Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RIVASTIGMINE 9.5 MG PATCH

Facility

$100.70

Service Code	NDC 78050215
Hospital Charge Code	60630007
Hospital Revenue Code	250
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$50.35
Rate for Payer: Aetna Commercial	$38.27
Rate for Payer: Aetna Medicare Advantage	$30.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.68
Rate for Payer: Cigna Commercial	$50.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.18
Rate for Payer: Oxford Commercial	$20.14
Rate for Payer: Qualcare PPO/HMO/WC	$15.11
Rate for Payer: UnitedHealthcare Commercial	$20.14
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

RIVASTIGMINE 9.5 MG PATCH

Facility

$100.70

Service Code	NDC 78050215
Hospital Charge Code	60630007
Hospital Revenue Code	250
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$15.11
Rate for Payer: Qualcare PPO/HMO/WC	$15.11

R&L HRT ART/GRAFT ANGIO

Facility

$16,190.00

Service Code	HCPCS 93461
Hospital Charge Code	5100669
Hospital Revenue Code	481
Min. Negotiated Rate	$2,428.50
Max. Negotiated Rate	$2,428.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50

R&L HRT ART/GRAFT ANGIO

Facility

$16,190.00

Service Code	HCPCS 93461
Hospital Charge Code	5100669
Hospital Revenue Code	481
Min. Negotiated Rate	$459.80
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,209.40
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$511.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$459.80

R&L HRT ART W OR W/O LV

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	5100668
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

R&L HRT ART W OR W/O LV

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	5100668
Hospital Revenue Code	481
Min. Negotiated Rate	$730.94
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,691.66
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$813.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$730.94

R&L HRT CATH CHD ABNL NT CNJ

Facility

$25,737.16

Service Code	HCPCS 93597
Hospital Charge Code	411093597
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

R&L HRT CATH CHD ABNL NT CNJ

Facility

$25,737.16

Service Code	HCPCS 93597
Hospital Charge Code	411093597
Hospital Revenue Code	481
Min. Negotiated Rate	$730.94
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,691.66
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$813.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$730.94

R&L HRT CATH CHD NML NT CNJ

Facility

$25,737.16

Service Code	HCPCS 93596
Hospital Charge Code	411093596
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

R&L HRT CATH CHD NML NT CNJ

Facility

$25,737.16

Service Code	HCPCS 93596
Hospital Charge Code	411093596
Hospital Revenue Code	481
Min. Negotiated Rate	$730.94
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,691.66
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$813.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$730.94

RMVL DEVITALIZED TISSUE NON-SE

Facility

$612.30

Service Code	HCPCS 97598
Hospital Charge Code	75190165
Hospital Revenue Code	761
Min. Negotiated Rate	$91.84
Max. Negotiated Rate	$91.84
Rate for Payer: Qualcare PPO/HMO/WC	$91.84

RMVL DEVITALIZED TISSUE NON-SE

Facility

$612.30

Service Code	HCPCS 97598
Hospital Charge Code	75190165
Hospital Revenue Code	761
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$183.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.14
Rate for Payer: Cigna Commercial	$306.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.20
Rate for Payer: Oxford Commercial	$122.46
Rate for Payer: Qualcare PPO/HMO/WC	$91.84
Rate for Payer: UnitedHealthcare Commercial	$122.46
Rate for Payer: UnitedHealthcare Community & State	$19.35
Rate for Payer: Wellpoint Medicaid Managed Care	$17.39

RMVL NINFCT MESH HERNIA RPR

Facility

$13,461.00

Service Code	HCPCS 49623
Hospital Charge Code	1600000389
Hospital Revenue Code	360
Min. Negotiated Rate	$2,019.15
Max. Negotiated Rate	$2,019.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,019.15

RMVL NINFCT MESH HERNIA RPR

Facility

$13,461.00

Service Code	HCPCS 49623
Hospital Charge Code	1600000389
Hospital Revenue Code	360
Min. Negotiated Rate	$382.29
Max. Negotiated Rate	$6,730.50
Rate for Payer: Aetna Commercial	$5,115.18
Rate for Payer: Aetna Medicare Advantage	$4,038.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,432.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,432.55
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	$3,432.55
Rate for Payer: Cigna Commercial	$6,730.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,499.86
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,019.15
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$425.37
Rate for Payer: Wellpoint Medicaid Managed Care	$382.29

RMVL OF SPINAL LAMINA SGL CERV

Facility

$47,548.90

Service Code	HCPCS 63045
Hospital Charge Code	16000652
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

RMVL OF SPINAL LAMINA SGL CERV

Facility

$47,548.90

Service Code	HCPCS 63045
Hospital Charge Code	16000652
Hospital Revenue Code	360
Min. Negotiated Rate	$1,350.39
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	$12,362.71
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,502.55
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	$1,350.39

RMVL OF SPINL LAMINA SGL THRCC

Facility

$47,548.90

Service Code	HCPCS 63046
Hospital Charge Code	16001021
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

RMVL OF SPINL LAMINA SGL THRCC

Facility

$47,548.90

Service Code	HCPCS 63046
Hospital Charge Code	16001021
Hospital Revenue Code	360
Min. Negotiated Rate	$1,350.39
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	$12,362.71
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,502.55
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	$1,350.39

RMVL OF SPNL LMNA LMBR,1-2VERT

Facility

$47,548.90

Service Code	HCPCS 63005
Hospital Charge Code	16000769
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

RMVL OF SPNL LMNA LMBR,1-2VERT

Facility

$47,548.90

Service Code	HCPCS 63005
Hospital Charge Code	16000769
Hospital Revenue Code	360
Min. Negotiated Rate	$1,350.39
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	$12,362.71
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,502.55
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	$1,350.39

RMVL TIS XPNDR WO INSJ IMPLT

Facility

$11,452.64

Service Code	HCPCS 11971
Hospital Charge Code	16000595
Hospital Revenue Code	360
Min. Negotiated Rate	$1,717.90
Max. Negotiated Rate	$1,717.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.90

RMVL TIS XPNDR WO INSJ IMPLT

Facility

$11,452.64

Service Code	HCPCS 11971
Hospital Charge Code	16000595
Hospital Revenue Code	360
Min. Negotiated Rate	$325.25
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
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	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,977.69
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.90
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$361.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$325.25

RMVL W REINSERT DRUG IMPL DEL

Facility

$1,670.85

Service Code	HCPCS 11983
Hospital Charge Code	412311983
Hospital Revenue Code	361
Min. Negotiated Rate	$47.45
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,443.56
Rate for Payer: Aetna Medicare Advantage	$1,719.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,925.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,925.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$530.72
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	$1,925.19
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: Cigna Medicare Advantage	$530.72
Rate for Payer: Clover Medicare Advantage	$504.18
Rate for Payer: EmblemHealth Commercial	$1,592.16
Rate for Payer: Humana Medicare Advantage	$546.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$530.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.42
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.63
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$52.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$530.72
Rate for Payer: Wellcare Medicare Advantage	$530.72
Rate for Payer: Wellpoint Medicaid Managed Care	$47.45

RMVL W REINSERT DRUG IMPL DEL

Facility

$1,670.85

Service Code	HCPCS 11983
Hospital Charge Code	412311983
Hospital Revenue Code	361
Min. Negotiated Rate	$250.63
Max. Negotiated Rate	$250.63
Rate for Payer: Qualcare PPO/HMO/WC	$250.63

RNA POLYMERASE III ANTIBODY

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	401183520
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges