Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INCISIONAL BX SKIN EA ADD LES

Facility

$920.69

Service Code	HCPCS 11107
Hospital Charge Code	303511107
Hospital Revenue Code	510
Min. Negotiated Rate	$138.10
Max. Negotiated Rate	$138.10
Rate for Payer: Qualcare PPO/HMO/WC	$138.10

INCISIONAL BX SKIN EA ADD LES

Facility

$920.69

Service Code	HCPCS 11107
Hospital Charge Code	303511107
Hospital Revenue Code	510
Min. Negotiated Rate	$22.19
Max. Negotiated Rate	$460.35
Rate for Payer: Aetna Commercial	$349.86
Rate for Payer: Aetna Medicare Advantage	$276.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.78
Rate for Payer: Cigna Commercial	$460.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.21
Rate for Payer: Qualcare PPO/HMO/WC	$138.10
Rate for Payer: UnitedHealthcare Community & State	$22.19
Rate for Payer: Wellpoint Medicaid Managed Care	$24.40

INCISIONAL BX SKIN EA ADD LES

Facility

$920.69

Service Code	HCPCS 11107
Hospital Charge Code	450211107
Hospital Revenue Code	761
Min. Negotiated Rate	$22.19
Max. Negotiated Rate	$460.35
Rate for Payer: Aetna Commercial	$349.86
Rate for Payer: Aetna Medicare Advantage	$276.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.78
Rate for Payer: Cigna Commercial	$460.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.21
Rate for Payer: Oxford Commercial	$184.14
Rate for Payer: Qualcare PPO/HMO/WC	$138.10
Rate for Payer: UnitedHealthcare Commercial	$184.14
Rate for Payer: UnitedHealthcare Community & State	$22.19
Rate for Payer: Wellpoint Medicaid Managed Care	$24.40

INCISIONAL BX SKIN EA ADD LES

Facility

$920.69

Service Code	HCPCS 11107
Hospital Charge Code	450211107
Hospital Revenue Code	761
Min. Negotiated Rate	$138.10
Max. Negotiated Rate	$138.10
Rate for Payer: Qualcare PPO/HMO/WC	$138.10

INCISIONAL BX SKIN EA ADD LES

Facility

$920.69

Service Code	HCPCS 11107
Hospital Charge Code	395011107
Hospital Revenue Code	761
Min. Negotiated Rate	$22.19
Max. Negotiated Rate	$460.35
Rate for Payer: Aetna Commercial	$349.86
Rate for Payer: Aetna Medicare Advantage	$276.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.78
Rate for Payer: Cigna Commercial	$460.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.21
Rate for Payer: Oxford Commercial	$184.14
Rate for Payer: Qualcare PPO/HMO/WC	$138.10
Rate for Payer: UnitedHealthcare Commercial	$184.14
Rate for Payer: UnitedHealthcare Community & State	$22.19
Rate for Payer: Wellpoint Medicaid Managed Care	$24.40

INCISIONAL BX SKIN EA ADD LES

Facility

$920.69

Service Code	HCPCS 11107
Hospital Charge Code	412311107
Hospital Revenue Code	361
Min. Negotiated Rate	$22.19
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$349.86
Rate for Payer: Aetna Medicare Advantage	$276.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.78
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	$234.78
Rate for Payer: Cigna Commercial	$460.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.21
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$22.19
Rate for Payer: Wellpoint Medicaid Managed Care	$24.40

INCISIONAL BX SKIN EA ADD LES

Facility

$920.69

Service Code	HCPCS 11107
Hospital Charge Code	395011107
Hospital Revenue Code	761
Min. Negotiated Rate	$138.10
Max. Negotiated Rate	$138.10
Rate for Payer: Qualcare PPO/HMO/WC	$138.10

INCISION DEEP TISS ABSCESS

Facility

$3,473.00

Service Code	HCPCS 20005
Hospital Charge Code	5780020
Hospital Revenue Code	450
Min. Negotiated Rate	$92.03
Max. Negotiated Rate	$1,736.50
Rate for Payer: Aetna Commercial	$1,319.74
Rate for Payer: Aetna Medicare Advantage	$1,041.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.62
Rate for Payer: Cigna Commercial	$1,736.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,041.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$520.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$92.03

INCISION DEEP TISS ABSCESS

Facility

$3,473.00

Service Code	HCPCS 20005
Hospital Charge Code	5780020
Hospital Revenue Code	450
Min. Negotiated Rate	$520.95
Max. Negotiated Rate	$520.95
Rate for Payer: Qualcare PPO/HMO/WC	$520.95

INCISION&DRN; PERIANAL ABSCESS

Facility

$6,258.84

Service Code	HCPCS 46050
Hospital Charge Code	1600000611
Hospital Revenue Code	360
Min. Negotiated Rate	$150.84
Max. Negotiated Rate	$3,988.03
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,988.03
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,877.65
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$938.83
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$150.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81
Rate for Payer: Wellpoint Medicaid Managed Care	$165.86

