Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-DRAIN PERIU ABSCE DEEP

Facility

$7,145.00

Service Code	HCPCS 53040
Hospital Charge Code	2690200
Hospital Revenue Code	361
Min. Negotiated Rate	$1,071.75
Max. Negotiated Rate	$1,071.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.75

IR-DRAIN PERIU ABSCE DEEP

Facility

$7,145.00

Service Code	HCPCS 53040
Hospital Charge Code	7411630
Hospital Revenue Code	361
Min. Negotiated Rate	$172.19
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,143.50
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.75
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$172.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$189.34

IR-DRAIN PROSTATE ABSCESS

Facility

$5,784.00

Service Code	HCPCS 52700
Hospital Charge Code	2690195
Hospital Revenue Code	361
Min. Negotiated Rate	$867.60
Max. Negotiated Rate	$867.60
Rate for Payer: Qualcare PPO/HMO/WC	$867.60

IR-DRAIN PROSTATE ABSCESS

Facility

$5,784.00

Service Code	HCPCS 52700
Hospital Charge Code	7411629
Hospital Revenue Code	361
Min. Negotiated Rate	$139.39
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.20
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$867.60
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$139.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$153.28

IR-DRAIN PROSTATE ABSCESS

Facility

$5,784.00

Service Code	HCPCS 52700
Hospital Charge Code	7411629
Hospital Revenue Code	361
Min. Negotiated Rate	$867.60
Max. Negotiated Rate	$867.60
Rate for Payer: Qualcare PPO/HMO/WC	$867.60

IR-DRAIN PROSTATE ABSCESS

Facility

$5,784.00

Service Code	HCPCS 52700
Hospital Charge Code	2690195
Hospital Revenue Code	361
Min. Negotiated Rate	$139.39
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.20
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$867.60
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$139.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$153.28

IR DRAIN RETROPERITONEAL ABCSS

Facility

$3,407.60

Service Code	HCPCS 75989
Hospital Charge Code	2600070
Hospital Revenue Code	320
Min. Negotiated Rate	$511.14
Max. Negotiated Rate	$511.14
Rate for Payer: Qualcare PPO/HMO/WC	$511.14

IR DRAIN RETROPERITONEAL ABCSS

Facility

$3,407.60

Service Code	HCPCS 75989
Hospital Charge Code	2600070
Hospital Revenue Code	320
Min. Negotiated Rate	$82.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,294.89
Rate for Payer: Aetna Medicare Advantage	$1,022.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$868.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$868.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$253.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$868.94
Rate for Payer: Cigna Commercial	$1,703.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,022.28
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$511.14
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$82.12
Rate for Payer: Wellpoint Medicaid Managed Care	$90.30

IR DRAIN RETROPERITONEAL ABCSS

Facility

$3,407.60

Service Code	HCPCS 75989
Hospital Charge Code	7411749
Hospital Revenue Code	320
Min. Negotiated Rate	$511.14
Max. Negotiated Rate	$511.14
Rate for Payer: Qualcare PPO/HMO/WC	$511.14

IR DRAIN RETROPERITONEAL ABCSS

Facility

$3,407.60

Service Code	HCPCS 75989
Hospital Charge Code	7411749
Hospital Revenue Code	320
Min. Negotiated Rate	$82.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,294.89
Rate for Payer: Aetna Medicare Advantage	$1,022.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$868.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$868.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$253.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$868.94
Rate for Payer: Cigna Commercial	$1,703.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,022.28
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$511.14
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$82.12
Rate for Payer: Wellpoint Medicaid Managed Care	$90.30

IR-DRAIN SKENES ABSCESS

Facility

$4,467.00

Service Code	HCPCS 53060
Hospital Charge Code	7411631
Hospital Revenue Code	361
Min. Negotiated Rate	$670.05
Max. Negotiated Rate	$670.05
Rate for Payer: Qualcare PPO/HMO/WC	$670.05

IR-DRAIN SKENES ABSCESS

Facility

$4,467.00

Service Code	HCPCS 53060
Hospital Charge Code	2690205
Hospital Revenue Code	361
Min. Negotiated Rate	$107.65
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
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	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,340.10
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$670.05
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$107.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$118.38

