Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH SODIUM OTHER SOURCE

Facility

$30.00

Service Code	HCPCS 84302
Hospital Charge Code	397073682
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

CH SODIUM RANDOM URINE

Facility

$97.57

Service Code	HCPCS 84300
Hospital Charge Code	397073111
Hospital Revenue Code	301
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$14.64
Rate for Payer: Qualcare PPO/HMO/WC	$14.64

CH SODIUM RANDOM URINE

Facility

$97.57

Service Code	HCPCS 84300
Hospital Charge Code	397073111
Hospital Revenue Code	301
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.27
Rate for Payer: Cigna Commercial	$48.78
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.64
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

CH SODIUM URINE 24 HR

Facility

$78.00

Service Code	HCPCS 84300
Hospital Charge Code	397071255
Hospital Revenue Code	301
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.27
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

CH SODIUM URINE 24 HR

Facility

$78.00

Service Code	HCPCS 84300
Hospital Charge Code	397071255
Hospital Revenue Code	301
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

CH SOLUBLE LIVER AG

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	397043278
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

CH SOLUBLE LIVER AG

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	397043278
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH SOMATOMEDIN C

Facility

$714.00

Service Code	HCPCS 84305
Hospital Charge Code	397072125
Hospital Revenue Code	301
Min. Negotiated Rate	$17.01
Max. Negotiated Rate	$357.00
Rate for Payer: Aetna Commercial	$57.83
Rate for Payer: Aetna Medicare Advantage	$68.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.74
Rate for Payer: Cigna Commercial	$357.00
Rate for Payer: Cigna Medicare Advantage	$21.26
Rate for Payer: Clover Medicare Advantage	$20.20
Rate for Payer: EmblemHealth Commercial	$63.78
Rate for Payer: Humana Medicare Advantage	$21.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$107.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.26
Rate for Payer: Wellcare Medicare Advantage	$21.26
Rate for Payer: Wellpoint Medicaid Managed Care	$18.92

CH SOMATOMEDIN C

Facility

$714.00

Service Code	HCPCS 84305
Hospital Charge Code	397072125
Hospital Revenue Code	301
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$107.10
Rate for Payer: Qualcare PPO/HMO/WC	$107.10

CH SOMATOSTATIN

Facility

$158.00

Service Code	HCPCS 84307
Hospital Charge Code	397071472
Hospital Revenue Code	301
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$723.02
Rate for Payer: Aetna Commercial	$49.72
Rate for Payer: Aetna Medicare Advantage	$59.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.99
Rate for Payer: Cigna Commercial	$79.00
Rate for Payer: Cigna Medicare Advantage	$18.28
Rate for Payer: Clover Medicare Advantage	$17.37
Rate for Payer: EmblemHealth Commercial	$54.84
Rate for Payer: Humana Medicare Advantage	$18.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.28
Rate for Payer: Wellcare Medicare Advantage	$18.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

CH SOMATOSTATIN

Facility

$158.00

Service Code	HCPCS 84307
Hospital Charge Code	397071472
Hospital Revenue Code	301
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

CH SPECIAL CULTURE

Facility

$390.00

Service Code	HCPCS 87070
Hospital Charge Code	397071520
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH SPECIAL CULTURE

Facility

$390.00

Service Code	HCPCS 87070
Hospital Charge Code	397071520
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

CH SPECIAL STAINS GROUP I

Facility

$390.00

Service Code	HCPCS 88312
Hospital Charge Code	397061366
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH SPECIAL STAINS GROUP I

Facility

$390.00

Service Code	HCPCS 88312
Hospital Charge Code	397061366
Hospital Revenue Code	310
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
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	$175.00
Rate for Payer: UnitedHealthcare Community & State	$92.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH SPECIAL STAINS GROUP II

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061365
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CH SPECIAL STAINS GROUP II

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	397061365
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

CH SPECIFIC GRAVITY FLUID

Facility

$25.00

Service Code	HCPCS 84315
Hospital Charge Code	397073166
Hospital Revenue Code	301
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$8.92
Rate for Payer: Aetna Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: Cigna Medicare Advantage	$3.28
Rate for Payer: Clover Medicare Advantage	$3.12
Rate for Payer: EmblemHealth Commercial	$9.84
Rate for Payer: Humana Medicare Advantage	$3.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.28
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	$2.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.28
Rate for Payer: Wellcare Medicare Advantage	$3.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

CH SPECIFIC GRAVITY FLUID

Facility

$25.00

Service Code	HCPCS 84315
Hospital Charge Code	397073166
Hospital Revenue Code	301
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

CH SPECIFIC GRAVITY URINE

Facility

$22.00

Service Code	HCPCS 81003
Hospital Charge Code	397073028
Hospital Revenue Code	307
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$6.12
Rate for Payer: Aetna Medicare Advantage	$7.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.25
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	$8.12
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: Cigna Medicare Advantage	$2.25
Rate for Payer: Clover Medicare Advantage	$2.14
Rate for Payer: EmblemHealth Commercial	$6.75
Rate for Payer: Humana Medicare Advantage	$2.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.25
Rate for Payer: Wellcare Medicare Advantage	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

CH SPECIFIC GRAVITY URINE

Facility

$22.00

Service Code	HCPCS 81003
Hospital Charge Code	397073028
Hospital Revenue Code	307
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

CH SPEC STAIN INC BODIES

Facility

$78.00

Service Code	HCPCS 87207
Hospital Charge Code	397073657
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$16.29
Rate for Payer: Aetna Medicare Advantage	$19.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.99
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	$21.62
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$5.69
Rate for Payer: EmblemHealth Commercial	$17.97
Rate for Payer: Humana Medicare Advantage	$6.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.99
Rate for Payer: Wellcare Medicare Advantage	$5.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

CH SPEC STAIN INC BODIES

Facility

$78.00

Service Code	HCPCS 87207
Hospital Charge Code	397073657
Hospital Revenue Code	309
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

CH SPINOBULBAR MUSC ATROPHY

Facility

$1,948.00

Hospital Charge Code	3970726
Hospital Revenue Code	301
Min. Negotiated Rate	$46.95
Max. Negotiated Rate	$974.00
Rate for Payer: Aetna Commercial	$740.24
Rate for Payer: Aetna Medicare Advantage	$584.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$496.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$496.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$496.74
Rate for Payer: Cigna Commercial	$974.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$584.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$292.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$46.95
Rate for Payer: Wellpoint Medicaid Managed Care	$51.62

CH SPINOBULBAR MUSC ATROPHY

Facility

$1,948.00

Hospital Charge Code	3970726
Hospital Revenue Code	301
Min. Negotiated Rate	$292.20
Max. Negotiated Rate	$292.20
Rate for Payer: Qualcare PPO/HMO/WC	$292.20

Know your out-of-pocket cost for care.

All Charges