Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ALPHA FETOPROTEIN (AFP)

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38472062
Hospital Revenue Code	301
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$45.61
Rate for Payer: Aetna Medicare Advantage	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.83
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: Cigna Medicare Advantage	$16.77
Rate for Payer: Clover Medicare Advantage	$15.93
Rate for Payer: EmblemHealth Commercial	$50.31
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.77
Rate for Payer: Wellcare Medicare Advantage	$16.77
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

ALPHAFETOPROTEIN,AFP

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38479404
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ALPHAFETOPROTEIN,AFP

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38479404
Hospital Revenue Code	301
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$45.61
Rate for Payer: Aetna Medicare Advantage	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.83
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: Cigna Medicare Advantage	$16.77
Rate for Payer: Clover Medicare Advantage	$15.93
Rate for Payer: EmblemHealth Commercial	$50.31
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.77
Rate for Payer: Wellcare Medicare Advantage	$16.77
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

ALPHA FETOPROTEIN, AMNIOTIC FL

Facility

$350.00

Service Code	HCPCS 82106
Hospital Charge Code	38472068
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ALPHA FETOPROTEIN, AMNIOTIC FL

Facility

$350.00

Service Code	HCPCS 82106
Hospital Charge Code	38472068
Hospital Revenue Code	301
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$46.24
Rate for Payer: Aetna Medicare Advantage	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.67
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: Cigna Medicare Advantage	$17.00
Rate for Payer: Clover Medicare Advantage	$16.15
Rate for Payer: EmblemHealth Commercial	$51.00
Rate for Payer: Humana Medicare Advantage	$17.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.00
Rate for Payer: Wellcare Medicare Advantage	$17.00
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

ALPHA-FETOPROTEIN L3

Facility

$290.78

Service Code	HCPCS 82107
Hospital Charge Code	401182107
Hospital Revenue Code	301
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$233.65
Rate for Payer: Aetna Commercial	$175.20
Rate for Payer: Aetna Medicare Advantage	$208.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.65
Rate for Payer: Cigna Commercial	$145.39
Rate for Payer: Cigna Medicare Advantage	$64.41
Rate for Payer: Clover Medicare Advantage	$61.19
Rate for Payer: EmblemHealth Commercial	$193.23
Rate for Payer: Humana Medicare Advantage	$66.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.62
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.41
Rate for Payer: Wellcare Medicare Advantage	$64.41
Rate for Payer: Wellpoint Medicaid Managed Care	$8.26

ALPHA-FETOPROTEIN L3

Facility

$290.78

Service Code	HCPCS 82107
Hospital Charge Code	401182107
Hospital Revenue Code	301
Min. Negotiated Rate	$43.62
Max. Negotiated Rate	$43.62
Rate for Payer: Qualcare PPO/HMO/WC	$43.62

ALPHA FETOPROTEIN,MATERNAL SER

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38472065
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ALPHA FETOPROTEIN,MATERNAL SER

Facility

$550.00

Service Code	HCPCS 82105
Hospital Charge Code	38472065
Hospital Revenue Code	301
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$45.61
Rate for Payer: Aetna Medicare Advantage	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.83
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: Cigna Medicare Advantage	$16.77
Rate for Payer: Clover Medicare Advantage	$15.93
Rate for Payer: EmblemHealth Commercial	$50.31
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.77
Rate for Payer: Wellcare Medicare Advantage	$16.77
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

ALPHAGAN, 0.2%, 5ML

Facility

$121.47

Service Code	NDC 24208041105
Hospital Charge Code	60635466
Hospital Revenue Code	250
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$18.22
Rate for Payer: Qualcare PPO/HMO/WC	$18.22

ALPHAGAN, 0.2%, 5ML

Facility

$121.47

Service Code	NDC 24208041105
Hospital Charge Code	60635466
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$60.73
Rate for Payer: Aetna Commercial	$46.16
Rate for Payer: Aetna Medicare Advantage	$36.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.97
Rate for Payer: Cigna Commercial	$60.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.58
Rate for Payer: Oxford Commercial	$24.29
Rate for Payer: Qualcare PPO/HMO/WC	$18.22
Rate for Payer: UnitedHealthcare Commercial	$24.29
Rate for Payer: UnitedHealthcare Community & State	$3.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.45

ALPHA-GLOBIN COMMON MUTAT

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900320
Hospital Revenue Code	310
Min. Negotiated Rate	$348.45
Max. Negotiated Rate	$348.45
Rate for Payer: Qualcare PPO/HMO/WC	$348.45

