Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PARTIAL DAY TX HOURLY MEDICAID

Facility

$367.85

Service Code	HCPCS 90834
Hospital Charge Code	87504155
Hospital Revenue Code	912
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

PARTIAL DAY TX HOURLY MEDICAID

Facility

$367.85

Service Code	HCPCS 90834
Hospital Charge Code	87504155
Hospital Revenue Code	912
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.64
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$11.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46
Rate for Payer: Wellpoint Medicaid Managed Care	$10.45

PARTIAL EC PHALANC TOE BONE

Facility

$19,998.60

Service Code	HCPCS 28124
Hospital Charge Code	16000225
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

PARTIAL EC PHALANC TOE BONE

Facility

$19,998.60

Service Code	HCPCS 28124
Hospital Charge Code	16000225
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

PARTIAL HIP REPL PROSTHESIS

Facility

$17,961.84

Service Code	HCPCS 27125
Hospital Charge Code	1600000373
Hospital Revenue Code	360
Min. Negotiated Rate	$510.12
Max. Negotiated Rate	$55,329.13
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,329.13
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,670.08
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,694.28
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$567.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$510.12

PARTIAL HIP REPL PROSTHESIS

Facility

$17,961.84

Service Code	HCPCS 27125
Hospital Charge Code	1600000373
Hospital Revenue Code	360
Min. Negotiated Rate	$2,694.28
Max. Negotiated Rate	$2,694.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,694.28

PARTIAL MASTECTOMY

Facility

$23,449.10

Service Code	HCPCS 19301
Hospital Charge Code	16000184
Hospital Revenue Code	360
Min. Negotiated Rate	$3,517.36
Max. Negotiated Rate	$3,517.36
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.36

PARTIAL MASTECTOMY

Facility

$23,449.10

Service Code	HCPCS 19301
Hospital Charge Code	16000184
Hospital Revenue Code	360
Min. Negotiated Rate	$665.95
Max. Negotiated Rate	$16,873.82
Rate for Payer: Aetna Commercial	$12,652.46
Rate for Payer: Aetna Medicare Advantage	$15,071.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,873.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,873.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,651.64
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	$16,873.82
Rate for Payer: Cigna Commercial	$9,324.19
Rate for Payer: Cigna Medicare Advantage	$4,651.64
Rate for Payer: Clover Medicare Advantage	$4,419.06
Rate for Payer: EmblemHealth Commercial	$13,954.92
Rate for Payer: Humana Medicare Advantage	$4,791.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,651.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,096.77
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.36
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$740.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,651.64
Rate for Payer: Wellcare Medicare Advantage	$4,651.64
Rate for Payer: Wellpoint Medicaid Managed Care	$665.95

PARTIAL REM FOOT PLANAR FASCIA

Facility

$19,998.60

Service Code	HCPCS 28060
Hospital Charge Code	16000326
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

PARTIAL REM FOOT PLANAR FASCIA

Facility

$19,998.60

Service Code	HCPCS 28060
Hospital Charge Code	16000326
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

PARTIAL REMOVAL BLADDER

Facility

$10,789.60

Service Code	HCPCS 51550
Hospital Charge Code	1600000811
Hospital Revenue Code	360
Min. Negotiated Rate	$306.42
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$4,100.05
Rate for Payer: Aetna Medicare Advantage	$3,236.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,751.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,751.35
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	$2,751.35
Rate for Payer: Cigna Commercial	$5,394.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,805.30
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,618.44
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$340.95
Rate for Payer: Wellpoint Medicaid Managed Care	$306.42

PARTIAL REMOVAL BLADDER

Facility

$10,789.60

Service Code	HCPCS 51550
Hospital Charge Code	1600000811
Hospital Revenue Code	360
Min. Negotiated Rate	$1,618.44
Max. Negotiated Rate	$1,618.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,618.44

PARTIAL REMOVAL FINGER BONE

Facility

$7,159.40

Service Code	HCPCS 26236
Hospital Charge Code	5792292
Hospital Revenue Code	450
Min. Negotiated Rate	$1,073.91
Max. Negotiated Rate	$1,073.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,073.91

