Heights University Hospital

All Charges

Charge

Type

Setting

Price

CH LYME PCR CSF

Facility

$784.00

Service Code	HCPCS 87476
Hospital Charge Code	397073341
Hospital Revenue Code	306
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$128.57
Rate for Payer: Aetna Commercial	$113.69
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.57
Rate for Payer: Cigna Commercial	$35.09
Rate for Payer: Cigna Medicare Advantage	$17.55
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$37.20
Rate for Payer: Wellcare Medicare Advantage	$35.09

CH LYMPHOCYTE SUBSET(CD4/CD8

Facility

$620.00

Service Code	HCPCS 86360
Hospital Charge Code	397021290
Hospital Revenue Code	302
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$93.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00

CH LYMPHOCYTE SUBSET(CD4/CD8

Facility

$620.00

Service Code	HCPCS 86360
Hospital Charge Code	397021290
Hospital Revenue Code	302
Min. Negotiated Rate	$23.49
Max. Negotiated Rate	$172.13
Rate for Payer: Aetna Commercial	$152.22
Rate for Payer: Aetna Medicare Advantage	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.13
Rate for Payer: Cigna Commercial	$46.98
Rate for Payer: Cigna Medicare Advantage	$23.49
Rate for Payer: Clover Medicare Advantage	$44.63
Rate for Payer: EmblemHealth Commercial	$140.94
Rate for Payer: Humana Medicare Advantage	$48.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$49.80
Rate for Payer: Wellcare Medicare Advantage	$46.98

CH LYMPHOCYTE SUBSETS

Facility

$2,063.00

Service Code	HCPCS 86360
Hospital Charge Code	397021286
Hospital Revenue Code	302
Min. Negotiated Rate	$309.45
Max. Negotiated Rate	$309.45
Rate for Payer: Qualcare PPO/HMO/WC	$309.45

CH LYMPHOCYTE SUBSETS

Facility

$2,063.00

Service Code	HCPCS 86360
Hospital Charge Code	397021286
Hospital Revenue Code	302
Min. Negotiated Rate	$23.49
Max. Negotiated Rate	$309.45
Rate for Payer: Aetna Commercial	$152.22
Rate for Payer: Aetna Medicare Advantage	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.13
Rate for Payer: Cigna Commercial	$46.98
Rate for Payer: Cigna Medicare Advantage	$23.49
Rate for Payer: Clover Medicare Advantage	$44.63
Rate for Payer: EmblemHealth Commercial	$140.94
Rate for Payer: Humana Medicare Advantage	$48.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.19
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$49.80
Rate for Payer: Wellcare Medicare Advantage	$46.98

CH LYSOZOME SERUM

Facility

$164.00

Service Code	HCPCS 85549
Hospital Charge Code	397072104
Hospital Revenue Code	305
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

CH LYSOZOME SERUM

Facility

$164.00

Service Code	HCPCS 85549
Hospital Charge Code	397072104
Hospital Revenue Code	305
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.70
Rate for Payer: Cigna Commercial	$18.75
Rate for Payer: Cigna Medicare Advantage	$9.38
Rate for Payer: Clover Medicare Advantage	$17.81
Rate for Payer: EmblemHealth Commercial	$56.25
Rate for Payer: Humana Medicare Advantage	$19.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.88
Rate for Payer: Wellcare Medicare Advantage	$18.75

CH LYSOZYME URINE

Facility

$123.00

Service Code	HCPCS 85549
Hospital Charge Code	397071053
Hospital Revenue Code	305
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

CH LYSOZYME URINE

Facility

$123.00

Service Code	HCPCS 85549
Hospital Charge Code	397071053
Hospital Revenue Code	305
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.70
Rate for Payer: Cigna Commercial	$18.75
Rate for Payer: Cigna Medicare Advantage	$9.38
Rate for Payer: Clover Medicare Advantage	$17.81
Rate for Payer: EmblemHealth Commercial	$56.25
Rate for Payer: Humana Medicare Advantage	$19.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.88
Rate for Payer: Wellcare Medicare Advantage	$18.75

