Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE LUCENT PC 12X17X11MM 5D

Facility

$16,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693128
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 PC 12X37X10MM 5D

Facility

$16,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697754
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 PC 12X37X10MM 5D

Facility

$16,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697754
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 PC 12X37X4MM 5D

Facility

$16,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697753
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 PC 12X37X4MM 5D

Facility

$16,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697753
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 PC 12X37X9MM 5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270697259
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 PC 12X37X9MM 5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270697259
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 PC 18X50X12MM 12D

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270695951
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENT PC 18X50X12MM 12D

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270695951
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENT PEEK 12X27X14MM5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270696220
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 PEEK 12X27X14MM5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270696220
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

CAGELUCENTTI-BOND12X37X13MM5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270697979
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

CAGELUCENTTI-BOND12X37X13MM5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270697979
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 LUNA XD 14MM 12D

Facility

$67,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270694361
Hospital Revenue Code	278
Min. Negotiated Rate	$1,614.70
Max. Negotiated Rate	$33,500.00
Rate for Payer: Aetna Commercial	$25,460.00
Rate for Payer: Aetna Medicare Advantage	$20,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,085.00
Rate for Payer: Cigna Commercial	$33,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,214.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,740.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,050.00
Rate for Payer: UnitedHealthcare Community & State	$1,614.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1,775.50

CAGE LUNA XD 14MM 12D

Facility

$67,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270694361
Hospital Revenue Code	278
Min. Negotiated Rate	$10,050.00
Max. Negotiated Rate	$16,214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,214.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,740.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,050.00

CAGE MAGNUM 37X27X10MM 12D

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270695736
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE MAGNUM 37X27X10MM 12D

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270695736
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

CAGE MAGNUM 37X27X14MM 18D

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270695737
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE MAGNUM 37X27X14MM 18D

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270695737
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

CAGE MAGNUM 41MMX27MMX14MM 12D

Facility

$25,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693015
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE MAGNUM 41MMX27MMX14MM 12D

Facility

$25,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270693015
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

CAGE MAGNUM PC 37X27X12MM 12D

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697716
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE MAGNUM PC 37X27X12MM 12D

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697716
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

CAGE MATRIX CORPEC 12X14X27 6D

Facility

$30,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270694312
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

CAGE MATRIX CORPEC 12X14X27 6D

Facility

$30,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270694312
Hospital Revenue Code	278
Min. Negotiated Rate	$723.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$11,400.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Community & State	$723.00
Rate for Payer: Wellpoint Medicaid Managed Care	$795.00

Know your out-of-pocket cost for care.

All Charges