Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH CREATININE FLUID

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	397073049
Hospital Revenue Code	301
Min. Negotiated Rate	$22.90
Max. Negotiated Rate	$22.90
Rate for Payer: Qualcare PPO/HMO/WC	$22.90

CH CREATININE FLUID

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	397073049
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$76.33
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

CH CREATININE (RANDOM)

Facility

$382.58

Service Code	HCPCS 82570
Hospital Charge Code	397073107
Hospital Revenue Code	301
Min. Negotiated Rate	$57.39
Max. Negotiated Rate	$57.39
Rate for Payer: Qualcare PPO/HMO/WC	$57.39

CH CREATININE (RANDOM)

Facility

$382.58

Service Code	HCPCS 82570
Hospital Charge Code	397073107
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$191.29
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$191.29
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.39
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.14

CH CREATININE URINE 24 HR

Facility

$57.00

Service Code	HCPCS 82570
Hospital Charge Code	397071265
Hospital Revenue Code	301
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

CH CREATININE URINE 24 HR

Facility

$57.00

Service Code	HCPCS 82570
Hospital Charge Code	397071265
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

CH CROSSMATCH

Facility

$246.00

Service Code	HCPCS 86920
Hospital Charge Code	397031008
Hospital Revenue Code	300
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Qualcare PPO/HMO/WC	$36.90

CH CROSSMATCH

Facility

$246.00

Service Code	HCPCS 86920
Hospital Charge Code	397031008
Hospital Revenue Code	300
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$6.52

CH CROSSMATCH PRE-WARM

Facility

$320.00

Service Code	HCPCS 86922
Hospital Charge Code	397031059
Hospital Revenue Code	300
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

CH CROSSMATCH PRE-WARM

Facility

$320.00

Service Code	HCPCS 86922
Hospital Charge Code	397031059
Hospital Revenue Code	300
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$8.48

CH CRYOGLOBULIN

Facility

$390.00

Service Code	HCPCS 82595
Hospital Charge Code	397071064
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH CRYOGLOBULIN

Facility

$390.00

Service Code	HCPCS 82595
Hospital Charge Code	397071064
Hospital Revenue Code	301
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH CRYOPRECIPITATE

Facility

$291.95

Hospital Charge Code	397031005
Hospital Revenue Code	390
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$110.94
Rate for Payer: Aetna Medicare Advantage	$87.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.45
Rate for Payer: Cigna Commercial	$145.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.58
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.79
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$7.04
Rate for Payer: Wellpoint Medicaid Managed Care	$7.74

CH CRYOPRECIPITATE

Facility

$291.95

Hospital Charge Code	397031005
Hospital Revenue Code	390
Min. Negotiated Rate	$43.79
Max. Negotiated Rate	$43.79
Rate for Payer: Qualcare PPO/HMO/WC	$43.79

CH CRYPTOCOCCUS ANTIGEN

Facility

$390.00

Service Code	HCPCS 87327
Hospital Charge Code	397041052
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH CRYPTOCOCCUS ANTIGEN

Facility

$390.00

Service Code	HCPCS 87327
Hospital Charge Code	397041052
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$36.50
Rate for Payer: Aetna Medicare Advantage	$43.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.44
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.42
Rate for Payer: Clover Medicare Advantage	$12.75
Rate for Payer: EmblemHealth Commercial	$40.26
Rate for Payer: Humana Medicare Advantage	$13.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.42
Rate for Payer: Wellcare Medicare Advantage	$13.42
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH CRYSTALS FLUID

Facility

$390.00

Service Code	HCPCS 89060
Hospital Charge Code	397021087
Hospital Revenue Code	300
Min. Negotiated Rate	$5.86
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$19.94
Rate for Payer: Aetna Medicare Advantage	$23.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$7.33
Rate for Payer: Clover Medicare Advantage	$6.96
Rate for Payer: EmblemHealth Commercial	$21.99
Rate for Payer: Humana Medicare Advantage	$7.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.33
Rate for Payer: Wellcare Medicare Advantage	$7.33
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH CRYSTALS FLUID

Facility

$390.00

Service Code	HCPCS 89060
Hospital Charge Code	397021087
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH CRYTOCOCCUS AB

Facility

$79.00

Service Code	HCPCS 86403
Hospital Charge Code	397071470
Hospital Revenue Code	302
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

CH CRYTOCOCCUS AB

Facility

$79.00

Service Code	HCPCS 86403
Hospital Charge Code	397071470
Hospital Revenue Code	302
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Aetna Medicare Advantage	$37.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.66
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: Cigna Medicare Advantage	$11.54
Rate for Payer: Clover Medicare Advantage	$10.96
Rate for Payer: EmblemHealth Commercial	$34.62
Rate for Payer: Humana Medicare Advantage	$11.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.54
Rate for Payer: Wellcare Medicare Advantage	$11.54
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

CH CSF FOR CREUTZFELDT JAKOB

Facility

$123.00

Service Code	HCPCS 83520
Hospital Charge Code	397071478
Hospital Revenue Code	301
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$61.50
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

CH CSF FOR CREUTZFELDT JAKOB

Facility

$123.00

Service Code	HCPCS 83520
Hospital Charge Code	397071478
Hospital Revenue Code	301
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

CH CT/NG DNA SDA, PAP VIAL

Facility

$252.50

Service Code	HCPCS 86658
Hospital Charge Code	397071444
Hospital Revenue Code	302
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$126.25
Rate for Payer: Aetna Commercial	$35.44
Rate for Payer: Aetna Medicare Advantage	$42.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.03
Rate for Payer: Cigna Commercial	$126.25
Rate for Payer: Cigna Medicare Advantage	$13.03
Rate for Payer: Clover Medicare Advantage	$12.38
Rate for Payer: EmblemHealth Commercial	$39.09
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.88
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.03
Rate for Payer: Wellcare Medicare Advantage	$13.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.69

CH CT/NG DNA SDA, PAP VIAL

Facility

$252.50

Service Code	HCPCS 86658
Hospital Charge Code	397071444
Hospital Revenue Code	302
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$37.88
Rate for Payer: Qualcare PPO/HMO/WC	$37.88

CH CU INDEX TM

Facility

$670.00

Service Code	HCPCS 86343
Hospital Charge Code	397073673
Hospital Revenue Code	302
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$100.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

Know your out-of-pocket cost for care.

All Charges