Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$14,587.31

Service Code	APR-DRG 2342
Min. Negotiated Rate	$14,301.28
Max. Negotiated Rate	$14,587.31
Rate for Payer: UnitedHealthcare Community & State	$14,301.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,587.31
Rate for Payer: Wellpoint Medicaid Managed Care	$14,301.28

APPENDETOMY,OPEN

Facility

$21,811.50

Service Code	HCPCS 44950
Hospital Charge Code	160000215
Hospital Revenue Code	360
Min. Negotiated Rate	$619.45
Max. Negotiated Rate	$27,899.36
Rate for Payer: Aetna Commercial	$20,919.71
Rate for Payer: Aetna Medicare Advantage	$24,919.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,899.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,899.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,691.07
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	$27,899.36
Rate for Payer: Cigna Commercial	$15,416.72
Rate for Payer: Cigna Medicare Advantage	$7,691.07
Rate for Payer: Clover Medicare Advantage	$7,306.52
Rate for Payer: EmblemHealth Commercial	$23,073.21
Rate for Payer: Humana Medicare Advantage	$7,921.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,691.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,670.99
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,271.72
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$689.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,691.07
Rate for Payer: Wellcare Medicare Advantage	$7,691.07
Rate for Payer: Wellpoint Medicaid Managed Care	$619.45

APPENDETOMY,OPEN

Facility

$21,811.50

Service Code	HCPCS 44950
Hospital Charge Code	160000215
Hospital Revenue Code	360
Min. Negotiated Rate	$3,271.72
Max. Negotiated Rate	$3,271.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,271.72

APPENDIX PROCEDURES WITH CC

Facility

$67,284.64

Service Code	MSDRG 398
Min. Negotiated Rate	$20,487.31
Max. Negotiated Rate	$67,284.64
Rate for Payer: Aetna Commercial	$49,779.37
Rate for Payer: Aetna Medicare Advantage	$67,284.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,565.59
Rate for Payer: Cigna Commercial	$33,742.68
Rate for Payer: Cigna Medicare Advantage	$21,565.59
Rate for Payer: Clover Medicare Advantage	$20,487.31
Rate for Payer: EmblemHealth Commercial	$64,696.77
Rate for Payer: Humana Medicare Advantage	$22,212.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,565.59
Rate for Payer: Oxford Commercial	$26,669.63
Rate for Payer: UnitedHealthcare Commercial	$35,698.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,565.59
Rate for Payer: Wellcare Medicare Advantage	$21,565.59

APPENDIX PROCEDURES WITH MCC

Facility

$95,128.08

Service Code	MSDRG 397
Min. Negotiated Rate	$28,965.28
Max. Negotiated Rate	$95,128.08
Rate for Payer: Aetna Commercial	$69,609.83
Rate for Payer: Aetna Medicare Advantage	$95,128.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30,489.77
Rate for Payer: Cigna Commercial	$53,389.51
Rate for Payer: Cigna Medicare Advantage	$30,489.77
Rate for Payer: Clover Medicare Advantage	$28,965.28
Rate for Payer: EmblemHealth Commercial	$91,469.31
Rate for Payer: Humana Medicare Advantage	$31,404.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30,489.77
Rate for Payer: Oxford Commercial	$42,198.14
Rate for Payer: UnitedHealthcare Commercial	$56,483.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$30,489.77
Rate for Payer: Wellcare Medicare Advantage	$30,489.77

APPENDIX PROCEDURES WITHOUT CC/MCC

Facility

$55,629.82

Service Code	MSDRG 399
Min. Negotiated Rate	$16,938.57
Max. Negotiated Rate	$55,629.82
Rate for Payer: Aetna Commercial	$41,478.70
Rate for Payer: Aetna Medicare Advantage	$55,629.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,830.07
Rate for Payer: Cigna Commercial	$25,518.80
Rate for Payer: Cigna Medicare Advantage	$17,830.07
Rate for Payer: Clover Medicare Advantage	$16,938.57
Rate for Payer: EmblemHealth Commercial	$53,490.21
Rate for Payer: Humana Medicare Advantage	$18,364.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,830.07
Rate for Payer: Oxford Commercial	$20,169.61
Rate for Payer: UnitedHealthcare Commercial	$26,997.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,830.07
Rate for Payer: Wellcare Medicare Advantage	$17,830.07

APPILCATOR VISTASEAL 35 CM

Facility

$319.70

Hospital Charge Code	270688804
Hospital Revenue Code	272
Min. Negotiated Rate	$9.08
Max. Negotiated Rate	$159.85
Rate for Payer: Aetna Commercial	$121.49
Rate for Payer: Aetna Medicare Advantage	$95.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.52
Rate for Payer: Cigna Commercial	$159.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.12
Rate for Payer: Oxford Commercial	$63.94
Rate for Payer: Qualcare PPO/HMO/WC	$47.95
Rate for Payer: UnitedHealthcare Commercial	$63.94
Rate for Payer: UnitedHealthcare Community & State	$10.10
Rate for Payer: Wellpoint Medicaid Managed Care	$9.08

