Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROUTINE VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	3400073
Hospital Revenue Code	300
Min. Negotiated Rate	$20.37
Max. Negotiated Rate	$20.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.37

ROUTINE VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	3400073
Hospital Revenue Code	300
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.88
Rate for Payer: Cigna Commercial	$67.90
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.31
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.37
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

ROUTINE VENIPUNCTURE

Facility

$390.00

Service Code	HCPCS 36415
Hospital Charge Code	412336415
Hospital Revenue Code	300
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.88
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ROXANOL-T ORAL SOL 20MG/M

Facility

$5.03

Service Code	NDC 406800330
Hospital Charge Code	60635311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.52
Rate for Payer: Aetna Commercial	$1.91
Rate for Payer: Aetna Medicare Advantage	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.28
Rate for Payer: Cigna Commercial	$2.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.31
Rate for Payer: Oxford Commercial	$1.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.01
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

ROXANOL-T ORAL SOL 20MG/M

Facility

$5.03

Service Code	NDC 406800330
Hospital Charge Code	60635311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

RPLC GTUBE NO REVJ TRC

Facility

$1,286.08

Service Code	HCPCS 43762
Hospital Charge Code	16000344
Hospital Revenue Code	360
Min. Negotiated Rate	$192.91
Max. Negotiated Rate	$192.91
Rate for Payer: Qualcare PPO/HMO/WC	$192.91

RPLC GTUBE NO REVJ TRC

Facility

$1,286.08

Service Code	HCPCS 43762
Hospital Charge Code	16000344
Hospital Revenue Code	360
Min. Negotiated Rate	$36.52
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
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	$1,076.75
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.38
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$192.91
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$40.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$36.52

RP LOCALTUM 2+AREA 1+D IMG

Facility

$2,155.44

Service Code	HCPCS 78801
Hospital Charge Code	406078801
Hospital Revenue Code	341
Min. Negotiated Rate	$323.32
Max. Negotiated Rate	$323.32
Rate for Payer: Qualcare PPO/HMO/WC	$323.32

RP LOCALTUM 2+AREA 1+D IMG

Facility

$2,155.44

Service Code	HCPCS 78801
Hospital Charge Code	406078801
Hospital Revenue Code	341
Min. Negotiated Rate	$61.21
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,722.84
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$560.41
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$323.32
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$68.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$61.21

RP LOCAL TUM SPECT 2 AREAS

Facility

$7,449.00

Service Code	HCPCS 78831
Hospital Charge Code	406078831
Hospital Revenue Code	341
Min. Negotiated Rate	$1,117.35
Max. Negotiated Rate	$1,117.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.35

RP LOCAL TUM SPECT 2 AREAS

Facility

$7,449.00

Service Code	HCPCS 78831
Hospital Charge Code	406078831
Hospital Revenue Code	341
Min. Negotiated Rate	$211.55
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.74
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.35
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$235.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$211.55

RP LOCAL TUM SPECT W/CT 1

Facility

$7,449.00

Service Code	HCPCS 78830
Hospital Charge Code	406078830
Hospital Revenue Code	341
Min. Negotiated Rate	$1,117.35
Max. Negotiated Rate	$1,117.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.35

RP LOCAL TUM SPECT W/CT 1

Facility

$7,449.00

Service Code	HCPCS 78830
Hospital Charge Code	406078830
Hospital Revenue Code	341
Min. Negotiated Rate	$211.55
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.74
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.35
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$235.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$211.55

RP LOCAL TUM SPECT W/CT 2

Facility

$8,450.06

Service Code	HCPCS 78832
Hospital Charge Code	406078832
Hospital Revenue Code	341
Min. Negotiated Rate	$1,267.51
Max. Negotiated Rate	$1,267.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.51

