Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE LT 14x17.5x23mm 8941423

Facility

$17,816.40

Hospital Charge Code	270630619
Hospital Revenue Code	272
Min. Negotiated Rate	$429.38
Max. Negotiated Rate	$8,908.20
Rate for Payer: Aetna Commercial	$6,770.23
Rate for Payer: Aetna Medicare Advantage	$5,344.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,543.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,543.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,543.18
Rate for Payer: Cigna Commercial	$8,908.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,344.92
Rate for Payer: Oxford Commercial	$3,563.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,672.46
Rate for Payer: UnitedHealthcare Commercial	$3,563.28
Rate for Payer: UnitedHealthcare Community & State	$429.38
Rate for Payer: Wellpoint Medicaid Managed Care	$472.13

CAGE LUCENT 10MMX27MMX10MM 5D

Facility

$8,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693044
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

CAGE LUCENT 10MMX27MMX10MM 5D

Facility

$8,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693044
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

CAGE LUCENT 10X22X13MM 5D

Facility

$6,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270695589
Hospital Revenue Code	278
Min. Negotiated Rate	$154.24
Max. Negotiated Rate	$3,200.00
Rate for Payer: Aetna Commercial	$2,432.00
Rate for Payer: Aetna Medicare Advantage	$1,920.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,632.00
Rate for Payer: Cigna Commercial	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,408.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.00
Rate for Payer: UnitedHealthcare Community & State	$154.24
Rate for Payer: Wellpoint Medicaid Managed Care	$169.60

CAGE LUCENT 10X22X13MM 5D

Facility

$6,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270695589
Hospital Revenue Code	278
Min. Negotiated Rate	$960.00
Max. Negotiated Rate	$1,548.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,408.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.00

CAGE LUCENT 10X22X8 5D

Facility

$8,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693988
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

CAGE LUCENT 10X22X8 5D

Facility

$8,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693988
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

CAGE LUCENT12MMX27MMX10MM 5DEG

Facility

$16,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270692995
Hospital Revenue Code	278
Min. Negotiated Rate	$385.60
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$385.60
Rate for Payer: Wellpoint Medicaid Managed Care	$424.00

CAGE LUCENT12MMX27MMX10MM 5DEG

Facility

$16,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270692995
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

CAGE LUCENT 12MMX27MMX11MM 5D

Facility

$16,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693037
Hospital Revenue Code	278
Min. Negotiated Rate	$385.60
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$385.60
Rate for Payer: Wellpoint Medicaid Managed Care	$424.00

CAGE LUCENT 12MMX27MMX11MM 5D

Facility

$16,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693037
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

CAGELUCENT12MMX27MMX12MM 5D PC

Facility

$8,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693035
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

CAGELUCENT12MMX27MMX12MM 5D PC

Facility

$8,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693035
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

CAGE LUCENT 12X27X12MM 5DEG

Facility

$16,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693007
Hospital Revenue Code	278
Min. Negotiated Rate	$385.60
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$385.60
Rate for Payer: Wellpoint Medicaid Managed Care	$424.00

CAGE LUCENT 12X27X12MM 5DEG

Facility

$16,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693007
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

CAGE LUCENT 12X27X9MM 5D PC

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270697141
Hospital Revenue Code	278
Min. Negotiated Rate	$1,920.00
Max. Negotiated Rate	$3,097.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,097.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,816.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,920.00

CAGE LUCENT 12X27X9MM 5D PC

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270697141
Hospital Revenue Code	278
Min. Negotiated Rate	$308.48
Max. Negotiated Rate	$6,400.00
Rate for Payer: Aetna Commercial	$4,864.00
Rate for Payer: Aetna Medicare Advantage	$3,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,264.00
Rate for Payer: Cigna Commercial	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,097.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,816.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,920.00
Rate for Payer: UnitedHealthcare Community & State	$308.48
Rate for Payer: Wellpoint Medicaid Managed Care	$339.20

CAGE LUCENT 12X37X11MM 5D PC

Facility

$17,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270696832
Hospital Revenue Code	278
Min. Negotiated Rate	$2,640.00
Max. Negotiated Rate	$4,259.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,259.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.00

CAGE LUCENT 12X37X11MM 5D PC

Facility

$17,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270696832
Hospital Revenue Code	278
Min. Negotiated Rate	$424.16
Max. Negotiated Rate	$8,800.00
Rate for Payer: Aetna Commercial	$6,688.00
Rate for Payer: Aetna Medicare Advantage	$5,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,488.00
Rate for Payer: Cigna Commercial	$8,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,259.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.00
Rate for Payer: UnitedHealthcare Community & State	$424.16
Rate for Payer: Wellpoint Medicaid Managed Care	$466.40

CAGE LUCENT 12X37X13MM 5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270697980
Hospital Revenue Code	278
Min. Negotiated Rate	$1,920.00
Max. Negotiated Rate	$3,097.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,097.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,816.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,920.00

CAGE LUCENT 12X37X13MM 5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270697980
Hospital Revenue Code	278
Min. Negotiated Rate	$308.48
Max. Negotiated Rate	$6,400.00
Rate for Payer: Aetna Commercial	$4,864.00
Rate for Payer: Aetna Medicare Advantage	$3,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,264.00
Rate for Payer: Cigna Commercial	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,097.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,816.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,920.00
Rate for Payer: UnitedHealthcare Community & State	$308.48
Rate for Payer: Wellpoint Medicaid Managed Care	$339.20

CAGE LUCENT 22X60X10MM 12D LAT

Facility

$26,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694362
Hospital Revenue Code	278
Min. Negotiated Rate	$638.65
Max. Negotiated Rate	$13,250.00
Rate for Payer: Aetna Commercial	$10,070.00
Rate for Payer: Aetna Medicare Advantage	$7,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,757.50
Rate for Payer: Cigna Commercial	$13,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,413.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,830.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,975.00
Rate for Payer: UnitedHealthcare Community & State	$638.65
Rate for Payer: Wellpoint Medicaid Managed Care	$702.25

CAGE LUCENT 22X60X10MM 12D LAT

Facility

$26,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694362
Hospital Revenue Code	278
Min. Negotiated Rate	$3,975.00
Max. Negotiated Rate	$6,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,413.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,830.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,975.00

CAGE LUCENT 22X60X12MM 12D LAT

Facility

$26,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694363
Hospital Revenue Code	278
Min. Negotiated Rate	$638.65
Max. Negotiated Rate	$13,250.00
Rate for Payer: Aetna Commercial	$10,070.00
Rate for Payer: Aetna Medicare Advantage	$7,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,757.50
Rate for Payer: Cigna Commercial	$13,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,413.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,830.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,975.00
Rate for Payer: UnitedHealthcare Community & State	$638.65
Rate for Payer: Wellpoint Medicaid Managed Care	$702.25

CAGE LUCENT 22X60X12MM 12D LAT

Facility

$26,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694363
Hospital Revenue Code	278
Min. Negotiated Rate	$3,975.00
Max. Negotiated Rate	$6,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,413.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,830.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,975.00

Know your out-of-pocket cost for care.

All Charges