Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CRYPTOSPORIDIUM

Facility

$178.00

Service Code	HCPCS 87328
Hospital Charge Code	38475104
Hospital Revenue Code	306
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.59
Rate for Payer: Aetna Medicare Advantage	$44.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.89
Rate for Payer: Cigna Commercial	$89.00
Rate for Payer: Cigna Medicare Advantage	$13.82
Rate for Payer: Clover Medicare Advantage	$13.13
Rate for Payer: EmblemHealth Commercial	$41.46
Rate for Payer: Humana Medicare Advantage	$14.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.82
Rate for Payer: Wellcare Medicare Advantage	$13.82
Rate for Payer: Wellpoint Medicaid Managed Care	$4.72

CRYPTOSPORIDIUM

Facility

$178.00

Service Code	HCPCS 87328
Hospital Charge Code	38475104
Hospital Revenue Code	306
Min. Negotiated Rate	$26.70
Max. Negotiated Rate	$26.70
Rate for Payer: Qualcare PPO/HMO/WC	$26.70

CRYPTOSPORIDIUM

Facility

$433.00

Service Code	HCPCS 87272
Hospital Charge Code	38475038
Hospital Revenue Code	309
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$216.50
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	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$216.50
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	$129.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.95
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	$11.47

CRYPTOSPORIDIUM

Facility

$433.00

Service Code	HCPCS 87272
Hospital Charge Code	38475038
Hospital Revenue Code	309
Min. Negotiated Rate	$64.95
Max. Negotiated Rate	$64.95
Rate for Payer: Qualcare PPO/HMO/WC	$64.95

CRYPTOSPORIDIUM AG,STOOL

Facility

$75.65

Service Code	HCPCS 87272
Hospital Charge Code	39900280
Hospital Revenue Code	306
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

CRYPTOSPORIDIUM AG,STOOL

Facility

$75.65

Service Code	HCPCS 87272
Hospital Charge Code	39900280
Hospital Revenue Code	306
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$124.00
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	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$37.83
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	$22.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
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	$2.00

CRYPTOSPORIDIUM AG,STOOL I

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	3990127A
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CRYPTOSPORIDIUM AG,STOOL I

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	3990127A
Hospital Revenue Code	309
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.11
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
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	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CRYPTOSPORIDIUM AG,STOOL II

Facility

$390.00

Service Code	HCPCS 87272
Hospital Charge Code	3990127B
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CRYPTOSPORIDIUM AG,STOOL II

Facility

$390.00

Service Code	HCPCS 87272
Hospital Charge Code	3990127B
Hospital Revenue Code	309
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	$12.08
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

CRYPTOSPORIDIUM SMEAR

Facility

$133.65

Service Code	HCPCS 87207
Hospital Charge Code	3009297
Hospital Revenue Code	309
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

CRYPTOSPORIDIUM SMEAR

Facility

$133.65

Service Code	HCPCS 87207
Hospital Charge Code	3009297
Hospital Revenue Code	309
Min. Negotiated Rate	$3.54
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	$66.83
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	$40.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
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	$3.54

CRYPTOSPORODIUM AG, STOOL2

Facility

$71.25

Service Code	HCPCS 87206
Hospital Charge Code	3035085B
Hospital Revenue Code	300
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$35.62
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

CRYPTOSPORODIUM AG, STOOL2

Facility

$71.25

Service Code	HCPCS 87206
Hospital Charge Code	3035085B
Hospital Revenue Code	300
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$10.69
Rate for Payer: Qualcare PPO/HMO/WC	$10.69

CRYSTAL IDENTIFICATION FLUID

Facility

$209.00

Service Code	HCPCS 89060
Hospital Charge Code	38477030
Hospital Revenue Code	309
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$124.00
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	$104.50
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	$62.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.35
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	$5.54

CRYSTAL IDENTIFICATION FLUID

Facility

$209.00

Service Code	HCPCS 89060
Hospital Charge Code	38477030
Hospital Revenue Code	309
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$31.35
Rate for Payer: Qualcare PPO/HMO/WC	$31.35

CRYSTAL ID (MICRO ANALYSIS)

Facility

$390.00

Service Code	HCPCS 89060
Hospital Charge Code	3001040
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CRYSTAL ID (MICRO ANALYSIS)

Facility

$390.00

Service Code	HCPCS 89060
Hospital Charge Code	3001040
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

CRYSTALINE NON-BRAIDED HI PRES

Facility

$6.50

Hospital Charge Code	270653898
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

CRYSTALINE NON-BRAIDED HI PRES

Facility

$6.50

Hospital Charge Code	270653898
Hospital Revenue Code	272
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

CRYSTALS,SYNOVIAL FLUID

Facility

$103.25

Service Code	HCPCS 89060
Hospital Charge Code	3001041
Hospital Revenue Code	309
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
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	$51.62
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	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
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	$2.74

CRYSTALS,SYNOVIAL FLUID

Facility

$103.25

Service Code	HCPCS 89060
Hospital Charge Code	3001041
Hospital Revenue Code	309
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

CRYSTAL VIOLET STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005256
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

CRYSTAL VIOLET STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005256
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

CRYST NONBRAID HIPRSS CONN L72

Facility

$32.50

Hospital Charge Code	2709003716
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

Know your out-of-pocket cost for care.

All Charges