Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEMODIALYSIS OP ESRD

Facility

$2,800.00

Service Code	HCPCS 90999
Hospital Charge Code	8200040
Hospital Revenue Code	821
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

HEMODIALYSIS OP NONPAT/ER

Facility

$2,800.00

Service Code	HCPCS 90935
Hospital Charge Code	8200521
Hospital Revenue Code	829
Min. Negotiated Rate	$67.48
Max. Negotiated Rate	$4,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,943.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,943.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$815.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$842.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,943.20
Rate for Payer: Cigna Commercial	$1,634.39
Rate for Payer: Clover Medicare Advantage	$774.59
Rate for Payer: EmblemHealth Commercial	$2,446.08
Rate for Payer: Humana Medicare Advantage	$839.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$815.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$700.00
Rate for Payer: Oxford Commercial	$2,546.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$4,468.00
Rate for Payer: UnitedHealthcare Community & State	$67.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$815.36
Rate for Payer: Wellcare Medicare Advantage	$815.36
Rate for Payer: Wellpoint Medicaid Managed Care	$74.20

HEMODIALYSIS OP NONPAT/ER

Facility

$2,800.00

Service Code	HCPCS 90935
Hospital Charge Code	8200521
Hospital Revenue Code	829
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

HEMOGLOB ELECTROPHORESIS

Facility

$406.00

Service Code	HCPCS 83020
Hospital Charge Code	38479437
Hospital Revenue Code	301
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$203.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
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	$46.46
Rate for Payer: Cigna Commercial	$203.00
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.76

HEMOGLOB ELECTROPHORESIS

Facility

$406.00

Service Code	HCPCS 83020
Hospital Charge Code	38479437
Hospital Revenue Code	301
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$60.90
Rate for Payer: Qualcare PPO/HMO/WC	$60.90

HEMOGLOBIN A1C

Facility

$66.70

Service Code	HCPCS 83036
Hospital Charge Code	39900092
Hospital Revenue Code	301
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.05
Rate for Payer: Cigna Commercial	$33.35
Rate for Payer: Cigna Medicare Advantage	$9.71
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.01
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Medicare Advantage	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.77

HEMOGLOBIN A1C

Facility

$13.66

Service Code	HCPCS 83036CF
Hospital Charge Code	8200314RS
Hospital Revenue Code	301
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

HEMOGLOBIN A1C

Facility

$13.66

Service Code	HCPCS 83036CF
Hospital Charge Code	8200314RS
Hospital Revenue Code	301
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

HEMOGLOBIN A1C

Facility

$616.31

Service Code	HCPCS 83036
Hospital Charge Code	39888001
Hospital Revenue Code	301
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$308.15
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.05
Rate for Payer: Cigna Commercial	$308.15
Rate for Payer: Cigna Medicare Advantage	$9.71
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Medicare Advantage	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

HEMOGLOBIN A1C

Facility

$66.70

Service Code	HCPCS 83036
Hospital Charge Code	39900092
Hospital Revenue Code	301
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$10.01
Rate for Payer: Qualcare PPO/HMO/WC	$10.01

HEMOGLOBIN A1C

Facility

$616.31

Service Code	HCPCS 83036
Hospital Charge Code	39888001
Hospital Revenue Code	301
Min. Negotiated Rate	$92.45
Max. Negotiated Rate	$92.45
Rate for Payer: Qualcare PPO/HMO/WC	$92.45

HEMOGLOBIN A1C GLYCOHEMOGLOB

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3031796
Hospital Revenue Code	301
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.05
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: Cigna Medicare Advantage	$9.71
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Medicare Advantage	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

HEMOGLOBIN A1C GLYCOHEMOGLOB

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3031796
Hospital Revenue Code	301
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

HEMOGLOBIN A1C (GLYCO HGB)***

Facility

$35.00

Service Code	HCPCS 83036
Hospital Charge Code	3004272
Hospital Revenue Code	301
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

HEMOGLOBIN A1C (GLYCO HGB)***

Facility

$35.00

Service Code	HCPCS 83036
Hospital Charge Code	3004272
Hospital Revenue Code	301
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.05
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: Cigna Medicare Advantage	$9.71
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Medicare Advantage	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

HEMOGLOBIN A2

Facility

$3,255.00

Service Code	HCPCS 83020
Hospital Charge Code	38472398
Hospital Revenue Code	301
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
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	$46.46
Rate for Payer: Cigna Commercial	$1,627.50
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$976.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$488.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$86.26

HEMOGLOBIN A2

Facility

$3,255.00

Service Code	HCPCS 83020
Hospital Charge Code	38472398
Hospital Revenue Code	301
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$488.25
Rate for Payer: Qualcare PPO/HMO/WC	$488.25

HEMOGLOBIN A2+F

Facility

$649.00

Service Code	HCPCS 82542
Hospital Charge Code	38479438
Hospital Revenue Code	301
Min. Negotiated Rate	$97.35
Max. Negotiated Rate	$97.35
Rate for Payer: Qualcare PPO/HMO/WC	$97.35

HEMOGLOBIN A2+F

Facility

$649.00

Service Code	HCPCS 82542
Hospital Charge Code	38479438
Hospital Revenue Code	301
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$324.50
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	$324.50
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	$194.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.35
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	$17.20

HEMOGLOBIN A2 + F

Facility

$649.00

Service Code	HCPCS 82542
Hospital Charge Code	38472009
Hospital Revenue Code	301
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$324.50
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	$324.50
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	$194.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.35
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	$17.20

HEMOGLOBIN A2 + F

Facility

$649.00

Service Code	HCPCS 82542
Hospital Charge Code	38472009
Hospital Revenue Code	301
Min. Negotiated Rate	$97.35
Max. Negotiated Rate	$97.35
Rate for Payer: Qualcare PPO/HMO/WC	$97.35

HEMOGLOBIN A2 & FETAL

Facility

$124.10

Service Code	HCPCS 83021
Hospital Charge Code	39900091
Hospital Revenue Code	301
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.12
Rate for Payer: Aetna Medicare Advantage	$58.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.06
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	$65.19
Rate for Payer: Cigna Commercial	$62.05
Rate for Payer: Cigna Medicare Advantage	$18.06
Rate for Payer: Clover Medicare Advantage	$17.16
Rate for Payer: EmblemHealth Commercial	$54.18
Rate for Payer: Humana Medicare Advantage	$18.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.61
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.06
Rate for Payer: Wellcare Medicare Advantage	$18.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

HEMOGLOBIN A2 & FETAL

Facility

$124.10

Service Code	HCPCS 83021
Hospital Charge Code	39900091
Hospital Revenue Code	301
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$18.61

HEMOGLOBIN A2 QUANT

Facility

$383.25

Service Code	HCPCS 84311
Hospital Charge Code	3031797
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$191.62
Rate for Payer: Aetna Commercial	$22.03
Rate for Payer: Aetna Medicare Advantage	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.24
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: Cigna Medicare Advantage	$8.10
Rate for Payer: Clover Medicare Advantage	$7.70
Rate for Payer: EmblemHealth Commercial	$24.30
Rate for Payer: Humana Medicare Advantage	$8.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.10
Rate for Payer: Wellcare Medicare Advantage	$8.10
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

HEMOGLOBIN A2 QUANT

Facility

$383.25

Service Code	HCPCS 84311
Hospital Charge Code	3031797
Hospital Revenue Code	301
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

Know your out-of-pocket cost for care.

All Charges