Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VON WILLEBRAND 2

Facility

$230.40

Service Code	HCPCS 85245
Hospital Charge Code	3036011B
Hospital Revenue Code	300
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$115.20
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.56
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$6.11

VON WILLEBRAND 2

Facility

$230.40

Service Code	HCPCS 85245
Hospital Charge Code	3036011B
Hospital Revenue Code	300
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$34.56
Rate for Payer: Qualcare PPO/HMO/WC	$34.56

VON WILLEBRAND 3

Facility

$230.40

Service Code	HCPCS 85246
Hospital Charge Code	3036011C
Hospital Revenue Code	300
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$34.56
Rate for Payer: Qualcare PPO/HMO/WC	$34.56

VON WILLEBRAND 3

Facility

$230.40

Service Code	HCPCS 85246
Hospital Charge Code	3036011C
Hospital Revenue Code	300
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$115.20
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.56
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$6.11

VON WILLEBRAND COMP PANEL I

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	3990128A
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL I

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	3990128A
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.61
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
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	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VON WILLEBRAND COMP PANEL II

Facility

$390.00

Service Code	HCPCS 85245
Hospital Charge Code	3990128B
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL II

Facility

$390.00

Service Code	HCPCS 85245
Hospital Charge Code	3990128B
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
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	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VON WILLEBRAND COMP PANEL III

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	3990128C
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL III

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	3990128C
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
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	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VON WILLEBRAND COMP PANEL IV

Facility

$390.00

Service Code	HCPCS 85247
Hospital Charge Code	3990128D
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
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	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VON WILLEBRAND COMP PANEL IV

Facility

$390.00

Service Code	HCPCS 85247
Hospital Charge Code	3990128D
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND COMP PANEL V

Facility

$390.00

Service Code	HCPCS 85730
Hospital Charge Code	3990128E
Hospital Revenue Code	305
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$16.35
Rate for Payer: Aetna Medicare Advantage	$19.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.01
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	$21.69
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.01
Rate for Payer: Clover Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$18.03
Rate for Payer: Humana Medicare Advantage	$6.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.01
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	$4.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.01
Rate for Payer: Wellcare Medicare Advantage	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VON WILLEBRAND COMP PANEL V

Facility

$390.00

Service Code	HCPCS 85730
Hospital Charge Code	3990128E
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLEBRAND FACTOR PRO

Facility

$157.70

Service Code	HCPCS 85397
Hospital Charge Code	39900172
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$83.94
Rate for Payer: Aetna Medicare Advantage	$99.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.40
Rate for Payer: Cigna Commercial	$78.85
Rate for Payer: Cigna Medicare Advantage	$30.86
Rate for Payer: Clover Medicare Advantage	$29.32
Rate for Payer: EmblemHealth Commercial	$92.58
Rate for Payer: Humana Medicare Advantage	$31.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.66
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.86
Rate for Payer: Wellcare Medicare Advantage	$30.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.18

VON WILLEBRAND FACTOR PRO

Facility

$157.70

Service Code	HCPCS 85397
Hospital Charge Code	39900172
Hospital Revenue Code	305
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$23.66
Rate for Payer: Qualcare PPO/HMO/WC	$23.66

VON WILLEBRANDS FACTOR ANTG

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38479463
Hospital Revenue Code	305
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$103.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.46

VON WILLEBRANDS FACTOR ANTG

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38479463
Hospital Revenue Code	305
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

VON WILLEBRANDS FACTOR ANTIGEN

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38478073
Hospital Revenue Code	305
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

VON WILLEBRANDS FACTOR ANTIGEN

Facility

$206.00

Service Code	HCPCS 85246
Hospital Charge Code	38478073
Hospital Revenue Code	305
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$103.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.46

VON WILLEFRAND FACTOR VIII***

Facility

$27.00

Hospital Charge Code	3032547
Hospital Revenue Code	309
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

VON WILLEFRAND FACTOR VIII***

Facility

$27.00

Hospital Charge Code	3032547
Hospital Revenue Code	309
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

VON WILLIBRAND FACTOR AG

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	39900510
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VON WILLIBRAND FACTOR AG

Facility

$390.00

Service Code	HCPCS 85246
Hospital Charge Code	39900510
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
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	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VORICONAZOLE 200 MG TAB

Facility

$592.62

Service Code	NDC 49318030
Hospital Charge Code	60629938
Hospital Revenue Code	250
Min. Negotiated Rate	$88.89
Max. Negotiated Rate	$88.89
Rate for Payer: Qualcare PPO/HMO/WC	$88.89

Know your out-of-pocket cost for care.

All Charges