Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GASTRODUODENOSTOMY WO VAGOTOMY

Facility

$112,126.91

Service Code	HCPCS 43850
Hospital Charge Code	1600186
Hospital Revenue Code	361
Min. Negotiated Rate	$16,819.04
Max. Negotiated Rate	$16,819.04
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

GASTRODUODENOSTOMY WO VAGOTOMY

Facility

$112,126.91

Service Code	HCPCS 43850
Hospital Charge Code	1600186
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$56,063.46
Rate for Payer: Aetna Commercial	$42,608.23
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,592.36
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	$28,592.36
Rate for Payer: Cigna Commercial	$56,063.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33,638.07
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04
Rate for Payer: UnitedHealthcare Community & State	$2,702.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2,971.36

GASTRODUODENOSTOMY W VAGOTOMY

Facility

$112,126.91

Service Code	HCPCS 43855
Hospital Charge Code	1600187
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$56,063.46
Rate for Payer: Aetna Commercial	$42,608.23
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,592.36
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	$28,592.36
Rate for Payer: Cigna Commercial	$56,063.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33,638.07
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04
Rate for Payer: UnitedHealthcare Community & State	$2,702.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2,971.36

GASTRODUODENOSTOMY W VAGOTOMY

Facility

$112,126.91

Service Code	HCPCS 43855
Hospital Charge Code	1600187
Hospital Revenue Code	361
Min. Negotiated Rate	$16,819.04
Max. Negotiated Rate	$16,819.04
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

GASTROGRAFIN 120 ML ORAL

Facility

$534.86

Service Code	NDC 270044540
Hospital Charge Code	606390130
Hospital Revenue Code	250
Min. Negotiated Rate	$80.23
Max. Negotiated Rate	$80.23
Rate for Payer: Qualcare PPO/HMO/WC	$80.23

GASTROGRAFIN 120 ML ORAL

Facility

$534.86

Service Code	NDC 270044540
Hospital Charge Code	606390130
Hospital Revenue Code	250
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$267.43
Rate for Payer: Aetna Commercial	$203.25
Rate for Payer: Aetna Medicare Advantage	$160.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.39
Rate for Payer: Cigna Commercial	$267.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.46
Rate for Payer: Oxford Commercial	$106.97
Rate for Payer: Qualcare PPO/HMO/WC	$80.23
Rate for Payer: UnitedHealthcare Commercial	$106.97
Rate for Payer: UnitedHealthcare Community & State	$12.89
Rate for Payer: Wellpoint Medicaid Managed Care	$14.17

GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$33,831.91

Service Code	MSDRG 378
Min. Negotiated Rate	$10,301.38
Max. Negotiated Rate	$33,831.91
Rate for Payer: Aetna Commercial	$23,503.71
Rate for Payer: Aetna Medicare Advantage	$33,831.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,795.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,795.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,843.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,795.78
Rate for Payer: Cigna Commercial	$18,352.82
Rate for Payer: Cigna Medicare Advantage	$10,843.56
Rate for Payer: Clover Medicare Advantage	$10,301.38
Rate for Payer: EmblemHealth Commercial	$32,530.68
Rate for Payer: Humana Medicare Advantage	$11,168.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,843.56
Rate for Payer: Oxford Commercial	$13,190.42
Rate for Payer: UnitedHealthcare Commercial	$23,129.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,843.56
Rate for Payer: Wellcare Medicare Advantage	$10,843.56

GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$61,218.05

Service Code	MSDRG 377
Min. Negotiated Rate	$18,640.11
Max. Negotiated Rate	$61,218.05
Rate for Payer: Aetna Commercial	$42,321.11
Rate for Payer: Aetna Medicare Advantage	$61,218.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,637.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,637.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,621.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,637.19
Rate for Payer: Cigna Commercial	$34,209.19
Rate for Payer: Cigna Medicare Advantage	$19,621.17
Rate for Payer: Clover Medicare Advantage	$18,640.11
Rate for Payer: EmblemHealth Commercial	$58,863.51
Rate for Payer: Humana Medicare Advantage	$20,209.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,621.17
Rate for Payer: Oxford Commercial	$24,586.60
Rate for Payer: UnitedHealthcare Commercial	$43,113.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,621.17
Rate for Payer: Wellcare Medicare Advantage	$19,621.17

GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$22,509.65

Service Code	MSDRG 379
Min. Negotiated Rate	$6,853.90
Max. Negotiated Rate	$22,509.65
Rate for Payer: Aetna Commercial	$15,724.02
Rate for Payer: Aetna Medicare Advantage	$22,509.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,654.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,654.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,214.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,654.43
Rate for Payer: Cigna Commercial	$11,797.31
Rate for Payer: Cigna Medicare Advantage	$7,214.63
Rate for Payer: Clover Medicare Advantage	$6,853.90
Rate for Payer: EmblemHealth Commercial	$21,643.89
Rate for Payer: Humana Medicare Advantage	$7,431.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,214.63
Rate for Payer: Oxford Commercial	$8,478.88
Rate for Payer: UnitedHealthcare Commercial	$14,867.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,214.63
Rate for Payer: Wellcare Medicare Advantage	$7,214.63

GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$27,661.67

Service Code	MSDRG 389
Min. Negotiated Rate	$8,422.62
Max. Negotiated Rate	$27,661.67
Rate for Payer: Aetna Commercial	$19,264.06
Rate for Payer: Aetna Medicare Advantage	$27,661.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,608.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,608.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,865.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,608.80
Rate for Payer: Cigna Commercial	$14,780.32
Rate for Payer: Cigna Medicare Advantage	$8,865.92
Rate for Payer: Clover Medicare Advantage	$8,422.62
Rate for Payer: EmblemHealth Commercial	$26,597.76
Rate for Payer: Humana Medicare Advantage	$9,131.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,865.92
Rate for Payer: Oxford Commercial	$10,622.81
Rate for Payer: UnitedHealthcare Commercial	$18,627.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,865.92
Rate for Payer: Wellcare Medicare Advantage	$8,865.92

GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$49,866.68

Service Code	MSDRG 388
Min. Negotiated Rate	$15,183.76
Max. Negotiated Rate	$49,866.68
Rate for Payer: Aetna Commercial	$34,521.43
Rate for Payer: Aetna Medicare Advantage	$49,866.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,728.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,728.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,982.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,728.45
Rate for Payer: Cigna Commercial	$27,636.84
Rate for Payer: Cigna Medicare Advantage	$15,982.91
Rate for Payer: Clover Medicare Advantage	$15,183.76
Rate for Payer: EmblemHealth Commercial	$47,948.73
Rate for Payer: Humana Medicare Advantage	$16,462.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,982.91
Rate for Payer: Oxford Commercial	$19,862.96
Rate for Payer: UnitedHealthcare Commercial	$34,830.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,982.91
Rate for Payer: Wellcare Medicare Advantage	$15,982.91

GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC

Facility

$19,717.06

Service Code	MSDRG 390
Min. Negotiated Rate	$6,003.59
Max. Negotiated Rate	$19,717.06
Rate for Payer: Aetna Commercial	$13,805.19
Rate for Payer: Aetna Medicare Advantage	$19,717.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,026.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,026.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,319.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,026.16
Rate for Payer: Cigna Commercial	$10,180.42
Rate for Payer: Cigna Medicare Advantage	$6,319.57
Rate for Payer: Clover Medicare Advantage	$6,003.59
Rate for Payer: EmblemHealth Commercial	$18,958.71
Rate for Payer: Humana Medicare Advantage	$6,509.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,319.57
Rate for Payer: Oxford Commercial	$7,316.80
Rate for Payer: UnitedHealthcare Commercial	$12,830.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,319.57
Rate for Payer: Wellcare Medicare Advantage	$6,319.57

