Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ASSAY OF ARSENIC

Facility

$390.00

Service Code	HCPCS 82175
Hospital Charge Code	401082175
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF ARSENIC

Facility

$390.00

Service Code	HCPCS 82175
Hospital Charge Code	401082175
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$51.60
Rate for Payer: Aetna Medicare Advantage	$61.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.97
Rate for Payer: Clover Medicare Advantage	$18.02
Rate for Payer: EmblemHealth Commercial	$56.91
Rate for Payer: Humana Medicare Advantage	$19.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.97
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	$15.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.97
Rate for Payer: Wellcare Medicare Advantage	$18.97
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ASSAY OF BLOOD FATTY ACIDS

Facility

$93.85

Service Code	HCPCS 82725
Hospital Charge Code	401382725B
Hospital Revenue Code	306
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$14.08

ASSAY OF BLOOD FATTY ACIDS

Facility

$93.85

Service Code	HCPCS 82725
Hospital Charge Code	401382725B
Hospital Revenue Code	306
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$51.05
Rate for Payer: Aetna Medicare Advantage	$60.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.09
Rate for Payer: Cigna Commercial	$46.92
Rate for Payer: Cigna Medicare Advantage	$18.77
Rate for Payer: Clover Medicare Advantage	$17.83
Rate for Payer: EmblemHealth Commercial	$56.31
Rate for Payer: Humana Medicare Advantage	$19.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.08
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.77
Rate for Payer: Wellcare Medicare Advantage	$18.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

ASSAY OF CADMIUM

Facility

$390.00

Service Code	HCPCS 82300
Hospital Charge Code	401082300
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$64.30
Rate for Payer: Aetna Medicare Advantage	$76.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.75
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$23.64
Rate for Payer: Clover Medicare Advantage	$22.46
Rate for Payer: EmblemHealth Commercial	$70.92
Rate for Payer: Humana Medicare Advantage	$24.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.64
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	$18.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.64
Rate for Payer: Wellcare Medicare Advantage	$23.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ASSAY OF CADMIUM

Facility

$390.00

Service Code	HCPCS 82300
Hospital Charge Code	401082300
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF FREE TESTOSTERONE

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	401184402
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF FREE TESTOSTERONE

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	401184402
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$69.28
Rate for Payer: Aetna Medicare Advantage	$82.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.39
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$25.47
Rate for Payer: Clover Medicare Advantage	$24.20
Rate for Payer: EmblemHealth Commercial	$76.41
Rate for Payer: Humana Medicare Advantage	$26.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.47
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	$20.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.47
Rate for Payer: Wellcare Medicare Advantage	$25.47
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ASSAY OF LEAD

Facility

$390.00

Service Code	HCPCS 83655
Hospital Charge Code	401083655
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF LEAD

Facility

$390.00

Service Code	HCPCS 83655
Hospital Charge Code	401083655
Hospital Revenue Code	301
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.93
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
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	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ASSAY OF MERCURY

Facility

$390.00

Service Code	HCPCS 83825
Hospital Charge Code	401083825
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.23
Rate for Payer: Aetna Medicare Advantage	$52.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.98
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.26
Rate for Payer: Clover Medicare Advantage	$15.45
Rate for Payer: EmblemHealth Commercial	$48.78
Rate for Payer: Humana Medicare Advantage	$16.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.26
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	$13.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.26
Rate for Payer: Wellcare Medicare Advantage	$16.26
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ASSAY OF MERCURY

Facility

$390.00

Service Code	HCPCS 83825
Hospital Charge Code	401083825
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF TOTAL ESTRADIOL

Facility

$123.17

Service Code	HCPCS 82670
Hospital Charge Code	401182670
Hospital Revenue Code	300
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$18.48
Rate for Payer: Qualcare PPO/HMO/WC	$18.48

ASSAY OF TOTAL ESTRADIOL

Facility

$123.17

Service Code	HCPCS 82670
Hospital Charge Code	401182670
Hospital Revenue Code	300
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.94
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	$101.35
Rate for Payer: Cigna Commercial	$61.59
Rate for Payer: Cigna Medicare Advantage	$27.94
Rate for Payer: Clover Medicare Advantage	$26.54
Rate for Payer: EmblemHealth Commercial	$83.82
Rate for Payer: Humana Medicare Advantage	$28.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.48
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$22.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.94
Rate for Payer: Wellcare Medicare Advantage	$27.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.50

ASSAY OF URINE CREATININE

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	401082570B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF URINE CREATININE

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	401082570
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY OF URINE CREATININE

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	401082570
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ASSAY OF URINE CREATININE

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	401082570B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ASSAY PROTEIN URINE

Facility

$390.00

Service Code	HCPCS 84166
Hospital Charge Code	401084166
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASSAY PROTEIN URINE

Facility

$390.00

Service Code	HCPCS 84166
Hospital Charge Code	401084166
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.50
Rate for Payer: Aetna Medicare Advantage	$57.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.68
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.83
Rate for Payer: Clover Medicare Advantage	$16.94
Rate for Payer: EmblemHealth Commercial	$53.49
Rate for Payer: Humana Medicare Advantage	$18.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.83
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	$14.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.83
Rate for Payer: Wellcare Medicare Advantage	$17.83
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ASSEMBL DEXTRUS SEAL CAP HAPO2

Facility

$2,366.25

Hospital Charge Code	270640477
Hospital Revenue Code	272
Min. Negotiated Rate	$354.94
Max. Negotiated Rate	$354.94
Rate for Payer: Qualcare PPO/HMO/WC	$354.94

ASSEMBL DEXTRUS SEAL CAP HAPO2

Facility

$2,366.25

Hospital Charge Code	270640477
Hospital Revenue Code	272
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$1,183.12
Rate for Payer: Aetna Commercial	$899.17
Rate for Payer: Aetna Medicare Advantage	$709.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$603.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$603.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$603.39
Rate for Payer: Cigna Commercial	$1,183.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.23
Rate for Payer: Oxford Commercial	$473.25
Rate for Payer: Qualcare PPO/HMO/WC	$354.94
Rate for Payer: UnitedHealthcare Commercial	$473.25
Rate for Payer: UnitedHealthcare Community & State	$74.77
Rate for Payer: Wellpoint Medicaid Managed Care	$67.20

ASSEMBLY KIT

Facility

$3,070.00

Hospital Charge Code	270687909
Hospital Revenue Code	272
Min. Negotiated Rate	$460.50
Max. Negotiated Rate	$460.50
Rate for Payer: Qualcare PPO/HMO/WC	$460.50

ASSEMBLY KIT

Facility

$3,070.00

Hospital Charge Code	270687909
Hospital Revenue Code	272
Min. Negotiated Rate	$87.19
Max. Negotiated Rate	$1,535.00
Rate for Payer: Aetna Commercial	$1,166.60
Rate for Payer: Aetna Medicare Advantage	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$782.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$782.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$782.85
Rate for Payer: Cigna Commercial	$1,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.20
Rate for Payer: Oxford Commercial	$614.00
Rate for Payer: Qualcare PPO/HMO/WC	$460.50
Rate for Payer: UnitedHealthcare Commercial	$614.00
Rate for Payer: UnitedHealthcare Community & State	$97.01
Rate for Payer: Wellpoint Medicaid Managed Care	$87.19

ASSERT IQ ICM UMRI US

Facility

$19,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270704930
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

Know your out-of-pocket cost for care.

All Charges