Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ER INTERMEDIATE - III

Facility

$13,269.54

Service Code	HCPCS 99283
Hospital Charge Code	5700083
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$2,638.00
Rate for Payer: Aetna Commercial	$882.10
Rate for Payer: Aetna Medicare Advantage	$1,050.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$324.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.40
Rate for Payer: Cigna Commercial	$650.06
Rate for Payer: Cigna Medicare Advantage	$324.30
Rate for Payer: Clover Medicare Advantage	$308.08
Rate for Payer: EmblemHealth Commercial	$972.90
Rate for Payer: Humana Medicare Advantage	$334.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$324.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$869.00
Rate for Payer: Oxford Commercial	$2,337.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,990.43
Rate for Payer: UnitedHealthcare Commercial	$2,638.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$324.30
Rate for Payer: Wellcare Medicare Advantage	$324.30
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER INTERMEDIATE - III

Facility

$13,269.54

Service Code	HCPCS 99283
Hospital Charge Code	5700083
Hospital Revenue Code	450
Min. Negotiated Rate	$1,990.43
Max. Negotiated Rate	$1,990.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,990.43

ER INTERMEDIATE - III W/O MF

Facility

$5,991.00

Service Code	HCPCS 99283
Hospital Charge Code	5700082
Hospital Revenue Code	450
Min. Negotiated Rate	$898.65
Max. Negotiated Rate	$898.65
Rate for Payer: Qualcare PPO/HMO/WC	$898.65

ER INTERMEDIATE - III W/O MF

Facility

$5,991.00

Service Code	HCPCS 99283
Hospital Charge Code	5700082
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$2,638.00
Rate for Payer: Aetna Commercial	$882.10
Rate for Payer: Aetna Medicare Advantage	$1,050.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$324.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.40
Rate for Payer: Cigna Commercial	$650.06
Rate for Payer: Cigna Medicare Advantage	$324.30
Rate for Payer: Clover Medicare Advantage	$308.08
Rate for Payer: EmblemHealth Commercial	$972.90
Rate for Payer: Humana Medicare Advantage	$334.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$324.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$869.00
Rate for Payer: Oxford Commercial	$2,337.00
Rate for Payer: Qualcare PPO/HMO/WC	$898.65
Rate for Payer: UnitedHealthcare Commercial	$2,638.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$324.30
Rate for Payer: Wellcare Medicare Advantage	$324.30
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER-INTRA-AORTIC BALLOON CATH

Facility

$22,823.38

Service Code	HCPCS 33967
Hospital Charge Code	5780180
Hospital Revenue Code	361
Min. Negotiated Rate	$648.18
Max. Negotiated Rate	$20,109.00
Rate for Payer: Aetna Commercial	$8,672.88
Rate for Payer: Aetna Medicare Advantage	$6,847.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,819.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,819.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,819.96
Rate for Payer: Cigna Commercial	$11,411.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,934.08
Rate for Payer: Oxford Commercial	$18,024.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,423.51
Rate for Payer: UnitedHealthcare Commercial	$20,109.00
Rate for Payer: UnitedHealthcare Community & State	$721.22
Rate for Payer: Wellpoint Medicaid Managed Care	$648.18

ER-INTRA-AORTIC BALLOON CATH

Facility

$22,823.38

Service Code	HCPCS 33967
Hospital Charge Code	5780180
Hospital Revenue Code	361
Min. Negotiated Rate	$3,423.51
Max. Negotiated Rate	$3,423.51
Rate for Payer: Qualcare PPO/HMO/WC	$3,423.51

ER INTRAOSSEOUS INFUSION

Facility

$1,550.25

Service Code	HCPCS 36680
Hospital Charge Code	5700784
Hospital Revenue Code	450
Min. Negotiated Rate	$232.54
Max. Negotiated Rate	$232.54
Rate for Payer: Qualcare PPO/HMO/WC	$232.54

ER INTRAOSSEOUS INFUSION

Facility

$1,550.25

Service Code	HCPCS 36680
Hospital Charge Code	5700784
Hospital Revenue Code	450
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$1,925.19
Rate for Payer: Aetna Commercial	$1,443.56
Rate for Payer: Aetna Medicare Advantage	$1,719.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,925.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,925.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$530.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,925.19
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: Cigna Medicare Advantage	$530.72
Rate for Payer: Clover Medicare Advantage	$504.18
Rate for Payer: EmblemHealth Commercial	$1,592.16
Rate for Payer: Humana Medicare Advantage	$546.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$530.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.06
Rate for Payer: Qualcare PPO/HMO/WC	$232.54
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$530.72
Rate for Payer: Wellcare Medicare Advantage	$530.72
Rate for Payer: Wellpoint Medicaid Managed Care	$44.03

