Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ENDOVASC TEMPORY VESSEL OCCL

Facility

$61,620.70

Service Code	HCPCS 61623
Hospital Charge Code	411061623
Hospital Revenue Code	361
Min. Negotiated Rate	$1,485.06
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,486.21
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,243.10
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,485.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.95

ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES

Facility

$186,590.54

Service Code	MSDRG 213
Min. Negotiated Rate	$56,814.43
Max. Negotiated Rate	$186,590.54
Rate for Payer: Aetna Commercial	$128,466.30
Rate for Payer: Aetna Medicare Advantage	$186,590.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$59,804.66
Rate for Payer: Cigna Commercial	$106,798.93
Rate for Payer: Cigna Medicare Advantage	$59,804.66
Rate for Payer: Clover Medicare Advantage	$56,814.43
Rate for Payer: EmblemHealth Commercial	$179,413.98
Rate for Payer: Humana Medicare Advantage	$61,598.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$59,804.66
Rate for Payer: Oxford Commercial	$76,757.80
Rate for Payer: UnitedHealthcare Commercial	$134,597.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$59,804.66
Rate for Payer: Wellcare Medicare Advantage	$59,804.66

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$200,214.08

Service Code	MSDRG 266
Min. Negotiated Rate	$60,962.62
Max. Negotiated Rate	$200,214.08
Rate for Payer: Aetna Commercial	$137,827.22
Rate for Payer: Aetna Medicare Advantage	$200,214.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145,381.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145,381.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64,171.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145,381.25
Rate for Payer: Cigna Commercial	$114,686.88
Rate for Payer: Cigna Medicare Advantage	$64,171.18
Rate for Payer: Clover Medicare Advantage	$60,962.62
Rate for Payer: EmblemHealth Commercial	$192,513.54
Rate for Payer: Humana Medicare Advantage	$66,096.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64,171.18
Rate for Payer: Oxford Commercial	$82,426.98
Rate for Payer: UnitedHealthcare Commercial	$144,538.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$64,171.18
Rate for Payer: Wellcare Medicare Advantage	$64,171.18

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$156,010.98

Service Code	MSDRG 267
Min. Negotiated Rate	$47,503.34
Max. Negotiated Rate	$156,010.98
Rate for Payer: Aetna Commercial	$107,454.64
Rate for Payer: Aetna Medicare Advantage	$156,010.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113,513.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113,513.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$50,003.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113,513.68
Rate for Payer: Cigna Commercial	$89,093.61
Rate for Payer: Cigna Medicare Advantage	$50,003.52
Rate for Payer: Clover Medicare Advantage	$47,503.34
Rate for Payer: EmblemHealth Commercial	$150,010.56
Rate for Payer: Humana Medicare Advantage	$51,503.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$50,003.52
Rate for Payer: Oxford Commercial	$64,032.76
Rate for Payer: UnitedHealthcare Commercial	$112,283.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$50,003.52
Rate for Payer: Wellcare Medicare Advantage	$50,003.52

ENDOVASCULAR REVASCULARIZATION

Facility

$25,200.00

Service Code	HCPCS 37264
Hospital Charge Code	404637264
Hospital Revenue Code	481
Min. Negotiated Rate	$3,780.00
Max. Negotiated Rate	$3,780.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,780.00

ENDOVASCULAR REVASCULARIZATION

Facility

$68,574.00

Service Code	HCPCS 37298
Hospital Charge Code	404637298
Hospital Revenue Code	481
Min. Negotiated Rate	$1,652.63
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,572.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,286.10
Rate for Payer: UnitedHealthcare Community & State	$1,652.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,817.21

ENDOVASCULAR REVASCULARIZATION

Facility

$68,574.00

Service Code	HCPCS 37298
Hospital Charge Code	404637298
Hospital Revenue Code	481
Min. Negotiated Rate	$10,286.10
Max. Negotiated Rate	$10,286.10
Rate for Payer: Qualcare PPO/HMO/WC	$10,286.10

