Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VON WILLEBRAND COMP PANEL I

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	3990128A
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
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	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VON WILLEBRAND COMP PANEL I

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	3990128A
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL II

Facility

$390.00

Service Code	HCPCS 85245
Hospital Charge Code	3990128B
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.21
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
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	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VON WILLEBRAND COMP PANEL II

Facility

$390.00

Service Code	HCPCS 85245
Hospital Charge Code	3990128B
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL III

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	3990128C
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.21
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
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	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VON WILLEBRAND COMP PANEL III

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	3990128C
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL IV

Facility

$390.00

Service Code	HCPCS 85247
Hospital Charge Code	3990128D
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL IV

Facility

$390.00

Service Code	HCPCS 85247
Hospital Charge Code	3990128D
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.21
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
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	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VON WILLEBRAND COMP PANEL V

Facility

$390.00

Service Code	HCPCS 85730
Hospital Charge Code	3990128E
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL V

Facility

$390.00

Service Code	HCPCS 85730
Hospital Charge Code	3990128E
Hospital Revenue Code	305
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$16.35
Rate for Payer: Aetna Medicare Advantage	$19.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.01
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	$21.80
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.01
Rate for Payer: Clover Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$18.03
Rate for Payer: Humana Medicare Advantage	$6.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.01
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	$4.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.01
Rate for Payer: Wellcare Medicare Advantage	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VON WILLEBRAND FACTOR PRO

Facility

$157.70

Service Code	HCPCS 85397
Hospital Charge Code	39900172
Hospital Revenue Code	305
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$23.66
Rate for Payer: Qualcare PPO/HMO/WC	$23.66

VON WILLEBRAND FACTOR PRO

Facility

$157.70

Service Code	HCPCS 85397
Hospital Charge Code	39900172
Hospital Revenue Code	305
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$83.94
Rate for Payer: Aetna Medicare Advantage	$99.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.94
Rate for Payer: Cigna Commercial	$78.85
Rate for Payer: Cigna Medicare Advantage	$30.86
Rate for Payer: Clover Medicare Advantage	$29.32
Rate for Payer: EmblemHealth Commercial	$92.58
Rate for Payer: Humana Medicare Advantage	$31.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.66
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$24.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.86
Rate for Payer: Wellcare Medicare Advantage	$30.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.48

VON WILLEBRANDS FACTOR ANTG

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38479463
Hospital Revenue Code	305
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

VON WILLEBRANDS FACTOR ANTG

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38479463
Hospital Revenue Code	305
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.21
Rate for Payer: Cigna Commercial	$103.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.85

VON WILLEBRANDS FACTOR ANTIGEN

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38478073
Hospital Revenue Code	305
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

VON WILLEBRANDS FACTOR ANTIGEN

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38478073
Hospital Revenue Code	305
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.21
Rate for Payer: Cigna Commercial	$103.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.85

VON WILLIBRAND FACTOR AG

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	39900510
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLIBRAND FACTOR AG

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	39900510
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.21
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
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	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VORICONAZOLE 200 MG TAB

Facility

$592.62

Service Code	NDC 49318030
Hospital Charge Code	60629938
Hospital Revenue Code	250
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$296.31
Rate for Payer: Aetna Commercial	$225.20
Rate for Payer: Aetna Medicare Advantage	$177.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.12
Rate for Payer: Cigna Commercial	$296.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.08
Rate for Payer: Oxford Commercial	$118.52
Rate for Payer: Qualcare PPO/HMO/WC	$88.89
Rate for Payer: UnitedHealthcare Commercial	$118.52
Rate for Payer: UnitedHealthcare Community & State	$18.73
Rate for Payer: Wellpoint Medicaid Managed Care	$16.83

VORICONAZOLE 200 MG TAB

Facility

$592.62

Service Code	NDC 49318030
Hospital Charge Code	60629938
Hospital Revenue Code	250
Min. Negotiated Rate	$88.89
Max. Negotiated Rate	$88.89
Rate for Payer: Qualcare PPO/HMO/WC	$88.89

VORICONAZOLE 200 MG VIAL

Facility

$1,199.50

Service Code	HCPCS J3465
Hospital Charge Code	60629297
Hospital Revenue Code	636
Min. Negotiated Rate	$34.07
Max. Negotiated Rate	$599.75
Rate for Payer: Aetna Commercial	$455.81
Rate for Payer: Aetna Medicare Advantage	$359.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$305.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$305.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$305.87
Rate for Payer: Cigna Commercial	$599.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.28
Rate for Payer: Qualcare PPO/HMO/WC	$179.93
Rate for Payer: UnitedHealthcare Community & State	$37.90
Rate for Payer: Wellpoint Medicaid Managed Care	$34.07

VORICONAZOLE 200 MG VIAL

Facility

$1,199.50

Service Code	HCPCS J3465
Hospital Charge Code	60629297
Hospital Revenue Code	636
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$290.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.28
Rate for Payer: Qualcare PPO/HMO/WC	$179.93

VORICONAZOLE LC MS MS

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	401080299
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VORICONAZOLE LC MS MS

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	401080299
Hospital Revenue Code	301
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
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	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VORTEX VACUUM MIXING SYSTEM

Facility

$5,547.40

Hospital Charge Code	270686907
Hospital Revenue Code	272
Min. Negotiated Rate	$832.11
Max. Negotiated Rate	$832.11
Rate for Payer: Qualcare PPO/HMO/WC	$832.11

Know your out-of-pocket cost for care.

All Charges