Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

XR BARIUM ENEMA SINGLE CONT

Facility

$5,100.00

Service Code	HCPCS 74270
Hospital Charge Code	2000263
Hospital Revenue Code	320
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR BARIUM ENEMA W/AIR CONT

Facility

$5,100.00

Service Code	HCPCS 74280
Hospital Charge Code	2001667
Hospital Revenue Code	320
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR BARIUM ENEMA W/AIR CONT

Facility

$5,100.00

Service Code	HCPCS 74280
Hospital Charge Code	2001667
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR-BIOPSY KIDNEY-BI

Facility

$10,607.10

Service Code	HCPCS 5020050
Hospital Charge Code	2709019
Hospital Revenue Code	361
Min. Negotiated Rate	$301.24
Max. Negotiated Rate	$5,303.55
Rate for Payer: Aetna Commercial	$4,030.70
Rate for Payer: Aetna Medicare Advantage	$3,182.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,704.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,704.81
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	$2,704.81
Rate for Payer: Cigna Commercial	$5,303.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,757.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,591.07
Rate for Payer: UnitedHealthcare Community & State	$335.18
Rate for Payer: Wellpoint Medicaid Managed Care	$301.24

XR-BIOPSY KIDNEY-BI

Facility

$10,607.10

Service Code	HCPCS 5020050
Hospital Charge Code	2709019
Hospital Revenue Code	361
Min. Negotiated Rate	$1,591.07
Max. Negotiated Rate	$1,591.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,591.07

XR-BIOPSY KIDNEY-LT

Facility

$7,071.40

Service Code	HCPCS 50200LT
Hospital Charge Code	2709020
Hospital Revenue Code	361
Min. Negotiated Rate	$200.83
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,687.13
Rate for Payer: Aetna Medicare Advantage	$2,121.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,803.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,803.21
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	$1,803.21
Rate for Payer: Cigna Commercial	$3,535.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,838.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71
Rate for Payer: UnitedHealthcare Community & State	$223.46
Rate for Payer: Wellpoint Medicaid Managed Care	$200.83

XR-BIOPSY KIDNEY-LT

Facility

$7,071.40

Service Code	HCPCS 50200LT
Hospital Charge Code	2709020
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

XR-BIOPSY KIDNEY-RT

Facility

$7,071.40

Service Code	HCPCS 50200RT
Hospital Charge Code	2709021
Hospital Revenue Code	361
Min. Negotiated Rate	$200.83
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,687.13
Rate for Payer: Aetna Medicare Advantage	$2,121.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,803.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,803.21
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	$1,803.21
Rate for Payer: Cigna Commercial	$3,535.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,838.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71
Rate for Payer: UnitedHealthcare Community & State	$223.46
Rate for Payer: Wellpoint Medicaid Managed Care	$200.83

XR-BIOPSY KIDNEY-RT

Facility

$7,071.40

Service Code	HCPCS 50200RT
Hospital Charge Code	2709021
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

XR BONE AGE WRISTS

Facility

$5,100.00

Service Code	HCPCS 77072
Hospital Charge Code	2002061
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BONE AGE WRISTS

Facility

$5,100.00

Service Code	HCPCS 77072
Hospital Charge Code	2002061
Hospital Revenue Code	320
Min. Negotiated Rate	$26.48
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	$26.48
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR BONE SURVEY COMPLETE

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2000909
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BONE SURVEY COMPLETE

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2000909
Hospital Revenue Code	320
Min. Negotiated Rate	$30.89
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	$30.89
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR BONE SURVEY LIMITED

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2011150
Hospital Revenue Code	320
Min. Negotiated Rate	$30.89
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	$30.89
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR BONE SURVEY LIMITED

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2011150
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BREAST NEEDLE LOCALIZATION

Facility

$996.00

Service Code	HCPCS 19281
Hospital Charge Code	2002210
Hospital Revenue Code	361
Min. Negotiated Rate	$28.29
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.96
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.40
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$31.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$28.29

XR BREAST NEEDLE LOCALIZATION

Facility

$996.00

Service Code	HCPCS 19281
Hospital Charge Code	2002210
Hospital Revenue Code	361
Min. Negotiated Rate	$149.40
Max. Negotiated Rate	$149.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.40

XR BREAST PLACE LOC WIRE INIT

Facility

$996.00

Service Code	HCPCS 19281
Hospital Charge Code	2004430
Hospital Revenue Code	361
Min. Negotiated Rate	$28.29
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.96
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.40
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$31.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$28.29

XR BREAST PLACE LOC WIRE INIT

Facility

$996.00

Service Code	HCPCS 19281
Hospital Charge Code	2004430
Hospital Revenue Code	361
Min. Negotiated Rate	$149.40
Max. Negotiated Rate	$149.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.40

XR BREAST SPECIMEN

Facility

$5,100.00

Service Code	HCPCS 76098
Hospital Charge Code	94064037
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BREAST SPECIMEN

Facility

$5,100.00

Service Code	HCPCS 76098
Hospital Charge Code	94064037
Hospital Revenue Code	320
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$2,354.83
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,354.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,354.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,354.83
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
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	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR BREAST SPECIMEN EA ADDL>1

Facility

$2,974.75

Service Code	HCPCS 7609859
Hospital Charge Code	2200932
Hospital Revenue Code	320
Min. Negotiated Rate	$84.48
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$1,130.40
Rate for Payer: Aetna Medicare Advantage	$892.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.56
Rate for Payer: Cigna Commercial	$1,487.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$773.43
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.21
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$94.00
Rate for Payer: Wellpoint Medicaid Managed Care	$84.48

XR BREAST SPECIMEN EA ADDL>1

Facility

$2,974.75

Service Code	HCPCS 7609859
Hospital Charge Code	2200932
Hospital Revenue Code	320
Min. Negotiated Rate	$446.21
Max. Negotiated Rate	$446.21
Rate for Payer: Qualcare PPO/HMO/WC	$446.21

XR BREAST SPECIMEN LT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002285
Hospital Revenue Code	320
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$2,354.83
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,354.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,354.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,354.83
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$773.43
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.21
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$94.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$84.48

XR BREAST SPECIMEN LT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002285
Hospital Revenue Code	320
Min. Negotiated Rate	$446.21
Max. Negotiated Rate	$446.21
Rate for Payer: Qualcare PPO/HMO/WC	$446.21

Know your out-of-pocket cost for care.

All Charges