Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH FREE KAPPA LAMBDA (SERUM)

Facility

$680.00

Service Code	HCPCS 83883
Hospital Charge Code	397071510
Hospital Revenue Code	301
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$165.64
Rate for Payer: Aetna Commercial	$44.06
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.83
Rate for Payer: Cigna Commercial	$13.60
Rate for Payer: Cigna Medicare Advantage	$6.80
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.42
Rate for Payer: Wellcare Medicare Advantage	$13.60

CH FREE T3

Facility

$667.59

Service Code	HCPCS 84481
Hospital Charge Code	397073592
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH FREE T3

Facility

$667.59

Service Code	HCPCS 84481
Hospital Charge Code	397073592
Hospital Revenue Code	301
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.89
Rate for Payer: Aetna Medicare Advantage	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.07
Rate for Payer: Cigna Commercial	$16.94
Rate for Payer: Cigna Medicare Advantage	$8.47
Rate for Payer: Clover Medicare Advantage	$16.09
Rate for Payer: EmblemHealth Commercial	$50.82
Rate for Payer: Humana Medicare Advantage	$17.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.94
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.96
Rate for Payer: Wellcare Medicare Advantage	$16.94

CH FRESH FRZN PLAS CRYO POOR

Facility

$289.45

Service Code	HCPCS P9059
Hospital Charge Code	397031174
Hospital Revenue Code	390
Min. Negotiated Rate	$43.42
Max. Negotiated Rate	$43.42
Rate for Payer: Qualcare PPO/HMO/WC	$43.42

CH FRESH FRZN PLAS CRYO POOR

Facility

$289.45

Service Code	HCPCS P9059
Hospital Charge Code	397031174
Hospital Revenue Code	390
Min. Negotiated Rate	$37.63
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$86.83
Rate for Payer: Aetna Medicare Advantage	$86.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.81
Rate for Payer: Cigna Commercial	$171.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.63
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.42
Rate for Payer: UnitedHealthcare Commercial	$756.00

CH FRUCTOSAMINE

Facility

$124.00

Service Code	HCPCS 82985
Hospital Charge Code	397072072
Hospital Revenue Code	301
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$54.30
Rate for Payer: Aetna Medicare Advantage	$16.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.41
Rate for Payer: Cigna Commercial	$16.76
Rate for Payer: Cigna Medicare Advantage	$8.38
Rate for Payer: Clover Medicare Advantage	$15.92
Rate for Payer: EmblemHealth Commercial	$50.28
Rate for Payer: Humana Medicare Advantage	$17.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.76
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.77
Rate for Payer: Wellcare Medicare Advantage	$16.76

CH FRUCTOSAMINE

Facility

$124.00

Service Code	HCPCS 82985
Hospital Charge Code	397072072
Hospital Revenue Code	301
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

CH FRUCTOSE, SEMEN

Facility

$110.00

Service Code	HCPCS 82757
Hospital Charge Code	397072073
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

CH FRUCTOSE, SEMEN

Facility

$110.00

Service Code	HCPCS 82757
Hospital Charge Code	397072073
Hospital Revenue Code	301
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: Aetna Medicare Advantage	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.53
Rate for Payer: Cigna Commercial	$17.34
Rate for Payer: Cigna Medicare Advantage	$8.67
Rate for Payer: Clover Medicare Advantage	$16.47
Rate for Payer: EmblemHealth Commercial	$52.02
Rate for Payer: Humana Medicare Advantage	$17.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.38
Rate for Payer: Wellcare Medicare Advantage	$17.34

CH G6PD

Facility

$113.00

Service Code	HCPCS 82955
Hospital Charge Code	397071302
Hospital Revenue Code	301
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

CH G6PD

Facility

$113.00

Service Code	HCPCS 82955
Hospital Charge Code	397071302
Hospital Revenue Code	301
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.43
Rate for Payer: Aetna Medicare Advantage	$9.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.54
Rate for Payer: Cigna Commercial	$9.70
Rate for Payer: Cigna Medicare Advantage	$4.85
Rate for Payer: Clover Medicare Advantage	$9.21
Rate for Payer: EmblemHealth Commercial	$29.10
Rate for Payer: Humana Medicare Advantage	$9.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.28
Rate for Payer: Wellcare Medicare Advantage	$9.70

CH GABITRIL

Facility

$294.00

Service Code	HCPCS 80299
Hospital Charge Code	397073211
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.10
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

CH GABITRIL

Facility

$294.00

Service Code	HCPCS 80299
Hospital Charge Code	397073211
Hospital Revenue Code	301
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

CH GANGLIOSIDE GD1A AB (IGG)

Facility

$284.00

Service Code	HCPCS 83520
Hospital Charge Code	397071527
Hospital Revenue Code	301
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$42.60
Rate for Payer: Qualcare PPO/HMO/WC	$42.60

CH GANGLIOSIDE GD1A AB (IGG)

Facility

$284.00

Service Code	HCPCS 83520
Hospital Charge Code	397071527
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

CH GANGLIOSIDE GD1A AB (IGM)

Facility

$299.00

Service Code	HCPCS 83520
Hospital Charge Code	397071525
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

CH GANGLIOSIDE GD1A AB (IGM)

Facility

$299.00

Service Code	HCPCS 83520
Hospital Charge Code	397071525
Hospital Revenue Code	301
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

CH GANGLIOSIDE GD1B AB IGG

Facility

$284.00

Service Code	HCPCS 83520
Hospital Charge Code	397071497
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

CH GANGLIOSIDE GD1B AB IGG

Facility

$284.00

Service Code	HCPCS 83520
Hospital Charge Code	397071497
Hospital Revenue Code	301
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$42.60
Rate for Payer: Qualcare PPO/HMO/WC	$42.60

CH GANGLIOSIDE GD1B AB IGM

Facility

$381.00

Service Code	HCPCS 83520
Hospital Charge Code	397071498
Hospital Revenue Code	301
Min. Negotiated Rate	$57.15
Max. Negotiated Rate	$57.15
Rate for Payer: Qualcare PPO/HMO/WC	$57.15

CH GANGLIOSIDE GD1B AB IGM

Facility

$381.00

Service Code	HCPCS 83520
Hospital Charge Code	397071498
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

CH GANGLIOSIDE GQ1B AB (IGG)

Facility

$459.00

Service Code	HCPCS 83520
Hospital Charge Code	397071526
Hospital Revenue Code	301
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$68.85
Rate for Payer: Qualcare PPO/HMO/WC	$68.85

CH GANGLIOSIDE GQ1B AB (IGG)

Facility

$459.00

Service Code	HCPCS 83520
Hospital Charge Code	397071526
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.67
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

CH GASTRIC ANALYSIS

Facility

$183.00

Service Code	HCPCS 82930
Hospital Charge Code	397071043
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.74
Rate for Payer: Aetna Medicare Advantage	$6.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.59
Rate for Payer: Cigna Commercial	$6.71
Rate for Payer: Cigna Medicare Advantage	$3.35
Rate for Payer: Clover Medicare Advantage	$6.37
Rate for Payer: EmblemHealth Commercial	$20.13
Rate for Payer: Humana Medicare Advantage	$6.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.71
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.11
Rate for Payer: Wellcare Medicare Advantage	$6.71

CH GASTRIC ANALYSIS

Facility

$183.00

Service Code	HCPCS 82930
Hospital Charge Code	397071043
Hospital Revenue Code	301
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

Know your out-of-pocket cost for care.

All Charges