Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VITAMIN B6,PLASMA

Facility

$193.10

Service Code	HCPCS 84207
Hospital Charge Code	39900126
Hospital Revenue Code	301
Min. Negotiated Rate	$28.96
Max. Negotiated Rate	$28.96
Rate for Payer: Qualcare PPO/HMO/WC	$28.96

VITAMIN B6,PLASMA

Facility

$193.10

Service Code	HCPCS 84207
Hospital Charge Code	39900126
Hospital Revenue Code	301
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$24,078.00
Rate for Payer: Aetna Commercial	$76.43
Rate for Payer: Aetna Medicare Advantage	$91.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.43
Rate for Payer: Cigna Commercial	$96.55
Rate for Payer: Cigna Medicare Advantage	$28.10
Rate for Payer: Clover Medicare Advantage	$26.70
Rate for Payer: EmblemHealth Commercial	$84.30
Rate for Payer: Humana Medicare Advantage	$28.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.96
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.10
Rate for Payer: Wellcare Medicare Advantage	$28.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,078.00
Rate for Payer: Wellpoint Medicaid Managed Care	$5.12

VITAMIN B6 (PYRIDOXAL PHOSPHAT

Facility

$514.00

Service Code	HCPCS 84207
Hospital Charge Code	38472689
Hospital Revenue Code	301
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$24,078.00
Rate for Payer: Aetna Commercial	$76.43
Rate for Payer: Aetna Medicare Advantage	$91.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.43
Rate for Payer: Cigna Commercial	$257.00
Rate for Payer: Cigna Medicare Advantage	$28.10
Rate for Payer: Clover Medicare Advantage	$26.70
Rate for Payer: EmblemHealth Commercial	$84.30
Rate for Payer: Humana Medicare Advantage	$28.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.10
Rate for Payer: Wellcare Medicare Advantage	$28.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,078.00
Rate for Payer: Wellpoint Medicaid Managed Care	$13.62

VITAMIN B6 (PYRIDOXAL PHOSPHAT

Facility

$514.00

Service Code	HCPCS 84207
Hospital Charge Code	38472689
Hospital Revenue Code	301
Min. Negotiated Rate	$77.10
Max. Negotiated Rate	$77.10
Rate for Payer: Qualcare PPO/HMO/WC	$77.10

VITAMIN B-6 PYRIDOXINE/50

Facility

$1.00

Hospital Charge Code	60634160
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

VITAMIN B-6 PYRIDOXINE/50

Facility

$1.00

Hospital Charge Code	60634160
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

VITAMIN B7 (BIOTIN)

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39900150
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.40
Rate for Payer: Aetna Medicare Advantage	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.58
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.06
Rate for Payer: Clover Medicare Advantage	$16.21
Rate for Payer: EmblemHealth Commercial	$51.18
Rate for Payer: Humana Medicare Advantage	$17.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.06
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	$13.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.06
Rate for Payer: Wellcare Medicare Advantage	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VITAMIN B7 (BIOTIN)

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39900150
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN C, 24 HOUR URINE

Facility

$119.25

Service Code	HCPCS 82180
Hospital Charge Code	3002774
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

VITAMIN C, 24 HOUR URINE

Facility

$119.25

Service Code	HCPCS 82180
Hospital Charge Code	3002774
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.90
Rate for Payer: Aetna Medicare Advantage	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: Cigna Medicare Advantage	$9.89
Rate for Payer: Clover Medicare Advantage	$9.40
Rate for Payer: EmblemHealth Commercial	$29.67
Rate for Payer: Humana Medicare Advantage	$10.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.89
Rate for Payer: Wellcare Medicare Advantage	$9.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

VITAMIN C (ASCORBIC ACID)

Facility

$231.00

Service Code	HCPCS 82180
Hospital Charge Code	38472695
Hospital Revenue Code	301
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$34.65
Rate for Payer: Qualcare PPO/HMO/WC	$34.65

VITAMIN C (ASCORBIC ACID)

Facility

$231.00

Service Code	HCPCS 82180
Hospital Charge Code	38472695
Hospital Revenue Code	301
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.90
Rate for Payer: Aetna Medicare Advantage	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$115.50
Rate for Payer: Cigna Medicare Advantage	$9.89
Rate for Payer: Clover Medicare Advantage	$9.40
Rate for Payer: EmblemHealth Commercial	$29.67
Rate for Payer: Humana Medicare Advantage	$10.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.89
Rate for Payer: Wellcare Medicare Advantage	$9.89
Rate for Payer: Wellpoint Medicaid Managed Care	$6.12

VITAMIN C, ASORBIC ACID

Facility

$119.25

Service Code	HCPCS 82180
Hospital Charge Code	3002771
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

