Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FP DRESS/DEBRID LARGE

Facility

$612.00

Service Code	HCPCS 16030
Hospital Charge Code	87502520
Hospital Revenue Code	361
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.12
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.80
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$19.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$17.38

FP DRESS/DEBRID LARGE

Facility

$612.00

Service Code	HCPCS 16030
Hospital Charge Code	87502520
Hospital Revenue Code	361
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$91.80
Rate for Payer: Qualcare PPO/HMO/WC	$91.80

FP DRESSING/DEBRID MEDIUM

Facility

$612.00

Service Code	HCPCS 16020
Hospital Charge Code	87502515
Hospital Revenue Code	761
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$864.65
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.12
Rate for Payer: Oxford Commercial	$122.40
Rate for Payer: Qualcare PPO/HMO/WC	$91.80
Rate for Payer: UnitedHealthcare Commercial	$122.40
Rate for Payer: UnitedHealthcare Community & State	$19.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$17.38

FP DRESSING/DEBRID MEDIUM

Facility

$612.00

Service Code	HCPCS 16020
Hospital Charge Code	87502515
Hospital Revenue Code	761
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$91.80
Rate for Payer: Qualcare PPO/HMO/WC	$91.80

FP EKG 12 LEADS

Facility

$2,050.00

Service Code	HCPCS 93005
Hospital Charge Code	87502625
Hospital Revenue Code	730
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$879.00
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	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
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	$67.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
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	$533.00
Rate for Payer: Oxford Commercial	$659.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Commercial	$879.00
Rate for Payer: UnitedHealthcare Community & State	$64.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$58.22

FP EKG 12 LEADS

Facility

$2,050.00

Service Code	HCPCS 93005
Hospital Charge Code	87502625
Hospital Revenue Code	730
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$307.50
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

FP EKG INTER & REPORT ONLY

Facility

$49.00

Service Code	HCPCS 93010
Hospital Charge Code	87502635
Hospital Revenue Code	730
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

FP EKG INTER & REPORT ONLY

Facility

$49.00

Service Code	HCPCS 93010
Hospital Charge Code	87502635
Hospital Revenue Code	730
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$879.00
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.74
Rate for Payer: Oxford Commercial	$659.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$879.00
Rate for Payer: UnitedHealthcare Community & State	$1.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

FP EKG W INTERPRETATION & RPT

Facility

$114.00

Service Code	HCPCS 93000
Hospital Charge Code	83652367
Hospital Revenue Code	730
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

FP EKG W INTERPRETATION & RPT

Facility

$114.00

Service Code	HCPCS 93000
Hospital Charge Code	83652367
Hospital Revenue Code	730
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$879.00
Rate for Payer: Aetna Commercial	$43.32
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.64
Rate for Payer: Oxford Commercial	$659.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.10
Rate for Payer: UnitedHealthcare Commercial	$879.00
Rate for Payer: UnitedHealthcare Community & State	$3.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

FP ENALAPRIL 5MG TAB(VASOTEC)

Facility

$59.00

Hospital Charge Code	83652607
Hospital Revenue Code	637
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

FP ENALAPRIL 5MG TAB(VASOTEC)

Facility

$59.00

Hospital Charge Code	83652607
Hospital Revenue Code	637
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Oxford Commercial	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$11.80
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

FP ER HIGH COMPLEXITY/SEVERITY

Professional

Both

$544.00

Service Code	HCPCS 99285
Hospital Charge Code	83652457
Hospital Revenue Code	981
Min. Negotiated Rate	$178.33
Max. Negotiated Rate	$539.05
Rate for Payer: Aetna Medicare Advantage	$178.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$539.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$539.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$539.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$539.05
Rate for Payer: Clover Medicare Advantage	$178.33

FP ER LOW-MODERATE SEVERITY

Professional

Both

$149.00

Service Code	HCPCS 99282
Hospital Charge Code	83652449
Hospital Revenue Code	981
Min. Negotiated Rate	$23.22
Max. Negotiated Rate	$129.27
Rate for Payer: Aetna Commercial	$95.24
Rate for Payer: Aetna Medicare Advantage	$92.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$129.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$129.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.27
Rate for Payer: Cigna Commercial	$92.35
Rate for Payer: Cigna Medicare Advantage	$92.35
Rate for Payer: Fidelis All Plans	$29.27
Rate for Payer: Marpai Administrators LLC Commercial	$34.15
Rate for Payer: UnitedHealthcare Commercial	$23.22
Rate for Payer: UnitedHealthcare Community & State	$23.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.22
Rate for Payer: Wellpoint Medicaid Managed Care	$43.64

