Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BILE ACIDS;TOTAL

Facility

$121.00

Service Code	HCPCS 82239
Hospital Charge Code	38477144
Hospital Revenue Code	301
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$46.57
Rate for Payer: Aetna Medicare Advantage	$55.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.12
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	$62.10
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: Cigna Medicare Advantage	$17.12
Rate for Payer: Clover Medicare Advantage	$16.26
Rate for Payer: EmblemHealth Commercial	$51.36
Rate for Payer: Humana Medicare Advantage	$17.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.12
Rate for Payer: Wellcare Medicare Advantage	$17.12
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

BILE TRACT SURGERY PROCEDURE

Facility

$10,620.50

Service Code	HCPCS 47999
Hospital Charge Code	2209085
Hospital Revenue Code	361
Min. Negotiated Rate	$301.62
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,908.70
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,761.33
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.08
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$335.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$301.62

BILE TRACT SURGERY PROCEDURE

Facility

$10,620.50

Service Code	HCPCS 47999
Hospital Charge Code	2209085
Hospital Revenue Code	361
Min. Negotiated Rate	$1,593.08
Max. Negotiated Rate	$1,593.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.08

BILIARY DILATOR

Facility

$146.00

Hospital Charge Code	270325606
Hospital Revenue Code	272
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

BILIARY DILATOR

Facility

$146.00

Hospital Charge Code	270325606
Hospital Revenue Code	272
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$55.48
Rate for Payer: Aetna Medicare Advantage	$43.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.23
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.96
Rate for Payer: Oxford Commercial	$29.20
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$29.20
Rate for Payer: UnitedHealthcare Community & State	$4.61
Rate for Payer: Wellpoint Medicaid Managed Care	$4.15

BILIARY ENDOSCOPY THRU SKIN

Facility

$17,259.20

Service Code	HCPCS 47555
Hospital Charge Code	321047555
Hospital Revenue Code	361
Min. Negotiated Rate	$490.16
Max. Negotiated Rate	$27,899.36
Rate for Payer: Aetna Commercial	$20,919.71
Rate for Payer: Aetna Medicare Advantage	$24,919.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,899.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,899.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,691.07
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	$27,899.36
Rate for Payer: Cigna Commercial	$15,416.72
Rate for Payer: Cigna Medicare Advantage	$7,691.07
Rate for Payer: Clover Medicare Advantage	$7,306.52
Rate for Payer: EmblemHealth Commercial	$23,073.21
Rate for Payer: Humana Medicare Advantage	$7,921.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,691.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,487.39
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$545.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,691.07
Rate for Payer: Wellcare Medicare Advantage	$7,691.07
Rate for Payer: Wellpoint Medicaid Managed Care	$490.16

BILIARY ENDOSCOPY THRU SKIN

Facility

$17,259.20

Service Code	HCPCS 47555
Hospital Charge Code	321047555
Hospital Revenue Code	361
Min. Negotiated Rate	$2,588.88
Max. Negotiated Rate	$2,588.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88

BILIARY ENDOSCOPY THRU SKIN

Facility

$10,885.55

Service Code	HCPCS 47555
Hospital Charge Code	5100831
Hospital Revenue Code	361
Min. Negotiated Rate	$309.15
Max. Negotiated Rate	$27,899.36
Rate for Payer: Aetna Commercial	$20,919.71
Rate for Payer: Aetna Medicare Advantage	$24,919.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,899.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,899.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,691.07
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	$27,899.36
Rate for Payer: Cigna Commercial	$15,416.72
Rate for Payer: Cigna Medicare Advantage	$7,691.07
Rate for Payer: Clover Medicare Advantage	$7,306.52
Rate for Payer: EmblemHealth Commercial	$23,073.21
Rate for Payer: Humana Medicare Advantage	$7,921.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,691.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,830.24
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,632.83
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$343.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,691.07
Rate for Payer: Wellcare Medicare Advantage	$7,691.07
Rate for Payer: Wellpoint Medicaid Managed Care	$309.15

BILIARY ENDOSCOPY THRU SKIN

Facility

$10,885.55

Service Code	HCPCS 47555
Hospital Charge Code	5100831
Hospital Revenue Code	361
Min. Negotiated Rate	$1,632.83
Max. Negotiated Rate	$1,632.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,632.83

BILIARY FLEXIMA SYS. W/LOCKING

Facility

$401.25

Service Code	HCPCS C1729
Hospital Charge Code	270655396
Hospital Revenue Code	272
Min. Negotiated Rate	$60.19
Max. Negotiated Rate	$60.19
Rate for Payer: Qualcare PPO/HMO/WC	$60.19