ER INT REP FACE 12.6-20

Facility

$2,305.60

Service Code	HCPCS 12055
Hospital Charge Code	5700538
Hospital Revenue Code	450
Min. Negotiated Rate	$345.84
Max. Negotiated Rate	$345.84
Rate for Payer: Qualcare PPO/HMO/WC	$345.84

ER INT REP FACE 12.6-20

Facility

$2,305.60

Service Code	HCPCS 12055
Hospital Charge Code	5700538
Hospital Revenue Code	450
Min. Negotiated Rate	$65.48
Max. Negotiated Rate	$1,751.90
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$172.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$599.46
Rate for Payer: Qualcare PPO/HMO/WC	$345.84
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$65.48

ER INT REP FACE 20.1-30

Facility

$2,000.00

Service Code	HCPCS 12056
Hospital Charge Code	5700713
Hospital Revenue Code	450
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

ER INT REP FACE 20.1-30

Facility

$2,000.00

Service Code	HCPCS 12056
Hospital Charge Code	5700713
Hospital Revenue Code	450
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,751.90
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$233.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$520.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$56.80

ER INT REP FACE 2.5-5.0

Facility

$836.00

Service Code	HCPCS 12052
Hospital Charge Code	5700535
Hospital Revenue Code	450
Min. Negotiated Rate	$125.40
Max. Negotiated Rate	$125.40
Rate for Payer: Qualcare PPO/HMO/WC	$125.40

ER INT REP FACE 2.5-5.0

Facility

$836.00

Service Code	HCPCS 12052
Hospital Charge Code	5700535
Hospital Revenue Code	450
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$1,751.90
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$114.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$217.36
Rate for Payer: Qualcare PPO/HMO/WC	$125.40
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$23.74

ER INT REP FACE > 30 CM

Facility

$2,500.00

Service Code	HCPCS 12057
Hospital Charge Code	5700714
Hospital Revenue Code	450
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,751.90
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$233.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

ER INT REP FACE > 30 CM

Facility

$2,500.00

Service Code	HCPCS 12057
Hospital Charge Code	5700714
Hospital Revenue Code	450
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

ER INT REP FACE 5.1-7.5

Facility

$1,813.80

Service Code	HCPCS 12053
Hospital Charge Code	5700536
Hospital Revenue Code	450
Min. Negotiated Rate	$51.51
Max. Negotiated Rate	$1,751.90
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$121.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$471.59
Rate for Payer: Qualcare PPO/HMO/WC	$272.07
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$51.51

ER INT REP FACE 5.1-7.5

Facility

$1,813.80

Service Code	HCPCS 12053
Hospital Charge Code	5700536
Hospital Revenue Code	450
Min. Negotiated Rate	$272.07
Max. Negotiated Rate	$272.07
Rate for Payer: Qualcare PPO/HMO/WC	$272.07

ER INT REP FACE 7.6-12.5

Facility

$1,500.00

Service Code	HCPCS 12054
Hospital Charge Code	5700537
Hospital Revenue Code	450
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$1,751.90
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$134.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$390.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$42.60

ER INT REP FACE 7.6-12.5

Facility

$1,500.00

Service Code	HCPCS 12054
Hospital Charge Code	5700537
Hospital Revenue Code	450
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

ER INT REP FACE UP TO 2.5

Facility

$1,293.00

Service Code	HCPCS 12051
Hospital Charge Code	5700534
Hospital Revenue Code	450
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$1,751.90
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$86.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$336.18
Rate for Payer: Qualcare PPO/HMO/WC	$193.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$36.72

ER INT REP FACE UP TO 2.5

Facility

$1,293.00

Service Code	HCPCS 12051
Hospital Charge Code	5700534
Hospital Revenue Code	450
Min. Negotiated Rate	$193.95
Max. Negotiated Rate	$193.95
Rate for Payer: Qualcare PPO/HMO/WC	$193.95

ER INT REP NEK HAD FOOT2.6-7.5

Facility

$1,280.00

Service Code	HCPCS 12042
Hospital Charge Code	5700532
Hospital Revenue Code	450
Min. Negotiated Rate	$192.00
Max. Negotiated Rate	$192.00
Rate for Payer: Qualcare PPO/HMO/WC	$192.00

ER INT REP NEK HAD FOOT2.6-7.5

Facility

$1,280.00

Service Code	HCPCS 12042
Hospital Charge Code	5700532
Hospital Revenue Code	450
Min. Negotiated Rate	$36.35
Max. Negotiated Rate	$1,751.90
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$114.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$332.80
Rate for Payer: Qualcare PPO/HMO/WC	$192.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$36.35

ER INT REP NEK HAD FOT12.6-20

Facility

$1,500.00

Service Code	HCPCS 12045
Hospital Charge Code	5700710
Hospital Revenue Code	450
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges