Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

US EXT NON VASC COMPLETE LT

Facility

$6,700.00

Service Code	HCPCS 76881LT
Hospital Charge Code	2307025
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXT NON VASC COMPLETE LT

Facility

$6,700.00

Service Code	HCPCS 76881LT
Hospital Charge Code	2307025
Hospital Revenue Code	402
Min. Negotiated Rate	$190.28
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US EXT NON VASC COMPLETE RT

Facility

$6,700.00

Service Code	HCPCS 76881RT
Hospital Charge Code	2307020
Hospital Revenue Code	402
Min. Negotiated Rate	$190.28
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US EXT NON VASC COMPLETE RT

Facility

$6,700.00

Service Code	HCPCS 76881RT
Hospital Charge Code	2307020
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXT NON VASC LTD BIL

Facility

$891.00

Service Code	HCPCS 7688250
Hospital Charge Code	2308010
Hospital Revenue Code	402
Min. Negotiated Rate	$133.65
Max. Negotiated Rate	$133.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.65

US EXT NON VASC LTD BIL

Facility

$891.00

Service Code	HCPCS 7688250
Hospital Charge Code	7412035
Hospital Revenue Code	891
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$445.50
Rate for Payer: Aetna Commercial	$338.58
Rate for Payer: Aetna Medicare Advantage	$267.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.21
Rate for Payer: Cigna Commercial	$445.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.66
Rate for Payer: Oxford Commercial	$178.20
Rate for Payer: Qualcare PPO/HMO/WC	$133.65
Rate for Payer: UnitedHealthcare Commercial	$178.20
Rate for Payer: UnitedHealthcare Community & State	$28.16
Rate for Payer: Wellpoint Medicaid Managed Care	$25.30

US EXT NON VASC LTD BIL

Facility

$891.00

Service Code	HCPCS 7688250
Hospital Charge Code	7412035
Hospital Revenue Code	891
Min. Negotiated Rate	$133.65
Max. Negotiated Rate	$133.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.65

US EXT NON VASC LTD BIL

Facility

$891.00

Service Code	HCPCS 7688250
Hospital Charge Code	2308010
Hospital Revenue Code	402
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$338.58
Rate for Payer: Aetna Medicare Advantage	$267.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.21
Rate for Payer: Cigna Commercial	$445.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.66
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.65
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$28.16
Rate for Payer: Wellpoint Medicaid Managed Care	$25.30

US EXTREMITY NON-VASCULAR COMP

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	2100263
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXTREMITY NON-VASCULAR COMP

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	2100263M
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXTREMITY NON-VASCULAR COMP

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	2100263
Hospital Revenue Code	402
Min. Negotiated Rate	$84.22
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US EXTREMITY NON-VASCULAR COMP

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	2100263M
Hospital Revenue Code	402
Min. Negotiated Rate	$84.22
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US EXTREMITY NON-VASCULAR LTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	94061505
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXTREMITY NON-VASCULAR LTD

Facility

$534.78

Service Code	HCPCS 76882
Hospital Charge Code	2100264M
Hospital Revenue Code	402
Min. Negotiated Rate	$15.19
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.04
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.22
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$16.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$298.19
Rate for Payer: Wellpoint Medicaid Managed Care	$15.19

US EXTREMITY NON-VASCULAR LTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	2100264
Hospital Revenue Code	402
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$298.19
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US EXTREMITY NON-VASCULAR LTD

Facility

$534.78

Service Code	HCPCS 76882
Hospital Charge Code	2100264M
Hospital Revenue Code	402
Min. Negotiated Rate	$80.22
Max. Negotiated Rate	$80.22
Rate for Payer: Qualcare PPO/HMO/WC	$80.22

US EXTREMITY NON-VASCULAR LTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	94061505
Hospital Revenue Code	402
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$298.19
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US EXTREMITY NON-VASCULAR LTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	2100264
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US FETAL AGE

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	2100030
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US FETAL AGE

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	2100030
Hospital Revenue Code	402
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US FETAL BIOPHYSICAL PROFILE

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	94061504B
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US FETAL BIOPHYSICAL PROFILE

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	94061504B
Hospital Revenue Code	402
Min. Negotiated Rate	$99.83
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US FETAL BIOPHYSICAL PROFILE

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	2100287
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US FETAL BIOPHYSICAL PROFILE

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	2100287
Hospital Revenue Code	402
Min. Negotiated Rate	$99.83
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US FINE NDL ASP W/IMAGE GUIDE

Facility

$2,403.20

Service Code	HCPCS 10022
Hospital Charge Code	2101153
Hospital Revenue Code	361
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$913.22
Rate for Payer: Aetna Medicare Advantage	$720.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.82
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	$612.82
Rate for Payer: Cigna Commercial	$1,201.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.83
Rate for Payer: Qualcare PPO/HMO/WC	$360.48
Rate for Payer: UnitedHealthcare Community & State	$75.94
Rate for Payer: Wellpoint Medicaid Managed Care	$68.25

Know your out-of-pocket cost for care.

All Charges