Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

REPAIR UA/ELBOW TENDON/MUSCLE

Facility

$44,916.00

Service Code	HCPCS 24341
Hospital Charge Code	16000392
Hospital Revenue Code	360
Min. Negotiated Rate	$1,275.61
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,678.16
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,737.40
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$1,419.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,275.61

REPAIR UA/ELBOW TENDON/MUSCLE

Facility

$44,916.00

Service Code	HCPCS 24341
Hospital Charge Code	16000392
Hospital Revenue Code	360
Min. Negotiated Rate	$6,737.40
Max. Negotiated Rate	$6,737.40
Rate for Payer: Qualcare PPO/HMO/WC	$6,737.40

REP COMP TUN CV DEV W SQ PORT

Facility

$14,614.45

Service Code	HCPCS 36582
Hospital Charge Code	404336582
Hospital Revenue Code	361
Min. Negotiated Rate	$415.05
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,799.76
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$461.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$415.05

REP COMP TUN CV DEV W SQ PORT

Facility

$14,614.45

Service Code	HCPCS 36582
Hospital Charge Code	404336582
Hospital Revenue Code	361
Min. Negotiated Rate	$2,192.17
Max. Negotiated Rate	$2,192.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17

REP DURL/CSF LEAK WO LAMINCTMY

Facility

$10,338.30

Service Code	HCPCS 63707
Hospital Charge Code	16000770
Hospital Revenue Code	360
Min. Negotiated Rate	$293.61
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,928.55
Rate for Payer: Aetna Medicare Advantage	$3,101.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,636.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,636.27
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	$2,636.27
Rate for Payer: Cigna Commercial	$5,169.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,687.96
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.74
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$326.69
Rate for Payer: Wellpoint Medicaid Managed Care	$293.61

REP DURL/CSF LEAK WO LAMINCTMY

Facility

$10,338.30

Service Code	HCPCS 63707
Hospital Charge Code	16000770
Hospital Revenue Code	360
Min. Negotiated Rate	$1,550.74
Max. Negotiated Rate	$1,550.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.74

REPERFUSIONCATHKITRED43 138CM

Facility

$13,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270700367S
Hospital Revenue Code	278
Min. Negotiated Rate	$390.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$434.50
Rate for Payer: Wellpoint Medicaid Managed Care	$390.50

REPERFUSIONCATHKITRED43 138CM

Facility

$13,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270700367S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

REPERFUSION CATH RED43 138CM

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270700366S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

REPERFUSION CATH RED43 138CM

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270700366S
Hospital Revenue Code	278
Min. Negotiated Rate	$339.38
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$377.62
Rate for Payer: Wellpoint Medicaid Managed Care	$339.38

REP FLXR TNDN NT Z2 WO GRFT EA

Facility

$26,471.80

Service Code	HCPCS 26350
Hospital Charge Code	16000338
Hospital Revenue Code	360
Min. Negotiated Rate	$751.80
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	$6,882.67
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$836.51
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	$751.80

REP FLXR TNDN NT Z2 WO GRFT EA

Facility

$26,471.80

Service Code	HCPCS 26350
Hospital Charge Code	16000338
Hospital Revenue Code	360
Min. Negotiated Rate	$3,970.77
Max. Negotiated Rate	$3,970.77
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77

REP INCOMPL CIRCUMCIS

Facility

$19,343.80

Service Code	HCPCS 54163
Hospital Charge Code	1600000505
Hospital Revenue Code	360
Min. Negotiated Rate	$549.36
Max. Negotiated Rate	$9,008.64
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
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	$9,008.64
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,029.39
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,901.57
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$611.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$549.36

REP INCOMPL CIRCUMCIS

Facility

$19,343.80

Service Code	HCPCS 54163
Hospital Charge Code	1600000505
Hospital Revenue Code	360
Min. Negotiated Rate	$2,901.57
Max. Negotiated Rate	$2,901.57
Rate for Payer: Qualcare PPO/HMO/WC	$2,901.57

