Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TARGET 360 ULTRA 5MM X 15CM

Facility

$10,426.25

Hospital Charge Code	270689889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,563.94
Max. Negotiated Rate	$2,523.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,085.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,523.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.94

TARGET 360 ULTRA 5MM X 15CM

Facility

$10,426.25

Hospital Charge Code	270689889S
Hospital Revenue Code	278
Min. Negotiated Rate	$296.11
Max. Negotiated Rate	$5,213.12
Rate for Payer: Aetna Commercial	$3,961.97
Rate for Payer: Aetna Medicare Advantage	$3,127.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,658.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,658.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,085.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,658.69
Rate for Payer: Cigna Commercial	$5,213.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,523.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.94
Rate for Payer: UnitedHealthcare Community & State	$329.47
Rate for Payer: Wellpoint Medicaid Managed Care	$296.11

TARGET HELICAL ULTRA 1 MM X 1

Facility

$7,125.00

Hospital Charge Code	270689890
Hospital Revenue Code	278
Min. Negotiated Rate	$202.35
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,816.88
Rate for Payer: Cigna Commercial	$3,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75
Rate for Payer: UnitedHealthcare Community & State	$225.15
Rate for Payer: Wellpoint Medicaid Managed Care	$202.35

TARGET HELICAL ULTRA 1 MM X 1

Facility

$7,125.00

Hospital Charge Code	270689890
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,724.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

TARGETING DEVICE RADIOLUCENT

Facility

$1,800.00

Hospital Charge Code	270614628
Hospital Revenue Code	272
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

TARGETING DEVICE RADIOLUCENT

Facility

$1,800.00

Hospital Charge Code	270614628
Hospital Revenue Code	272
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$468.00
Rate for Payer: Oxford Commercial	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$360.00
Rate for Payer: UnitedHealthcare Community & State	$56.88
Rate for Payer: Wellpoint Medicaid Managed Care	$51.12

TARSAL TUNNEL-RELEASE

Facility

$16,437.00

Service Code	HCPCS 28035
Hospital Charge Code	16000511
Hospital Revenue Code	360
Min. Negotiated Rate	$466.81
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,273.62
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$519.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$466.81

TARSAL TUNNEL-RELEASE

Facility

$16,437.00

Service Code	HCPCS 28035
Hospital Charge Code	16000511
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

TA SP BONE AGRFT LOCAL ADD-ONT

Facility

$11,887.22

Service Code	HCPCS 20936
Hospital Charge Code	16000286
Hospital Revenue Code	360
Min. Negotiated Rate	$375.64
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$4,517.14
Rate for Payer: Aetna Medicare Advantage	$3,566.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,031.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,031.24
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	$3,031.24
Rate for Payer: Cigna Commercial	$5,943.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,090.68
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$375.64

TA SP BONE AGRFT LOCAL ADD-ONT

Facility

$11,887.22

Service Code	HCPCS 20936
Hospital Charge Code	16000286
Hospital Revenue Code	360
Min. Negotiated Rate	$1,783.08
Max. Negotiated Rate	$1,783.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,783.08

TA THORAX SPINE FUSION

Facility

$14,222.30

Service Code	HCPCS 22610
Hospital Charge Code	16000804
Hospital Revenue Code	360
Min. Negotiated Rate	$403.91
Max. Negotiated Rate	$75,563.15
Rate for Payer: Aetna Commercial	$56,659.34
Rate for Payer: Aetna Medicare Advantage	$67,491.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,563.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,563.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,830.64
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	$75,563.15
Rate for Payer: Cigna Commercial	$41,754.94
Rate for Payer: Cigna Medicare Advantage	$20,830.64
Rate for Payer: Clover Medicare Advantage	$19,789.11
Rate for Payer: EmblemHealth Commercial	$62,491.92
Rate for Payer: Humana Medicare Advantage	$21,455.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,830.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,697.80
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.34
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$449.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,830.64
Rate for Payer: Wellcare Medicare Advantage	$20,830.64
Rate for Payer: Wellpoint Medicaid Managed Care	$403.91

TA THORAX SPINE FUSION

Facility

$14,222.30

Service Code	HCPCS 22610
Hospital Charge Code	16000804
Hospital Revenue Code	360
Min. Negotiated Rate	$2,133.34
Max. Negotiated Rate	$2,133.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.34

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	2692138
Hospital Revenue Code	361
Min. Negotiated Rate	$684.89
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,270.11
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$762.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$684.89

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	366837248
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	7412067
Hospital Revenue Code	361
Min. Negotiated Rate	$684.89
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,270.11
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$762.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$684.89

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	2692138
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	2709033
Hospital Revenue Code	361
Min. Negotiated Rate	$684.89
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,270.11
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$762.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$684.89

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	5100846
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$27,397.00

Service Code	HCPCS 37248
Hospital Charge Code	321037248
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	5100846
Hospital Revenue Code	361
Min. Negotiated Rate	$684.89
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,270.11
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$762.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$684.89

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$27,397.00

Service Code	HCPCS 37248
Hospital Charge Code	321037248
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	366837248
Hospital Revenue Code	361
Min. Negotiated Rate	$684.89
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,270.11
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$762.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$684.89

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	7412067
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	2709033
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT LE)

Facility

$24,115.80

Service Code	HCPCS 37246
Hospital Charge Code	7412065
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

Know your out-of-pocket cost for care.

All Charges