ENDOVASCULAR REVASCULARIZATION

Facility

$25,200.00

Service Code	HCPCS 37264
Hospital Charge Code	404637264
Hospital Revenue Code	481
Min. Negotiated Rate	$607.32
Max. Negotiated Rate	$12,600.00
Rate for Payer: Aetna Commercial	$9,576.00
Rate for Payer: Aetna Medicare Advantage	$7,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,426.00
Rate for Payer: Cigna Commercial	$12,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,560.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,780.00
Rate for Payer: UnitedHealthcare Community & State	$607.32
Rate for Payer: Wellpoint Medicaid Managed Care	$667.80

ENDO VASCULAR STAPLER 35MM

Facility

$501.00

Hospital Charge Code	270338711
Hospital Revenue Code	272
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$250.50
Rate for Payer: Aetna Commercial	$190.38
Rate for Payer: Aetna Medicare Advantage	$150.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.75
Rate for Payer: Cigna Commercial	$250.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.30
Rate for Payer: Oxford Commercial	$100.20
Rate for Payer: Qualcare PPO/HMO/WC	$75.15
Rate for Payer: UnitedHealthcare Commercial	$100.20
Rate for Payer: UnitedHealthcare Community & State	$12.07
Rate for Payer: Wellpoint Medicaid Managed Care	$13.28

ENDO VASCULAR STAPLER 35MM

Facility

$501.00

Hospital Charge Code	270338711
Hospital Revenue Code	272
Min. Negotiated Rate	$75.15
Max. Negotiated Rate	$75.15
Rate for Payer: Qualcare PPO/HMO/WC	$75.15

ENDO VENIPUNCTURE

Facility

$26.25

Service Code	HCPCS 36415
Hospital Charge Code	2300902
Hospital Revenue Code	300
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.71
Rate for Payer: Cigna Commercial	$13.12
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.94
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

ENDO VENIPUNCTURE

Facility

$26.25

Service Code	HCPCS 36415
Hospital Charge Code	2300902
Hospital Revenue Code	300
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$3.94
Rate for Payer: Qualcare PPO/HMO/WC	$3.94

ENDOVENOUS LASER 1ST VEIN

Facility

$17,623.95

Service Code	HCPCS 36478
Hospital Charge Code	421036478
Hospital Revenue Code	761
Min. Negotiated Rate	$424.74
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,181.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,287.19
Rate for Payer: Oxford Commercial	$3,524.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59
Rate for Payer: UnitedHealthcare Commercial	$3,524.79
Rate for Payer: UnitedHealthcare Community & State	$424.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$467.03

ENDOVENOUS LASER 1ST VEIN

Facility

$17,623.95

Service Code	HCPCS 36478
Hospital Charge Code	421036478
Hospital Revenue Code	761
Min. Negotiated Rate	$2,643.59
Max. Negotiated Rate	$2,643.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59

ENDOVENOUS LASER VEIN ADDON

Facility

$17,623.95

Service Code	HCPCS 36479
Hospital Charge Code	421036479
Hospital Revenue Code	761
Min. Negotiated Rate	$424.74
Max. Negotiated Rate	$8,811.98
Rate for Payer: Aetna Commercial	$6,697.10
Rate for Payer: Aetna Medicare Advantage	$5,287.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,494.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,494.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,494.11
Rate for Payer: Cigna Commercial	$8,811.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,287.19
Rate for Payer: Oxford Commercial	$3,524.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59
Rate for Payer: UnitedHealthcare Commercial	$3,524.79
Rate for Payer: UnitedHealthcare Community & State	$424.74
Rate for Payer: Wellpoint Medicaid Managed Care	$467.03

ENDOVENOUS LASER VEIN ADDON

Facility

$17,623.95

Service Code	HCPCS 36479
Hospital Charge Code	421036479
Hospital Revenue Code	761
Min. Negotiated Rate	$2,643.59
Max. Negotiated Rate	$2,643.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59

