Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CHRONOS 10cc

Facility

$2,960.20

Hospital Charge Code	270639428
Hospital Revenue Code	278
Min. Negotiated Rate	$71.34
Max. Negotiated Rate	$1,480.10
Rate for Payer: Aetna Commercial	$1,124.88
Rate for Payer: Aetna Medicare Advantage	$888.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$754.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$754.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$592.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$754.85
Rate for Payer: Cigna Commercial	$1,480.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$716.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$651.24
Rate for Payer: Qualcare PPO/HMO/WC	$444.03
Rate for Payer: UnitedHealthcare Community & State	$71.34
Rate for Payer: Wellpoint Medicaid Managed Care	$78.45

CHRONOS GRANULE 1.4-2.8mm/20cc

Facility

$4,227.10

Hospital Charge Code	270645879
Hospital Revenue Code	278
Min. Negotiated Rate	$634.07
Max. Negotiated Rate	$1,022.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$845.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,022.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$929.96
Rate for Payer: Qualcare PPO/HMO/WC	$634.07

CHRONOS GRANULE 1.4-2.8mm/20cc

Facility

$4,227.10

Hospital Charge Code	270645879
Hospital Revenue Code	278
Min. Negotiated Rate	$101.87
Max. Negotiated Rate	$2,113.55
Rate for Payer: Aetna Commercial	$1,606.30
Rate for Payer: Aetna Medicare Advantage	$1,268.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,077.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,077.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$845.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,077.91
Rate for Payer: Cigna Commercial	$2,113.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,022.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$929.96
Rate for Payer: Qualcare PPO/HMO/WC	$634.07
Rate for Payer: UnitedHealthcare Community & State	$101.87
Rate for Payer: Wellpoint Medicaid Managed Care	$112.02

CHRONULAC/10GM/15ML

Facility

$293.00

Hospital Charge Code	60632698
Hospital Revenue Code	250
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.90
Rate for Payer: Oxford Commercial	$58.60
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$58.60
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

CHRONULAC/10GM/15ML

Facility

$293.00

Hospital Charge Code	60632698
Hospital Revenue Code	250
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

CH ROSETTE TEST

Facility

$390.00

Service Code	HCPCS 85461
Hospital Charge Code	397031055
Hospital Revenue Code	305
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$30.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.79
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.36
Rate for Payer: Clover Medicare Advantage	$8.89
Rate for Payer: EmblemHealth Commercial	$28.08
Rate for Payer: Humana Medicare Advantage	$9.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.36
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	$7.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.36
Rate for Payer: Wellcare Medicare Advantage	$9.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH ROSETTE TEST

Facility

$390.00

Service Code	HCPCS 85461
Hospital Charge Code	397031055
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CHROSOME COUNT 5C,1KW BANDING

Facility

$1,251.60

Service Code	HCPCS 88261
Hospital Charge Code	38477215
Hospital Revenue Code	311
Min. Negotiated Rate	$187.74
Max. Negotiated Rate	$187.74
Rate for Payer: Qualcare PPO/HMO/WC	$187.74

CHROSOME COUNT 5C,1KW BANDING

Facility

$1,251.60

Service Code	HCPCS 88261
Hospital Charge Code	38477215
Hospital Revenue Code	311
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$954.19
Rate for Payer: Aetna Commercial	$719.00
Rate for Payer: Aetna Medicare Advantage	$856.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$954.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$954.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$264.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$954.19
Rate for Payer: Cigna Commercial	$625.80
Rate for Payer: Cigna Medicare Advantage	$264.34
Rate for Payer: Clover Medicare Advantage	$251.12
Rate for Payer: EmblemHealth Commercial	$793.02
Rate for Payer: Humana Medicare Advantage	$272.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$264.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.74
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$30.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$264.34
Rate for Payer: Wellcare Medicare Advantage	$264.34
Rate for Payer: Wellpoint Medicaid Managed Care	$33.17

CH ROTAVIRUS AG

Facility

$390.00

Service Code	HCPCS 87425
Hospital Charge Code	397041145
Hospital Revenue Code	306
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
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	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH ROTAVIRUS AG

Facility

$390.00

Service Code	HCPCS 87425
Hospital Charge Code	397041145
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH RUBELLA AB IGG