IR-DRAIN SKENES ABSCESS

Facility

$4,467.00

Service Code	HCPCS 53060
Hospital Charge Code	7411631
Hospital Revenue Code	361
Min. Negotiated Rate	$107.65
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
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	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,340.10
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$670.05
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$107.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$118.38

IR-DRAIN SKENES ABSCESS

Facility

$4,467.00

Service Code	HCPCS 53060
Hospital Charge Code	2690205
Hospital Revenue Code	361
Min. Negotiated Rate	$670.05
Max. Negotiated Rate	$670.05
Rate for Payer: Qualcare PPO/HMO/WC	$670.05

IR-DRAIN SPINAL CORD CYST

Facility

$741.00

Service Code	HCPCS 62268
Hospital Charge Code	7411648
Hospital Revenue Code	361
Min. Negotiated Rate	$111.15
Max. Negotiated Rate	$111.15
Rate for Payer: Qualcare PPO/HMO/WC	$111.15

IR-DRAIN SPINAL CORD CYST

Facility

$741.00

Service Code	HCPCS 62268
Hospital Charge Code	2690230
Hospital Revenue Code	361
Min. Negotiated Rate	$111.15
Max. Negotiated Rate	$111.15
Rate for Payer: Qualcare PPO/HMO/WC	$111.15

IR-DRAIN SPINAL CORD CYST

Facility

$741.00

Service Code	HCPCS 62268
Hospital Charge Code	7411648
Hospital Revenue Code	361
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
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	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.30
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.15
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$17.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$19.64

IR-DRAIN SPINAL CORD CYST

Facility

$741.00

Service Code	HCPCS 62268
Hospital Charge Code	2690230
Hospital Revenue Code	361
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
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	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.30
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.15
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$17.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$19.64

IR DRAIN SUBDIAPHRAGM/SUBPHRNC

Facility

$6,139.10

Hospital Charge Code	2600071
Hospital Revenue Code	361
Min. Negotiated Rate	$147.95
Max. Negotiated Rate	$3,069.55
Rate for Payer: Aetna Commercial	$2,332.86
Rate for Payer: Aetna Medicare Advantage	$1,841.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.47
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	$1,565.47
Rate for Payer: Cigna Commercial	$3,069.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,841.73
Rate for Payer: Qualcare PPO/HMO/WC	$920.87
Rate for Payer: UnitedHealthcare Community & State	$147.95
Rate for Payer: Wellpoint Medicaid Managed Care	$162.69

IR DRAIN SUBDIAPHRAGM/SUBPHRNC

Facility

$6,139.10

Hospital Charge Code	2600071
Hospital Revenue Code	361
Min. Negotiated Rate	$920.87
Max. Negotiated Rate	$920.87
Rate for Payer: Qualcare PPO/HMO/WC	$920.87

IR-DRAN CEREB SPINAL FLUD

Facility

$548.00

Service Code	HCPCS 62272
Hospital Charge Code	7411651
Hospital Revenue Code	361
Min. Negotiated Rate	$82.20
Max. Negotiated Rate	$82.20
Rate for Payer: Qualcare PPO/HMO/WC	$82.20

IR-DRAN CEREB SPINAL FLUD

Facility

$3,506.55

Service Code	HCPCS 62272
Hospital Charge Code	2690235
Hospital Revenue Code	361
Min. Negotiated Rate	$525.98
Max. Negotiated Rate	$525.98
Rate for Payer: Qualcare PPO/HMO/WC	$525.98

IR-DRAN CEREB SPINAL FLUD

Facility

$3,506.55

Service Code	HCPCS 62272
Hospital Charge Code	2690235
Hospital Revenue Code	361
Min. Negotiated Rate	$84.51
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,051.96
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.98
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$84.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$92.92

IR-DRAN CEREB SPINAL FLUD

Facility

$548.00

Service Code	HCPCS 62272
Hospital Charge Code	7411651
Hospital Revenue Code	361
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.40
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.20
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$13.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$14.52

IR-DRAN CEREB SPINAL FLUD

Facility

$3,506.55

Service Code	HCPCS 62272
Hospital Charge Code	321062272
Hospital Revenue Code	361
Min. Negotiated Rate	$525.98
Max. Negotiated Rate	$525.98
Rate for Payer: Qualcare PPO/HMO/WC	$525.98

Know your out-of-pocket cost for care.

All Charges