: Cigna Commercial	$23,774.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,264.67
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$1,145.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1,260.05

REMOVE SPINAL LAMINA ADD-ON

Facility

$47,548.90

Service Code	HCPCS 63048
Hospital Charge Code	16000319
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

REMOVE SPINE ELTRD PLATE

Facility

$11,517.52

Service Code	HCPCS 63662
Hospital Charge Code	1600000877
Hospital Revenue Code	360
Min. Negotiated Rate	$277.57
Max. Negotiated Rate	$14,992.78
Rate for Payer: Aetna Commercial	$11,297.44
Rate for Payer: Aetna Medicare Advantage	$13,457.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,992.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,992.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,153.47
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	$14,992.78
Rate for Payer: Cigna Commercial	$8,325.61
Rate for Payer: Cigna Medicare Advantage	$4,153.47
Rate for Payer: Clover Medicare Advantage	$3,945.80
Rate for Payer: EmblemHealth Commercial	$12,460.41
Rate for Payer: Humana Medicare Advantage	$4,278.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,153.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,455.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,727.63
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$277.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,153.47
Rate for Payer: Wellcare Medicare Advantage	$4,153.47
Rate for Payer: Wellpoint Medicaid Managed Care	$305.21

REMOVE SPINE ELTRD PLATE

Facility

$11,517.52

Service Code	HCPCS 63662
Hospital Charge Code	1600000877
Hospital Revenue Code	360
Min. Negotiated Rate	$1,727.63
Max. Negotiated Rate	$1,727.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,727.63

REMOVE SPINE FIXATION DEVICE

Facility

$13,677.00

Service Code	HCPCS 61783
Hospital Charge Code	1600000622
Hospital Revenue Code	360
Min. Negotiated Rate	$2,051.55
Max. Negotiated Rate	$2,051.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,051.55

REMOVE SPINE FIXATION DEVICE

Facility

$11,542.64

Service Code	HCPCS 22850
Hospital Charge Code	1600000479
Hospital Revenue Code	360
Min. Negotiated Rate	$278.18
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,462.79
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,731.40
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$278.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$305.88

REMOVE SPINE FIXATION DEVICE

Facility

$11,542.64

Service Code	HCPCS 22850
Hospital Charge Code	1600000479
Hospital Revenue Code	360
Min. Negotiated Rate	$1,731.40
Max. Negotiated Rate	$1,731.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,731.40

REMOVE SPINE FIXATION DEVICE

Facility

$13,677.00

Service Code	HCPCS 61783
Hospital Charge Code	1600000622
Hospital Revenue Code	360
Min. Negotiated Rate	$329.62
Max. Negotiated Rate	$6,838.50
Rate for Payer: Aetna Commercial	$5,197.26
Rate for Payer: Aetna Medicare Advantage	$4,103.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,487.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,487.64
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	$3,487.64
Rate for Payer: Cigna Commercial	$6,838.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,103.10
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,051.55
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$329.62
Rate for Payer: Wellpoint Medicaid Managed Care	$362.44

REMOVE SPINE LAMINA 1/2 THRC

Facility

$26,295.79

Service Code	HCPCS 63003
Hospital Charge Code	16001019
Hospital Revenue Code	360
Min. Negotiated Rate	$633.73
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,888.74
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,944.37
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$633.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$696.84

REMOVE SPINE LAMINA 1/2 THRC

Facility

$26,295.79

Service Code	HCPCS 63003
Hospital Charge Code	16001019
Hospital Revenue Code	360
Min. Negotiated Rate	$3,944.37
Max. Negotiated Rate	$3,944.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,944.37

REMOVE THYROID LESION

Facility

$49,367.70

Service Code	HCPCS 60200
Hospital Charge Code	1600000749
Hospital Revenue Code	360
Min. Negotiated Rate	$1,016.00
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,810.31
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,405.15
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,189.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,308.24

REMOVE THYROID LESION

Facility

$49,367.70

Service Code	HCPCS 60200
Hospital Charge Code	1600000749
Hospital Revenue Code	360
Min. Negotiated Rate	$7,405.15
Max. Negotiated Rate	$7,405.15
Rate for Payer: Qualcare PPO/HMO/WC	$7,405.15

REMOVE TNL CV CATH LT

Facility

$5,901.40

Service Code	HCPCS 36589
Hospital Charge Code	16000458
Hospital Revenue Code	360
Min. Negotiated Rate	$142.22
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,770.42
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.21
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$142.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$156.39

