Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

XR SPINE ENTIRE

Facility

$450.00

Hospital Charge Code	2000644
Hospital Revenue Code	320
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

XR SPINE ENTIRE

Facility

$450.00

Hospital Charge Code	2000644
Hospital Revenue Code	320
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$12.78

XR SPINE LS AP & LAT

Facility

$6,601.19

Service Code	HCPCS 72100
Hospital Charge Code	2000677
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SPINE LS AP & LAT

Facility

$6,601.19

Service Code	HCPCS 72100
Hospital Charge Code	2000677
Hospital Revenue Code	320
Min. Negotiated Rate	$36.30
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	$36.30
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	$1,716.31
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	$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	$187.47

XR SPINE LS BENDING ONLY MIN 4

Facility

$760.00

Service Code	HCPCS 72120
Hospital Charge Code	2011115
Hospital Revenue Code	320
Min. Negotiated Rate	$21.58
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	$197.60
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$24.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$21.58

XR SPINE LS BENDING ONLY MIN 4

Facility

$760.00

Service Code	HCPCS 72120
Hospital Charge Code	2011115
Hospital Revenue Code	320
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$114.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

XR SPINE LS COMPLETE INC BEND

Facility

$5,100.00

Service Code	HCPCS 72114
Hospital Charge Code	2011110
Hospital Revenue Code	320
Min. Negotiated Rate	$46.20
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	$46.20
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 SPINE LS COMPLETE INC BEND

Facility

$5,100.00

Service Code	HCPCS 72114
Hospital Charge Code	2011110
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SPINE SCOLIOSIS SPNE & STND

Facility

$957.00

Hospital Charge Code	2011390
Hospital Revenue Code	320
Min. Negotiated Rate	$143.55
Max. Negotiated Rate	$143.55
Rate for Payer: Qualcare PPO/HMO/WC	$143.55

XR SPINE SCOLIOSIS SPNE & STND

Facility

$957.00

Hospital Charge Code	2011390
Hospital Revenue Code	320
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$363.66
Rate for Payer: Aetna Medicare Advantage	$287.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.03
Rate for Payer: Cigna Commercial	$478.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.82
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$143.55
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$30.24
Rate for Payer: Wellpoint Medicaid Managed Care	$27.18

XR SPINE THORACIC AP & LAB SWI

Facility

$267.00

Service Code	HCPCS 72072
Hospital Charge Code	2011105
Hospital Revenue Code	320
Min. Negotiated Rate	$7.58
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	$69.42
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
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	$7.58

XR SPINE THORACIC AP & LAB SWI

Facility

$267.00

Service Code	HCPCS 72072
Hospital Charge Code	2011105
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

XR SPINE THORACOLUMBAR 2 VIEWS

Facility

$267.00

Service Code	HCPCS 72080
Hospital Charge Code	2011393
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

XR SPINE THORACOLUMBAR 2 VIEWS

Facility

$267.00

Service Code	HCPCS 72080
Hospital Charge Code	2011393
Hospital Revenue Code	320
Min. Negotiated Rate	$7.58
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	$31.37
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	$69.42
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
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	$7.58

XR SPINE THOR/LUM CHILD MIN 2V

Facility

$5,100.00

Service Code	HCPCS 72082
Hospital Charge Code	2002186
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SPINE THOR/LUM CHILD MIN 2V

Facility

$5,100.00

Service Code	HCPCS 72082
Hospital Charge Code	2002186
Hospital Revenue Code	320
Min. Negotiated Rate	$57.21
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	$57.21
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 SPNE CERVCAL CRSS-TBLE LTRL

Facility

$297.00

Service Code	HCPCS 72020
Hospital Charge Code	2011388
Hospital Revenue Code	320
Min. Negotiated Rate	$8.43
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	$20.11
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	$77.22
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.55
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$9.39
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	$8.43

XR SPNE CERVCAL CRSS-TBLE LTRL

Facility

$297.00

Service Code	HCPCS 72020
Hospital Charge Code	2011388
Hospital Revenue Code	320
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$44.55
Rate for Payer: Qualcare PPO/HMO/WC	$44.55

XR STEREO LOC BREAST BX EACH

Facility

$2,669.00

Service Code	HCPCS 19081
Hospital Charge Code	2000922
Hospital Revenue Code	361
Min. Negotiated Rate	$400.35
Max. Negotiated Rate	$400.35
Rate for Payer: Qualcare PPO/HMO/WC	$400.35

XR STEREO LOC BREAST BX EACH

Facility

$2,669.00

Service Code	HCPCS 19081
Hospital Charge Code	2000922
Hospital Revenue Code	361
Min. Negotiated Rate	$75.80
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	$693.94
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$400.35
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$84.34
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	$75.80

XR STERNOCLAV JOINTS

Facility

$5,100.00

Service Code	HCPCS 71130
Hospital Charge Code	2000610
Hospital Revenue Code	320
Min. Negotiated Rate	$33.00
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	$33.00
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	$1,326.00
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	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR STERNOCLAV JOINTS

Facility

$5,100.00

Service Code	HCPCS 71130
Hospital Charge Code	2000610
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR STERNUM

Facility

$5,100.00

Service Code	HCPCS 71120
Hospital Charge Code	2000602
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR STERNUM

Facility

$5,100.00

Service Code	HCPCS 71120
Hospital Charge Code	2000602
Hospital Revenue Code	320
Min. Negotiated Rate	$29.86
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	$29.86
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	$1,326.00
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	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR THORACENTESIS W IMAGING

Facility

$2,429.50

Service Code	HCPCS 32555
Hospital Charge Code	2004059
Hospital Revenue Code	361
Min. Negotiated Rate	$364.43
Max. Negotiated Rate	$364.43
Rate for Payer: Qualcare PPO/HMO/WC	$364.43

Know your out-of-pocket cost for care.

All Charges