Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

REMOVAL OF BONE LESION

Facility

$19,105.25

Service Code	HCPCS 23140
Hospital Charge Code	1600000804
Hospital Revenue Code	360
Min. Negotiated Rate	$2,865.79
Max. Negotiated Rate	$2,865.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,865.79

REMOVAL OF BRAIN LESION

Facility

$27,732.00

Service Code	HCPCS 61510
Hospital Charge Code	1600000656
Hospital Revenue Code	360
Min. Negotiated Rate	$787.59
Max. Negotiated Rate	$13,866.00
Rate for Payer: Aetna Commercial	$10,538.16
Rate for Payer: Aetna Medicare Advantage	$8,319.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,071.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,071.66
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	$7,071.66
Rate for Payer: Cigna Commercial	$13,866.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,210.32
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,159.80
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$876.33
Rate for Payer: Wellpoint Medicaid Managed Care	$787.59

REMOVAL OF BRAIN LESION

Facility

$27,732.00

Service Code	HCPCS 61510
Hospital Charge Code	1600000656
Hospital Revenue Code	360
Min. Negotiated Rate	$4,159.80
Max. Negotiated Rate	$4,159.80
Rate for Payer: Qualcare PPO/HMO/WC	$4,159.80

REMOVAL OF BREAST LESION 1+

Facility

$41,701.77

Service Code	HCPCS 19120
Hospital Charge Code	16000187
Hospital Revenue Code	360
Min. Negotiated Rate	$6,255.27
Max. Negotiated Rate	$6,255.27
Rate for Payer: Qualcare PPO/HMO/WC	$6,255.27

REMOVAL OF BREAST LESION 1+

Facility

$41,701.77

Service Code	HCPCS 19120
Hospital Charge Code	16000187
Hospital Revenue Code	360
Min. Negotiated Rate	$1,184.33
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	$10,842.46
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,255.27
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$1,317.78
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	$1,184.33

REMOVAL OF BREAST TISSUE

Facility

$15,552.48

Service Code	HCPCS 19300
Hospital Charge Code	16000407
Hospital Revenue Code	360
Min. Negotiated Rate	$441.69
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	$4,043.64
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.87
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$491.46
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	$441.69

REMOVAL OF BREAST TISSUE

Facility

$15,552.48

Service Code	HCPCS 19300
Hospital Charge Code	16000407
Hospital Revenue Code	360
Min. Negotiated Rate	$2,332.87
Max. Negotiated Rate	$2,332.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.87

REMOVAL OF COLON

Facility

$17,954.72

Service Code	HCPCS 44160
Hospital Charge Code	1600000577
Hospital Revenue Code	360
Min. Negotiated Rate	$509.91
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$6,822.79
Rate for Payer: Aetna Medicare Advantage	$5,386.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,578.45
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	$4,578.45
Rate for Payer: Cigna Commercial	$8,977.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,668.23
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,693.21
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$567.37
Rate for Payer: Wellpoint Medicaid Managed Care	$509.91

REMOVAL OF COLON

Facility

$17,954.72

Service Code	HCPCS 44160
Hospital Charge Code	1600000577
Hospital Revenue Code	360
Min. Negotiated Rate	$2,693.21
Max. Negotiated Rate	$2,693.21
Rate for Payer: Qualcare PPO/HMO/WC	$2,693.21

REMOVAL OF FINGER TENDON

Facility

$7,510.76

Service Code	HCPCS 26180
Hospital Charge Code	16000843
Hospital Revenue Code	360
Min. Negotiated Rate	$1,126.61
Max. Negotiated Rate	$1,126.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,126.61

REMOVAL OF FINGER TENDON

Facility

$7,510.76

Service Code	HCPCS 26180
Hospital Charge Code	16000843
Hospital Revenue Code	360
Min. Negotiated Rate	$213.31
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	$3,536.00
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	$1,952.80
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,126.61
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$237.34
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	$213.31

REMOVAL OF FOOT FASCIA-RT

Facility

$21,064.69

Service Code	HCPCS 28062
Hospital Charge Code	16000570
Hospital Revenue Code	360
Min. Negotiated Rate	$3,159.70
Max. Negotiated Rate	$3,159.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.70