REMOVE TNL CV CATH LT

Facility

$5,901.40

Service Code	HCPCS 36589
Hospital Charge Code	16000458
Hospital Revenue Code	360
Min. Negotiated Rate	$885.21
Max. Negotiated Rate	$885.21
Rate for Payer: Qualcare PPO/HMO/WC	$885.21

REMOVE TONSILS & ADNIDS<12YRS

Facility

$30,218.69

Service Code	HCPCS 42820
Hospital Charge Code	1600000272
Hospital Revenue Code	360
Min. Negotiated Rate	$728.27
Max. Negotiated Rate	$25,386.70
Rate for Payer: Aetna Commercial	$19,129.52
Rate for Payer: Aetna Medicare Advantage	$22,786.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,032.91
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	$25,386.70
Rate for Payer: Cigna Commercial	$14,097.46
Rate for Payer: Cigna Medicare Advantage	$7,032.91
Rate for Payer: Clover Medicare Advantage	$6,681.26
Rate for Payer: EmblemHealth Commercial	$21,098.73
Rate for Payer: Humana Medicare Advantage	$7,243.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,032.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,065.61
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,532.80
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$728.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,032.91
Rate for Payer: Wellcare Medicare Advantage	$7,032.91
Rate for Payer: Wellpoint Medicaid Managed Care	$800.80

REMOVE TONSILS & ADNIDS<12YRS

Facility

$30,218.69

Service Code	HCPCS 42820
Hospital Charge Code	1600000272
Hospital Revenue Code	360
Min. Negotiated Rate	$4,532.80
Max. Negotiated Rate	$4,532.80
Rate for Payer: Qualcare PPO/HMO/WC	$4,532.80

REMOVE/TRANSPLANT TENDON

Facility

$9,043.00

Service Code	HCPCS 23440
Hospital Charge Code	16000544
Hospital Revenue Code	360
Min. Negotiated Rate	$1,356.45
Max. Negotiated Rate	$1,356.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.45

REMOVE/TRANSPLANT TENDON

Facility

$9,043.00

Service Code	HCPCS 23440
Hospital Charge Code	16000544
Hospital Revenue Code	360
Min. Negotiated Rate	$217.94
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,712.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.45
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$217.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$239.64

REMOVE VAD DIFFERENT SESSION

Facility

$2,750.00

Service Code	HCPCS 33992
Hospital Charge Code	411033992
Hospital Revenue Code	361
Min. Negotiated Rate	$66.28
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
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	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$66.28
Rate for Payer: Wellpoint Medicaid Managed Care	$72.88

REMOVE VAD DIFFERENT SESSION

Facility

$2,750.00

Service Code	HCPCS 33992
Hospital Charge Code	411033992
Hospital Revenue Code	361
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

REMOVE VAGINAL WALL PARTIAL

Facility

$10,659.96

Service Code	HCPCS 57106
Hospital Charge Code	1600000806
Hospital Revenue Code	360
Min. Negotiated Rate	$1,598.99
Max. Negotiated Rate	$1,598.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.99

REMOVE VAGINAL WALL PARTIAL

Facility

$10,659.96

Service Code	HCPCS 57106
Hospital Charge Code	1600000806
Hospital Revenue Code	360
Min. Negotiated Rate	$256.91
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
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	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,197.99
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.99
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$256.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$282.49

REMOVE VERT BODY DCMPRN LMBR

Facility

$23,970.90

Service Code	HCPCS 63090
Hospital Charge Code	16001031
Hospital Revenue Code	360
Min. Negotiated Rate	$3,595.64
Max. Negotiated Rate	$3,595.64
Rate for Payer: Qualcare PPO/HMO/WC	$3,595.64

REMOVE VERT BODY DCMPRN LMBR

Facility

$23,970.90

Service Code	HCPCS 63090
Hospital Charge Code	16001031
Hospital Revenue Code	360
Min. Negotiated Rate	$577.70
Max. Negotiated Rate	$11,985.45
Rate for Payer: Aetna Commercial	$9,108.94
Rate for Payer: Aetna Medicare Advantage	$7,191.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,112.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,112.58
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	$6,112.58
Rate for Payer: Cigna Commercial	$11,985.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,191.27
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,595.64
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$577.70
Rate for Payer: Wellpoint Medicaid Managed Care	$635.23

Know your out-of-pocket cost for care.

All Charges