Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POC GLUCOSE

Facility

$639.70

Service Code	HCPCS 82948
Hospital Charge Code	3100140
Hospital Revenue Code	301
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$319.85
Rate for Payer: Aetna Commercial	$13.71
Rate for Payer: Aetna Medicare Advantage	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.19
Rate for Payer: Cigna Commercial	$319.85
Rate for Payer: Cigna Medicare Advantage	$5.04
Rate for Payer: Clover Medicare Advantage	$4.79
Rate for Payer: EmblemHealth Commercial	$15.12
Rate for Payer: Humana Medicare Advantage	$5.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04
Rate for Payer: Wellcare Medicare Advantage	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$16.95

POCKET II UNITOME BLADE

Facility

$308.00

Hospital Charge Code	270332560
Hospital Revenue Code	272
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$46.20

POCKET II UNITOME BLADE

Facility

$308.00

Hospital Charge Code	270332560
Hospital Revenue Code	272
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$154.00
Rate for Payer: Aetna Commercial	$117.04
Rate for Payer: Aetna Medicare Advantage	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.54
Rate for Payer: Cigna Commercial	$154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.40
Rate for Payer: Oxford Commercial	$61.60
Rate for Payer: Qualcare PPO/HMO/WC	$46.20
Rate for Payer: UnitedHealthcare Commercial	$61.60
Rate for Payer: UnitedHealthcare Community & State	$7.42
Rate for Payer: Wellpoint Medicaid Managed Care	$8.16

POCKET STRIP 10x2.5CM 20CC

Facility

$26,000.00

Hospital Charge Code	270674946
Hospital Revenue Code	278
Min. Negotiated Rate	$626.60
Max. Negotiated Rate	$13,000.00
Rate for Payer: Aetna Commercial	$9,880.00
Rate for Payer: Aetna Medicare Advantage	$7,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,630.00
Rate for Payer: Cigna Commercial	$13,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,292.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,720.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,900.00
Rate for Payer: UnitedHealthcare Community & State	$626.60
Rate for Payer: Wellpoint Medicaid Managed Care	$689.00

POCKET STRIP 10x2.5CM 20CC

Facility

$26,000.00

Hospital Charge Code	270674946
Hospital Revenue Code	278
Min. Negotiated Rate	$3,900.00
Max. Negotiated Rate	$6,292.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,292.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,720.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,900.00

POD ASPIRATE BULA CYST, HEMA

Facility

$5,456.19

Service Code	HCPCS 10140
Hospital Charge Code	84208010
Hospital Revenue Code	510
Min. Negotiated Rate	$73.18
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	$73.18
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	$1,636.86
Rate for Payer: Qualcare PPO/HMO/WC	$818.43
Rate for Payer: UnitedHealthcare Community & State	$131.49
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	$144.59

POD ASPIRATE BULA CYST, HEMA

Facility

$5,456.19

Service Code	HCPCS 10140
Hospital Charge Code	84208010
Hospital Revenue Code	510
Min. Negotiated Rate	$818.43
Max. Negotiated Rate	$818.43
Rate for Payer: Qualcare PPO/HMO/WC	$818.43

POD AVULSION NAIL

Facility

$372.00

Service Code	HCPCS 11730
Hospital Charge Code	84208065
Hospital Revenue Code	510
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

POD AVULSION NAIL

Facility

$372.00

Service Code	HCPCS 11730
Hospital Charge Code	84208065
Hospital Revenue Code	510
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

POD BELOW KNEE CAST

Facility

$1,360.45

Service Code	HCPCS 29405
Hospital Charge Code	84208175
Hospital Revenue Code	510
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

POD BELOW KNEE CAST

Facility

$468.75

Service Code	HCPCS 29799
Hospital Charge Code	84208210
Hospital Revenue Code	510
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$696.85
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$696.85
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.62
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$12.42

POD BELOW KNEE CAST

Facility

$1,360.45

Service Code	HCPCS 29405
Hospital Charge Code	84208175
Hospital Revenue Code	510
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$1,199.43
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,199.43
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$408.13
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Community & State	$32.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$36.05

POD BELOW KNEE CAST

Facility

$468.75

Service Code	HCPCS 29799
Hospital Charge Code	84208210
Hospital Revenue Code	510
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

POD BIOPSY SKIN

Facility

$648.00

Service Code	HCPCS 11100
Hospital Charge Code	84208035
Hospital Revenue Code	361
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$97.20
Rate for Payer: Qualcare PPO/HMO/WC	$97.20

POD BIOPSY SKIN

Facility

$648.00

Service Code	HCPCS 11100
Hospital Charge Code	84208035
Hospital Revenue Code	361
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$1,058.74
Rate for Payer: Aetna Commercial	$246.24
Rate for Payer: Aetna Medicare Advantage	$194.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.24
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	$165.24
Rate for Payer: Cigna Commercial	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$97.20
Rate for Payer: UnitedHealthcare Community & State	$15.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

POD DEB CALLUS 2, 3, 4

Facility

$597.00

Service Code	HCPCS 11056
Hospital Charge Code	84208025
Hospital Revenue Code	361
Min. Negotiated Rate	$89.55
Max. Negotiated Rate	$89.55
Rate for Payer: Qualcare PPO/HMO/WC	$89.55

POD DEB CALLUS 2, 3, 4

Facility

$597.00

Service Code	HCPCS 11056
Hospital Charge Code	84208025
Hospital Revenue Code	361
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.10
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$89.55
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$14.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$15.82

POD DEB CALLUS 5+

Facility

$1,025.00

Service Code	HCPCS 11057
Hospital Charge Code	84208030
Hospital Revenue Code	361
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.50
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

POD DEB CALLUS 5+

Facility

$1,025.00

Service Code	HCPCS 11057
Hospital Charge Code	84208030
Hospital Revenue Code	361
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$153.75
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

POD DEB CALLUS I

Facility

$592.00

Service Code	HCPCS 11055
Hospital Charge Code	84208020
Hospital Revenue Code	510
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$88.80
Rate for Payer: Qualcare PPO/HMO/WC	$88.80

POD DEB CALLUS I

Facility

$592.00

Service Code	HCPCS 11055
Hospital Charge Code	84208020
Hospital Revenue Code	510
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.60
Rate for Payer: Qualcare PPO/HMO/WC	$88.80
Rate for Payer: UnitedHealthcare Community & State	$14.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$15.69

POD DEB ULCER SUBCUT

Facility

$1,447.00

Service Code	HCPCS 11042
Hospital Charge Code	84208015
Hospital Revenue Code	361
Min. Negotiated Rate	$217.05
Max. Negotiated Rate	$217.05
Rate for Payer: Qualcare PPO/HMO/WC	$217.05

POD DEB ULCER SUBCUT

Facility

$1,447.00

Service Code	HCPCS 11042
Hospital Charge Code	84208015
Hospital Revenue Code	361
Min. Negotiated Rate	$34.87
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
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	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.10
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.05
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$34.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

POD DEB VERRUCA 1

Facility

$372.00

Service Code	HCPCS 17000
Hospital Charge Code	84208100
Hospital Revenue Code	510
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

POD DEB VERRUCA 1

Facility

$372.00

Service Code	HCPCS 17000
Hospital Charge Code	84208100
Hospital Revenue Code	510
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

Know your out-of-pocket cost for care.

All Charges