Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR NEPHROSTOMY CATHETER CHANGE

Facility

$5,100.00

Service Code	HCPCS 75984
Hospital Charge Code	2002111
Hospital Revenue Code	320
Min. Negotiated Rate	$99.61
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

IR NEPHROSTOMY CATHETER CHANGE

Facility

$5,100.00

Service Code	HCPCS 75984
Hospital Charge Code	411075984
Hospital Revenue Code	320
Min. Negotiated Rate	$99.61
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

IR NEPHROSTOMY CATHETER CHANGE

Facility

$1,608.85

Service Code	HCPCS 75984
Hospital Charge Code	7411743
Hospital Revenue Code	320
Min. Negotiated Rate	$38.77
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$611.36
Rate for Payer: Aetna Medicare Advantage	$482.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.26
Rate for Payer: Cigna Commercial	$804.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$482.65
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$241.33
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$38.77
Rate for Payer: Wellpoint Medicaid Managed Care	$42.63

IR NEPHROSTOMY CATHETER CHANGE

Facility

$5,100.00

Service Code	HCPCS 75984
Hospital Charge Code	411075984
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

IR NEPHROSTOMY DILATION

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	2004935
Hospital Revenue Code	320
Min. Negotiated Rate	$267.13
Max. Negotiated Rate	$267.13
Rate for Payer: Qualcare PPO/HMO/WC	$267.13

IR NEPHROSTOMY DILATION

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	7411682
Hospital Revenue Code	320
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$1,738.40
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$267.13
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$42.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$47.19

IR NEPHROSTOMY DILATION

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	2004935
Hospital Revenue Code	320
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$1,738.40
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$267.13
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$42.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$47.19

IR NEPHROSTOMY DILATION

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	7411682
Hospital Revenue Code	320
Min. Negotiated Rate	$267.13
Max. Negotiated Rate	$267.13
Rate for Payer: Qualcare PPO/HMO/WC	$267.13

IR NEPHROSTOMY DILATION LEFT

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	7411683
Hospital Revenue Code	320
Min. Negotiated Rate	$267.13
Max. Negotiated Rate	$267.13
Rate for Payer: Qualcare PPO/HMO/WC	$267.13

IR NEPHROSTOMY DILATION LEFT

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	2600105
Hospital Revenue Code	320
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$1,738.40
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$267.13
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$42.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$47.19

IR NEPHROSTOMY DILATION LEFT

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	2600105
Hospital Revenue Code	320
Min. Negotiated Rate	$267.13
Max. Negotiated Rate	$267.13
Rate for Payer: Qualcare PPO/HMO/WC	$267.13

IR NEPHROSTOMY DILATION LEFT

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	7411683
Hospital Revenue Code	320
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$1,738.40
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$267.13
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$42.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$47.19

IR NEPHROSTOMY DILATION RIGHT

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	2600106
Hospital Revenue Code	320
Min. Negotiated Rate	$267.13
Max. Negotiated Rate	$267.13
Rate for Payer: Qualcare PPO/HMO/WC	$267.13

IR NEPHROSTOMY DILATION RIGHT

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	2600106
Hospital Revenue Code	320
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$1,738.40
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$267.13
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$42.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$47.19

IR NEPHROSTOMY DILATION RIGHT

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	7411684
Hospital Revenue Code	320
Min. Negotiated Rate	$42.92
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$1,738.40
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$267.13
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$42.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$47.19

IR NEPHROSTOMY DILATION RIGHT

Facility

$1,780.85

Service Code	HCPCS 74485
Hospital Charge Code	7411684
Hospital Revenue Code	320
Min. Negotiated Rate	$267.13
Max. Negotiated Rate	$267.13
Rate for Payer: Qualcare PPO/HMO/WC	$267.13

IR OFFICE CONSULTATION

Facility

$225.20

Service Code	HCPCS 99241
Hospital Charge Code	2101160
Hospital Revenue Code	510
Min. Negotiated Rate	$33.78
Max. Negotiated Rate	$33.78
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

IR OFFICE CONSULTATION

Facility

$225.20

Service Code	HCPCS 99241
Hospital Charge Code	2101160
Hospital Revenue Code	510
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$112.60
Rate for Payer: Aetna Commercial	$85.58
Rate for Payer: Aetna Medicare Advantage	$67.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.43
Rate for Payer: Cigna Commercial	$112.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.56
Rate for Payer: Qualcare PPO/HMO/WC	$33.78
Rate for Payer: UnitedHealthcare Community & State	$5.43
Rate for Payer: Wellpoint Medicaid Managed Care	$5.97

IRON

Facility

$239.00

Service Code	HCPCS 83540
Hospital Charge Code	38472425
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

IRON

Facility

$239.00

Service Code	HCPCS 83540
Hospital Charge Code	38472425
Hospital Revenue Code	301
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IRON B12 VIT C,E, FOLATE TAB

Facility

$8.35

Hospital Charge Code	60628498
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.25

IRON B12 VIT C,E, FOLATE TAB

Facility

$8.35

Hospital Charge Code	60628498
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna Commercial	$3.17
Rate for Payer: Aetna Medicare Advantage	$2.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.13
Rate for Payer: Cigna Commercial	$4.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$1.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.25
Rate for Payer: UnitedHealthcare Commercial	$1.67
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

IRON BINDING CAP

Facility

$267.00

Service Code	HCPCS 83550
Hospital Charge Code	38479471
Hospital Revenue Code	301
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

IRON BINDING CAP

Facility

$267.00

Service Code	HCPCS 83550
Hospital Charge Code	38479471
Hospital Revenue Code	301
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna Commercial	$23.77
Rate for Payer: Aetna Medicare Advantage	$28.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.55
Rate for Payer: Cigna Commercial	$133.50
Rate for Payer: Cigna Medicare Advantage	$8.74
Rate for Payer: Clover Medicare Advantage	$8.30
Rate for Payer: EmblemHealth Commercial	$26.22
Rate for Payer: Humana Medicare Advantage	$9.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.74
Rate for Payer: Wellcare Medicare Advantage	$8.74
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

IRON BINDING CAPACITY

Facility

$267.00

Service Code	HCPCS 83550
Hospital Charge Code	38472428
Hospital Revenue Code	301
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

Know your out-of-pocket cost for care.

All Charges