RP LOCAL TUM SPECT W/CT 2

Facility

$8,450.06

Service Code	HCPCS 78832
Hospital Charge Code	406078832
Hospital Revenue Code	341
Min. Negotiated Rate	$239.98
Max. Negotiated Rate	$6,162.47
Rate for Payer: Aetna Commercial	$4,620.79
Rate for Payer: Aetna Medicare Advantage	$5,504.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,162.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,162.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,698.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$708.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,162.47
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: Cigna Medicare Advantage	$1,189.17
Rate for Payer: Clover Medicare Advantage	$1,613.88
Rate for Payer: EmblemHealth Commercial	$5,096.46
Rate for Payer: Humana Medicare Advantage	$1,749.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,698.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.02
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.51
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$267.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,698.82
Rate for Payer: Wellcare Medicare Advantage	$1,698.82
Rate for Payer: Wellpoint Medicaid Managed Care	$239.98

RP LOC TUMOR, W B, 2 OR > DAYS

Facility

$4,899.00

Service Code	HCPCS 78804
Hospital Charge Code	7411761
Hospital Revenue Code	341
Min. Negotiated Rate	$734.85
Max. Negotiated Rate	$734.85
Rate for Payer: Qualcare PPO/HMO/WC	$734.85

RP LOC TUMOR, W B, 2 OR > DAYS

Facility

$4,899.00

Service Code	HCPCS 78804
Hospital Charge Code	7411761
Hospital Revenue Code	341
Min. Negotiated Rate	$139.13
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.96
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,273.74
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$734.85
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$154.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$139.13

RP LOC TUMOR, W B, 2 OR > DAYS

Facility

$4,899.00

Service Code	HCPCS 78804
Hospital Charge Code	2680370
Hospital Revenue Code	341
Min. Negotiated Rate	$139.13
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.96
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,273.74
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$734.85
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$154.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$139.13

RP LOC TUMOR, W B, 2 OR > DAYS

Facility

$4,899.00

Service Code	HCPCS 78804
Hospital Charge Code	2680370
Hospital Revenue Code	341
Min. Negotiated Rate	$734.85
Max. Negotiated Rate	$734.85
Rate for Payer: Qualcare PPO/HMO/WC	$734.85

RPR

Facility

$667.59

Service Code	HCPCS 86592
Hospital Charge Code	3004694
Hospital Revenue Code	302
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

RPR

Facility

$667.59

Service Code	HCPCS 86592
Hospital Charge Code	3004694
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

RPR AA HRN 1ST > 10 NCR/STRN

Facility

$11,151.60

Service Code	HCPCS 49596
Hospital Charge Code	16000754
Hospital Revenue Code	360
Min. Negotiated Rate	$316.71
Max. Negotiated Rate	$14,869.00
Rate for Payer: Aetna Commercial	$4,237.61
Rate for Payer: Aetna Medicare Advantage	$3,345.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,843.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,843.66
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	$2,843.66
Rate for Payer: Cigna Commercial	$5,575.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,899.42
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,672.74
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$352.39
Rate for Payer: Wellpoint Medicaid Managed Care	$316.71

RPR AA HRN 1ST > 10 NCR/STRN

Facility

$11,151.60

Service Code	HCPCS 49596
Hospital Charge Code	16000754
Hospital Revenue Code	360
Min. Negotiated Rate	$1,672.74
Max. Negotiated Rate	$1,672.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,672.74

RPR AA HRN 1ST 3-10 NCR/STRN

Facility

$25,013.88

Service Code	HCPCS 49594
Hospital Charge Code	160000184
Hospital Revenue Code	360
Min. Negotiated Rate	$710.39
Max. Negotiated Rate	$26,053.61
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,053.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,053.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$26,053.61
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,503.61
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,752.08
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$790.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$710.39

RPR AA HRN 1ST 3-10 NCR/STRN

Facility

$25,013.88

Service Code	HCPCS 49594
Hospital Charge Code	160000184
Hospital Revenue Code	360
Min. Negotiated Rate	$3,752.08
Max. Negotiated Rate	$3,752.08
Rate for Payer: Qualcare PPO/HMO/WC	$3,752.08

Know your out-of-pocket cost for care.

All Charges