Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH CULTURE NOSE

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	397041286
Hospital Revenue Code	306
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.12
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

CH CULTURE NOSE

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	397041286
Hospital Revenue Code	306
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

CH CULTURE SPINAL FLUID

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	397041034
Hospital Revenue Code	306
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.12
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

CH CULTURE SPINAL FLUID

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	397041034
Hospital Revenue Code	306
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

CH CULTURE SPUTUM

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	397041070
Hospital Revenue Code	306
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

CH CULTURE SPUTUM

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	397041070
Hospital Revenue Code	306
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.12
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

CH CULTURE STOOL

Facility

$150.45

Service Code	HCPCS 87045
Hospital Charge Code	397041042
Hospital Revenue Code	309
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.68
Rate for Payer: Aetna Medicare Advantage	$30.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$75.22
Rate for Payer: Cigna Medicare Advantage	$9.44
Rate for Payer: Clover Medicare Advantage	$8.97
Rate for Payer: EmblemHealth Commercial	$28.32
Rate for Payer: Humana Medicare Advantage	$9.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.44
Rate for Payer: Wellcare Medicare Advantage	$9.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.99

CH CULTURE STOOL

Facility

$150.45

Service Code	HCPCS 87045
Hospital Charge Code	397041042
Hospital Revenue Code	309
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$22.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.57

CH CULTURE THROAT

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	397041078
Hospital Revenue Code	306
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.12
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

CH CULTURE THROAT

Facility

$93.65

Service Code	HCPCS 87070
Hospital Charge Code	397041078
Hospital Revenue Code	306
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

CH CULTURE TYPE IMMUNO

Facility

$33.00

Service Code	HCPCS 87140
Hospital Charge Code	397071480
Hospital Revenue Code	309
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.15
Rate for Payer: Aetna Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.57
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	$20.11
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: Cigna Medicare Advantage	$5.57
Rate for Payer: Clover Medicare Advantage	$5.29
Rate for Payer: EmblemHealth Commercial	$16.71
Rate for Payer: Humana Medicare Advantage	$5.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.57
Rate for Payer: Wellcare Medicare Advantage	$5.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

CH CULTURE TYPE IMMUNO

Facility

$33.00

Service Code	HCPCS 87140
Hospital Charge Code	397071480
Hospital Revenue Code	309
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

CH CULTURE URINE

Facility

$399.41

Service Code	HCPCS 87086
Hospital Charge Code	397041068
Hospital Revenue Code	306
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$199.71
Rate for Payer: Aetna Commercial	$21.95
Rate for Payer: Aetna Medicare Advantage	$26.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.13
Rate for Payer: Cigna Commercial	$199.71
Rate for Payer: Cigna Medicare Advantage	$8.07
Rate for Payer: Clover Medicare Advantage	$7.67
Rate for Payer: EmblemHealth Commercial	$24.21
Rate for Payer: Humana Medicare Advantage	$8.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.91
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.07
Rate for Payer: Wellcare Medicare Advantage	$8.07
Rate for Payer: Wellpoint Medicaid Managed Care	$10.58

CH CULTURE URINE

Facility

$399.41

Service Code	HCPCS 87086
Hospital Charge Code	397041068
Hospital Revenue Code	306
Min. Negotiated Rate	$59.91
Max. Negotiated Rate	$59.91
Rate for Payer: Qualcare PPO/HMO/WC	$59.91

CH CYANIDE

Facility

$173.00

Service Code	HCPCS 82600
Hospital Charge Code	397072007
Hospital Revenue Code	301
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$52.77
Rate for Payer: Aetna Medicare Advantage	$62.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.03
Rate for Payer: Cigna Commercial	$86.50
Rate for Payer: Cigna Medicare Advantage	$19.40
Rate for Payer: Clover Medicare Advantage	$18.43
Rate for Payer: EmblemHealth Commercial	$58.20
Rate for Payer: Humana Medicare Advantage	$19.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.40
Rate for Payer: Wellcare Medicare Advantage	$19.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

CH CYANIDE

Facility

$173.00

Service Code	HCPCS 82600
Hospital Charge Code	397072007
Hospital Revenue Code	301
Min. Negotiated Rate	$25.95
Max. Negotiated Rate	$25.95
Rate for Payer: Qualcare PPO/HMO/WC	$25.95

CH CYCLIC AMP U

Facility

$1,079.00

Service Code	HCPCS 82030
Hospital Charge Code	397073151
Hospital Revenue Code	307
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$539.50
Rate for Payer: Aetna Commercial	$70.18
Rate for Payer: Aetna Medicare Advantage	$83.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.13
Rate for Payer: Cigna Commercial	$539.50
Rate for Payer: Cigna Medicare Advantage	$25.80
Rate for Payer: Clover Medicare Advantage	$24.51
Rate for Payer: EmblemHealth Commercial	$77.40
Rate for Payer: Humana Medicare Advantage	$26.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$323.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$161.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.80
Rate for Payer: Wellcare Medicare Advantage	$25.80
Rate for Payer: Wellpoint Medicaid Managed Care	$28.59

CH CYCLIC AMP U

Facility

$1,079.00

Service Code	HCPCS 82030
Hospital Charge Code	397073151
Hospital Revenue Code	307
Min. Negotiated Rate	$161.85
Max. Negotiated Rate	$161.85
Rate for Payer: Qualcare PPO/HMO/WC	$161.85

CH CYCLOSPORINE

Facility

$195.00

Service Code	HCPCS 80158
Hospital Charge Code	397072054
Hospital Revenue Code	301
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.10
Rate for Payer: Aetna Medicare Advantage	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.16
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: Cigna Medicare Advantage	$18.05
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.05
Rate for Payer: Wellcare Medicare Advantage	$18.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

CH CYCLOSPORINE

Facility

$195.00

Service Code	HCPCS 80158
Hospital Charge Code	397072054
Hospital Revenue Code	301
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

CH CYSTATHIONINE

Facility

$226.00

Service Code	HCPCS 82542
Hospital Charge Code	397073278
Hospital Revenue Code	301
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$113.00
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$5.99

CH CYSTATHIONINE

Facility

$226.00

Service Code	HCPCS 82542
Hospital Charge Code	397073278
Hospital Revenue Code	301
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$33.90
Rate for Payer: Qualcare PPO/HMO/WC	$33.90

CH CYSTICERCUS

Facility

$195.00

Service Code	HCPCS 86682
Hospital Charge Code	397072154
Hospital Revenue Code	302
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.39
Rate for Payer: Aetna Medicare Advantage	$42.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.96
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: Cigna Medicare Advantage	$13.01
Rate for Payer: Clover Medicare Advantage	$12.36
Rate for Payer: EmblemHealth Commercial	$39.03
Rate for Payer: Humana Medicare Advantage	$13.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.01
Rate for Payer: Wellcare Medicare Advantage	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

CH CYSTICERCUS

Facility

$195.00

Service Code	HCPCS 86682
Hospital Charge Code	397072154
Hospital Revenue Code	302
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

CH CYTOLOGY, ASPIRATES

Facility

$806.00

Service Code	HCPCS 88173
Hospital Charge Code	397061046
Hospital Revenue Code	311
Min. Negotiated Rate	$120.90
Max. Negotiated Rate	$120.90
Rate for Payer: Qualcare PPO/HMO/WC	$120.90

Know your out-of-pocket cost for care.

All Charges