Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR-CERV PUNCT FOR MYELOGRAM

Facility

$3,103.00

Service Code	HCPCS 61055
Hospital Charge Code	2680235
Hospital Revenue Code	361
Min. Negotiated Rate	$88.13
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$806.78
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.45
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$98.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$88.13

IR CHANGE GASTROSTOMY TUBE

Facility

$1,147.55

Service Code	HCPCS 43760
Hospital Charge Code	411043760
Hospital Revenue Code	361
Min. Negotiated Rate	$36.26
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$436.07
Rate for Payer: Aetna Medicare Advantage	$344.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$292.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$292.63
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	$292.63
Rate for Payer: Cigna Commercial	$573.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.36
Rate for Payer: Qualcare PPO/HMO/WC	$172.13
Rate for Payer: UnitedHealthcare Community & State	$36.26
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$781.67
Rate for Payer: Wellpoint Medicaid Managed Care	$766.34

IR CHANGE GASTROSTOMY TUBE

Facility

$1,147.55

Service Code	HCPCS 43760
Hospital Charge Code	411043760
Hospital Revenue Code	361
Min. Negotiated Rate	$172.13
Max. Negotiated Rate	$172.13
Rate for Payer: Qualcare PPO/HMO/WC	$172.13

IR CHANGE PERC BIL DRAIN CATH

Facility

$6,672.00

Hospital Charge Code	2004739
Hospital Revenue Code	361
Min. Negotiated Rate	$1,000.80
Max. Negotiated Rate	$1,000.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,000.80

IR CHANGE PERC BIL DRAIN CATH

Facility

$6,672.00

Hospital Charge Code	2004739
Hospital Revenue Code	361
Min. Negotiated Rate	$189.48
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,535.36
Rate for Payer: Aetna Medicare Advantage	$2,001.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,701.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,701.36
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	$1,701.36
Rate for Payer: Cigna Commercial	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,734.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,000.80
Rate for Payer: UnitedHealthcare Community & State	$210.84
Rate for Payer: Wellpoint Medicaid Managed Care	$189.48

IR CNTRL VENOUS CATHTER BRUSHN

Facility

$602.00

Service Code	HCPCS 75902
Hospital Charge Code	7411731
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

IR CNTRL VENOUS CATHTER BRUSHN

Facility

$602.00

Service Code	HCPCS 75902
Hospital Charge Code	7411731
Hospital Revenue Code	320
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$228.76
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.52
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$19.02
Rate for Payer: Wellpoint Medicaid Managed Care	$17.10

IR CNTRL VENOUS CATHTER BRUSHN

Facility

$602.00

Service Code	HCPCS 75902
Hospital Charge Code	2600056
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

IR CNTRL VENOUS CATHTER BRUSHN

Facility

$602.00

Service Code	HCPCS 75902
Hospital Charge Code	2600056
Hospital Revenue Code	320
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$228.76
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.52
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$19.02
Rate for Payer: Wellpoint Medicaid Managed Care	$17.10

IR CNTRL VENOUS CATHTER STRPNG

Facility

$602.00

Service Code	HCPCS 75901
Hospital Charge Code	7411730
Hospital Revenue Code	320
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$228.76
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.52
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$19.02
Rate for Payer: Wellpoint Medicaid Managed Care	$17.10

IR CNTRL VENOUS CATHTER STRPNG

Facility

$602.00

Service Code	HCPCS 75901
Hospital Charge Code	7411730
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	7411601
Hospital Revenue Code	361
Min. Negotiated Rate	$79.52
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
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	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.00
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$88.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$79.52

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	366849465
Hospital Revenue Code	361
Min. Negotiated Rate	$79.52
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
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	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.00
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$88.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$79.52

IR CONTRAST INJ PEG TUBE

Facility

$1,350.15

Service Code	HCPCS 49465
Hospital Charge Code	2670005
Hospital Revenue Code	361
Min. Negotiated Rate	$38.34
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
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	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.04
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.52
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$42.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$38.34

IR CONTRAST INJ PEG TUBE

Facility

$1,350.15

Service Code	HCPCS 49465
Hospital Charge Code	2670005
Hospital Revenue Code	361
Min. Negotiated Rate	$202.52
Max. Negotiated Rate	$202.52
Rate for Payer: Qualcare PPO/HMO/WC	$202.52

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	411049465
Hospital Revenue Code	361
Min. Negotiated Rate	$79.52
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
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	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.00
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$88.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$79.52

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	366849465
Hospital Revenue Code	361
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

IR CONTRAST INJ PEG TUBE

Facility

$1,350.15

Service Code	HCPCS 49465
Hospital Charge Code	321049465
Hospital Revenue Code	361
Min. Negotiated Rate	$38.34
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
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	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.04
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.52
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$42.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$38.34

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	7411601
Hospital Revenue Code	361
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

IR CONTRAST INJ PEG TUBE

Facility

$2,800.00

Service Code	HCPCS 49465
Hospital Charge Code	411049465
Hospital Revenue Code	361
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

IR CONTRAST INJ PEG TUBE

Facility

$1,350.15

Service Code	HCPCS 49465
Hospital Charge Code	321049465
Hospital Revenue Code	361
Min. Negotiated Rate	$202.52
Max. Negotiated Rate	$202.52
Rate for Payer: Qualcare PPO/HMO/WC	$202.52

IR-CONV G-TUBE / G-J-TUBE

Facility

$8,686.35

Service Code	HCPCS 49446
Hospital Charge Code	7411596
Hospital Revenue Code	361
Min. Negotiated Rate	$1,302.95
Max. Negotiated Rate	$1,302.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,302.95

IR-CONV G-TUBE / G-J-TUBE

Facility

$8,686.35

Service Code	HCPCS 49446
Hospital Charge Code	7411596
Hospital Revenue Code	361
Min. Negotiated Rate	$246.69
Max. Negotiated Rate	$8,269.65
Rate for Payer: Aetna Commercial	$6,200.81
Rate for Payer: Aetna Medicare Advantage	$7,386.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,269.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,269.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,279.71
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	$8,269.65
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Cigna Medicare Advantage	$2,279.71
Rate for Payer: Clover Medicare Advantage	$2,165.72
Rate for Payer: EmblemHealth Commercial	$6,839.13
Rate for Payer: Humana Medicare Advantage	$2,348.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,279.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,258.45
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,302.95
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$274.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,279.71
Rate for Payer: Wellcare Medicare Advantage	$2,279.71
Rate for Payer: Wellpoint Medicaid Managed Care	$246.69

IR CORPORA CAVERNOSOGRAPHY

Facility

$1,046.00

Service Code	HCPCS 74445
Hospital Charge Code	2680310
Hospital Revenue Code	320
Min. Negotiated Rate	$29.71
Max. Negotiated Rate	$2,231.00
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	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
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	$85.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
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	$271.96
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$156.90
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$33.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.71

IR CORPORA CAVERNOSOGRAPHY

Facility

$1,046.00

Service Code	HCPCS 74445
Hospital Charge Code	2680310
Hospital Revenue Code	320
Min. Negotiated Rate	$156.90
Max. Negotiated Rate	$156.90
Rate for Payer: Qualcare PPO/HMO/WC	$156.90

Know your out-of-pocket cost for care.

All Charges