Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH PROLACTIN, TOTAL & FREE

Facility

$416.00

Service Code	HCPCS 84146
Hospital Charge Code	397071494
Hospital Revenue Code	301
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$62.40

CH PROPOXPHENE CONF GCMS

Facility

$318.00

Service Code	HCPCS 80300
Hospital Charge Code	397073077
Hospital Revenue Code	301
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$47.70

CH PROPOXPHENE CONF GCMS

Facility

$318.00

Service Code	HCPCS 80300
Hospital Charge Code	397073077
Hospital Revenue Code	301
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$120.84
Rate for Payer: Aetna Medicare Advantage	$95.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.09
Rate for Payer: Cigna Commercial	$159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: Wellpoint Medicaid Managed Care	$8.43

CH PRO-PREDICTRX METAB

Facility

$1,323.00

Service Code	HCPCS 80299
Hospital Charge Code	397070007
Hospital Revenue Code	301
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$198.45
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

CH PRO-PREDICTRX METAB

Facility

$1,323.00

Service Code	HCPCS 80299
Hospital Charge Code	397070007
Hospital Revenue Code	301
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$661.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$35.06

CH PRO PREDICTRX METABOLITES

Facility

$295.00

Service Code	HCPCS 82542
Hospital Charge Code	397070023
Hospital Revenue Code	301
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$147.50
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	$147.50
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	$88.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
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	$7.82

CH PRO PREDICTRX METABOLITES

Facility

$295.00

Service Code	HCPCS 82542
Hospital Charge Code	397070023
Hospital Revenue Code	301
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

CH PROSTATIC ACID PHOSP

Facility

$244.00

Service Code	HCPCS 84066
Hospital Charge Code	397071207
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.28
Rate for Payer: Aetna Medicare Advantage	$31.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.87
Rate for Payer: Cigna Commercial	$122.00
Rate for Payer: Cigna Medicare Advantage	$9.66
Rate for Payer: Clover Medicare Advantage	$9.18
Rate for Payer: EmblemHealth Commercial	$28.98
Rate for Payer: Humana Medicare Advantage	$9.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.66
Rate for Payer: Wellcare Medicare Advantage	$9.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.47

CH PROSTATIC ACID PHOSP

Facility

$244.00

Service Code	HCPCS 84066
Hospital Charge Code	397071207
Hospital Revenue Code	301
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

CH PROTEIN 24HR URINE

Facility

$75.00

Service Code	HCPCS 84156
Hospital Charge Code	397071080
Hospital Revenue Code	301
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

CH PROTEIN 24HR URINE

Facility

$75.00

Service Code	HCPCS 84156
Hospital Charge Code	397071080
Hospital Revenue Code	301
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.98
Rate for Payer: Aetna Medicare Advantage	$11.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.25
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: Cigna Medicare Advantage	$3.67
Rate for Payer: Clover Medicare Advantage	$3.49
Rate for Payer: EmblemHealth Commercial	$11.01
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.67
Rate for Payer: Wellcare Medicare Advantage	$3.67
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

CH PROTEIN BODY FLUIDS

Facility

$68.75

Service Code	HCPCS 84157
Hospital Charge Code	397071110
Hospital Revenue Code	301
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$15,880.57
Rate for Payer: Aetna Commercial	$10.88
Rate for Payer: Aetna Medicare Advantage	$12.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.44
Rate for Payer: Cigna Commercial	$34.38
Rate for Payer: Cigna Medicare Advantage	$4.00
Rate for Payer: Clover Medicare Advantage	$3.80
Rate for Payer: EmblemHealth Commercial	$12.00
Rate for Payer: Humana Medicare Advantage	$4.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.00
Rate for Payer: Wellcare Medicare Advantage	$4.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,880.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

CH PROTEIN BODY FLUIDS

Facility

$68.75

Service Code	HCPCS 84157
Hospital Charge Code	397071110
Hospital Revenue Code	301
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$10.31
Rate for Payer: Qualcare PPO/HMO/WC	$10.31

