Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$24,215.32

Service Code	APR-DRG 3222
Min. Negotiated Rate	$23,740.51
Max. Negotiated Rate	$24,215.32
Rate for Payer: UnitedHealthcare Community & State	$23,740.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,215.32
Rate for Payer: Wellpoint Medicaid Managed Care	$23,740.51

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$22,439.43

Service Code	APR-DRG 3221
Min. Negotiated Rate	$21,999.44
Max. Negotiated Rate	$22,439.43
Rate for Payer: UnitedHealthcare Community & State	$21,999.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,439.43
Rate for Payer: Wellpoint Medicaid Managed Care	$21,999.44

SHOULDER,ARTHOSCOPY,DX

Facility

$25,603.80

Service Code	HCPCS 29805
Hospital Charge Code	16000728
Hospital Revenue Code	360
Min. Negotiated Rate	$3,840.57
Max. Negotiated Rate	$3,840.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57

SHOULDER,ARTHOSCOPY,DX

Facility

$25,603.80

Service Code	HCPCS 29805
Hospital Charge Code	16000728
Hospital Revenue Code	360
Min. Negotiated Rate	$617.05
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,681.14
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$617.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$678.50

SHOULDER ARTHOSCOPY KIT

Facility

$647.00

Hospital Charge Code	270338754
Hospital Revenue Code	272
Min. Negotiated Rate	$15.59
Max. Negotiated Rate	$323.50
Rate for Payer: Aetna Commercial	$245.86
Rate for Payer: Aetna Medicare Advantage	$194.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.99
Rate for Payer: Cigna Commercial	$323.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.10
Rate for Payer: Oxford Commercial	$129.40
Rate for Payer: Qualcare PPO/HMO/WC	$97.05
Rate for Payer: UnitedHealthcare Commercial	$129.40
Rate for Payer: UnitedHealthcare Community & State	$15.59
Rate for Payer: Wellpoint Medicaid Managed Care	$17.15

SHOULDER ARTHOSCOPY KIT

Facility

$647.00

Hospital Charge Code	270338754
Hospital Revenue Code	272
Min. Negotiated Rate	$97.05
Max. Negotiated Rate	$97.05
Rate for Payer: Qualcare PPO/HMO/WC	$97.05

SHOULDER ARTHROGRAM INJ

Facility

$272.05

Service Code	HCPCS 23350
Hospital Charge Code	16000676
Hospital Revenue Code	360
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$103.38
Rate for Payer: Aetna Medicare Advantage	$81.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.37
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	$69.37
Rate for Payer: Cigna Commercial	$136.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.61
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.81
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$6.56
Rate for Payer: Wellpoint Medicaid Managed Care	$7.21

SHOULDER ARTHROGRAM INJ

Facility

$272.05

Service Code	HCPCS 23350
Hospital Charge Code	16000676
Hospital Revenue Code	360
Min. Negotiated Rate	$40.81
Max. Negotiated Rate	$40.81
Rate for Payer: Qualcare PPO/HMO/WC	$40.81

SHOULDER ARTHROSCOPY/SURGER-RT

Facility

$50,586.00

Service Code	HCPCS 29807
Hospital Charge Code	16000243
Hospital Revenue Code	360
Min. Negotiated Rate	$7,587.90
Max. Negotiated Rate	$7,587.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90

SHOULDER ARTHROSCOPY/SURGER-RT

Facility

$50,586.00

Service Code	HCPCS 29807
Hospital Charge Code	16000243
Hospital Revenue Code	360
Min. Negotiated Rate	$1,219.12
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	$1,355.00
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	$15,175.80
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,219.12
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	$1,340.53

SHOULDER ARTHROSCOPY/SURGERY

Facility

$26,295.79

Service Code	HCPCS 29820
Hospital Charge Code	16000296
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

SHOULDER ARTHROSCOPY/SURGERY

Facility

$26,295.79

Service Code	HCPCS 29820
Hospital Charge Code	16000296
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	$1,355.00
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

SHOULDER ARTHROSCOPY/SURGRY-R

Facility

$50,586.00

Service Code	HCPCS 29806
Hospital Charge Code	16000341
Hospital Revenue Code	360
Min. Negotiated Rate	$1,219.12
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	$1,355.00
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	$15,175.80
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,219.12
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	$1,340.53

SHOULDER ARTHROSCOPY/SURGRY-R

Facility

$50,586.00

Service Code	HCPCS 29806
Hospital Charge Code	16000341
Hospital Revenue Code	360
Min. Negotiated Rate	$7,587.90
Max. Negotiated Rate	$7,587.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90

SHOULDER BMT 7 115 11-113703

Facility

$15,585.00

Hospital Charge Code	270619988
Hospital Revenue Code	278
Min. Negotiated Rate	$375.60
Max. Negotiated Rate	$7,792.50
Rate for Payer: Aetna Commercial	$5,922.30
Rate for Payer: Aetna Medicare Advantage	$4,675.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,974.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,974.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,974.18
Rate for Payer: Cigna Commercial	$7,792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,771.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,428.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,337.75
Rate for Payer: UnitedHealthcare Community & State	$375.60
Rate for Payer: Wellpoint Medicaid Managed Care	$413.00

SHOULDER BMT 7 115 11-113703

Facility

$15,585.00

Hospital Charge Code	270619988
Hospital Revenue Code	278
Min. Negotiated Rate	$2,337.75
Max. Negotiated Rate	$3,771.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,771.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,428.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,337.75