Facility

$667.59

Service Code	HCPCS 86762
Hospital Charge Code	397041197
Hospital Revenue Code	302
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
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	$51.94
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

CH RUBELLA AB IGG

Facility

$667.59

Service Code	HCPCS 86762
Hospital Charge Code	397041197
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH RUBELLA AB (IGG) QUANT

Facility

$25.00

Service Code	HCPCS 86762
Hospital Charge Code	397071413
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

CH RUBELLA AB (IGG) QUANT

Facility

$25.00

Service Code	HCPCS 86762
Hospital Charge Code	397071413
Hospital Revenue Code	302
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
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	$51.94
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

CH SALICYLATE

Facility

$194.00

Service Code	HCPCS 80329
Hospital Charge Code	397071280
Hospital Revenue Code	301
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$29.10
Rate for Payer: Qualcare PPO/HMO/WC	$29.10

CH SALICYLATE

Facility

$194.00

Service Code	HCPCS 80329
Hospital Charge Code	397071280
Hospital Revenue Code	301
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$73.72
Rate for Payer: Aetna Medicare Advantage	$58.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.47
Rate for Payer: Cigna Commercial	$97.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.14

CH SECOND MRSA SCREEN

Facility

$667.59

Service Code	HCPCS 87070
Hospital Charge Code	397043274
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$333.80
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	$333.80
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	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
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	$17.69

CH SECOND MRSA SCREEN

Facility

$667.59

Service Code	HCPCS 87070
Hospital Charge Code	397043274
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH SEDIMENTATION RATE-AUTO

Facility

$80.00

Service Code	HCPCS 85652
Hospital Charge Code	397021010
Hospital Revenue Code	305
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: Aetna Medicare Advantage	$8.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.75
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: Cigna Medicare Advantage	$2.70
Rate for Payer: Clover Medicare Advantage	$2.56
Rate for Payer: EmblemHealth Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$2.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.70
Rate for Payer: Wellcare Medicare Advantage	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

CH SEDIMENTATION RATE-AUTO

Facility

$80.00

Service Code	HCPCS 85652
Hospital Charge Code	397021010
Hospital Revenue Code	305
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

CH SELENIUM

Facility

$883.27

Service Code	HCPCS 84255
Hospital Charge Code	397071434
Hospital Revenue Code	301
Min. Negotiated Rate	$20.42
Max. Negotiated Rate	$441.63
Rate for Payer: Aetna Commercial	$69.44
Rate for Payer: Aetna Medicare Advantage	$82.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.16
Rate for Payer: Cigna Commercial	$441.63
Rate for Payer: Cigna Medicare Advantage	$25.53
Rate for Payer: Clover Medicare Advantage	$24.25
Rate for Payer: EmblemHealth Commercial	$76.59
Rate for Payer: Humana Medicare Advantage	$26.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.53
Rate for Payer: Wellcare Medicare Advantage	$25.53
Rate for Payer: Wellpoint Medicaid Managed Care	$23.41

CH SELENIUM

Facility

$883.27

Service Code	HCPCS 84255
Hospital Charge Code	397071434
Hospital Revenue Code	301
Min. Negotiated Rate	$132.49
Max. Negotiated Rate	$132.49
Rate for Payer: Qualcare PPO/HMO/WC	$132.49

CH SEMEN ANALYSIS

Facility

$214.00

Service Code	HCPCS 89320
Hospital Charge Code	397021046
Hospital Revenue Code	300
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.48
Rate for Payer: Aetna Medicare Advantage	$39.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.44
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: Cigna Medicare Advantage	$12.31
Rate for Payer: Clover Medicare Advantage	$11.69
Rate for Payer: EmblemHealth Commercial	$36.93
Rate for Payer: Humana Medicare Advantage	$12.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.31
Rate for Payer: Wellcare Medicare Advantage	$12.31
Rate for Payer: Wellpoint Medicaid Managed Care	$5.67

CH SEMEN ANALYSIS

Facility

$214.00

Service Code	HCPCS 89320
Hospital Charge Code	397021046
Hospital Revenue Code	300
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

Know your out-of-pocket cost for care.

All Charges