Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR-WITHDRAW ART BLD

Facility

$623.55

Service Code	HCPCS 36600
Hospital Charge Code	2690060
Hospital Revenue Code	761
Min. Negotiated Rate	$93.53
Max. Negotiated Rate	$93.53
Rate for Payer: Qualcare PPO/HMO/WC	$93.53

IR-WITHDRAW ART BLD

Facility

$109.00

Service Code	HCPCS 36600
Hospital Charge Code	7411479
Hospital Revenue Code	761
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$16.35
Rate for Payer: Qualcare PPO/HMO/WC	$16.35

IR-WITHDRAW ART BLD

Facility

$525.15

Service Code	HCPCS 36600
Hospital Charge Code	411036600
Hospital Revenue Code	361
Min. Negotiated Rate	$16.59
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.54
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.77
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$16.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37
Rate for Payer: Wellpoint Medicaid Managed Care	$193.50

IR-WITHDRAW ART BLD

Facility

$525.15

Service Code	HCPCS 36600
Hospital Charge Code	411036600
Hospital Revenue Code	361
Min. Negotiated Rate	$78.77
Max. Negotiated Rate	$78.77
Rate for Payer: Qualcare PPO/HMO/WC	$78.77

IR-WITHDRAW ART BLD

Facility

$109.00

Service Code	HCPCS 36600
Hospital Charge Code	7411479
Hospital Revenue Code	761
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.34
Rate for Payer: Oxford Commercial	$21.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.35
Rate for Payer: UnitedHealthcare Commercial	$21.80
Rate for Payer: UnitedHealthcare Community & State	$3.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

IR-WITHDRAW ART BLD

Facility

$623.55

Service Code	HCPCS 36600
Hospital Charge Code	321036600
Hospital Revenue Code	761
Min. Negotiated Rate	$93.53
Max. Negotiated Rate	$93.53
Rate for Payer: Qualcare PPO/HMO/WC	$93.53

IR-WITHDRAW ART BLD

Facility

$525.15

Service Code	HCPCS 36600
Hospital Charge Code	366836600
Hospital Revenue Code	361
Min. Negotiated Rate	$78.77
Max. Negotiated Rate	$78.77
Rate for Payer: Qualcare PPO/HMO/WC	$78.77

IR WRIST,ARTHROGRAPHY,RAD S &I

Facility

$1,633.00

Service Code	HCPCS 73115
Hospital Charge Code	2680275
Hospital Revenue Code	322
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,503.49
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.58
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.95
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$51.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

IR WRIST,ARTHROGRAPHY,RAD S &I

Facility

$1,633.00

Service Code	HCPCS 73115
Hospital Charge Code	2680275
Hospital Revenue Code	322
Min. Negotiated Rate	$244.95
Max. Negotiated Rate	$244.95
Rate for Payer: Qualcare PPO/HMO/WC	$244.95

IR WRIST,ARTHROGRAPHY,RAD S &I

Facility

$1,633.00

Service Code	HCPCS 73115
Hospital Charge Code	7411666
Hospital Revenue Code	322
Min. Negotiated Rate	$244.95
Max. Negotiated Rate	$244.95
Rate for Payer: Qualcare PPO/HMO/WC	$244.95

IR WRIST,ARTHROGRAPHY,RAD S &I

Facility

$1,633.00

Service Code	HCPCS 73115
Hospital Charge Code	7411666
Hospital Revenue Code	322
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,503.49
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.58
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.95
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$51.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

IR XPOSE FOR ENDOPROSTH FEM BI

Facility

$3,200.00

Service Code	HCPCS 3481250
Hospital Charge Code	321034812B
Hospital Revenue Code	361
Min. Negotiated Rate	$90.88
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,216.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
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	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$832.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00
Rate for Payer: UnitedHealthcare Community & State	$101.12
Rate for Payer: Wellpoint Medicaid Managed Care	$90.88

IR XPOSE FOR ENDOPROSTH FEM BI

Facility

$3,200.00

Service Code	HCPCS 3481250
Hospital Charge Code	321034812B
Hospital Revenue Code	361
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$480.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

IR XPOSE FOR ENDOPROSTH FEM BI

Facility

$3,200.00

Service Code	HCPCS 3481250
Hospital Charge Code	2011289
Hospital Revenue Code	361
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$480.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

IR XPOSE FOR ENDOPROSTH FEM BI

Facility

$3,200.00

Service Code	HCPCS 3481250
Hospital Charge Code	2011289
Hospital Revenue Code	361
Min. Negotiated Rate	$90.88
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,216.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
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	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$832.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00
Rate for Payer: UnitedHealthcare Community & State	$101.12
Rate for Payer: Wellpoint Medicaid Managed Care	$90.88