BILIARY FLEXIMA SYS. W/LOCKING

Facility

$401.25

Service Code	HCPCS C1729
Hospital Charge Code	270655396N
Hospital Revenue Code	272
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$200.62
Rate for Payer: Aetna Commercial	$152.47
Rate for Payer: Aetna Medicare Advantage	$120.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.32
Rate for Payer: Cigna Commercial	$200.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.33
Rate for Payer: Oxford Commercial	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$60.19
Rate for Payer: UnitedHealthcare Commercial	$80.25
Rate for Payer: UnitedHealthcare Community & State	$12.68
Rate for Payer: Wellpoint Medicaid Managed Care	$11.40

BILIARY FLEXIMA SYS. W/LOCKING

Facility

$401.25

Service Code	HCPCS C1729
Hospital Charge Code	270655396
Hospital Revenue Code	272
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$200.62
Rate for Payer: Aetna Commercial	$152.47
Rate for Payer: Aetna Medicare Advantage	$120.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.32
Rate for Payer: Cigna Commercial	$200.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.33
Rate for Payer: Oxford Commercial	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$60.19
Rate for Payer: UnitedHealthcare Commercial	$80.25
Rate for Payer: UnitedHealthcare Community & State	$12.68
Rate for Payer: Wellpoint Medicaid Managed Care	$11.40

BILIARY FLEXIMA SYS. W/LOCKING

Facility

$401.25

Service Code	HCPCS C1729
Hospital Charge Code	270655396N
Hospital Revenue Code	272
Min. Negotiated Rate	$60.19
Max. Negotiated Rate	$60.19
Rate for Payer: Qualcare PPO/HMO/WC	$60.19

BILIARY PIGTAIL STENT 7FR.X2.8

Facility

$1,451.00

Hospital Charge Code	270332378
Hospital Revenue Code	272
Min. Negotiated Rate	$217.65
Max. Negotiated Rate	$217.65
Rate for Payer: Qualcare PPO/HMO/WC	$217.65

BILIARY PIGTAIL STENT 7FR.X2.8

Facility

$1,451.00

Hospital Charge Code	270332378
Hospital Revenue Code	272
Min. Negotiated Rate	$41.21
Max. Negotiated Rate	$725.50
Rate for Payer: Aetna Commercial	$551.38
Rate for Payer: Aetna Medicare Advantage	$435.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$370.00
Rate for Payer: Cigna Commercial	$725.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.26
Rate for Payer: Oxford Commercial	$290.20
Rate for Payer: Qualcare PPO/HMO/WC	$217.65
Rate for Payer: UnitedHealthcare Commercial	$290.20
Rate for Payer: UnitedHealthcare Community & State	$45.85
Rate for Payer: Wellpoint Medicaid Managed Care	$41.21

BILIARY STENT 7FR-11CM

Facility

$642.00

Hospital Charge Code	270332260
Hospital Revenue Code	278
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$155.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.36
Rate for Payer: Qualcare PPO/HMO/WC	$96.30

BILIARY STENT 7FR-11CM

Facility

$642.00

Hospital Charge Code	270332260
Hospital Revenue Code	278
Min. Negotiated Rate	$18.23
Max. Negotiated Rate	$321.00
Rate for Payer: Aetna Commercial	$243.96
Rate for Payer: Aetna Medicare Advantage	$192.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.71
Rate for Payer: Cigna Commercial	$321.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.36
Rate for Payer: Qualcare PPO/HMO/WC	$96.30
Rate for Payer: UnitedHealthcare Community & State	$20.29
Rate for Payer: Wellpoint Medicaid Managed Care	$18.23

BILIARY STENT 7FR-6CM

Facility

$642.00

Hospital Charge Code	270332258
Hospital Revenue Code	278
Min. Negotiated Rate	$18.23
Max. Negotiated Rate	$321.00
Rate for Payer: Aetna Commercial	$243.96
Rate for Payer: Aetna Medicare Advantage	$192.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.71
Rate for Payer: Cigna Commercial	$321.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.36
Rate for Payer: Qualcare PPO/HMO/WC	$96.30
Rate for Payer: UnitedHealthcare Community & State	$20.29
Rate for Payer: Wellpoint Medicaid Managed Care	$18.23

