Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERQ ACCESS & CLSR FEM ART

Facility

$6,785.00

Service Code	HCPCS 34713
Hospital Charge Code	411034713
Hospital Revenue Code	360
Min. Negotiated Rate	$1,017.75
Max. Negotiated Rate	$1,017.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.75

PERQ ACCESS & CLSR FEM ART

Facility

$6,785.00

Service Code	HCPCS 34713
Hospital Charge Code	404634713
Hospital Revenue Code	361
Min. Negotiated Rate	$1,017.75
Max. Negotiated Rate	$1,017.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.75

PERQ ART M-THROMBECT &/NFS

Facility

$61,616.39

Service Code	HCPCS 61645
Hospital Charge Code	411061645
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

PERQ ART M-THROMBECT &/NFS

Facility

$61,616.39

Service Code	HCPCS 61645
Hospital Charge Code	366861645
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

PERQ ART M-THROMBECT &/NFS

Facility

$61,616.39

Service Code	HCPCS 61645
Hospital Charge Code	366861645
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

PERQ ART M-THROMBECT &/NFS

Facility

$61,616.39

Service Code	HCPCS 61645
Hospital Charge Code	411061645
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

PERQ CERVICOTHORACIC INJECT

Facility

$15,447.21

Service Code	HCPCS 22510
Hospital Charge Code	7411352
Hospital Revenue Code	320
Min. Negotiated Rate	$372.28
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	$2,006.59
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	$2,721.05
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	$4,634.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$372.28
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	$409.35

PERQ CERVICOTHORACIC INJECT

Facility

$15,447.21

Service Code	HCPCS 22510
Hospital Charge Code	5701103
Hospital Revenue Code	320
Min. Negotiated Rate	$2,317.08
Max. Negotiated Rate	$2,317.08
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08

PERQ CERVICOTHORACIC INJECT

Facility

$15,447.21

Service Code	HCPCS 22510
Hospital Charge Code	5701103
Hospital Revenue Code	320
Min. Negotiated Rate	$372.28
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	$2,006.59
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	$2,721.05
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	$4,634.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$372.28
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	$409.35

PERQ CERVICOTHORACIC INJECT

Facility

$15,447.21

Service Code	HCPCS 22510
Hospital Charge Code	7411352
Hospital Revenue Code	320
Min. Negotiated Rate	$2,317.08
Max. Negotiated Rate	$2,317.08
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08

PERQ DEV BREAST 1ST STRTCTC

Facility

$1,167.00

Service Code	HCPCS 19283
Hospital Charge Code	16000534
Hospital Revenue Code	360
Min. Negotiated Rate	$175.05
Max. Negotiated Rate	$175.05
Rate for Payer: Qualcare PPO/HMO/WC	$175.05

PERQ DEV BREAST 1ST STRTCTC

Facility

$1,167.00

Service Code	HCPCS 19283
Hospital Charge Code	16000534
Hospital Revenue Code	360
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.10
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.05
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$28.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$30.93

PERQ DEV BREAST 1ST US IMAG

Facility

$1,167.00

Service Code	HCPCS 19285
Hospital Charge Code	16000195
Hospital Revenue Code	360
Min. Negotiated Rate	$175.05
Max. Negotiated Rate	$175.05
Rate for Payer: Qualcare PPO/HMO/WC	$175.05

PERQ DEV BREAST 1ST US IMAG

Facility

$1,167.00

Service Code	HCPCS 19285
Hospital Charge Code	16000195
Hospital Revenue Code	360
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.10
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.05
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$28.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$30.93

PERQ DEVICE BREAST 1ST IMAG

Facility

$1,167.00

Service Code	HCPCS 19281
Hospital Charge Code	16000188
Hospital Revenue Code	360
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.10
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.05
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$28.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$30.93

PERQ DEVICE BREAST 1ST IMAG

Facility

$1,167.00

Service Code	HCPCS 19281
Hospital Charge Code	16000188
Hospital Revenue Code	360
Min. Negotiated Rate	$175.05
Max. Negotiated Rate	$175.05
Rate for Payer: Qualcare PPO/HMO/WC	$175.05

PERQ LAMOT/LAM LUMBAR

Facility

$33,651.56

Service Code	HCPCS 62330
Hospital Charge Code	1600000390
Hospital Revenue Code	360
Min. Negotiated Rate	$5,047.73
Max. Negotiated Rate	$5,047.73
Rate for Payer: Qualcare PPO/HMO/WC	$5,047.73

PERQ LAMOT/LAM LUMBAR

Facility

$33,651.56

Service Code	HCPCS 62330
Hospital Charge Code	1600000390
Hospital Revenue Code	360
Min. Negotiated Rate	$811.00
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,095.47
Rate for Payer: Qualcare PPO/HMO/WC	$5,047.73
Rate for Payer: UnitedHealthcare Community & State	$811.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$891.77

PERQ LUMBOSACRAL INJECTION

Facility

$15,447.21

Service Code	HCPCS 22511
Hospital Charge Code	321022511
Hospital Revenue Code	320
Min. Negotiated Rate	$2,317.08
Max. Negotiated Rate	$2,317.08
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08

PERQ LUMBOSACRAL INJECTION

Facility

$15,447.21

Service Code	HCPCS 22511
Hospital Charge Code	7411353
Hospital Revenue Code	320
Min. Negotiated Rate	$2,317.08
Max. Negotiated Rate	$2,317.08
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08

PERQ LUMBOSACRAL INJECTION

Facility

$15,447.21

Service Code	HCPCS 22511
Hospital Charge Code	321022511
Hospital Revenue Code	320
Min. Negotiated Rate	$372.28
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	$1,990.73
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	$2,721.05
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	$4,634.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$372.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,822.27
Rate for Payer: Wellpoint Medicaid Managed Care	$409.35

PERQ LUMBOSACRAL INJECTION

Facility

$15,447.21

Service Code	HCPCS 22511
Hospital Charge Code	7411353
Hospital Revenue Code	320
Min. Negotiated Rate	$372.28
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	$1,990.73
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	$2,721.05
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	$4,634.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$372.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,822.27
Rate for Payer: Wellpoint Medicaid Managed Care	$409.35

PERQ LUMBOSACRAL INJECTION

Facility

$15,447.21

Service Code	HCPCS 22511
Hospital Charge Code	5701104
Hospital Revenue Code	320
Min. Negotiated Rate	$372.28
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	$1,990.73
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	$2,721.05
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	$4,634.16
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$372.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,822.27
Rate for Payer: Wellpoint Medicaid Managed Care	$409.35

PERQ LUMBOSACRAL INJECTION

Facility

$15,447.21

Service Code	HCPCS 22511
Hospital Charge Code	5701104
Hospital Revenue Code	320
Min. Negotiated Rate	$2,317.08
Max. Negotiated Rate	$2,317.08
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.08

PERQ NJX ALGC FLUOR LMBR 1ST

Facility

$59,508.84

Service Code	HCPCS 0627T
Hospital Charge Code	1600000770
Hospital Revenue Code	360
Min. Negotiated Rate	$8,926.33
Max. Negotiated Rate	$8,926.33
Rate for Payer: Qualcare PPO/HMO/WC	$8,926.33

Know your out-of-pocket cost for care.

All Charges