Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CHROMIUM

Facility

$667.59

Service Code	HCPCS 82495
Hospital Charge Code	38473066
Hospital Revenue Code	301
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$55.16
Rate for Payer: Aetna Medicare Advantage	$65.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.57
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$20.28
Rate for Payer: Clover Medicare Advantage	$19.27
Rate for Payer: EmblemHealth Commercial	$60.84
Rate for Payer: Humana Medicare Advantage	$20.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.28
Rate for Payer: Wellcare Medicare Advantage	$20.28
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHROMIUM

Facility

$667.59

Service Code	HCPCS 82495
Hospital Charge Code	38473066
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHROMIUM ASSAY PLASMA

Facility

$101.40

Service Code	HCPCS 82495
Hospital Charge Code	401182495
Hospital Revenue Code	301
Min. Negotiated Rate	$15.21
Max. Negotiated Rate	$15.21
Rate for Payer: Qualcare PPO/HMO/WC	$15.21

CHROMIUM ASSAY PLASMA

Facility

$101.40

Service Code	HCPCS 82495
Hospital Charge Code	401182495
Hospital Revenue Code	301
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$55.16
Rate for Payer: Aetna Medicare Advantage	$65.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.57
Rate for Payer: Cigna Commercial	$50.70
Rate for Payer: Cigna Medicare Advantage	$20.28
Rate for Payer: Clover Medicare Advantage	$19.27
Rate for Payer: EmblemHealth Commercial	$60.84
Rate for Payer: Humana Medicare Advantage	$20.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.21
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.28
Rate for Payer: Wellcare Medicare Advantage	$20.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.88

CHROMOGENIC SUBST ASSAY

Facility

$305.00

Service Code	HCPCS 85130
Hospital Charge Code	38477104
Hospital Revenue Code	305
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$45.75
Rate for Payer: Qualcare PPO/HMO/WC	$45.75

CHROMOGENIC SUBST ASSAY

Facility

$305.00

Service Code	HCPCS 85130
Hospital Charge Code	38477104
Hospital Revenue Code	305
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.34
Rate for Payer: Aetna Medicare Advantage	$38.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.13
Rate for Payer: Cigna Commercial	$152.50
Rate for Payer: Cigna Medicare Advantage	$11.89
Rate for Payer: Clover Medicare Advantage	$11.30
Rate for Payer: EmblemHealth Commercial	$35.67
Rate for Payer: Humana Medicare Advantage	$12.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.89
Rate for Payer: Wellcare Medicare Advantage	$11.89
Rate for Payer: Wellpoint Medicaid Managed Care	$8.66

CHROMOGRANIN A,ECL

Facility

$667.59

Service Code	HCPCS 86316
Hospital Charge Code	39900210
Hospital Revenue Code	302
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
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	$75.49
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHROMOGRANIN A,ECL

Facility

$667.59

Service Code	HCPCS 86316
Hospital Charge Code	39900210
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHROMOSOMAL MICROARRAY

Facility

$1.00

Hospital Charge Code	39708032
Hospital Revenue Code	301
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

CHROMOSOMAL MICROARRAY

Facility

$1.00

Hospital Charge Code	39708032
Hospital Revenue Code	301
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

CHROMOSOME, 15-20 CELLS

Facility

$877.00

Service Code	HCPCS 88262
Hospital Charge Code	38474057
Hospital Revenue Code	311
Min. Negotiated Rate	$131.55
Max. Negotiated Rate	$131.55
Rate for Payer: Qualcare PPO/HMO/WC	$131.55