REP INIT FEM HRN RDCBL,INCARCE

Facility

$30,877.00

Service Code	HCPCS 49553
Hospital Charge Code	1600000308
Hospital Revenue Code	360
Min. Negotiated Rate	$4,631.55
Max. Negotiated Rate	$4,631.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,631.55

REP INIT FEM HRN RDCBL,INCARCE

Facility

$30,877.00

Service Code	HCPCS 49553
Hospital Charge Code	1600000308
Hospital Revenue Code	360
Min. Negotiated Rate	$876.91
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	$8,028.02
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,631.55
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$975.71
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	$876.91

REP INIT INCI/ VENTRAL HERNIA

Facility

$30,877.00

Service Code	HCPCS 49560
Hospital Charge Code	16000989
Hospital Revenue Code	360
Min. Negotiated Rate	$4,631.55
Max. Negotiated Rate	$4,631.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,631.55

REP INIT INCI/ VENTRAL HERNIA

Facility

$30,877.00

Service Code	HCPCS 49560
Hospital Charge Code	16000989
Hospital Revenue Code	360
Min. Negotiated Rate	$876.91
Max. Negotiated Rate	$15,438.50
Rate for Payer: Aetna Commercial	$11,733.26
Rate for Payer: Aetna Medicare Advantage	$9,263.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,873.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,873.64
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	$7,873.64
Rate for Payer: Cigna Commercial	$15,438.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,028.02
Rate for Payer: Qualcare PPO/HMO/WC	$4,631.55
Rate for Payer: UnitedHealthcare Community & State	$975.71
Rate for Payer: Wellpoint Medicaid Managed Care	$876.91

REPLACE CVAD CATH

Facility

$3,931.88

Service Code	HCPCS 36580
Hospital Charge Code	16000947
Hospital Revenue Code	360
Min. Negotiated Rate	$111.67
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,022.29
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$589.78
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$124.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$111.67

REPLACE CVAD CATH

Facility

$3,931.88

Service Code	HCPCS 36580
Hospital Charge Code	16000947
Hospital Revenue Code	360
Min. Negotiated Rate	$589.78
Max. Negotiated Rate	$589.78
Rate for Payer: Qualcare PPO/HMO/WC	$589.78

REPLACE G/C TUBE PERC

Facility

$270.35

Service Code	HCPCS 49450
Hospital Charge Code	5792271
Hospital Revenue Code	450
Min. Negotiated Rate	$40.55
Max. Negotiated Rate	$40.55
Rate for Payer: Qualcare PPO/HMO/WC	$40.55

REPLACE G/C TUBE PERC

Facility

$270.35

Service Code	HCPCS 49450
Hospital Charge Code	5792271
Hospital Revenue Code	450
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$3,908.70
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,908.70
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.29
Rate for Payer: Qualcare PPO/HMO/WC	$40.55
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

REPLACE G/C TUBE PERC

Facility

$2,973.96

Service Code	HCPCS 49450
Hospital Charge Code	16000521
Hospital Revenue Code	360
Min. Negotiated Rate	$446.09
Max. Negotiated Rate	$446.09
Rate for Payer: Qualcare PPO/HMO/WC	$446.09

REPLACE G/C TUBE PERC

Facility

$2,973.96

Service Code	HCPCS 49450
Hospital Charge Code	16000521
Hospital Revenue Code	360
Min. Negotiated Rate	$84.46
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,908.70
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$773.23
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.09
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$93.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$84.46

REPLACE G TUBE WO REV G TRACT

Facility

$1,356.77

Service Code	HCPCS 43762
Hospital Charge Code	321043762
Hospital Revenue Code	361
Min. Negotiated Rate	$203.52
Max. Negotiated Rate	$203.52
Rate for Payer: Qualcare PPO/HMO/WC	$203.52

Know your out-of-pocket cost for care.

All Charges