GASTROINTESTINAL PANEL

Facility

$545.40

Hospital Charge Code	397073354
Hospital Revenue Code	306
Min. Negotiated Rate	$81.81
Max. Negotiated Rate	$81.81
Rate for Payer: Qualcare PPO/HMO/WC	$81.81

GASTROINTESTINAL PANEL

Facility

$545.40

Hospital Charge Code	397073354
Hospital Revenue Code	306
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$272.70
Rate for Payer: Aetna Commercial	$207.25
Rate for Payer: Aetna Medicare Advantage	$163.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.08
Rate for Payer: Cigna Commercial	$272.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.81
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.14
Rate for Payer: Wellpoint Medicaid Managed Care	$14.45

GASTROINTESTINAL TRACT IMAGING, INTRALUMINAL (EG, CAPSULE ENDOSCOPY), ESOPHAGUS THROUGH ILEUM, WITH INTERPRETATION AND REPORT

Facility

$5,311.00

Service Code	CPT 91110
Hospital Revenue Code	750
Min. Negotiated Rate	$1,023.64
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52

GASTROINTESTINAL TRACT IMAGING, INTRALUMINAL (EG, CAPSULE ENDOSCOPY), ESOPHAGUS WITH INTERPRETATION AND REPORT

Facility

$5,311.00

Service Code	CPT 91111
Hospital Revenue Code	750
Min. Negotiated Rate	$891.33
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52

GASTROINTESTINAL TRANSIT AND PRESSURE MEASUREMENT, STOMACH THROUGH COLON, WIRELESS CAPSULE, WITH INTERPRETATION AND REPORT

Facility

$5,311.00

Service Code	CPT 91112
Hospital Revenue Code	750
Min. Negotiated Rate	$1,023.64
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52

GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$7,421.48

Service Code	APR-DRG 2461
Min. Negotiated Rate	$7,275.96
Max. Negotiated Rate	$7,421.48
Rate for Payer: UnitedHealthcare Community & State	$7,275.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,421.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7,275.96

GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$9,311.07

Service Code	APR-DRG 2462
Min. Negotiated Rate	$9,128.50
Max. Negotiated Rate	$9,311.07
Rate for Payer: UnitedHealthcare Community & State	$9,128.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,311.07
Rate for Payer: Wellpoint Medicaid Managed Care	$9,128.50

GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$12,985.42

Service Code	APR-DRG 2463
Min. Negotiated Rate	$12,730.80
Max. Negotiated Rate	$12,985.42
Rate for Payer: UnitedHealthcare Community & State	$12,730.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,985.42
Rate for Payer: Wellpoint Medicaid Managed Care	$12,730.80

GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$19,268.11

Service Code	APR-DRG 2464
Min. Negotiated Rate	$18,890.30
Max. Negotiated Rate	$19,268.11
Rate for Payer: UnitedHealthcare Community & State	$18,890.30
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,268.11
Rate for Payer: Wellpoint Medicaid Managed Care	$18,890.30

GASTROSTOMY (PEG) TRAY 20FR

Facility

$724.00

Hospital Charge Code	270332481
Hospital Revenue Code	272
Min. Negotiated Rate	$108.60
Max. Negotiated Rate	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$108.60

GASTROSTOMY (PEG) TRAY 20FR

Facility

$724.00

Hospital Charge Code	270332481
Hospital Revenue Code	272
Min. Negotiated Rate	$17.45
Max. Negotiated Rate	$362.00
Rate for Payer: Aetna Commercial	$275.12
Rate for Payer: Aetna Medicare Advantage	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.62
Rate for Payer: Cigna Commercial	$362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.20
Rate for Payer: Oxford Commercial	$144.80
Rate for Payer: Qualcare PPO/HMO/WC	$108.60
Rate for Payer: UnitedHealthcare Commercial	$144.80
Rate for Payer: UnitedHealthcare Community & State	$17.45
Rate for Payer: Wellpoint Medicaid Managed Care	$19.19

GATA3

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	4016883421
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

GATA3

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	4016883421
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

Know your out-of-pocket cost for care.

All Charges