Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

I&D EAR ABSCESS COMPLICATED

Facility

$8,259.00

Service Code	HCPCS 69005
Hospital Charge Code	5780255
Hospital Revenue Code	450
Min. Negotiated Rate	$1,238.85
Max. Negotiated Rate	$1,238.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,238.85

IDET 1 OR MORE LEVELS

Facility

$30,000.00

Service Code	HCPCS 22527
Hospital Charge Code	16000801
Hospital Revenue Code	360
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$4,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

IDET 1 OR MORE LEVELS

Facility

$30,000.00

Service Code	HCPCS 22527
Hospital Charge Code	16000801
Hospital Revenue Code	360
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$11,400.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
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	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,800.00
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$948.00
Rate for Payer: Wellpoint Medicaid Managed Care	$852.00

IDET,SINGLE LEVEL--LT

Facility

$30,000.00

Service Code	HCPCS 22526
Hospital Charge Code	16000800
Hospital Revenue Code	360
Min. Negotiated Rate	$948.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$11,400.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
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	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,800.00
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$948.00

IDET,SINGLE LEVEL--LT

Facility

$30,000.00

Service Code	HCPCS 22526
Hospital Charge Code	16000800
Hospital Revenue Code	360
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$4,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

I&D EYELID ABSCESS

Facility

$1,578.95

Service Code	HCPCS 67700
Hospital Charge Code	5780250
Hospital Revenue Code	450
Min. Negotiated Rate	$236.84
Max. Negotiated Rate	$236.84
Rate for Payer: Qualcare PPO/HMO/WC	$236.84

I&D EYELID ABSCESS

Facility

$1,578.95

Service Code	HCPCS 67700
Hospital Charge Code	5780250
Hospital Revenue Code	450
Min. Negotiated Rate	$35.15
Max. Negotiated Rate	$1,367.89
Rate for Payer: Aetna Commercial	$1,025.68
Rate for Payer: Aetna Medicare Advantage	$1,221.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,367.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,367.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$377.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,367.89
Rate for Payer: Cigna Commercial	$755.86
Rate for Payer: Cigna Medicare Advantage	$377.09
Rate for Payer: Clover Medicare Advantage	$358.24
Rate for Payer: EmblemHealth Commercial	$1,131.27
Rate for Payer: Humana Medicare Advantage	$388.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$377.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.53
Rate for Payer: Qualcare PPO/HMO/WC	$236.84
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$377.09
Rate for Payer: Wellcare Medicare Advantage	$377.09
Rate for Payer: Wellpoint Medicaid Managed Care	$44.84

I&D HEMATOMA

Facility

$882.00

Service Code	HCPCS 10140
Hospital Charge Code	87502125
Hospital Revenue Code	761
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$132.30
Rate for Payer: Qualcare PPO/HMO/WC	$132.30

I&D HEMATOMA

Facility

$882.00

Service Code	HCPCS 10140
Hospital Charge Code	87502125
Hospital Revenue Code	761
Min. Negotiated Rate	$25.05
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	$41.58
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	$229.32
Rate for Payer: Oxford Commercial	$176.40
Rate for Payer: Qualcare PPO/HMO/WC	$132.30
Rate for Payer: UnitedHealthcare Commercial	$176.40
Rate for Payer: UnitedHealthcare Community & State	$27.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$25.05

I&D HEMATOMA/FLUID

Facility

$5,638.35

Service Code	HCPCS 10140
Hospital Charge Code	16000308
Hospital Revenue Code	360
Min. Negotiated Rate	$845.75
Max. Negotiated Rate	$845.75
Rate for Payer: Qualcare PPO/HMO/WC	$845.75

I&D HEMATOMA/FLUID

Facility

$5,638.35

Service Code	HCPCS 10140
Hospital Charge Code	16000308
Hospital Revenue Code	360
Min. Negotiated Rate	$160.13
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	$1,465.97
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$845.75
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$178.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$160.13

I&D LEG/ANKLE DEEP ABSC/HEMATO

Facility

$10,870.60

Service Code	HCPCS 27603
Hospital Charge Code	16000889
Hospital Revenue Code	360
Min. Negotiated Rate	$1,630.59
Max. Negotiated Rate	$1,630.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,630.59