CHROMOSOME, 15-20 CELLS

Facility

$877.00

Service Code	HCPCS 88262
Hospital Charge Code	38474057
Hospital Revenue Code	311
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$455.21
Rate for Payer: Aetna Commercial	$341.33
Rate for Payer: Aetna Medicare Advantage	$406.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$455.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$455.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$125.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$455.21
Rate for Payer: Cigna Commercial	$438.50
Rate for Payer: Cigna Medicare Advantage	$125.49
Rate for Payer: Clover Medicare Advantage	$119.22
Rate for Payer: EmblemHealth Commercial	$376.47
Rate for Payer: Humana Medicare Advantage	$129.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$125.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$100.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$125.49
Rate for Payer: Wellcare Medicare Advantage	$125.49
Rate for Payer: Wellpoint Medicaid Managed Care	$24.91

CHROMOSOME AMNIOTIC/CHORIONIC

Facility

$1,265.00

Service Code	HCPCS 88267
Hospital Charge Code	38477216
Hospital Revenue Code	311
Min. Negotiated Rate	$189.75
Max. Negotiated Rate	$189.75
Rate for Payer: Qualcare PPO/HMO/WC	$189.75

CHROMOSOME AMNIOTIC/CHORIONIC

Facility

$1,265.00

Service Code	HCPCS 88267
Hospital Charge Code	38477216
Hospital Revenue Code	311
Min. Negotiated Rate	$35.93
Max. Negotiated Rate	$684.04
Rate for Payer: Aetna Commercial	$512.91
Rate for Payer: Aetna Medicare Advantage	$610.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$188.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.04
Rate for Payer: Cigna Commercial	$632.50
Rate for Payer: Cigna Medicare Advantage	$188.57
Rate for Payer: Clover Medicare Advantage	$179.14
Rate for Payer: EmblemHealth Commercial	$565.71
Rate for Payer: Humana Medicare Advantage	$194.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$188.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.90
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$150.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$188.57
Rate for Payer: Wellcare Medicare Advantage	$188.57
Rate for Payer: Wellpoint Medicaid Managed Care	$35.93

CHROMOSOME ANALYSIS,BLOOD

Facility

$4,469.00

Service Code	HCPCS 88262
Hospital Charge Code	38474106
Hospital Revenue Code	311
Min. Negotiated Rate	$100.39
Max. Negotiated Rate	$2,234.50
Rate for Payer: Aetna Commercial	$341.33
Rate for Payer: Aetna Medicare Advantage	$406.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$455.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$455.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$125.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$455.21
Rate for Payer: Cigna Commercial	$2,234.50
Rate for Payer: Cigna Medicare Advantage	$125.49
Rate for Payer: Clover Medicare Advantage	$119.22
Rate for Payer: EmblemHealth Commercial	$376.47
Rate for Payer: Humana Medicare Advantage	$129.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$125.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$670.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$100.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$125.49
Rate for Payer: Wellcare Medicare Advantage	$125.49
Rate for Payer: Wellpoint Medicaid Managed Care	$126.92

CHROMOSOME ANALYSIS,BLOOD

Facility

$4,469.00

Service Code	HCPCS 88262
Hospital Charge Code	38474106
Hospital Revenue Code	311
Min. Negotiated Rate	$670.35
Max. Negotiated Rate	$670.35
Rate for Payer: Qualcare PPO/HMO/WC	$670.35

CHROMOSOME ANALYSIS,TISSUE

Facility

$1,000.00

Service Code	HCPCS 88233
Hospital Charge Code	38474109
Hospital Revenue Code	311
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CHROMOSOME ANALYSIS,TISSUE

Facility

$1,000.00

Service Code	HCPCS 88233
Hospital Charge Code	38474109
Hospital Revenue Code	311
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$510.50
Rate for Payer: Aetna Commercial	$382.79
Rate for Payer: Aetna Medicare Advantage	$455.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$140.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.50
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: Cigna Medicare Advantage	$140.73
Rate for Payer: Clover Medicare Advantage	$133.69
Rate for Payer: EmblemHealth Commercial	$422.19
Rate for Payer: Humana Medicare Advantage	$144.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$140.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$112.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.73
Rate for Payer: Wellcare Medicare Advantage	$140.73
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