REMOVAL OF FOOT FASCIA-RT

Facility

$21,064.69

Service Code	HCPCS 28062
Hospital Charge Code	16000570
Hospital Revenue Code	360
Min. Negotiated Rate	$598.24
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	$5,476.82
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.70
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$665.64
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	$598.24

REMOVAL OF FOOT FOREIGN BODY

Facility

$2,392.12

Service Code	HCPCS 28192
Hospital Charge Code	1600000642
Hospital Revenue Code	360
Min. Negotiated Rate	$358.82
Max. Negotiated Rate	$358.82
Rate for Payer: Qualcare PPO/HMO/WC	$358.82

REMOVAL OF FOOT FOREIGN BODY

Facility

$2,392.12

Service Code	HCPCS 28192
Hospital Charge Code	1600000642
Hospital Revenue Code	360
Min. Negotiated Rate	$67.94
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	$621.95
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$358.82
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$75.59
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	$67.94

REMOVAL OF HEMORRHOID CLOT

Facility

$4,707.24

Service Code	HCPCS 46320
Hospital Charge Code	1600000288
Hospital Revenue Code	360
Min. Negotiated Rate	$706.09
Max. Negotiated Rate	$706.09
Rate for Payer: Qualcare PPO/HMO/WC	$706.09

REMOVAL OF HEMORRHOID CLOT

Facility

$21,472.19

Service Code	HCPCS 46320
Hospital Charge Code	1600000557
Hospital Revenue Code	360
Min. Negotiated Rate	$3,220.83
Max. Negotiated Rate	$3,220.83
Rate for Payer: Qualcare PPO/HMO/WC	$3,220.83

REMOVAL OF HEMORRHOID CLOT

Facility

$4,707.24

Service Code	HCPCS 46320
Hospital Charge Code	1600000288
Hospital Revenue Code	360
Min. Negotiated Rate	$133.69
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	$1,223.88
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.09
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$148.75
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	$133.69

REMOVAL OF HEMORRHOID CLOT

Facility

$21,472.19

Service Code	HCPCS 46320
Hospital Charge Code	1600000557
Hospital Revenue Code	360
Min. Negotiated Rate	$609.81
Max. Negotiated Rate	$5,582.77
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	$5,582.77
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,220.83
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$678.52
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	$609.81

REMOVAL OF HYDROCELES

Facility

$16,642.12

Service Code	HCPCS 55041
Hospital Charge Code	1600000394
Hospital Revenue Code	360
Min. Negotiated Rate	$472.64
Max. Negotiated Rate	$15,429.97
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,429.97
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,326.95
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,496.32
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$525.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$472.64

REMOVAL OF HYDROCELES

Facility

$16,642.12

Service Code	HCPCS 55041
Hospital Charge Code	1600000394
Hospital Revenue Code	360
Min. Negotiated Rate	$2,496.32
Max. Negotiated Rate	$2,496.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,496.32

REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF

Facility

$3,629.00

Service Code	CPT 32552
Hospital Revenue Code	361
Min. Negotiated Rate	$707.99
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,703.39
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25

REMOVAL OF KIDNEY LESION

Facility

$9,262.80

Hospital Charge Code	1600000860
Hospital Revenue Code	360
Min. Negotiated Rate	$263.06
Max. Negotiated Rate	$4,631.40
Rate for Payer: Aetna Commercial	$3,519.86
Rate for Payer: Aetna Medicare Advantage	$2,778.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.01
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	$2,362.01
Rate for Payer: Cigna Commercial	$4,631.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,408.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.42
Rate for Payer: UnitedHealthcare Community & State	$292.70
Rate for Payer: Wellpoint Medicaid Managed Care	$263.06

REMOVAL OF KIDNEY LESION

Facility

$9,262.80

Hospital Charge Code	1600000860
Hospital Revenue Code	360
Min. Negotiated Rate	$1,389.42
Max. Negotiated Rate	$1,389.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.42

REMOVAL OF KNEECAP

Facility

$30,595.00

Service Code	HCPCS 27350
Hospital Charge Code	16000561
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

Know your out-of-pocket cost for care.

All Charges