I&D LEG/ANKLE DEEP ABSC/HEMATO

Facility

$10,870.60

Service Code	HCPCS 27603
Hospital Charge Code	16000889
Hospital Revenue Code	360
Min. Negotiated Rate	$308.73
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
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	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,826.36
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,630.59
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$343.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$308.73

I&D OF SUBMUCOSAL ABSCESS,RCTM

Facility

$16,865.10

Service Code	HCPCS 45005
Hospital Charge Code	16000643
Hospital Revenue Code	360
Min. Negotiated Rate	$478.97
Max. Negotiated Rate	$5,347.00
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	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,157.00
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,157.00
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	$4,384.93
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$532.94
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	$478.97

I&D OF SUBMUCOSAL ABSCESS,RCTM

Facility

$16,865.10

Service Code	HCPCS 45005
Hospital Charge Code	16000643
Hospital Revenue Code	360
Min. Negotiated Rate	$2,529.76
Max. Negotiated Rate	$2,529.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76

IDOSORB GEL 40 GM

Facility

$184.95

Hospital Charge Code	60630080W
Hospital Revenue Code	250
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$92.47
Rate for Payer: Aetna Commercial	$70.28
Rate for Payer: Aetna Medicare Advantage	$55.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.16
Rate for Payer: Cigna Commercial	$92.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.09
Rate for Payer: Oxford Commercial	$36.99
Rate for Payer: Qualcare PPO/HMO/WC	$27.74
Rate for Payer: UnitedHealthcare Commercial	$36.99
Rate for Payer: UnitedHealthcare Community & State	$5.84
Rate for Payer: Wellpoint Medicaid Managed Care	$5.25

IDOSORB GEL 40 GM

Facility

$184.95

Hospital Charge Code	60630080W
Hospital Revenue Code	250
Min. Negotiated Rate	$27.74
Max. Negotiated Rate	$27.74
Rate for Payer: Qualcare PPO/HMO/WC	$27.74

I&D PALATE OR UVULA

Facility

$1,453.00

Service Code	HCPCS 42000
Hospital Charge Code	5780200
Hospital Revenue Code	450
Min. Negotiated Rate	$217.95
Max. Negotiated Rate	$217.95
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

I&D PALATE OR UVULA

Facility

$1,453.00

Service Code	HCPCS 42000
Hospital Charge Code	5780200
Hospital Revenue Code	450
Min. Negotiated Rate	$23.96
Max. Negotiated Rate	$1,020.71
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.71
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.78
Rate for Payer: Qualcare PPO/HMO/WC	$217.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$41.27

I&D PELV/HIP JNT ABSC,DEEP

Facility

$19,467.90

Service Code	HCPCS 26990
Hospital Charge Code	1600000485
Hospital Revenue Code	360
Min. Negotiated Rate	$552.89
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	$5,061.65
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$615.19
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	$552.89

I&D PELV/HIP JNT ABSC,DEEP

Facility

$19,467.90

Service Code	HCPCS 26990
Hospital Charge Code	1600000485
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

I&D,PERECTAL OR ISCHIAL ABSCES

Facility

$16,865.10

Service Code	HCPCS 46040
Hospital Charge Code	1600000564
Hospital Revenue Code	360
Min. Negotiated Rate	$2,529.76
Max. Negotiated Rate	$2,529.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76

I&D,PERECTAL OR ISCHIAL ABSCES

Facility

$16,865.10

Service Code	HCPCS 46040
Hospital Charge Code	1600000564
Hospital Revenue Code	360
Min. Negotiated Rate	$478.97
Max. Negotiated Rate	$5,347.00
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	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,157.00
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,157.00
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	$4,384.93
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$532.94
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	$478.97

I&D;PERIRECTAL/ISCHIAL ABSCESS

Facility

$17,708.36

Service Code	HCPCS 46040
Hospital Charge Code	1600000295
Hospital Revenue Code	360
Min. Negotiated Rate	$502.92
Max. Negotiated Rate	$5,347.00
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	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,157.00
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,157.00
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	$4,604.17
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,656.25
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$559.58
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	$502.92

I&D;PERIRECTAL/ISCHIAL ABSCESS

Facility

$17,708.36

Service Code	HCPCS 46040
Hospital Charge Code	1600000295
Hospital Revenue Code	360
Min. Negotiated Rate	$2,656.25
Max. Negotiated Rate	$2,656.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,656.25

Know your out-of-pocket cost for care.

All Charges