ALPHA-GLOBIN COMMON MUTAT

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900320
Hospital Revenue Code	310
Min. Negotiated Rate	$65.97
Max. Negotiated Rate	$1,161.50
Rate for Payer: Aetna Commercial	$278.15
Rate for Payer: Aetna Medicare Advantage	$331.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$370.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$370.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$102.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$370.95
Rate for Payer: Cigna Commercial	$1,161.50
Rate for Payer: Cigna Medicare Advantage	$102.26
Rate for Payer: Clover Medicare Advantage	$97.15
Rate for Payer: EmblemHealth Commercial	$306.78
Rate for Payer: Humana Medicare Advantage	$105.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$102.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$603.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$81.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.26
Rate for Payer: Wellcare Medicare Advantage	$102.26
Rate for Payer: Wellpoint Medicaid Managed Care	$65.97

ALPHA-GLOBIN COMPLETE

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900030
Hospital Revenue Code	310
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$819.67
Rate for Payer: Aetna Medicare Advantage	$976.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,093.15
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$301.35
Rate for Payer: Clover Medicare Advantage	$286.28
Rate for Payer: EmblemHealth Commercial	$904.05
Rate for Payer: Humana Medicare Advantage	$310.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$301.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$241.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.35
Rate for Payer: Wellcare Medicare Advantage	$301.35
Rate for Payer: Wellpoint Medicaid Managed Care	$67.45

ALPHA-GLOBIN COMPLETE

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900030
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

ALPHA-GLOBIN SEQUENCING

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900322
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

ALPHA-GLOBIN SEQUENCING

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900322
Hospital Revenue Code	310
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$819.67
Rate for Payer: Aetna Medicare Advantage	$976.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,093.15
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$301.35
Rate for Payer: Clover Medicare Advantage	$286.28
Rate for Payer: EmblemHealth Commercial	$904.05
Rate for Payer: Humana Medicare Advantage	$310.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$301.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$241.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.35
Rate for Payer: Wellcare Medicare Advantage	$301.35
Rate for Payer: Wellpoint Medicaid Managed Care	$67.45

ALPHAGRAFT CBM 10CC

Facility

$23,225.00

Hospital Charge Code	270703551
Hospital Revenue Code	278
Min. Negotiated Rate	$3,483.75
Max. Negotiated Rate	$5,620.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,620.45
Rate for Payer: Qualcare PPO/HMO/WC	$3,483.75

ALPHAGRAFT CBM 10CC

Facility

$23,225.00

Hospital Charge Code	270703551
Hospital Revenue Code	278
Min. Negotiated Rate	$659.59
Max. Negotiated Rate	$11,612.50
Rate for Payer: Aetna Commercial	$8,825.50
Rate for Payer: Aetna Medicare Advantage	$6,967.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,922.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,922.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,922.38
Rate for Payer: Cigna Commercial	$11,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,620.45
Rate for Payer: Qualcare PPO/HMO/WC	$3,483.75
Rate for Payer: UnitedHealthcare Community & State	$733.91
Rate for Payer: Wellpoint Medicaid Managed Care	$659.59

ALPHAGRAFT CBM 5CC

Facility

$13,145.00

Hospital Charge Code	270702571
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.75
Max. Negotiated Rate	$3,181.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,629.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,181.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.75

ALPHAGRAFT CBM 5CC

Facility

$13,145.00

Hospital Charge Code	270702571
Hospital Revenue Code	278
Min. Negotiated Rate	$373.32
Max. Negotiated Rate	$6,572.50
Rate for Payer: Aetna Commercial	$4,995.10
Rate for Payer: Aetna Medicare Advantage	$3,943.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,351.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,351.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,351.97
Rate for Payer: Cigna Commercial	$6,572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,181.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.75
Rate for Payer: UnitedHealthcare Community & State	$415.38
Rate for Payer: Wellpoint Medicaid Managed Care	$373.32

ALPHAGRAFT DBM FIBER 5CC

Facility

$6,500.00

Service Code	HCPCS C1762
Hospital Charge Code	270704196
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

ALPHAGRAFT DBM FIBER 5CC

Facility

$6,500.00

Service Code	HCPCS C1762
Hospital Charge Code	270704196
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

ALPHAGRAFT DBM FIBER FLOW 2.5C

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270703774
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ALPHAGRAFT DBM FIBER FLOW 2.5C

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270703774
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

Know your out-of-pocket cost for care.

All Charges