Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SIGMOIDOSCOPE W/SUBMUC INJ

Facility

$3,720.52

Service Code	HCPCS 45335
Hospital Charge Code	16000981
Hospital Revenue Code	360
Min. Negotiated Rate	$105.66
Max. Negotiated Rate	$4,007.70
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
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	$4,007.70
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$967.34
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$558.08
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$117.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81
Rate for Payer: Wellpoint Medicaid Managed Care	$105.66

SIGMOIDOSCOPY AND BIOPSY

Facility

$3,330.02

Service Code	HCPCS 45331
Hospital Charge Code	16000403
Hospital Revenue Code	360
Min. Negotiated Rate	$94.57
Max. Negotiated Rate	$4,007.70
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
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	$4,007.70
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.81
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$499.50
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$105.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81
Rate for Payer: Wellpoint Medicaid Managed Care	$94.57

SIGMOIDOSCOPY AND BIOPSY

Facility

$3,330.02

Service Code	HCPCS 45331
Hospital Charge Code	16000403
Hospital Revenue Code	360
Min. Negotiated Rate	$499.50
Max. Negotiated Rate	$499.50
Rate for Payer: Qualcare PPO/HMO/WC	$499.50

SIGMOIDOSCOPY DX W/WO BRUSH/W

Facility

$5,319.00

Hospital Charge Code	1600000552
Hospital Revenue Code	360
Min. Negotiated Rate	$797.85
Max. Negotiated Rate	$797.85
Rate for Payer: Qualcare PPO/HMO/WC	$797.85

SIGMOIDOSCOPY DX W/WO BRUSH/W

Facility

$5,319.00

Hospital Charge Code	1600000552
Hospital Revenue Code	360
Min. Negotiated Rate	$151.06
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,021.22
Rate for Payer: Aetna Medicare Advantage	$1,595.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,356.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,356.35
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	$1,356.35
Rate for Payer: Cigna Commercial	$2,659.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,382.94
Rate for Payer: Qualcare PPO/HMO/WC	$797.85
Rate for Payer: UnitedHealthcare Community & State	$168.08
Rate for Payer: Wellpoint Medicaid Managed Care	$151.06

SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$4,007.70

Service Code	CPT 45330
Hospital Revenue Code	360
Min. Negotiated Rate	$1,049.57
Max. Negotiated Rate	$4,007.70
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
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	$4,007.70
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81

SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$4,007.70

Service Code	CPT 45330
Hospital Revenue Code	750
Min. Negotiated Rate	$52.25
Max. Negotiated Rate	$4,007.70
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.70
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81

SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$4,007.70

Service Code	CPT 45331
Hospital Revenue Code	750
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$4,007.70
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.70
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81

Signia Linear Adapter

Facility

$10,180.30

Hospital Charge Code	270691833
Hospital Revenue Code	272
Min. Negotiated Rate	$289.12
Max. Negotiated Rate	$5,090.15
Rate for Payer: Aetna Commercial	$3,868.51
Rate for Payer: Aetna Medicare Advantage	$3,054.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,595.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,595.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,595.98
Rate for Payer: Cigna Commercial	$5,090.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,646.88
Rate for Payer: Oxford Commercial	$2,036.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,527.05
Rate for Payer: UnitedHealthcare Commercial	$2,036.06
Rate for Payer: UnitedHealthcare Community & State	$321.70
Rate for Payer: Wellpoint Medicaid Managed Care	$289.12

Signia Linear Adapter

Facility

$10,180.30

Hospital Charge Code	270691833
Hospital Revenue Code	272
Min. Negotiated Rate	$1,527.05
Max. Negotiated Rate	$1,527.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,527.05

SIGNIA TRI STAPLE CURVE 30MM

Facility

$2,187.00

Hospital Charge Code	270698034
Hospital Revenue Code	272
Min. Negotiated Rate	$62.11
Max. Negotiated Rate	$1,093.50
Rate for Payer: Aetna Commercial	$831.06
Rate for Payer: Aetna Medicare Advantage	$656.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$557.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$557.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$557.68
Rate for Payer: Cigna Commercial	$1,093.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.62
Rate for Payer: Oxford Commercial	$437.40
Rate for Payer: Qualcare PPO/HMO/WC	$328.05
Rate for Payer: UnitedHealthcare Commercial	$437.40
Rate for Payer: UnitedHealthcare Community & State	$69.11
Rate for Payer: Wellpoint Medicaid Managed Care	$62.11

SIGNIA TRI STAPLE CURVE 30MM

Facility

$2,187.00

Hospital Charge Code	270698034
Hospital Revenue Code	272
Min. Negotiated Rate	$328.05
Max. Negotiated Rate	$328.05
Rate for Payer: Qualcare PPO/HMO/WC	$328.05

SIGN POST 5 FT 19 IN W 19 IN D

Facility

$694.10

Hospital Charge Code	270683581
Hospital Revenue Code	272
Min. Negotiated Rate	$104.11
Max. Negotiated Rate	$104.11
Rate for Payer: Qualcare PPO/HMO/WC	$104.11

SIGN POST 5 FT 19 IN W 19 IN D

Facility

$694.10

Hospital Charge Code	270683581
Hospital Revenue Code	272
Min. Negotiated Rate	$19.71
Max. Negotiated Rate	$347.05
Rate for Payer: Aetna Commercial	$263.76
Rate for Payer: Aetna Medicare Advantage	$208.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.00
Rate for Payer: Cigna Commercial	$347.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.47
Rate for Payer: Oxford Commercial	$138.82
Rate for Payer: Qualcare PPO/HMO/WC	$104.11
Rate for Payer: UnitedHealthcare Commercial	$138.82
Rate for Payer: UnitedHealthcare Community & State	$21.93
Rate for Payer: Wellpoint Medicaid Managed Care	$19.71

SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$61,224.98

Service Code	MSDRG 555
Min. Negotiated Rate	$18,642.22
Max. Negotiated Rate	$61,224.98
Rate for Payer: Aetna Commercial	$45,463.65
Rate for Payer: Aetna Medicare Advantage	$61,224.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38,787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38,787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,623.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38,787.00
Rate for Payer: Cigna Commercial	$29,466.89
Rate for Payer: Cigna Medicare Advantage	$19,623.39
Rate for Payer: Clover Medicare Advantage	$18,642.22
Rate for Payer: EmblemHealth Commercial	$58,870.17
Rate for Payer: Humana Medicare Advantage	$20,212.09
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,623.39
Rate for Payer: Oxford Commercial	$23,290.12
Rate for Payer: UnitedHealthcare Commercial	$31,174.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,623.39
Rate for Payer: Wellcare Medicare Advantage	$19,623.39

SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC

Facility

$45,706.25

Service Code	MSDRG 556
Min. Negotiated Rate	$13,916.97
Max. Negotiated Rate	$45,706.25
Rate for Payer: Aetna Commercial	$34,411.03
Rate for Payer: Aetna Medicare Advantage	$45,706.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,718.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,718.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,649.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,718.10
Rate for Payer: Cigna Commercial	$18,516.57
Rate for Payer: Cigna Medicare Advantage	$14,649.44
Rate for Payer: Clover Medicare Advantage	$13,916.97
Rate for Payer: EmblemHealth Commercial	$43,948.32
Rate for Payer: Humana Medicare Advantage	$15,088.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,649.44
Rate for Payer: Oxford Commercial	$14,635.17
Rate for Payer: UnitedHealthcare Commercial	$19,589.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,649.44
Rate for Payer: Wellcare Medicare Advantage	$14,649.44

SIGNS AND SYMPTOMS WITH MCC

Facility

$59,569.54

Service Code	MSDRG 947
Min. Negotiated Rate	$18,138.16
Max. Negotiated Rate	$59,569.54
Rate for Payer: Aetna Commercial	$44,284.62
Rate for Payer: Aetna Medicare Advantage	$59,569.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34,631.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34,631.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34,631.25
Rate for Payer: Cigna Commercial	$28,298.73
Rate for Payer: Cigna Medicare Advantage	$19,092.80
Rate for Payer: Clover Medicare Advantage	$18,138.16
Rate for Payer: EmblemHealth Commercial	$57,278.40
Rate for Payer: Humana Medicare Advantage	$19,665.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,092.80
Rate for Payer: Oxford Commercial	$22,366.83
Rate for Payer: UnitedHealthcare Commercial	$29,938.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,092.80
Rate for Payer: Wellcare Medicare Advantage	$19,092.80

SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$44,755.28

Service Code	MSDRG 948
Min. Negotiated Rate	$13,627.41
Max. Negotiated Rate	$44,755.28
Rate for Payer: Aetna Commercial	$33,733.73
Rate for Payer: Aetna Medicare Advantage	$44,755.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,164.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,164.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,344.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,164.00
Rate for Payer: Cigna Commercial	$17,845.55
Rate for Payer: Cigna Medicare Advantage	$14,344.64
Rate for Payer: Clover Medicare Advantage	$13,627.41
Rate for Payer: EmblemHealth Commercial	$43,033.92
Rate for Payer: Humana Medicare Advantage	$14,774.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,344.64
Rate for Payer: Oxford Commercial	$14,104.81
Rate for Payer: UnitedHealthcare Commercial	$18,879.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,344.64
Rate for Payer: Wellcare Medicare Advantage	$14,344.64

SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$17,571.65

Service Code	APR-DRG 8614
Min. Negotiated Rate	$17,227.11
Max. Negotiated Rate	$17,571.65
Rate for Payer: UnitedHealthcare Community & State	$17,227.11
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,571.65
Rate for Payer: Wellpoint Medicaid Managed Care	$17,227.11

SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$12,233.59

Service Code	APR-DRG 8613
Min. Negotiated Rate	$11,993.72
Max. Negotiated Rate	$12,233.59
Rate for Payer: UnitedHealthcare Community & State	$11,993.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,233.59
Rate for Payer: Wellpoint Medicaid Managed Care	$11,993.72

SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$5,152.65

Service Code	APR-DRG 8611
Min. Negotiated Rate	$5,051.62
Max. Negotiated Rate	$5,152.65
Rate for Payer: UnitedHealthcare Community & State	$5,051.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,152.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5,051.62

SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$8,417.85

Service Code	APR-DRG 8612
Min. Negotiated Rate	$8,252.79
Max. Negotiated Rate	$8,417.85
Rate for Payer: UnitedHealthcare Community & State	$8,252.79
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,417.85
Rate for Payer: Wellpoint Medicaid Managed Care	$8,252.79

SI JOINTS 3+ VIEWS

Facility

$5,100.00

Service Code	HCPCS 72202
Hospital Charge Code	94061099
Hospital Revenue Code	320
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

SI JOINTS 3+ VIEWS

Facility

$5,100.00

Service Code	HCPCS 72202
Hospital Charge Code	94061099
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SILDENAFIL 10MG (HALF TAB)

Facility

$141.17

Service Code	HCPCS S0090
Hospital Charge Code	606390401
Hospital Revenue Code	636
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$34.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.16
Rate for Payer: Qualcare PPO/HMO/WC	$21.18

Know your out-of-pocket cost for care.

All Charges