CH PROTEIN C

Facility

$75.00

Service Code	HCPCS 85302
Hospital Charge Code	397072068
Hospital Revenue Code	305
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.67
Rate for Payer: Aetna Medicare Advantage	$38.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: Cigna Medicare Advantage	$12.01
Rate for Payer: Clover Medicare Advantage	$11.41
Rate for Payer: EmblemHealth Commercial	$36.03
Rate for Payer: Humana Medicare Advantage	$12.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.01
Rate for Payer: Wellcare Medicare Advantage	$12.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

CH PROTEIN C

Facility

$75.00

Service Code	HCPCS 85302
Hospital Charge Code	397072068
Hospital Revenue Code	305
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

CH PROTEIN C

Facility

$449.00

Service Code	HCPCS 85302
Hospital Charge Code	397021298
Hospital Revenue Code	305
Min. Negotiated Rate	$67.35
Max. Negotiated Rate	$67.35
Rate for Payer: Qualcare PPO/HMO/WC	$67.35

CH PROTEIN C

Facility

$449.00

Service Code	HCPCS 85302
Hospital Charge Code	397021298
Hospital Revenue Code	305
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$224.50
Rate for Payer: Aetna Commercial	$32.67
Rate for Payer: Aetna Medicare Advantage	$38.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$224.50
Rate for Payer: Cigna Medicare Advantage	$12.01
Rate for Payer: Clover Medicare Advantage	$11.41
Rate for Payer: EmblemHealth Commercial	$36.03
Rate for Payer: Humana Medicare Advantage	$12.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.01
Rate for Payer: Wellcare Medicare Advantage	$12.01
Rate for Payer: Wellpoint Medicaid Managed Care	$11.90

CH PROTEIN C, ANTIGEN

Facility

$72.00

Service Code	HCPCS 85302
Hospital Charge Code	397071447
Hospital Revenue Code	305
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

CH PROTEIN C, ANTIGEN

Facility

$72.00

Service Code	HCPCS 85302
Hospital Charge Code	397071447
Hospital Revenue Code	305
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.67
Rate for Payer: Aetna Medicare Advantage	$38.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: Cigna Medicare Advantage	$12.01
Rate for Payer: Clover Medicare Advantage	$11.41
Rate for Payer: EmblemHealth Commercial	$36.03
Rate for Payer: Humana Medicare Advantage	$12.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.01
Rate for Payer: Wellcare Medicare Advantage	$12.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

CH PROTEIN ELECTRO FL

Facility

$68.00

Service Code	HCPCS 84165
Hospital Charge Code	397071193
Hospital Revenue Code	301
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

CH PROTEIN ELECTRO FL

Facility

$68.00

Service Code	HCPCS 84165
Hospital Charge Code	397071193
Hospital Revenue Code	301
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
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	$38.77
Rate for Payer: Cigna Commercial	$34.00
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.80

CH PROTEIN ELECTROPHOR

Facility

$170.00

Service Code	HCPCS 84165
Hospital Charge Code	397071161
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
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	$38.77
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

CH PROTEIN ELECTROPHOR

Facility

$170.00

Service Code	HCPCS 84165
Hospital Charge Code	397071161
Hospital Revenue Code	301
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

CH PROTEIN ELECTROPHOR CSF

Facility

$113.00

Service Code	HCPCS 84166
Hospital Charge Code	397071375
Hospital Revenue Code	301
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.50
Rate for Payer: Aetna Medicare Advantage	$57.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.36
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: Cigna Medicare Advantage	$17.83
Rate for Payer: Clover Medicare Advantage	$16.94
Rate for Payer: EmblemHealth Commercial	$53.49
Rate for Payer: Humana Medicare Advantage	$18.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.83
Rate for Payer: Wellcare Medicare Advantage	$17.83
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

CH PROTEIN ELECTROPHOR CSF

Facility

$113.00

Service Code	HCPCS 84166
Hospital Charge Code	397071375
Hospital Revenue Code	301
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

Know your out-of-pocket cost for care.

All Charges