APPILCATOR VISTASEAL 35 CM

Facility

$319.70

Hospital Charge Code	270688804
Hospital Revenue Code	272
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

APPLICATION CYLINDER CAST

Facility

$1,067.95

Service Code	HCPCS 29365
Hospital Charge Code	5780140
Hospital Revenue Code	450
Min. Negotiated Rate	$30.33
Max. Negotiated Rate	$1,205.35
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,205.35
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.67
Rate for Payer: Qualcare PPO/HMO/WC	$160.19
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$30.33

APPLICATION CYLINDER CAST

Facility

$1,067.95

Service Code	HCPCS 29365
Hospital Charge Code	5780140
Hospital Revenue Code	450
Min. Negotiated Rate	$160.19
Max. Negotiated Rate	$160.19
Rate for Payer: Qualcare PPO/HMO/WC	$160.19

APPLICATION LONG ARM CAST

Facility

$1,360.45

Service Code	HCPCS 29065
Hospital Charge Code	412329065
Hospital Revenue Code	361
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,205.35
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.72
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$42.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$38.64

APPLICATION LONG ARM CAST

Facility

$1,360.45

Service Code	HCPCS 29065
Hospital Charge Code	412329065
Hospital Revenue Code	361
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

APPLICATION LONG LEG CAST

Facility

$1,360.45

Service Code	HCPCS 29345
Hospital Charge Code	412329345
Hospital Revenue Code	361
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

APPLICATION LONG LEG CAST

Facility

$1,360.45

Service Code	HCPCS 29345
Hospital Charge Code	412329345
Hospital Revenue Code	361
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,205.35
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.72
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$42.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$38.64

APPLICATION LONG LEG SPLIT -R

Facility

$1,190.20

Service Code	HCPCS 29505
Hospital Charge Code	1600000472
Hospital Revenue Code	360
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$700.29
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.45
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$178.53
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$37.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$33.80

APPLICATION LONG LEG SPLIT -R

Facility

$1,190.20

Service Code	HCPCS 29505
Hospital Charge Code	1600000472
Hospital Revenue Code	360
Min. Negotiated Rate	$178.53
Max. Negotiated Rate	$178.53
Rate for Payer: Qualcare PPO/HMO/WC	$178.53

APPLICATION OF BODY CAST

Facility

$1,360.45

Service Code	HCPCS 29035
Hospital Charge Code	412329035
Hospital Revenue Code	361
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

APPLICATION OF BODY CAST

Facility

$1,360.45

Service Code	HCPCS 29035
Hospital Charge Code	412329035
Hospital Revenue Code	361
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,205.35
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.72
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$42.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$38.64

APPLICATION OF FOREARM CAST

Facility

$1,676.25

Service Code	HCPCS 29075
Hospital Charge Code	1600000818
Hospital Revenue Code	360
Min. Negotiated Rate	$251.44
Max. Negotiated Rate	$251.44
Rate for Payer: Qualcare PPO/HMO/WC	$251.44

APPLICATION OF FOREARM CAST

Facility

$1,676.25

Service Code	HCPCS 29075
Hospital Charge Code	1600000818
Hospital Revenue Code	360
Min. Negotiated Rate	$52.97
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,205.35
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.82
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$251.44
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$52.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,472.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1,443.93

APPLICATION OF FOREARM CAST

Facility

$1,391.15

Service Code	HCPCS 29075
Hospital Charge Code	412329075
Hospital Revenue Code	361
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,205.35
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.70
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$208.67
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$43.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,472.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1,443.93

APPLICATION OF FOREARM CAST

Facility

$1,391.15

Service Code	HCPCS 29075
Hospital Charge Code	412329075
Hospital Revenue Code	361
Min. Negotiated Rate	$208.67
Max. Negotiated Rate	$208.67
Rate for Payer: Qualcare PPO/HMO/WC	$208.67

APPLICATION OF HIP CAST

Facility

$1,360.45

Service Code	HCPCS 29305
Hospital Charge Code	412329305
Hospital Revenue Code	361
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

APPLICATION OF HIP CAST

Facility

$1,360.45

Service Code	HCPCS 29305
Hospital Charge Code	412329305
Hospital Revenue Code	361
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,205.35
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$353.72
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$42.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$38.64

APPLICATION OF LONG LEG CAST

Facility

$1,563.80

Service Code	HCPCS 29365
Hospital Charge Code	1600000357
Hospital Revenue Code	360
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$234.57
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

Know your out-of-pocket cost for care.

All Charges