PARTIAL REMOVAL FINGER BONE

Facility

$7,159.40

Service Code	HCPCS 26236
Hospital Charge Code	5792292
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
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	$210.30
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	$1,861.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,073.91
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$203.33

PARTIAL REMOVAL OF COLON

Facility

$27,864.00

Service Code	HCPCS 44146
Hospital Charge Code	1600000495
Hospital Revenue Code	360
Min. Negotiated Rate	$4,179.60
Max. Negotiated Rate	$4,179.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,179.60

PARTIAL REMOVAL OF COLON

Facility

$27,864.00

Service Code	HCPCS 44146
Hospital Charge Code	1600000495
Hospital Revenue Code	360
Min. Negotiated Rate	$791.34
Max. Negotiated Rate	$13,932.00
Rate for Payer: Aetna Commercial	$10,588.32
Rate for Payer: Aetna Medicare Advantage	$8,359.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,105.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,105.32
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	$7,105.32
Rate for Payer: Cigna Commercial	$13,932.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,244.64
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,179.60
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$880.50
Rate for Payer: Wellpoint Medicaid Managed Care	$791.34

PARTIAL REMOVAL OF FIBULA

Facility

$30,595.00

Service Code	HCPCS 27641
Hospital Charge Code	16000892
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

PARTIAL REMOVAL OF FIBULA

Facility

$30,595.00

Service Code	HCPCS 27641
Hospital Charge Code	16000892
Hospital Revenue Code	360
Min. Negotiated Rate	$868.90
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	$7,954.70
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$966.80
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	$868.90

PARTIAL REMOVAL OF KIDNEY

Facility

$21,065.33

Service Code	HCPCS 50240
Hospital Charge Code	1600000600
Hospital Revenue Code	360
Min. Negotiated Rate	$598.26
Max. Negotiated Rate	$10,532.67
Rate for Payer: Aetna Commercial	$8,004.83
Rate for Payer: Aetna Medicare Advantage	$6,319.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,371.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,371.66
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	$5,371.66
Rate for Payer: Cigna Commercial	$10,532.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,476.99
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.80
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$665.66
Rate for Payer: Wellpoint Medicaid Managed Care	$598.26

PARTIAL REMOVAL OF KIDNEY

Facility

$21,065.33

Service Code	HCPCS 50240
Hospital Charge Code	1600000600
Hospital Revenue Code	360
Min. Negotiated Rate	$3,159.80
Max. Negotiated Rate	$3,159.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.80

PARTIAL REMOVAL OF PANCREAS

Facility

$99,458.44

Service Code	HCPCS 48150
Hospital Charge Code	1600000276
Hospital Revenue Code	360
Min. Negotiated Rate	$2,824.62
Max. Negotiated Rate	$49,729.22
Rate for Payer: Aetna Commercial	$37,794.21
Rate for Payer: Aetna Medicare Advantage	$29,837.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,361.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,361.90
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	$25,361.90
Rate for Payer: Cigna Commercial	$49,729.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,859.19
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,918.77
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$3,142.89
Rate for Payer: Wellpoint Medicaid Managed Care	$2,824.62

PARTIAL REMOVAL OF PANCREAS

Facility

$99,458.44

Service Code	HCPCS 48150
Hospital Charge Code	1600000276
Hospital Revenue Code	360
Min. Negotiated Rate	$14,918.77
Max. Negotiated Rate	$14,918.77
Rate for Payer: Qualcare PPO/HMO/WC	$14,918.77

PARTIAL REMOVAL OF PENIS

Facility

$20,308.55

Service Code	HCPCS 54120
Hospital Charge Code	1600000701
Hospital Revenue Code	360
Min. Negotiated Rate	$3,046.28
Max. Negotiated Rate	$3,046.28
Rate for Payer: Qualcare PPO/HMO/WC	$3,046.28

PARTIAL REMOVAL OF PENIS

Facility

$20,308.55

Service Code	HCPCS 54120
Hospital Charge Code	1600000701
Hospital Revenue Code	360
Min. Negotiated Rate	$576.76
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,280.22
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,046.28
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$641.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$576.76

PARTIAL REMOVAL OF RADIUS

Facility

$12,406.91

Service Code	HCPCS 25230
Hospital Charge Code	16000832
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

Know your out-of-pocket cost for care.

All Charges