Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

REM&REPL NEPHROURET STENT

Facility

$6,757.27

Service Code	HCPCS 50387
Hospital Charge Code	7412031
Hospital Revenue Code	361
Min. Negotiated Rate	$1,013.59
Max. Negotiated Rate	$1,013.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.59

REM/REV LONG ARM/LEG CAST

Facility

$468.75

Service Code	HCPCS 29705
Hospital Charge Code	5780160
Hospital Revenue Code	450
Min. Negotiated Rate	$12.42
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	$70.99
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	$140.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$12.42

REM/REV LONG ARM/LEG CAST

Facility

$468.75

Service Code	HCPCS 29705
Hospital Charge Code	5780160
Hospital Revenue Code	450
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

REM RG T8MM 30 CM RS X70CM

Facility

$4,170.00

Hospital Charge Code	270658080
Hospital Revenue Code	278
Min. Negotiated Rate	$625.50
Max. Negotiated Rate	$1,009.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$917.40
Rate for Payer: Qualcare PPO/HMO/WC	$625.50

REM RG T8MM 30 CM RS X70CM

Facility

$4,170.00

Hospital Charge Code	270658080
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$2,085.00
Rate for Payer: Aetna Commercial	$1,584.60
Rate for Payer: Aetna Medicare Advantage	$1,251.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$834.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,063.35
Rate for Payer: Cigna Commercial	$2,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$917.40
Rate for Payer: Qualcare PPO/HMO/WC	$625.50
Rate for Payer: UnitedHealthcare Community & State	$100.50
Rate for Payer: Wellpoint Medicaid Managed Care	$110.50

REM SUBQ CARD RHYTHM MONITOR

Facility

$3,396.55

Service Code	HCPCS 33286
Hospital Charge Code	366833286
Hospital Revenue Code	361
Min. Negotiated Rate	$509.48
Max. Negotiated Rate	$509.48
Rate for Payer: Qualcare PPO/HMO/WC	$509.48

REM SUBQ CARD RHYTHM MONITOR

Facility

$3,396.55

Service Code	HCPCS 33286
Hospital Charge Code	703033286
Hospital Revenue Code	481
Min. Negotiated Rate	$81.86
Max. Negotiated Rate	$6,600.00
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	$3,194.00
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	$1,018.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$509.48
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$90.01

REM SUBQ CARD RHYTHM MONITOR

Facility

$3,396.55

Service Code	HCPCS 33286
Hospital Charge Code	403433286
Hospital Revenue Code	361
Min. Negotiated Rate	$81.86
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	$1,018.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$509.48
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$90.01

REM SUBQ CARD RHYTHM MONITOR

Facility

$3,396.55

Service Code	HCPCS 33286
Hospital Charge Code	703033286
Hospital Revenue Code	481
Min. Negotiated Rate	$509.48
Max. Negotiated Rate	$509.48
Rate for Payer: Qualcare PPO/HMO/WC	$509.48

REM SUBQ CARD RHYTHM MONITOR

Facility

$3,396.55

Service Code	HCPCS 33286
Hospital Charge Code	403433286
Hospital Revenue Code	361
Min. Negotiated Rate	$509.48
Max. Negotiated Rate	$509.48
Rate for Payer: Qualcare PPO/HMO/WC	$509.48

REM SUBQ CARD RHYTHM MONITOR

Facility

$3,396.55

Service Code	HCPCS 33286
Hospital Charge Code	411033286
Hospital Revenue Code	361
Min. Negotiated Rate	$81.86
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	$1,018.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$509.48
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$90.01

REM SUBQ CARD RHYTHM MONITOR

Facility

$3,396.55

Service Code	HCPCS 33286
Hospital Charge Code	411033286
Hospital Revenue Code	361
Min. Negotiated Rate	$509.48
Max. Negotiated Rate	$509.48
Rate for Payer: Qualcare PPO/HMO/WC	$509.48

REM SUBQ CARD RHYTHM MONITOR

Facility

$3,396.55

Service Code	HCPCS 33286
Hospital Charge Code	366833286
Hospital Revenue Code	361
Min. Negotiated Rate	$81.86
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	$1,018.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$509.48
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$90.01

