Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

QUADLINK IMPL SYS ALL INSIDE W

Facility

$14,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704140
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.25
Max. Negotiated Rate	$3,454.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,454.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,141.25

QUADLINK IMPL SYS ALL INSIDE W

Facility

$14,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704140
Hospital Revenue Code	278
Min. Negotiated Rate	$405.41
Max. Negotiated Rate	$7,137.50
Rate for Payer: Aetna Commercial	$5,424.50
Rate for Payer: Aetna Medicare Advantage	$4,282.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,640.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,640.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,640.12
Rate for Payer: Cigna Commercial	$7,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,454.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,141.25
Rate for Payer: UnitedHealthcare Community & State	$451.09
Rate for Payer: Wellpoint Medicaid Managed Care	$405.41

QUADLINK KIT 10MM

Facility

$10,875.00

Service Code	HCPCS L8699
Hospital Charge Code	270696143
Hospital Revenue Code	278
Min. Negotiated Rate	$308.85
Max. Negotiated Rate	$5,437.50
Rate for Payer: Aetna Commercial	$4,132.50
Rate for Payer: Aetna Medicare Advantage	$3,262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,773.12
Rate for Payer: Cigna Commercial	$5,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25
Rate for Payer: UnitedHealthcare Community & State	$343.65
Rate for Payer: Wellpoint Medicaid Managed Care	$308.85

QUADLINK KIT 10MM

Facility

$10,875.00

Service Code	HCPCS L8699
Hospital Charge Code	270696143
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$2,631.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25

QUAD SCREEN I

Facility

$390.00

Service Code	HCPCS 82105
Hospital Charge Code	39990125A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$13.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.77
Rate for Payer: Wellcare Medicare Advantage	$16.77
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

QUAD SCREEN I

Facility

$390.00

Service Code	HCPCS 82105
Hospital Charge Code	39990125A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

QUAD SCREEN II

Facility

$390.00

Service Code	HCPCS 82677
Hospital Charge Code	39990125B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.77
Rate for Payer: Aetna Medicare Advantage	$78.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.71
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.18
Rate for Payer: Clover Medicare Advantage	$22.97
Rate for Payer: EmblemHealth Commercial	$72.54
Rate for Payer: Humana Medicare Advantage	$24.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.18
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	$19.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.18
Rate for Payer: Wellcare Medicare Advantage	$24.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

QUAD SCREEN II

Facility

$390.00

Service Code	HCPCS 82677
Hospital Charge Code	39990125B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

QUAD SCREEN III

Facility

$390.00

Service Code	HCPCS 84702
Hospital Charge Code	39990125C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

QUAD SCREEN III

Facility

$390.00

Service Code	HCPCS 84702
Hospital Charge Code	39990125C
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
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	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

QUAD SCREEN IV

Facility

$390.00

Service Code	HCPCS 86336
Hospital Charge Code	39990125D
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$42.40
Rate for Payer: Aetna Medicare Advantage	$50.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.55
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.59
Rate for Payer: Clover Medicare Advantage	$14.81
Rate for Payer: EmblemHealth Commercial	$46.77
Rate for Payer: Humana Medicare Advantage	$16.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.59
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	$12.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.59
Rate for Payer: Wellcare Medicare Advantage	$15.59
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

QUAD SCREEN IV

Facility

$390.00

Service Code	HCPCS 86336
Hospital Charge Code	39990125D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

QUANT DIF PULM PERF & VENT

Facility

$1,899.00

Service Code	HCPCS 78598
Hospital Charge Code	4508025
Hospital Revenue Code	341
Min. Negotiated Rate	$284.85
Max. Negotiated Rate	$284.85
Rate for Payer: Qualcare PPO/HMO/WC	$284.85

QUANT DIF PULM PERF & VENT

Facility

$1,899.00

Service Code	HCPCS 78598
Hospital Charge Code	4508025
Hospital Revenue Code	341
Min. Negotiated Rate	$53.93
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.96
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.74
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.85
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$60.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$53.93

