Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EXPLORE/TREAT ANKLE JOINT-LT

Facility

$32,127.31

Service Code	HCPCS 27610
Hospital Charge Code	16000890
Hospital Revenue Code	360
Min. Negotiated Rate	$4,819.10
Max. Negotiated Rate	$4,819.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,819.10

EXPLORE/TREAT ELBOW JOINT

Facility

$12,406.91

Service Code	HCPCS 24101
Hospital Charge Code	16000820
Hospital Revenue Code	360
Min. Negotiated Rate	$1,861.04
Max. Negotiated Rate	$1,861.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,861.04

EXPLORE/TREAT ELBOW JOINT

Facility

$12,406.91

Service Code	HCPCS 24101
Hospital Charge Code	16000820
Hospital Revenue Code	360
Min. Negotiated Rate	$352.36
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,225.80
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,861.04
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$392.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$352.36

EXPLOR/TREAT ANKLE JOINT

Facility

$12,832.72

Service Code	HCPCS 27620
Hospital Charge Code	1600000796
Hospital Revenue Code	360
Min. Negotiated Rate	$364.45
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,336.51
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.91
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$405.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$364.45

EXPLOR/TREAT ANKLE JOINT

Facility

$12,832.72

Service Code	HCPCS 27620
Hospital Charge Code	1600000796
Hospital Revenue Code	360
Min. Negotiated Rate	$1,924.91
Max. Negotiated Rate	$1,924.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.91

EXPL P WND,ABD/FLANK

Facility

$20,772.85

Service Code	HCPCS 20102
Hospital Charge Code	16000791
Hospital Revenue Code	360
Min. Negotiated Rate	$3,115.93
Max. Negotiated Rate	$3,115.93
Rate for Payer: Qualcare PPO/HMO/WC	$3,115.93

EXPL P WND,ABD/FLANK

Facility

$20,772.85

Service Code	HCPCS 20102
Hospital Charge Code	16000791
Hospital Revenue Code	360
Min. Negotiated Rate	$589.95
Max. Negotiated Rate	$8,891.84
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	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,891.84
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	$5,400.94
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,115.93
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$656.42
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	$589.95

EXPL P WOUND EXTREM

Facility

$10,109.05

Service Code	HCPCS 20103
Hospital Charge Code	1600000334
Hospital Revenue Code	360
Min. Negotiated Rate	$319.45
Max. Negotiated Rate	$7,117.66
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	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
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	$2,628.35
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,516.36
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$319.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,950.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1,912.33

EXPL P WOUND EXTREM

Facility

$10,109.05

Service Code	HCPCS 20103
Hospital Charge Code	1600000334
Hospital Revenue Code	360
Min. Negotiated Rate	$1,516.36
Max. Negotiated Rate	$1,516.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,516.36

EXPL/REM FB IPH JOINT EA

Facility

$14,318.80

Service Code	HCPCS 26080
Hospital Charge Code	16000841
Hospital Revenue Code	360
Min. Negotiated Rate	$406.65
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,722.89
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.82
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$452.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$406.65

EXPL/REM FB IPH JOINT EA

Facility

$14,318.80

Service Code	HCPCS 26080
Hospital Charge Code	16000841
Hospital Revenue Code	360
Min. Negotiated Rate	$2,147.82
Max. Negotiated Rate	$2,147.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.82

EXPL/REM FB MCP JOINT

Facility

$14,854.00

Service Code	HCPCS 26075
Hospital Charge Code	1600000463
Hospital Revenue Code	360
Min. Negotiated Rate	$421.85
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,862.04
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,228.10
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$469.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$421.85

EXPL/REM FB MCP JOINT

Facility

$14,854.00

Service Code	HCPCS 26075
Hospital Charge Code	1600000463
Hospital Revenue Code	360
Min. Negotiated Rate	$2,228.10
Max. Negotiated Rate	$2,228.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,228.10

EXPL W DRAIN/REM FB - IT/MT FO

Facility

$20,545.30

Service Code	HCPCS 28020
Hospital Charge Code	16000716
Hospital Revenue Code	360
Min. Negotiated Rate	$583.49
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,341.78
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,081.80
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$649.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$583.49

EXPL W DRAIN/REM FB - IT/MT FO

Facility

$20,545.30

Service Code	HCPCS 28020
Hospital Charge Code	16000716
Hospital Revenue Code	360
Min. Negotiated Rate	$3,081.80
Max. Negotiated Rate	$3,081.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,081.80

EXPL W DR/REM FB - IP FOOT JNT

Facility

$17,164.20

Service Code	HCPCS 28024
Hospital Charge Code	16000568
Hospital Revenue Code	360
Min. Negotiated Rate	$2,574.63
Max. Negotiated Rate	$2,574.63
Rate for Payer: Qualcare PPO/HMO/WC	$2,574.63

EXPL W DR/REM FB - IP FOOT JNT

Facility

$17,164.20

Service Code	HCPCS 28024
Hospital Charge Code	16000568
Hospital Revenue Code	360
Min. Negotiated Rate	$487.46
Max. Negotiated Rate	$8,192.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,462.69
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,574.63
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$542.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$487.46

EXPL W DR/REM FB-MTP FOOT JNT

Facility

$19,998.60

Service Code	HCPCS 28022
Hospital Charge Code	16000717
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

EXPL W DR/REM FB-MTP FOOT JNT

Facility

$19,998.60

Service Code	HCPCS 28022
Hospital Charge Code	16000717
Hospital Revenue Code	360
Min. Negotiated Rate	$567.96
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,199.64
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$631.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$567.96

EXPOSRE SET

Facility

$7,476.50

Hospital Charge Code	270687446
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.47
Max. Negotiated Rate	$1,121.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.47

EXPOSRE SET

Facility

$7,476.50

Hospital Charge Code	270687446
Hospital Revenue Code	272
Min. Negotiated Rate	$212.33
Max. Negotiated Rate	$3,738.25
Rate for Payer: Aetna Commercial	$2,841.07
Rate for Payer: Aetna Medicare Advantage	$2,242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.51
Rate for Payer: Cigna Commercial	$3,738.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,943.89
Rate for Payer: Oxford Commercial	$1,495.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.47
Rate for Payer: UnitedHealthcare Commercial	$1,495.30
Rate for Payer: UnitedHealthcare Community & State	$236.26
Rate for Payer: Wellpoint Medicaid Managed Care	$212.33

EXPO STANDARD FR4

Facility

$142.50

Hospital Charge Code	270684318N
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare Advantage	$42.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.34
Rate for Payer: Cigna Commercial	$71.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.05
Rate for Payer: Oxford Commercial	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.38
Rate for Payer: UnitedHealthcare Commercial	$28.50
Rate for Payer: UnitedHealthcare Community & State	$4.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

EXPO STANDARD FR4

Facility

$142.50

Hospital Charge Code	270684318
Hospital Revenue Code	272
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.38

EXPO STANDARD FR4

Facility

$142.50

Hospital Charge Code	270684318
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare Advantage	$42.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.34
Rate for Payer: Cigna Commercial	$71.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.05
Rate for Payer: Oxford Commercial	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.38
Rate for Payer: UnitedHealthcare Commercial	$28.50
Rate for Payer: UnitedHealthcare Community & State	$4.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

EXPO STANDARD FR4

Facility

$142.50

Hospital Charge Code	270684318N
Hospital Revenue Code	272
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.38

Know your out-of-pocket cost for care.

All Charges