FP EXC BENIGN LESION SKIN TAG

Facility

$678.00

Service Code	HCPCS 11400
Hospital Charge Code	83652037
Hospital Revenue Code	761
Min. Negotiated Rate	$19.26
Max. Negotiated Rate	$3,051.74
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.28
Rate for Payer: Oxford Commercial	$135.60
Rate for Payer: Qualcare PPO/HMO/WC	$101.70
Rate for Payer: UnitedHealthcare Commercial	$135.60
Rate for Payer: UnitedHealthcare Community & State	$21.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$19.26

FP EXC BENIGN LESION SKIN TAG

Facility

$678.00

Service Code	HCPCS 11400
Hospital Charge Code	83652037
Hospital Revenue Code	761
Min. Negotiated Rate	$101.70
Max. Negotiated Rate	$101.70
Rate for Payer: Qualcare PPO/HMO/WC	$101.70

FP EXC DIAM OVER 4.0

Facility

$440.80

Service Code	HCPCS 11406
Hospital Charge Code	87502465
Hospital Revenue Code	761
Min. Negotiated Rate	$12.52
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.61
Rate for Payer: Oxford Commercial	$88.16
Rate for Payer: Qualcare PPO/HMO/WC	$66.12
Rate for Payer: UnitedHealthcare Commercial	$88.16
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$12.52

FP EXC DIAM OVER 4.0

Facility

$440.80

Service Code	HCPCS 11406
Hospital Charge Code	87502465
Hospital Revenue Code	761
Min. Negotiated Rate	$66.12
Max. Negotiated Rate	$66.12
Rate for Payer: Qualcare PPO/HMO/WC	$66.12

FP EXC OTHER BENIGN LES 0.5 CM

Facility

$745.00

Service Code	HCPCS 11440
Hospital Charge Code	87502470
Hospital Revenue Code	761
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$111.75
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

FP EXC OTHER BENIGN LES 0.5 CM

Facility

$745.00

Service Code	HCPCS 11440
Hospital Charge Code	87502470
Hospital Revenue Code	761
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$3,051.74
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.70
Rate for Payer: Oxford Commercial	$149.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Commercial	$149.00
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

FP EXC.OTHER BENIGN LES 0.5 CM

Facility

$745.00

Service Code	HCPCS 11440
Hospital Charge Code	83652047
Hospital Revenue Code	761
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$111.75
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

FP EXC.OTHER BENIGN LES 0.5 CM

Facility

$745.00

Service Code	HCPCS 11440
Hospital Charge Code	83652047
Hospital Revenue Code	761
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$3,051.74
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.70
Rate for Payer: Oxford Commercial	$149.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Commercial	$149.00
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

FP EXC PILONIDAL CYST

Facility

$15,496.15

Service Code	HCPCS 11770
Hospital Charge Code	87502500
Hospital Revenue Code	761
Min. Negotiated Rate	$2,324.42
Max. Negotiated Rate	$2,324.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42

FP EXC PILONIDAL CYST

Facility

$15,496.15

Service Code	HCPCS 11770
Hospital Charge Code	87502500
Hospital Revenue Code	761
Min. Negotiated Rate	$166.10
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,029.00
Rate for Payer: Oxford Commercial	$3,099.23
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42
Rate for Payer: UnitedHealthcare Commercial	$3,099.23
Rate for Payer: UnitedHealthcare Community & State	$489.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$440.09

FP EXC SKIN & SUBC HIDRADENIT

Facility

$2,052.00

Service Code	HCPCS 11450
Hospital Charge Code	87502475
Hospital Revenue Code	761
Min. Negotiated Rate	$307.80
Max. Negotiated Rate	$307.80
Rate for Payer: Qualcare PPO/HMO/WC	$307.80

Know your out-of-pocket cost for care.

All Charges