CH MACRODENTIN

Facility

$217.00

Service Code	HCPCS 80299
Hospital Charge Code	397073681
Hospital Revenue Code	301
Min. Negotiated Rate	$32.55
Max. Negotiated Rate	$32.55
Rate for Payer: Qualcare PPO/HMO/WC	$32.55

CH MACRODENTIN

Facility

$217.00

Service Code	HCPCS 80299
Hospital Charge Code	397073681
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	$28.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.55
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 MAGNESIUM

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	397071295
Hospital Revenue Code	301
Min. Negotiated Rate	$29.98
Max. Negotiated Rate	$29.98
Rate for Payer: Qualcare PPO/HMO/WC	$29.98

CH MAGNESIUM

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	397071295
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.71
Rate for Payer: Aetna Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.55
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: Cigna Medicare Advantage	$3.35
Rate for Payer: Clover Medicare Advantage	$6.37
Rate for Payer: EmblemHealth Commercial	$20.10
Rate for Payer: Humana Medicare Advantage	$6.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.98
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.10
Rate for Payer: Wellcare Medicare Advantage	$6.70

CH MAGNESIUM URINE 24HR

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	397073103
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$21.71
Rate for Payer: Aetna Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.55
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: Cigna Medicare Advantage	$3.35
Rate for Payer: Clover Medicare Advantage	$6.37
Rate for Payer: EmblemHealth Commercial	$20.10
Rate for Payer: Humana Medicare Advantage	$6.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.98
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.70
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.10
Rate for Payer: Wellcare Medicare Advantage	$6.70

CH MAGNESIUM URINE 24HR

Facility

$199.90

Service Code	HCPCS 83735
Hospital Charge Code	397073103
Hospital Revenue Code	301
Min. Negotiated Rate	$29.98
Max. Negotiated Rate	$29.98
Rate for Payer: Qualcare PPO/HMO/WC	$29.98

CH MALARIA SMEAR

Facility

$390.00

Service Code	HCPCS 87207
Hospital Charge Code	397021028
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH MALARIA SMEAR

Facility

$390.00

Service Code	HCPCS 87207
Hospital Charge Code	397021028
Hospital Revenue Code	309
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.95
Rate for Payer: Cigna Commercial	$5.99
Rate for Payer: Cigna Medicare Advantage	$3.00
Rate for Payer: Clover Medicare Advantage	$5.69
Rate for Payer: EmblemHealth Commercial	$17.97
Rate for Payer: Humana Medicare Advantage	$6.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.99
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$6.35
Rate for Payer: Wellcare Medicare Advantage	$5.99

CH MAMMAGLOBIN 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061371
Hospital Revenue Code	310
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$324.69
Rate for Payer: Aetna Medicare Advantage	$324.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.99
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$62.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$114.00

CH MAMMAGLOBIN 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061371
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

CH MEASLES AB (IGG) QUANT

Facility

$42.00

Service Code	HCPCS 86765
Hospital Charge Code	397071412
Hospital Revenue Code	302
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

CH MEASLES AB (IGG) QUANT

Facility

$42.00

Service Code	HCPCS 86765
Hospital Charge Code	397071412
Hospital Revenue Code	302
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

CH MEASLES ABS IGG, IGM

Facility

$200.00

Service Code	HCPCS 86765
Hospital Charge Code	397071400
Hospital Revenue Code	302
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

CH MEASLES ABS IGG, IGM

Facility

$200.00

Service Code	HCPCS 86765
Hospital Charge Code	397071400
Hospital Revenue Code	302
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.73
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.19
Rate for Payer: Cigna Commercial	$12.88
Rate for Payer: Cigna Medicare Advantage	$6.44
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.65
Rate for Payer: Wellcare Medicare Advantage	$12.88

CH MEGALOBLASTIC ANEMIA

Facility

$998.00

Service Code	HCPCS 83520
Hospital Charge Code	397072105
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$149.70
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	$129.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.70
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 MEGALOBLASTIC ANEMIA

Facility

$998.00

Service Code	HCPCS 83520
Hospital Charge Code	397072105
Hospital Revenue Code	301
Min. Negotiated Rate	$149.70
Max. Negotiated Rate	$149.70
Rate for Payer: Qualcare PPO/HMO/WC	$149.70

Know your out-of-pocket cost for care.

All Charges