Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

XR MYELOGRAM LUMBOSACRAL

Facility

$5,100.00

Service Code	HCPCS 72265
Hospital Charge Code	2000735
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR MYELOGRAM THORACIC

Facility

$2,963.00

Service Code	HCPCS 72255
Hospital Charge Code	2004364
Hospital Revenue Code	320
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$3,378.36
Rate for Payer: Aetna Commercial	$2,533.19
Rate for Payer: Aetna Medicare Advantage	$3,017.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$931.32
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	$3,378.36
Rate for Payer: Cigna Commercial	$1,866.82
Rate for Payer: Cigna Medicare Advantage	$651.92
Rate for Payer: Clover Medicare Advantage	$884.75
Rate for Payer: EmblemHealth Commercial	$2,793.96
Rate for Payer: Humana Medicare Advantage	$959.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$931.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$770.38
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$444.45
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$93.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$931.32
Rate for Payer: Wellcare Medicare Advantage	$931.32
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,627.00
Rate for Payer: Wellpoint Medicaid Managed Care	$84.15

XR MYELOGRAM THORACIC

Facility

$2,963.00

Service Code	HCPCS 72255
Hospital Charge Code	2004364
Hospital Revenue Code	320
Min. Negotiated Rate	$444.45
Max. Negotiated Rate	$444.45
Rate for Payer: Qualcare PPO/HMO/WC	$444.45

XR NASAL BONES MIN 3 VWS

Facility

$6,601.19

Service Code	HCPCS 70160
Hospital Charge Code	2000370
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR NASAL BONES MIN 3 VWS

Facility

$6,601.19

Service Code	HCPCS 70160
Hospital Charge Code	2000370
Hospital Revenue Code	320
Min. Negotiated Rate	$27.23
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

XR NECK SOFT TISSUE

Facility

$6,601.19

Service Code	HCPCS 70360
Hospital Charge Code	2000487
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR NECK SOFT TISSUE

Facility

$6,601.19

Service Code	HCPCS 70360
Hospital Charge Code	2000487
Hospital Revenue Code	320
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

XR NEEDLE BIOPSY RENAL PERC

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	2004547
Hospital Revenue Code	361
Min. Negotiated Rate	$200.83
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	$1,838.56
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$223.46
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	$200.83

XR NEEDLE BIOPSY RENAL PERC

Facility

$7,071.40

Service Code	HCPCS 50200
Hospital Charge Code	2004547
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 NEEDLE BX LYMPH NODES

Facility

$8,054.80

Service Code	HCPCS 38505
Hospital Charge Code	321038505
Hospital Revenue Code	361
Min. Negotiated Rate	$228.76
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	$2,094.25
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$254.53
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	$228.76

XR NEEDLE BX LYMPH NODES

Facility

$8,054.80

Service Code	HCPCS 38505
Hospital Charge Code	5700150
Hospital Revenue Code	361
Min. Negotiated Rate	$1,208.22
Max. Negotiated Rate	$1,208.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22

XR NEEDLE BX LYMPH NODES

Facility

$8,054.80

Service Code	HCPCS 38505
Hospital Charge Code	321038505
Hospital Revenue Code	361
Min. Negotiated Rate	$1,208.22
Max. Negotiated Rate	$1,208.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22

XR NEEDLE BX LYMPH NODES

Facility

$6,202.00

Service Code	HCPCS 38505
Hospital Charge Code	7411544
Hospital Revenue Code	361
Min. Negotiated Rate	$176.14
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	$1,612.52
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$930.30
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$195.98
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	$176.14

XR NEEDLE BX LYMPH NODES

Facility

$8,054.80

Service Code	HCPCS 38505
Hospital Charge Code	5700150
Hospital Revenue Code	361
Min. Negotiated Rate	$228.76
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	$2,094.25
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,208.22
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$254.53
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	$228.76

XR NEEDLE BX LYMPH NODES

Facility

$6,202.00

Service Code	HCPCS 38505
Hospital Charge Code	7411544
Hospital Revenue Code	361
Min. Negotiated Rate	$930.30
Max. Negotiated Rate	$930.30
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

XR ORBITS COMPL MIN 4 VWS

Facility

$5,100.00

Service Code	HCPCS 70200
Hospital Charge Code	2000453
Hospital Revenue Code	320
Min. Negotiated Rate	$41.25
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	$41.25
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 ORBITS COMPL MIN 4 VWS

Facility

$5,100.00

Service Code	HCPCS 70200
Hospital Charge Code	2000453
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR PARACENTESIS W/O IMAGING

Facility

$2,275.00

Service Code	HCPCS 49082
Hospital Charge Code	2004034
Hospital Revenue Code	361
Min. Negotiated Rate	$64.61
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,908.70
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$341.25
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$71.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$64.61

XR PARACENTESIS W/O IMAGING

Facility

$2,275.00

Service Code	HCPCS 49082
Hospital Charge Code	7411575
Hospital Revenue Code	361
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$341.25
Rate for Payer: Qualcare PPO/HMO/WC	$341.25

XR PARACENTESIS W/O IMAGING

Facility

$2,275.00

Service Code	HCPCS 49082
Hospital Charge Code	2004034
Hospital Revenue Code	361
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$341.25
Rate for Payer: Qualcare PPO/HMO/WC	$341.25

XR PARACENTESIS W/O IMAGING

Facility

$2,275.00

Service Code	HCPCS 49082
Hospital Charge Code	7411575
Hospital Revenue Code	361
Min. Negotiated Rate	$64.61
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,908.70
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$341.25
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$71.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$64.61

XR PARACENTESIS W/O IMAGING

Facility

$2,275.00

Service Code	HCPCS 49082
Hospital Charge Code	5600154
Hospital Revenue Code	361
Min. Negotiated Rate	$64.61
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,908.70
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$341.25
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$71.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$64.61

XR PARACENTESIS W/O IMAGING

Facility

$2,275.00

Service Code	HCPCS 49082
Hospital Charge Code	5600154
Hospital Revenue Code	361
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$341.25
Rate for Payer: Qualcare PPO/HMO/WC	$341.25

XR PATELLA/KNEE 3 VWS LT

Facility

$6,601.19

Service Code	HCPCS 73562LT
Hospital Charge Code	2001535
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR PATELLA/KNEE 3 VWS LT

Facility

$6,601.19

Service Code	HCPCS 73562LT
Hospital Charge Code	2001535
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

Know your out-of-pocket cost for care.

All Charges