Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

REMOVAL OF HEMORRHOID CLOT

Facility

$4,707.64

Service Code	HCPCS 46320
Hospital Charge Code	1600000288
Hospital Revenue Code	360
Min. Negotiated Rate	$113.45
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
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	$5,131.69
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.29
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.15
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$113.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$124.75

REMOVAL OF HEMORRHOID CLOT

Facility

$21,472.19

Service Code	HCPCS 46320
Hospital Charge Code	1600000557
Hospital Revenue Code	360
Min. Negotiated Rate	$517.48
Max. Negotiated Rate	$6,441.66
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
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	$5,131.69
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,441.66
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,220.83
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$517.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$569.01

REMOVAL OF HEMORRHOID CLOT

Facility

$4,707.64

Service Code	HCPCS 46320
Hospital Charge Code	1600000288
Hospital Revenue Code	360
Min. Negotiated Rate	$706.15
Max. Negotiated Rate	$706.15
Rate for Payer: Qualcare PPO/HMO/WC	$706.15

REMOVAL OF HYDROCELES

Facility

$16,624.12

Service Code	HCPCS 55041
Hospital Charge Code	1600000394
Hospital Revenue Code	360
Min. Negotiated Rate	$2,493.62
Max. Negotiated Rate	$2,493.62
Rate for Payer: Qualcare PPO/HMO/WC	$2,493.62

REMOVAL OF HYDROCELES

Facility

$16,624.12

Service Code	HCPCS 55041
Hospital Charge Code	1600000394
Hospital Revenue Code	360
Min. Negotiated Rate	$400.64
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	$1,742.00
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	$4,987.24
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,493.62
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$400.64
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	$440.54

REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF

Facility

$3,593.00

Service Code	CPT 32552
Hospital Revenue Code	361
Min. Negotiated Rate	$707.99
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25

REMOVAL OF KIDNEY LESION

Facility

$9,262.80

Hospital Charge Code	1600000860
Hospital Revenue Code	360
Min. Negotiated Rate	$1,389.42
Max. Negotiated Rate	$1,389.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.42

REMOVAL OF KIDNEY LESION

Facility

$9,262.80

Hospital Charge Code	1600000860
Hospital Revenue Code	360
Min. Negotiated Rate	$223.23
Max. Negotiated Rate	$4,631.40
Rate for Payer: Aetna Commercial	$3,519.86
Rate for Payer: Aetna Medicare Advantage	$2,778.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.01
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	$2,362.01
Rate for Payer: Cigna Commercial	$4,631.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,778.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.42
Rate for Payer: UnitedHealthcare Community & State	$223.23
Rate for Payer: Wellpoint Medicaid Managed Care	$245.46

REMOVAL OF KNEECAP

Facility

$30,595.00

Service Code	HCPCS 27350
Hospital Charge Code	16000561
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

REMOVAL OF KNEECAP

Facility

$30,595.00

Service Code	HCPCS 27350
Hospital Charge Code	16000561
Hospital Revenue Code	360
Min. Negotiated Rate	$737.34
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	$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	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$810.77

REMOVAL OF LARYNX LESION

Facility

$19,096.15

Service Code	HCPCS 31300
Hospital Charge Code	1600000702
Hospital Revenue Code	360
Min. Negotiated Rate	$2,864.42
Max. Negotiated Rate	$2,864.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,864.42

REMOVAL OF LARYNX LESION

Facility

$19,096.15

Service Code	HCPCS 31300
Hospital Charge Code	1600000702
Hospital Revenue Code	360
Min. Negotiated Rate	$460.22
Max. Negotiated Rate	$14,218.07
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,218.07
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,728.85
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,864.42
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$460.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$506.05

REMOVAL OF LUNG LESION

Facility

$23,450.23

Service Code	HCPCS 32540
Hospital Charge Code	1600000406
Hospital Revenue Code	360
Min. Negotiated Rate	$3,517.53
Max. Negotiated Rate	$3,517.53
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.53

REMOVAL OF LUNG LESION

Facility

$23,450.23

Service Code	HCPCS 32540
Hospital Charge Code	1600000406
Hospital Revenue Code	360
Min. Negotiated Rate	$565.15
Max. Negotiated Rate	$11,725.11
Rate for Payer: Aetna Commercial	$8,911.09
Rate for Payer: Aetna Medicare Advantage	$7,035.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,979.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,979.81
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	$5,979.81
Rate for Payer: Cigna Commercial	$11,725.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,035.07
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.53
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$565.15
Rate for Payer: Wellpoint Medicaid Managed Care	$621.43