CHROMOSOME ANALYZE 20-25 CELLS

Facility

$877.00

Service Code	HCPCS 88264
Hospital Charge Code	38477208
Hospital Revenue Code	311
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$524.57
Rate for Payer: Aetna Commercial	$393.34
Rate for Payer: Aetna Medicare Advantage	$468.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$524.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$524.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$144.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$524.57
Rate for Payer: Cigna Commercial	$438.50
Rate for Payer: Cigna Medicare Advantage	$144.61
Rate for Payer: Clover Medicare Advantage	$137.38
Rate for Payer: EmblemHealth Commercial	$433.83
Rate for Payer: Humana Medicare Advantage	$148.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$144.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$115.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$144.61
Rate for Payer: Wellcare Medicare Advantage	$144.61
Rate for Payer: Wellpoint Medicaid Managed Care	$24.91

CHROMOSOME ANALYZE 20-25 CELLS

Facility

$877.00

Service Code	HCPCS 88264
Hospital Charge Code	38477208
Hospital Revenue Code	311
Min. Negotiated Rate	$131.55
Max. Negotiated Rate	$131.55
Rate for Payer: Qualcare PPO/HMO/WC	$131.55

CHROMOSOME BREAKAGE STUDY

Facility

$2,082.00

Service Code	HCPCS 88248
Hospital Charge Code	38474100
Hospital Revenue Code	310
Min. Negotiated Rate	$312.30
Max. Negotiated Rate	$312.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.30

CHROMOSOME BREAKAGE STUDY

Facility

$2,082.00

Service Code	HCPCS 88248
Hospital Charge Code	38474100
Hospital Revenue Code	310
Min. Negotiated Rate	$59.13
Max. Negotiated Rate	$1,041.00
Rate for Payer: Aetna Commercial	$471.02
Rate for Payer: Aetna Medicare Advantage	$561.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$628.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$628.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$173.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$628.17
Rate for Payer: Cigna Commercial	$1,041.00
Rate for Payer: Cigna Medicare Advantage	$173.17
Rate for Payer: Clover Medicare Advantage	$164.51
Rate for Payer: EmblemHealth Commercial	$519.51
Rate for Payer: Humana Medicare Advantage	$178.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$173.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$541.32
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$138.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.17
Rate for Payer: Wellcare Medicare Advantage	$173.17
Rate for Payer: Wellpoint Medicaid Managed Care	$59.13

CHROMOSOME COUNT 45C,2KW BANDI

Facility

$1,057.00

Service Code	HCPCS 88263
Hospital Charge Code	38477213
Hospital Revenue Code	311
Min. Negotiated Rate	$158.55
Max. Negotiated Rate	$158.55
Rate for Payer: Qualcare PPO/HMO/WC	$158.55

CHROMOSOME COUNT 45C,2KW BANDI

Facility

$1,057.00

Service Code	HCPCS 88263
Hospital Charge Code	38477213
Hospital Revenue Code	311
Min. Negotiated Rate	$30.02
Max. Negotiated Rate	$545.18
Rate for Payer: Aetna Commercial	$408.79
Rate for Payer: Aetna Medicare Advantage	$486.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$545.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$545.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$150.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$545.18
Rate for Payer: Cigna Commercial	$528.50
Rate for Payer: Cigna Medicare Advantage	$150.29
Rate for Payer: Clover Medicare Advantage	$142.78
Rate for Payer: EmblemHealth Commercial	$450.87
Rate for Payer: Humana Medicare Advantage	$154.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$150.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.82
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$158.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$120.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$150.29
Rate for Payer: Wellcare Medicare Advantage	$150.29
Rate for Payer: Wellpoint Medicaid Managed Care	$30.02

CHROMOSOME IN SITU AMNIOTIC FL

Facility

$1,170.00

Service Code	HCPCS 88269
Hospital Charge Code	38477214
Hospital Revenue Code	311
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$175.50
Rate for Payer: Qualcare PPO/HMO/WC	$175.50

Know your out-of-pocket cost for care.

All Charges