Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR MANDIBLE

Facility

$5,100.00

Service Code	HCPCS 70110
Hospital Charge Code	2000354
Hospital Revenue Code	320
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,627.00
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR MANDIBLE PARTIAL < 4 VIEW

Facility

$5,100.00

Service Code	HCPCS 70100
Hospital Charge Code	2011080
Hospital Revenue Code	320
Min. Negotiated Rate	$31.94
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR MANDIBLE PARTIAL < 4 VIEW

Facility

$5,100.00

Service Code	HCPCS 70100
Hospital Charge Code	2011080
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR MANUAL STRESS APPLIC-JOINT

Facility

$259.80

Service Code	HCPCS 77071
Hospital Charge Code	2011359
Hospital Revenue Code	320
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.94
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.97
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.88

XR MANUAL STRESS APPLIC-JOINT

Facility

$259.80

Service Code	HCPCS 77071
Hospital Charge Code	2011359
Hospital Revenue Code	320
Min. Negotiated Rate	$38.97
Max. Negotiated Rate	$38.97
Rate for Payer: Qualcare PPO/HMO/WC	$38.97

XR MASTOIDS <3 VIEWS BILATERAL

Facility

$517.40

Service Code	HCPCS 7012050
Hospital Charge Code	2011360
Hospital Revenue Code	320
Min. Negotiated Rate	$77.61
Max. Negotiated Rate	$77.61
Rate for Payer: Qualcare PPO/HMO/WC	$77.61

XR MASTOIDS <3 VIEWS BILATERAL

Facility

$517.40

Service Code	HCPCS 7012050
Hospital Charge Code	2011360
Hospital Revenue Code	320
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$196.61
Rate for Payer: Aetna Medicare Advantage	$155.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.94
Rate for Payer: Cigna Commercial	$258.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.61
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$13.71

XR MASTOIDS < 3 VIEWS RIGHT

Facility

$258.70

Service Code	HCPCS 70120RT
Hospital Charge Code	2011361
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR MASTOIDS < 3 VIEWS RIGHT

Facility

$258.70

Service Code	HCPCS 70120RT
Hospital Charge Code	2011361
Hospital Revenue Code	320
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$98.31
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.97
Rate for Payer: Cigna Commercial	$129.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.23
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

XR MASTOIDS COMPLETE BILETERAL

Facility

$1,398.50

Service Code	HCPCS 7013050
Hospital Charge Code	2011362
Hospital Revenue Code	320
Min. Negotiated Rate	$209.78
Max. Negotiated Rate	$209.78
Rate for Payer: Qualcare PPO/HMO/WC	$209.78

XR MASTOIDS COMPLETE BILETERAL

Facility

$1,398.50

Service Code	HCPCS 7013050
Hospital Charge Code	2011362
Hospital Revenue Code	320
Min. Negotiated Rate	$33.70
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$531.43
Rate for Payer: Aetna Medicare Advantage	$419.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$356.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$356.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$356.62
Rate for Payer: Cigna Commercial	$699.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$209.78
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$33.70
Rate for Payer: Wellpoint Medicaid Managed Care	$37.06

XR MASTOIDS COMPLETE LEFT

Facility

$699.25

Service Code	HCPCS 70130LT
Hospital Charge Code	2011363
Hospital Revenue Code	320
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$265.71
Rate for Payer: Aetna Medicare Advantage	$209.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.31
Rate for Payer: Cigna Commercial	$349.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.89
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$18.53

XR MASTOIDS COMPLETE LEFT

Facility

$699.25

Service Code	HCPCS 70130LT
Hospital Charge Code	2011363
Hospital Revenue Code	320
Min. Negotiated Rate	$104.89
Max. Negotiated Rate	$104.89
Rate for Payer: Qualcare PPO/HMO/WC	$104.89

XR MASTOIDS COMPLETE RIGHT

Facility

$699.25

Service Code	HCPCS 70130RT
Hospital Charge Code	2011364
Hospital Revenue Code	320
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$265.71
Rate for Payer: Aetna Medicare Advantage	$209.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.31
Rate for Payer: Cigna Commercial	$349.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.89
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$18.53

XR MASTOIDS COMPLETE RIGHT

Facility

$699.25

Service Code	HCPCS 70130RT
Hospital Charge Code	2011364
Hospital Revenue Code	320
Min. Negotiated Rate	$104.89
Max. Negotiated Rate	$104.89
Rate for Payer: Qualcare PPO/HMO/WC	$104.89

XR MASTOIDS COMP STUDY

Facility

$699.25

Service Code	HCPCS 70130
Hospital Charge Code	2000438
Hospital Revenue Code	320
Min. Negotiated Rate	$104.89
Max. Negotiated Rate	$104.89
Rate for Payer: Qualcare PPO/HMO/WC	$104.89

XR MASTOIDS COMP STUDY

Facility

$699.25

Service Code	HCPCS 70130
Hospital Charge Code	2000438
Hospital Revenue Code	320
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.89
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$16.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$18.53

XR MECH REMOV TUNN CV CATH

Facility

$15,468.50

Service Code	HCPCS 36595
Hospital Charge Code	321036595
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

XR MECH REMOV TUNN CV CATH

Facility

$15,468.50

Service Code	HCPCS 36595
Hospital Charge Code	5600138
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

XR MECH REMOV TUNN CV CATH

Facility

$15,468.50

Service Code	HCPCS 36595
Hospital Charge Code	5600138
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

XR MECH REMOV TUNN CV CATH

Facility

$11,315.45

Service Code	HCPCS 36595
Hospital Charge Code	7411475
Hospital Revenue Code	361
Min. Negotiated Rate	$1,697.32
Max. Negotiated Rate	$1,697.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.32

XR MECH REMOV TUNN CV CATH

Facility

$11,315.45

Service Code	HCPCS 36595
Hospital Charge Code	7411475
Hospital Revenue Code	361
Min. Negotiated Rate	$272.70
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,394.64
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,697.32
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$272.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$299.86

XR MECH REMOV TUNN CV CATH

Facility

$15,468.50

Service Code	HCPCS 36595
Hospital Charge Code	321036595
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

XR MEC REMOV TUN CV CATH LUMEN

Facility

$4,914.50

Service Code	HCPCS 36596
Hospital Charge Code	366836596
Hospital Revenue Code	361
Min. Negotiated Rate	$118.44
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	$1,626.00
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	$1,474.35
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$737.17
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$118.44
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	$130.23

XR MEC REMOV TUN CV CATH LUMEN

Facility

$6,404.20

Service Code	HCPCS 36596
Hospital Charge Code	321036596
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

Know your out-of-pocket cost for care.

All Charges