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC

Facility

$74,980.84

Service Code	MSDRG 062
Min. Negotiated Rate	$22,830.70
Max. Negotiated Rate	$74,980.84
Rate for Payer: Aetna Medicare Advantage	$74,980.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,808.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,808.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,032.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,808.35
Rate for Payer: Cigna Commercial	$39,173.26
Rate for Payer: Cigna Medicare Advantage	$24,032.32
Rate for Payer: Clover Medicare Advantage	$22,830.70
Rate for Payer: EmblemHealth Commercial	$72,096.96
Rate for Payer: Humana Medicare Advantage	$24,753.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,032.32
Rate for Payer: Oxford Commercial	$30,961.86
Rate for Payer: UnitedHealthcare Commercial	$41,443.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,032.32
Rate for Payer: Wellcare Medicare Advantage	$24,032.32

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC

Facility

$106,571.24

Service Code	MSDRG 061
Min. Negotiated Rate	$32,449.58
Max. Negotiated Rate	$106,571.24
Rate for Payer: Aetna Medicare Advantage	$106,571.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34,157.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77,574.00
Rate for Payer: Cigna Commercial	$61,464.03
Rate for Payer: Cigna Medicare Advantage	$34,157.45
Rate for Payer: Clover Medicare Advantage	$32,449.58
Rate for Payer: EmblemHealth Commercial	$102,472.35
Rate for Payer: Humana Medicare Advantage	$35,182.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34,157.45
Rate for Payer: Oxford Commercial	$48,580.10
Rate for Payer: UnitedHealthcare Commercial	$65,026.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$34,157.45
Rate for Payer: Wellcare Medicare Advantage	$34,157.45

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility

$63,815.73

Service Code	MSDRG 063
Min. Negotiated Rate	$19,431.07
Max. Negotiated Rate	$63,815.73
Rate for Payer: Aetna Medicare Advantage	$63,815.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,280.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,280.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,453.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,280.45
Rate for Payer: Cigna Commercial	$31,294.91
Rate for Payer: Cigna Medicare Advantage	$20,453.76
Rate for Payer: Clover Medicare Advantage	$19,431.07
Rate for Payer: EmblemHealth Commercial	$61,361.28
Rate for Payer: Humana Medicare Advantage	$21,067.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,453.76
Rate for Payer: Oxford Commercial	$24,734.96
Rate for Payer: UnitedHealthcare Commercial	$33,108.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,453.76
Rate for Payer: Wellcare Medicare Advantage	$20,453.76

IS CROSSMATCH

Facility

$652.55

Service Code	HCPCS 86920
Hospital Charge Code	3100625
Hospital Revenue Code	300
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.88
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$18.53

IS CROSSMATCH

Facility

$652.55

Service Code	HCPCS 86920
Hospital Charge Code	3100625
Hospital Revenue Code	300
Min. Negotiated Rate	$97.88
Max. Negotiated Rate	$97.88
Rate for Payer: Qualcare PPO/HMO/WC	$97.88

ISLET CELL AB SCRN W/REFL

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	39900369
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$64.11
Rate for Payer: Aetna Medicare Advantage	$76.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.50
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$23.57
Rate for Payer: Clover Medicare Advantage	$22.39
Rate for Payer: EmblemHealth Commercial	$70.71
Rate for Payer: Humana Medicare Advantage	$24.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.57
Rate for Payer: Wellcare Medicare Advantage	$23.57
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ISLET CELL AB SCRN W/REFL

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	39900369
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ISLET CELL ANTIBODY

Facility

$224.00

Service Code	HCPCS 86341
Hospital Charge Code	38476220
Hospital Revenue Code	302
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$64.11
Rate for Payer: Aetna Medicare Advantage	$76.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.50
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: Cigna Medicare Advantage	$23.57
Rate for Payer: Clover Medicare Advantage	$22.39
Rate for Payer: EmblemHealth Commercial	$70.71
Rate for Payer: Humana Medicare Advantage	$24.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.57
Rate for Payer: Wellcare Medicare Advantage	$23.57
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

ISLET CELL ANTIBODY

Facility

$224.00

Service Code	HCPCS 86341
Hospital Charge Code	38476220
Hospital Revenue Code	302
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

I SNARE SYSTEM 25G 5MM

Facility

$425.00

Hospital Charge Code	270680913
Hospital Revenue Code	272
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

Know your out-of-pocket cost for care.

All Charges