SHOULDER BMT 9 115 11-113705

Facility

$15,585.00

Hospital Charge Code	270620288
Hospital Revenue Code	278
Min. Negotiated Rate	$2,337.75
Max. Negotiated Rate	$3,771.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,771.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,428.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,337.75

SHOULDER BMT 9 115 11-113705

Facility

$15,585.00

Hospital Charge Code	270620288
Hospital Revenue Code	278
Min. Negotiated Rate	$375.60
Max. Negotiated Rate	$7,792.50
Rate for Payer: Aetna Commercial	$5,922.30
Rate for Payer: Aetna Medicare Advantage	$4,675.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,974.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,974.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,974.18
Rate for Payer: Cigna Commercial	$7,792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,771.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,428.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,337.75
Rate for Payer: UnitedHealthcare Community & State	$375.60
Rate for Payer: Wellpoint Medicaid Managed Care	$413.00

SHOULDER DEBRIDEMENT RASP

Facility

$1,900.00

Hospital Charge Code	270656561
Hospital Revenue Code	272
Min. Negotiated Rate	$45.79
Max. Negotiated Rate	$950.00
Rate for Payer: Aetna Commercial	$722.00
Rate for Payer: Aetna Medicare Advantage	$570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.50
Rate for Payer: Cigna Commercial	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$570.00
Rate for Payer: Oxford Commercial	$380.00
Rate for Payer: Qualcare PPO/HMO/WC	$285.00
Rate for Payer: UnitedHealthcare Commercial	$380.00
Rate for Payer: UnitedHealthcare Community & State	$45.79
Rate for Payer: Wellpoint Medicaid Managed Care	$50.35

SHOULDER DEBRIDEMENT RASP

Facility

$1,900.00

Hospital Charge Code	270656561
Hospital Revenue Code	272
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$285.00
Rate for Payer: Qualcare PPO/HMO/WC	$285.00

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$69,343.68

Service Code	MSDRG 511
Min. Negotiated Rate	$21,114.26
Max. Negotiated Rate	$69,343.68
Rate for Payer: Aetna Commercial	$47,904.32
Rate for Payer: Aetna Medicare Advantage	$69,343.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,289.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,289.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,225.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,289.39
Rate for Payer: Cigna Commercial	$38,913.89
Rate for Payer: Cigna Medicare Advantage	$22,225.54
Rate for Payer: Clover Medicare Advantage	$21,114.26
Rate for Payer: EmblemHealth Commercial	$66,676.62
Rate for Payer: Humana Medicare Advantage	$22,892.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,225.54
Rate for Payer: Oxford Commercial	$27,967.93
Rate for Payer: UnitedHealthcare Commercial	$49,042.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,225.54
Rate for Payer: Wellcare Medicare Advantage	$22,225.54

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility

$99,761.66

Service Code	MSDRG 510
Min. Negotiated Rate	$30,376.15
Max. Negotiated Rate	$99,761.66
Rate for Payer: Aetna Commercial	$68,804.97
Rate for Payer: Aetna Medicare Advantage	$99,761.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63,269.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63,269.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31,974.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63,269.92
Rate for Payer: Cigna Commercial	$56,525.64
Rate for Payer: Cigna Medicare Advantage	$31,974.89
Rate for Payer: Clover Medicare Advantage	$30,376.15
Rate for Payer: EmblemHealth Commercial	$95,924.67
Rate for Payer: Humana Medicare Advantage	$32,934.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31,974.89
Rate for Payer: Oxford Commercial	$40,625.72
Rate for Payer: UnitedHealthcare Commercial	$71,238.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$31,974.89
Rate for Payer: Wellcare Medicare Advantage	$31,974.89

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$55,639.37

Service Code	MSDRG 512
Min. Negotiated Rate	$16,941.47
Max. Negotiated Rate	$55,639.37
Rate for Payer: Aetna Commercial	$38,487.88
Rate for Payer: Aetna Medicare Advantage	$55,639.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,450.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,450.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,833.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,450.21
Rate for Payer: Cigna Commercial	$30,979.16
Rate for Payer: Cigna Medicare Advantage	$17,833.13
Rate for Payer: Clover Medicare Advantage	$16,941.47
Rate for Payer: EmblemHealth Commercial	$53,499.39
Rate for Payer: Humana Medicare Advantage	$18,368.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,833.13
Rate for Payer: Oxford Commercial	$22,265.13
Rate for Payer: UnitedHealthcare Commercial	$39,042.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,833.13
Rate for Payer: Wellcare Medicare Advantage	$17,833.13

SHOULDER EQUINOXE HUMERAL 0 mm

Facility

$27,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270679728
Hospital Revenue Code	278
Min. Negotiated Rate	$4,181.25
Max. Negotiated Rate	$6,745.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,745.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,132.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,181.25

SHOULDER EQUINOXE HUMERAL 0 mm

Facility

$27,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270679728
Hospital Revenue Code	278
Min. Negotiated Rate	$671.79
Max. Negotiated Rate	$13,937.50
Rate for Payer: Aetna Commercial	$10,592.50
Rate for Payer: Aetna Medicare Advantage	$8,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,108.12
Rate for Payer: Cigna Commercial	$13,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,745.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,132.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,181.25
Rate for Payer: UnitedHealthcare Community & State	$671.79
Rate for Payer: Wellpoint Medicaid Managed Care	$738.69

Know your out-of-pocket cost for care.

All Charges