INCISION&DRN; PERIANAL ABSCESS

Facility

$6,258.84

Service Code	HCPCS 46050
Hospital Charge Code	1600000611
Hospital Revenue Code	360
Min. Negotiated Rate	$938.83
Max. Negotiated Rate	$938.83
Rate for Payer: Qualcare PPO/HMO/WC	$938.83

INCISION OF FIBULA LT

Facility

$30,595.00

Service Code	HCPCS 27707
Hospital Charge Code	16000899
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

INCISION OF FIBULA LT

Facility

$30,595.00

Service Code	HCPCS 27707
Hospital Charge Code	16000899
Hospital Revenue Code	360
Min. Negotiated Rate	$737.34
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,178.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$737.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$810.77

INCISION OF FINGER TENDON

Facility

$9,423.70

Service Code	HCPCS 26060
Hospital Charge Code	1600000584
Hospital Revenue Code	360
Min. Negotiated Rate	$227.11
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,827.11
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.56
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$227.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$249.73

INCISION OF FINGER TENDON

Facility

$9,423.70

Service Code	HCPCS 26060
Hospital Charge Code	1600000584
Hospital Revenue Code	360
Min. Negotiated Rate	$1,413.56
Max. Negotiated Rate	$1,413.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.56

INCISION OF GAUBLADDER

Facility

$6,415.25

Service Code	HCPCS 47490
Hospital Charge Code	3035108
Hospital Revenue Code	361
Min. Negotiated Rate	$154.61
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,924.58
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$962.29
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$154.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$170.00

INCISION OF GAUBLADDER

Facility

$6,415.25

Service Code	HCPCS 47490
Hospital Charge Code	3035108
Hospital Revenue Code	361
Min. Negotiated Rate	$962.29
Max. Negotiated Rate	$962.29
Rate for Payer: Qualcare PPO/HMO/WC	$962.29

INCISION OF METATARSAL

Facility

$19,998.60

Service Code	HCPCS 28308
Hospital Charge Code	16000203
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

INCISION OF METATARSAL

Facility

$19,998.60

Service Code	HCPCS 28308
Hospital Charge Code	16000203
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

INCISION OF RECTAL ABCESS

Facility

$25,493.40

Service Code	HCPCS 46060
Hospital Charge Code	1600000361
Hospital Revenue Code	360
Min. Negotiated Rate	$614.39
Max. Negotiated Rate	$11,903.20
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,903.20
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,648.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,824.01
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$614.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56
Rate for Payer: Wellpoint Medicaid Managed Care	$675.58

INCISION OF RECTAL ABCESS

Facility

$25,493.40

Service Code	HCPCS 46060
Hospital Charge Code	1600000361
Hospital Revenue Code	360
Min. Negotiated Rate	$3,824.01
Max. Negotiated Rate	$3,824.01
Rate for Payer: Qualcare PPO/HMO/WC	$3,824.01

INCISION OF THIGH TENDON

Facility

$15,284.00

Service Code	HCPCS 27307
Hospital Charge Code	1600000535
Hospital Revenue Code	360
Min. Negotiated Rate	$2,292.60
Max. Negotiated Rate	$2,292.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,292.60

INCISION OF THIGH TENDON

Facility

$15,284.00

Service Code	HCPCS 27307
Hospital Charge Code	1600000535
Hospital Revenue Code	360
Min. Negotiated Rate	$368.34
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,585.20
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,292.60
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$368.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$405.03

INCISION OF TOUNGUE FOLD

Facility

$6,938.46

Service Code	HCPCS 41010
Hospital Charge Code	1600000327
Hospital Revenue Code	360
Min. Negotiated Rate	$167.22
Max. Negotiated Rate	$6,653.83
Rate for Payer: Aetna Commercial	$5,013.83
Rate for Payer: Aetna Medicare Advantage	$5,972.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,653.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,653.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,843.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,653.83
Rate for Payer: Cigna Commercial	$3,694.94
Rate for Payer: Cigna Medicare Advantage	$1,843.32
Rate for Payer: Clover Medicare Advantage	$1,751.15
Rate for Payer: EmblemHealth Commercial	$5,529.96
Rate for Payer: Humana Medicare Advantage	$1,898.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,843.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,081.54
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,040.77
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$167.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,843.32
Rate for Payer: Wellcare Medicare Advantage	$1,843.32
Rate for Payer: Wellpoint Medicaid Managed Care	$183.87

INCISION OF TOUNGUE FOLD

Facility

$6,938.46

Service Code	HCPCS 41010
Hospital Charge Code	1600000327
Hospital Revenue Code	360
Min. Negotiated Rate	$1,040.77
Max. Negotiated Rate	$1,040.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,040.77

Know your out-of-pocket cost for care.

All Charges