REMOVAL OF NAIL BED

Facility

$1,822.15

Service Code	HCPCS 11750
Hospital Charge Code	412311750
Hospital Revenue Code	361
Min. Negotiated Rate	$273.32
Max. Negotiated Rate	$273.32
Rate for Payer: Qualcare PPO/HMO/WC	$273.32

REMOVAL OF NAIL BED

Facility

$1,822.15

Service Code	HCPCS 11750
Hospital Charge Code	412311750
Hospital Revenue Code	361
Min. Negotiated Rate	$43.91
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	$862.00
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	$546.64
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$273.32
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$43.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$48.29

REMOVAL OF NAIL PLATE

Facility

$990.50

Service Code	HCPCS 11730
Hospital Charge Code	412311730
Hospital Revenue Code	361
Min. Negotiated Rate	$23.87
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	$297.15
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$148.57
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$26.25

REMOVAL OF NAIL PLATE

Facility

$990.50

Service Code	HCPCS 11730
Hospital Charge Code	412311730
Hospital Revenue Code	361
Min. Negotiated Rate	$148.57
Max. Negotiated Rate	$148.57
Rate for Payer: Qualcare PPO/HMO/WC	$148.57

REMOVAL OF NAIL PLATE ADD-ON

Facility

$495.25

Service Code	HCPCS 11732
Hospital Charge Code	412311732
Hospital Revenue Code	361
Min. Negotiated Rate	$74.29
Max. Negotiated Rate	$74.29
Rate for Payer: Qualcare PPO/HMO/WC	$74.29

REMOVAL OF NAIL PLATE ADD-ON

Facility

$495.25

Service Code	HCPCS 11732
Hospital Charge Code	412311732
Hospital Revenue Code	361
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$188.19
Rate for Payer: Aetna Medicare Advantage	$148.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.29
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	$126.29
Rate for Payer: Cigna Commercial	$247.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.57
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.29
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$11.94
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

REMOVAL OF PANCREAS

Facility

$38,810.60

Service Code	HCPCS 48155
Hospital Charge Code	1600000695
Hospital Revenue Code	360
Min. Negotiated Rate	$935.34
Max. Negotiated Rate	$19,405.30
Rate for Payer: Aetna Commercial	$14,748.03
Rate for Payer: Aetna Medicare Advantage	$11,643.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,896.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,896.70
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	$9,896.70
Rate for Payer: Cigna Commercial	$19,405.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,643.18
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,821.59
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$935.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1,028.48

REMOVAL OF PANCREAS

Facility

$38,810.60

Service Code	HCPCS 48155
Hospital Charge Code	1600000695
Hospital Revenue Code	360
Min. Negotiated Rate	$5,821.59
Max. Negotiated Rate	$5,821.59
Rate for Payer: Qualcare PPO/HMO/WC	$5,821.59

REMOVAL OF PELVIC STRUCTURES

Facility

$48,449.00

Service Code	HCPCS 51597
Hospital Charge Code	1600000727
Hospital Revenue Code	360
Min. Negotiated Rate	$7,267.35
Max. Negotiated Rate	$7,267.35
Rate for Payer: Qualcare PPO/HMO/WC	$7,267.35

REMOVAL OF PELVIC STRUCTURES

Facility

$48,449.00

Service Code	HCPCS 51597
Hospital Charge Code	1600000727
Hospital Revenue Code	360
Min. Negotiated Rate	$1,167.62
Max. Negotiated Rate	$24,224.50
Rate for Payer: Aetna Commercial	$18,410.62
Rate for Payer: Aetna Medicare Advantage	$14,534.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,354.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,354.50
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	$12,354.50
Rate for Payer: Cigna Commercial	$24,224.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,534.70
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,267.35
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,167.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1,283.90

REMOVAL OF PELVIS CONTENTS

Facility

$15,702.60

Service Code	HCPCS 58240
Hospital Charge Code	1600000729
Hospital Revenue Code	360
Min. Negotiated Rate	$2,355.39
Max. Negotiated Rate	$2,355.39
Rate for Payer: Qualcare PPO/HMO/WC	$2,355.39

Know your out-of-pocket cost for care.

All Charges