Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR-REM TUN PLEURL CATH-LT

Facility

$6,404.20

Service Code	HCPCS 32551LT
Hospital Charge Code	2691070
Hospital Revenue Code	361
Min. Negotiated Rate	$181.88
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,665.09
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Community & State	$202.37
Rate for Payer: Wellpoint Medicaid Managed Care	$181.88

IR-REM TUN PLEURL CATH-LT

Facility

$6,404.20

Service Code	HCPCS 32551LT
Hospital Charge Code	2691070
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

IR-REM TUN PLEURL CATH-LT

Facility

$6,404.20

Service Code	HCPCS 32551LT
Hospital Charge Code	321032551L
Hospital Revenue Code	361
Min. Negotiated Rate	$181.88
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,665.09
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Community & State	$202.37
Rate for Payer: Wellpoint Medicaid Managed Care	$181.88

IR-REM TUN PLEURL CATH-LT

Facility

$6,404.20

Service Code	HCPCS 32551LT
Hospital Charge Code	321032551L
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

IR REMV/NEPHROSTOMY TUBE FL G

Facility

$3,042.00

Service Code	HCPCS 50389
Hospital Charge Code	2680210
Hospital Revenue Code	361
Min. Negotiated Rate	$456.30
Max. Negotiated Rate	$456.30
Rate for Payer: Qualcare PPO/HMO/WC	$456.30

IR REMV/NEPHROSTOMY TUBE FL G

Facility

$3,042.00

Service Code	HCPCS 50389
Hospital Charge Code	2680210
Hospital Revenue Code	361
Min. Negotiated Rate	$86.39
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$3,005.06
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$790.92
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$456.30
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$96.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$86.39

IR REMV/NEPHROSTOMY TUBE FL G

Facility

$3,042.00

Service Code	HCPCS 50389
Hospital Charge Code	7411603
Hospital Revenue Code	361
Min. Negotiated Rate	$456.30
Max. Negotiated Rate	$456.30
Rate for Payer: Qualcare PPO/HMO/WC	$456.30

IR REMV/NEPHROSTOMY TUBE FL G

Facility

$3,042.00

Service Code	HCPCS 50389
Hospital Charge Code	7411603
Hospital Revenue Code	361
Min. Negotiated Rate	$86.39
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$3,005.06
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$790.92
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$456.30
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$96.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$86.39

IR-RENAL BIOPS,PERCT,TROCAR,ND

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	7411602
Hospital Revenue Code	361
Min. Negotiated Rate	$200.83
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	$1,838.56
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$223.46
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	$200.83

IR-RENAL BIOPS,PERCT,TROCAR,ND

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	2680205
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

IR-RENAL BIOPS,PERCT,TROCAR,ND

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	7411602
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

IR-RENAL BIOPS,PERCT,TROCAR,ND

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	2680205
Hospital Revenue Code	361
Min. Negotiated Rate	$200.83
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	$1,838.56
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$223.46
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	$200.83

IR RENAL CYST ASPIRATION PERC

Facility

$3,392.55

Service Code	HCPCS 50390
Hospital Charge Code	321050390
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

IR RENAL CYST ASPIRATION PERC

Facility

$3,392.55

Service Code	HCPCS 50390
Hospital Charge Code	2004091
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	366850390
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	366850390
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR RENAL CYST ASPIRATION PERC

Facility

$3,392.55

Service Code	HCPCS 50390
Hospital Charge Code	2004091
Hospital Revenue Code	361
Min. Negotiated Rate	$96.35
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$882.06
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$508.88
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$107.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$96.35

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	411050390
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	411050390
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR RENAL CYST ASPIRATION PERC

Facility

$3,392.55

Service Code	HCPCS 50390
Hospital Charge Code	321050390
Hospital Revenue Code	361
Min. Negotiated Rate	$96.35
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$882.06
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$508.88
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$107.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$96.35

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	7411604
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR RENAL CYST ASPIRATION PERC

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	7411604
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

IR RENAL CYST ASP PERC BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	7412053
Hospital Revenue Code	361
Min. Negotiated Rate	$1,059.73
Max. Negotiated Rate	$1,059.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73

IR RENAL CYST ASP PERC BI

Facility

$7,064.85

Service Code	HCPCS 5039050
Hospital Charge Code	7412053
Hospital Revenue Code	361
Min. Negotiated Rate	$200.64
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,684.64
Rate for Payer: Aetna Medicare Advantage	$2,119.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,801.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,801.54
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	$1,801.54
Rate for Payer: Cigna Commercial	$3,532.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,836.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,059.73
Rate for Payer: UnitedHealthcare Community & State	$223.25
Rate for Payer: Wellpoint Medicaid Managed Care	$200.64

IR RENAL CYST ASP PERC LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	7412054
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

Know your out-of-pocket cost for care.

All Charges