REM SUTURE W AN,OS

Facility

$3,264.00

Service Code	HCPCS 15851
Hospital Charge Code	1600000293
Hospital Revenue Code	360
Min. Negotiated Rate	$489.60
Max. Negotiated Rate	$489.60
Rate for Payer: Qualcare PPO/HMO/WC	$489.60

REM SUTURE W AN,OS

Facility

$3,264.00

Service Code	HCPCS 15851
Hospital Charge Code	1600000293
Hospital Revenue Code	360
Min. Negotiated Rate	$78.66
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$979.20
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$489.60
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$78.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$86.50

REM SUTURE W AN,SS

Facility

$3,264.00

Service Code	HCPCS 15850
Hospital Charge Code	16000601
Hospital Revenue Code	360
Min. Negotiated Rate	$78.66
Max. Negotiated Rate	$1,632.00
Rate for Payer: Aetna Commercial	$1,240.32
Rate for Payer: Aetna Medicare Advantage	$979.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$832.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$832.32
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	$832.32
Rate for Payer: Cigna Commercial	$1,632.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$979.20
Rate for Payer: Qualcare PPO/HMO/WC	$489.60
Rate for Payer: UnitedHealthcare Community & State	$78.66
Rate for Payer: Wellpoint Medicaid Managed Care	$86.50

REM SUTURE W AN,SS

Facility

$3,264.00

Service Code	HCPCS 15850
Hospital Charge Code	16000601
Hospital Revenue Code	360
Min. Negotiated Rate	$489.60
Max. Negotiated Rate	$489.60
Rate for Payer: Qualcare PPO/HMO/WC	$489.60

REM TOT KNEE PROSTH METHLMETH

Facility

$13,561.50

Service Code	HCPCS 27488
Hospital Charge Code	1600000421
Hospital Revenue Code	360
Min. Negotiated Rate	$2,034.22
Max. Negotiated Rate	$2,034.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,034.22

REM TOT KNEE PROSTH METHLMETH

Facility

$13,561.50

Service Code	HCPCS 27488
Hospital Charge Code	1600000421
Hospital Revenue Code	360
Min. Negotiated Rate	$326.83
Max. Negotiated Rate	$55,057.64
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,057.64
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,068.45
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,034.22
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$326.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$359.38

REM TUNN CV CATH W/PO/PUMP

Facility

$3,630.70

Service Code	HCPCS 36590
Hospital Charge Code	323036590
Hospital Revenue Code	450
Min. Negotiated Rate	$96.21
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$96.21

REM TUNN CV CATH W/PO/PUMP

Facility

$3,630.70

Service Code	HCPCS 36590
Hospital Charge Code	323036590
Hospital Revenue Code	450
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$544.61
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

REM TUNNELED CVAD W PORT/PUMP

Facility

$2,904.56

Service Code	HCPCS 36590
Hospital Charge Code	16000165
Hospital Revenue Code	360
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.37
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$435.68
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$70.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$76.97

REM TUNNELED CVAD W PORT/PUMP

Facility

$2,904.56

Service Code	HCPCS 36590
Hospital Charge Code	16000165
Hospital Revenue Code	360
Min. Negotiated Rate	$435.68
Max. Negotiated Rate	$435.68
Rate for Payer: Qualcare PPO/HMO/WC	$435.68

REMUR ACORN 12mm 232412

Facility

$744.00

Hospital Charge Code	270635265
Hospital Revenue Code	272
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$372.00
Rate for Payer: Aetna Commercial	$282.72
Rate for Payer: Aetna Medicare Advantage	$223.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.72
Rate for Payer: Cigna Commercial	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.20
Rate for Payer: Oxford Commercial	$148.80
Rate for Payer: Qualcare PPO/HMO/WC	$111.60
Rate for Payer: UnitedHealthcare Commercial	$148.80
Rate for Payer: UnitedHealthcare Community & State	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$19.72

REMUR ACORN 12mm 232412

Facility

$744.00

Hospital Charge Code	270635265
Hospital Revenue Code	272
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

Know your out-of-pocket cost for care.

All Charges