BILIARY STENT 7FR-6CM

Facility

$642.00

Hospital Charge Code	270332258
Hospital Revenue Code	278
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$155.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.36
Rate for Payer: Qualcare PPO/HMO/WC	$96.30

BILIARY STENT SET 8.5FR-5CM

Facility

$642.00

Hospital Charge Code	270332255
Hospital Revenue Code	278
Min. Negotiated Rate	$18.23
Max. Negotiated Rate	$321.00
Rate for Payer: Aetna Commercial	$243.96
Rate for Payer: Aetna Medicare Advantage	$192.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.71
Rate for Payer: Cigna Commercial	$321.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.36
Rate for Payer: Qualcare PPO/HMO/WC	$96.30
Rate for Payer: UnitedHealthcare Community & State	$20.29
Rate for Payer: Wellpoint Medicaid Managed Care	$18.23

BILIARY STENT SET 8.5FR-5CM

Facility

$642.00

Hospital Charge Code	270332255
Hospital Revenue Code	278
Min. Negotiated Rate	$96.30
Max. Negotiated Rate	$155.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.36
Rate for Payer: Qualcare PPO/HMO/WC	$96.30

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$88,253.32

Service Code	MSDRG 409
Min. Negotiated Rate	$26,872.00
Max. Negotiated Rate	$88,253.32
Rate for Payer: Aetna Commercial	$64,713.55
Rate for Payer: Aetna Medicare Advantage	$88,253.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54,301.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54,301.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,286.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54,301.80
Rate for Payer: Cigna Commercial	$48,538.55
Rate for Payer: Cigna Medicare Advantage	$28,286.32
Rate for Payer: Clover Medicare Advantage	$26,872.00
Rate for Payer: EmblemHealth Commercial	$84,858.96
Rate for Payer: Humana Medicare Advantage	$29,134.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28,286.32
Rate for Payer: Oxford Commercial	$38,364.03
Rate for Payer: UnitedHealthcare Commercial	$51,351.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,286.32
Rate for Payer: Wellcare Medicare Advantage	$28,286.32

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$132,114.65

Service Code	MSDRG 408
Min. Negotiated Rate	$40,227.22
Max. Negotiated Rate	$132,114.65
Rate for Payer: Aetna Commercial	$95,952.07
Rate for Payer: Aetna Medicare Advantage	$132,114.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103,062.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103,062.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42,344.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103,062.60
Rate for Payer: Cigna Commercial	$79,487.92
Rate for Payer: Cigna Medicare Advantage	$42,344.44
Rate for Payer: Clover Medicare Advantage	$40,227.22
Rate for Payer: EmblemHealth Commercial	$127,033.32
Rate for Payer: Humana Medicare Advantage	$43,614.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42,344.44
Rate for Payer: Oxford Commercial	$62,825.87
Rate for Payer: UnitedHealthcare Commercial	$84,094.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$42,344.44
Rate for Payer: Wellcare Medicare Advantage	$42,344.44

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$69,625.73

Service Code	MSDRG 410
Min. Negotiated Rate	$21,200.14
Max. Negotiated Rate	$69,625.73
Rate for Payer: Aetna Commercial	$51,446.76
Rate for Payer: Aetna Medicare Advantage	$69,625.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,496.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,496.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,315.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,496.85
Rate for Payer: Cigna Commercial	$35,394.60
Rate for Payer: Cigna Medicare Advantage	$22,315.94
Rate for Payer: Clover Medicare Advantage	$21,200.14
Rate for Payer: EmblemHealth Commercial	$66,947.82
Rate for Payer: Humana Medicare Advantage	$22,985.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,315.94
Rate for Payer: Oxford Commercial	$27,975.27
Rate for Payer: UnitedHealthcare Commercial	$37,445.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,315.94
Rate for Payer: Wellcare Medicare Advantage	$22,315.94

BILIARY WALL STENT

Facility

$4,264.00

Hospital Charge Code	270335524
Hospital Revenue Code	278
Min. Negotiated Rate	$121.10
Max. Negotiated Rate	$2,132.00
Rate for Payer: Aetna Commercial	$1,620.32
Rate for Payer: Aetna Medicare Advantage	$1,279.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,087.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,087.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$852.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,087.32
Rate for Payer: Cigna Commercial	$2,132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,031.89
Rate for Payer: Qualcare PPO/HMO/WC	$639.60
Rate for Payer: UnitedHealthcare Community & State	$134.74
Rate for Payer: Wellpoint Medicaid Managed Care	$121.10

Know your out-of-pocket cost for care.

All Charges