QUANTIFERON-TB GOLD

Facility

$426.00

Service Code	HCPCS 86480
Hospital Charge Code	39900223
Hospital Revenue Code	302
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$224.83
Rate for Payer: Aetna Commercial	$168.59
Rate for Payer: Aetna Medicare Advantage	$200.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.83
Rate for Payer: Cigna Commercial	$213.00
Rate for Payer: Cigna Medicare Advantage	$61.98
Rate for Payer: Clover Medicare Advantage	$58.88
Rate for Payer: EmblemHealth Commercial	$185.94
Rate for Payer: Humana Medicare Advantage	$63.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.76
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$49.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.98
Rate for Payer: Wellcare Medicare Advantage	$61.98
Rate for Payer: Wellpoint Medicaid Managed Care	$12.10

QUANTIFERON-TB GOLD

Facility

$426.00

Service Code	HCPCS 86480
Hospital Charge Code	39900223
Hospital Revenue Code	302
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$63.90

QUANTIFERON-TB GOLD PLUS

Facility

$426.00

Service Code	HCPCS 86480
Hospital Charge Code	401186480
Hospital Revenue Code	306
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$63.90

QUANTIFERON-TB GOLD PLUS

Facility

$426.00

Service Code	HCPCS 86480
Hospital Charge Code	401186480
Hospital Revenue Code	306
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$224.83
Rate for Payer: Aetna Commercial	$168.59
Rate for Payer: Aetna Medicare Advantage	$200.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.83
Rate for Payer: Cigna Commercial	$213.00
Rate for Payer: Cigna Medicare Advantage	$61.98
Rate for Payer: Clover Medicare Advantage	$58.88
Rate for Payer: EmblemHealth Commercial	$185.94
Rate for Payer: Humana Medicare Advantage	$63.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.76
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$49.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.98
Rate for Payer: Wellcare Medicare Advantage	$61.98
Rate for Payer: Wellpoint Medicaid Managed Care	$12.10

QUANTIFICATION EA ORGANISM

Facility

$394.00

Service Code	HCPCS 87799
Hospital Charge Code	38478100
Hospital Revenue Code	306
Min. Negotiated Rate	$59.10
Max. Negotiated Rate	$59.10
Rate for Payer: Qualcare PPO/HMO/WC	$59.10

QUANTIFICATION EA ORGANISM

Facility

$394.00

Service Code	HCPCS 87799
Hospital Charge Code	38478100
Hospital Revenue Code	306
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$197.00
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.40
Rate for Payer: Cigna Commercial	$197.00
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.44
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$11.19

QUANT LIPOPROOTEINS BY ULTRA

Facility

$175.00

Service Code	HCPCS 83701
Hospital Charge Code	38474063
Hospital Revenue Code	301
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$92.10
Rate for Payer: Aetna Medicare Advantage	$109.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.83
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: Cigna Medicare Advantage	$33.86
Rate for Payer: Clover Medicare Advantage	$32.17
Rate for Payer: EmblemHealth Commercial	$101.58
Rate for Payer: Humana Medicare Advantage	$34.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$27.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.86
Rate for Payer: Wellcare Medicare Advantage	$33.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

QUANT LIPOPROOTEINS BY ULTRA

Facility

$175.00

Service Code	HCPCS 83701
Hospital Charge Code	38474063
Hospital Revenue Code	301
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

QUARRTO LINK ANCHOR 4.5MM SP

Facility

$2,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270683673
Hospital Revenue Code	278
Min. Negotiated Rate	$64.61
Max. Negotiated Rate	$1,137.50
Rate for Payer: Aetna Commercial	$864.50
Rate for Payer: Aetna Medicare Advantage	$682.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$580.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$580.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$580.12
Rate for Payer: Cigna Commercial	$1,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.55
Rate for Payer: Qualcare PPO/HMO/WC	$341.25
Rate for Payer: UnitedHealthcare Community & State	$71.89
Rate for Payer: Wellpoint Medicaid Managed Care	$64.61

QUARRTO LINK ANCHOR 4.5MM SP

Facility

$2,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270683673
Hospital Revenue Code	278
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$550.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.55
Rate for Payer: Qualcare PPO/HMO/WC	$341.25

QUATTRO SPIKE MEDIUM 6143.2517

Facility

$7,425.00

Service Code	HCPCS C1889
Hospital Charge Code	270696763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,113.75
Max. Negotiated Rate	$1,796.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,796.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,113.75

Know your out-of-pocket cost for care.

All Charges