ENDOVENOUS MCHNCHEM 1ST VEIN

Facility

$17,623.95

Service Code	HCPCS 36473
Hospital Charge Code	421036473
Hospital Revenue Code	761
Min. Negotiated Rate	$2,643.59
Max. Negotiated Rate	$2,643.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59

ENDOVENOUS MCHNCHEM 1ST VEIN

Facility

$17,623.95

Service Code	HCPCS 36473
Hospital Charge Code	421036473
Hospital Revenue Code	761
Min. Negotiated Rate	$424.74
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,537.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,287.19
Rate for Payer: Oxford Commercial	$3,524.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59
Rate for Payer: UnitedHealthcare Commercial	$3,524.79
Rate for Payer: UnitedHealthcare Community & State	$424.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$467.03

ENDOVENOUS MCHNCHEM ADD ON

Facility

$2,084.00

Service Code	HCPCS 36474
Hospital Charge Code	1600000805
Hospital Revenue Code	360
Min. Negotiated Rate	$312.60
Max. Negotiated Rate	$312.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.60

ENDOVENOUS MCHNCHEM ADD ON

Facility

$2,084.00

Service Code	HCPCS 36474
Hospital Charge Code	1600000805
Hospital Revenue Code	360
Min. Negotiated Rate	$50.22
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$791.92
Rate for Payer: Aetna Medicare Advantage	$625.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.42
Rate for Payer: Cigna Commercial	$1,042.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$625.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.60
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$50.22
Rate for Payer: Wellpoint Medicaid Managed Care	$55.23

ENDOVENOUS MCHNCHEM ADD ON

Facility

$2,084.00

Service Code	HCPCS 36474
Hospital Charge Code	404636474
Hospital Revenue Code	361
Min. Negotiated Rate	$50.22
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$791.92
Rate for Payer: Aetna Medicare Advantage	$625.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.42
Rate for Payer: Cigna Commercial	$1,042.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$625.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.60
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$50.22
Rate for Payer: Wellpoint Medicaid Managed Care	$55.23

ENDOVENOUS MCHNCHEM ADD ON

Facility

$2,084.00

Service Code	HCPCS 36474
Hospital Charge Code	404636474
Hospital Revenue Code	361
Min. Negotiated Rate	$312.60
Max. Negotiated Rate	$312.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.60

ENDOVENOUS MCHNCHEM ADD-ON

Facility

$17,623.95

Service Code	HCPCS 36474
Hospital Charge Code	421036474
Hospital Revenue Code	761
Min. Negotiated Rate	$281.65
Max. Negotiated Rate	$8,811.98
Rate for Payer: Aetna Commercial	$6,697.10
Rate for Payer: Aetna Medicare Advantage	$5,287.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,494.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,494.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$281.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,494.11
Rate for Payer: Cigna Commercial	$8,811.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,287.19
Rate for Payer: Oxford Commercial	$3,524.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59
Rate for Payer: UnitedHealthcare Commercial	$3,524.79
Rate for Payer: UnitedHealthcare Community & State	$424.74
Rate for Payer: Wellpoint Medicaid Managed Care	$467.03

ENDOVENOUS MCHNCHEM ADD-ON

Facility

$17,623.95

Service Code	HCPCS 36474
Hospital Charge Code	421036474
Hospital Revenue Code	761
Min. Negotiated Rate	$2,643.59
Max. Negotiated Rate	$2,643.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59

ENDOVENOUS RF 1ST VEIN

Facility

$25,406.80

Service Code	HCPCS 36475
Hospital Charge Code	1600000571
Hospital Revenue Code	360
Min. Negotiated Rate	$3,811.02
Max. Negotiated Rate	$3,811.02
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02

Know your out-of-pocket cost for care.

All Charges