Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

US-OB<14 WEEKS ADDITNL FETUS

Facility

$1,117.00

Service Code	HCPCS 76802
Hospital Charge Code	2008030
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

US-OB<14 WEEKS SINGLE FETUS-EA

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	2307015
Hospital Revenue Code	402
Min. Negotiated Rate	$44.41
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	$90.75
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	$406.59
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$234.57
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$49.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$44.41

US-OB<14 WEEKS SINGLE FETUS-EA

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	2307015
Hospital Revenue Code	402
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$234.57
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

US OB >/=14 WKS ADDL FETUS

Facility

$555.00

Service Code	HCPCS 76810
Hospital Charge Code	412376810
Hospital Revenue Code	402
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$210.90
Rate for Payer: Aetna Medicare Advantage	$166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$212.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.53
Rate for Payer: Cigna Commercial	$277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.30
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.25
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$17.54
Rate for Payer: Wellpoint Medicaid Managed Care	$15.76

US OB >/=14 WKS ADDL FETUS

Facility

$555.00

Service Code	HCPCS 76810
Hospital Charge Code	412376810
Hospital Revenue Code	402
Min. Negotiated Rate	$83.25
Max. Negotiated Rate	$83.25
Rate for Payer: Qualcare PPO/HMO/WC	$83.25

US OB >/=14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76810
Hospital Charge Code	2101116
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) NJ Health	$212.40
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 OB >/=14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76810
Hospital Charge Code	2101116
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 OB<14 WKS NUCHAL EA ADDTL

Facility

$370.00

Service Code	HCPCS 76814
Hospital Charge Code	83653065
Hospital Revenue Code	402
Min. Negotiated Rate	$10.51
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.20
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: Wellpoint Medicaid Managed Care	$10.51

US OB<14 WKS NUCHAL EA ADDTL

Facility

$370.00

Service Code	HCPCS 76814
Hospital Charge Code	83653065
Hospital Revenue Code	402
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

US OB NUCHAL TRANSLUCENCY MEAS

Facility

$518.00

Service Code	HCPCS 76813
Hospital Charge Code	83653060
Hospital Revenue Code	402
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$77.70
Rate for Payer: Qualcare PPO/HMO/WC	$77.70

US OB NUCHAL TRANSLUCENCY MEAS

Facility

$518.00

Service Code	HCPCS 76813
Hospital Charge Code	83653060
Hospital Revenue Code	402
Min. Negotiated Rate	$14.71
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	$110.14
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	$134.68
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.70
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$16.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$14.71

US PANCREAS

Facility

$6,700.00

Service Code	HCPCS 76705
Hospital Charge Code	2100063
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 PANCREAS

Facility

$6,700.00

Service Code	HCPCS 76705
Hospital Charge Code	2100063
Hospital Revenue Code	402
Min. Negotiated Rate	$72.60
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	$72.60
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 PELVIS COMPL

Facility

$6,700.00

Service Code	HCPCS 76856
Hospital Charge Code	2100071
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 PELVIS COMPL

Facility

$6,700.00

Service Code	HCPCS 76856
Hospital Charge Code	2100071
Hospital Revenue Code	402
Min. Negotiated Rate	$108.90
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	$108.90
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US PELVIS DUPLEX COMPLETE

Facility

$17,200.00

Service Code	HCPCS 93975
Hospital Charge Code	2101108
Hospital Revenue Code	921
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$7,555.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$356.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.00
Rate for Payer: Oxford Commercial	$6,888.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$7,555.00
Rate for Payer: UnitedHealthcare Community & State	$543.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$488.48

US PELVIS DUPLEX COMPLETE

Facility

$17,200.00

Service Code	HCPCS 93975
Hospital Charge Code	2101108
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US PELVIS TRANSVAGINAL

Facility

$6,700.00

Service Code	HCPCS 76830
Hospital Charge Code	2100279
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 PELVIS TRANSVAGINAL

Facility

$6,700.00

Service Code	HCPCS 76830
Hospital Charge Code	2100279
Hospital Revenue Code	402
Min. Negotiated Rate	$117.99
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	$121.61
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 PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	94061503
Hospital Revenue Code	402
Min. Negotiated Rate	$72.60
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	$72.60
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	2101138
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 PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	2101138
Hospital Revenue Code	402
Min. Negotiated Rate	$72.60
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	$72.60
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

US PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	94061503
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 PERC RENAL CYST ASP

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2100543
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

US PERC RENAL CYST ASP

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2100543
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

Know your out-of-pocket cost for care.

All Charges