VITAMIN C, ASORBIC ACID

Facility

$119.25

Service Code	HCPCS 82180
Hospital Charge Code	3002771
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.90
Rate for Payer: Aetna Medicare Advantage	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: Cigna Medicare Advantage	$9.89
Rate for Payer: Clover Medicare Advantage	$9.40
Rate for Payer: EmblemHealth Commercial	$29.67
Rate for Payer: Humana Medicare Advantage	$10.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.89
Rate for Payer: Wellcare Medicare Advantage	$9.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

VITAMIN C,SERUM

Facility

$390.00

Service Code	HCPCS 82180
Hospital Charge Code	39900046
Hospital Revenue Code	301
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$26.90
Rate for Payer: Aetna Medicare Advantage	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.89
Rate for Payer: Clover Medicare Advantage	$9.40
Rate for Payer: EmblemHealth Commercial	$29.67
Rate for Payer: Humana Medicare Advantage	$10.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.89
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	$7.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.89
Rate for Payer: Wellcare Medicare Advantage	$9.89
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VITAMIN C,SERUM

Facility

$390.00

Service Code	HCPCS 82180
Hospital Charge Code	39900046
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN D,1,25 DIHYDROXY

Facility

$358.45

Service Code	HCPCS 82652
Hospital Charge Code	3000601
Hospital Revenue Code	301
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

VITAMIN D,1,25 DIHYDROXY

Facility

$358.45

Service Code	HCPCS 82652
Hospital Charge Code	3000601
Hospital Revenue Code	301
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$179.22
Rate for Payer: Aetna Commercial	$104.72
Rate for Payer: Aetna Medicare Advantage	$124.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$179.22
Rate for Payer: Cigna Medicare Advantage	$38.50
Rate for Payer: Clover Medicare Advantage	$36.58
Rate for Payer: EmblemHealth Commercial	$115.50
Rate for Payer: Humana Medicare Advantage	$39.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.50
Rate for Payer: Wellcare Medicare Advantage	$38.50
Rate for Payer: Wellpoint Medicaid Managed Care	$9.50

VITAMIN D,1,25 DIHYDROXY***

Facility

$436.00

Hospital Charge Code	3010600
Hospital Revenue Code	301
Min. Negotiated Rate	$65.40
Max. Negotiated Rate	$65.40
Rate for Payer: Qualcare PPO/HMO/WC	$65.40

VITAMIN D,1,25 DIHYDROXY***

Facility

$436.00

Hospital Charge Code	3010600
Hospital Revenue Code	301
Min. Negotiated Rate	$10.51
Max. Negotiated Rate	$218.00
Rate for Payer: Aetna Commercial	$165.68
Rate for Payer: Aetna Medicare Advantage	$130.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.18
Rate for Payer: Cigna Commercial	$218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.51
Rate for Payer: Wellpoint Medicaid Managed Care	$11.55

VITAMIN D 1,25 - DIHYDROXY

Facility

$1,691.20

Service Code	HCPCS 82652
Hospital Charge Code	38472039
Hospital Revenue Code	301
Min. Negotiated Rate	$253.68
Max. Negotiated Rate	$253.68
Rate for Payer: Qualcare PPO/HMO/WC	$253.68

VITAMIN D 1,25 - DIHYDROXY

Facility

$1,691.20

Service Code	HCPCS 82652
Hospital Charge Code	38472039
Hospital Revenue Code	301
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$845.60
Rate for Payer: Aetna Commercial	$104.72
Rate for Payer: Aetna Medicare Advantage	$124.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$845.60
Rate for Payer: Cigna Medicare Advantage	$38.50
Rate for Payer: Clover Medicare Advantage	$36.58
Rate for Payer: EmblemHealth Commercial	$115.50
Rate for Payer: Humana Medicare Advantage	$39.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$507.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$253.68
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.50
Rate for Payer: Wellcare Medicare Advantage	$38.50
Rate for Payer: Wellpoint Medicaid Managed Care	$44.82

VITAMIN D 25 DI-HYDROXY

Facility

$390.00

Service Code	HCPCS 82652
Hospital Charge Code	39900329
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$104.72
Rate for Payer: Aetna Medicare Advantage	$124.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$38.50
Rate for Payer: Clover Medicare Advantage	$36.58
Rate for Payer: EmblemHealth Commercial	$115.50
Rate for Payer: Humana Medicare Advantage	$39.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.50
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	$30.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.50
Rate for Payer: Wellcare Medicare Advantage	$38.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VITAMIN D 25 DI-HYDROXY

Facility

$390.00

Service Code	HCPCS 82652
Hospital Charge Code	39900329
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Vitamin D, 25-Hydroxy

Facility

$667.59

Service Code	HCPCS 82306
Hospital Charge Code	39888005
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Know your out-of-pocket cost for care.

All Charges