Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FETAL BIOPHYSICAL WNST EA ADTL

Facility

$1,724.80

Service Code	HCPCS 76818
Hospital Charge Code	74308355
Hospital Revenue Code	402
Min. Negotiated Rate	$258.72
Max. Negotiated Rate	$258.72
Rate for Payer: Qualcare PPO/HMO/WC	$258.72

FETAL BIOPHY W/O NST

Facility

$572.00

Service Code	HCPCS 76819
Hospital Charge Code	83653090
Hospital Revenue Code	402
Min. Negotiated Rate	$16.24
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.72
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.80
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$18.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$16.24

FETAL BIOPHY W/O NST

Facility

$572.00

Service Code	HCPCS 76819
Hospital Charge Code	83653090
Hospital Revenue Code	402
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$85.80
Rate for Payer: Qualcare PPO/HMO/WC	$85.80

FETAL DOPPLER ECHO COMPLETE

Facility

$904.00

Service Code	HCPCS 76827
Hospital Charge Code	74308360
Hospital Revenue Code	402
Min. Negotiated Rate	$135.60
Max. Negotiated Rate	$135.60
Rate for Payer: Qualcare PPO/HMO/WC	$135.60

FETAL DOPPLER ECHO COMPLETE

Facility

$904.00

Service Code	HCPCS 76827
Hospital Charge Code	74308360
Hospital Revenue Code	402
Min. Negotiated Rate	$25.67
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.04
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.60
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$28.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$25.67

FETAL DOPPLR ECHO FOLLOW UP

Facility

$721.00

Service Code	HCPCS 76828
Hospital Charge Code	74308365
Hospital Revenue Code	402
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$108.15
Rate for Payer: Qualcare PPO/HMO/WC	$108.15

FETAL DOPPLR ECHO FOLLOW UP

Facility

$721.00

Service Code	HCPCS 76828
Hospital Charge Code	83653110
Hospital Revenue Code	402
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$108.15
Rate for Payer: Qualcare PPO/HMO/WC	$108.15

FETAL DOPPLR ECHO FOLLOW UP

Facility

$721.00

Service Code	HCPCS 76828
Hospital Charge Code	83653110
Hospital Revenue Code	402
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.46
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.15
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$22.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.48

FETAL DOPPLR ECHO FOLLOW UP

Facility

$721.00

Service Code	HCPCS 76828
Hospital Charge Code	74308365
Hospital Revenue Code	402
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.46
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.15
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$22.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.48

FETAL ERYTHROCYTES

Facility

$53.20

Service Code	HCPCS 85460
Hospital Charge Code	39900175
Hospital Revenue Code	305
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$7.98
Rate for Payer: Qualcare PPO/HMO/WC	$7.98

FETAL ERYTHROCYTES

Facility

$53.20

Service Code	HCPCS 85460
Hospital Charge Code	39900175
Hospital Revenue Code	305
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$21.03
Rate for Payer: Aetna Medicare Advantage	$25.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.04
Rate for Payer: Cigna Commercial	$26.60
Rate for Payer: Cigna Medicare Advantage	$7.73
Rate for Payer: Clover Medicare Advantage	$7.34
Rate for Payer: EmblemHealth Commercial	$23.19
Rate for Payer: Humana Medicare Advantage	$7.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.83
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.98
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.73
Rate for Payer: Wellcare Medicare Advantage	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

FETAL FIBRONECTIN

Facility

$456.15

Service Code	HCPCS 82731
Hospital Charge Code	38474060
Hospital Revenue Code	301
Min. Negotiated Rate	$68.42
Max. Negotiated Rate	$68.42
Rate for Payer: Qualcare PPO/HMO/WC	$68.42

FETAL FIBRONECTIN

Facility

$456.15

Service Code	HCPCS 82731
Hospital Charge Code	38474060
Hospital Revenue Code	301
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$233.65
Rate for Payer: Aetna Commercial	$175.20
Rate for Payer: Aetna Medicare Advantage	$208.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.65
Rate for Payer: Cigna Commercial	$228.07
Rate for Payer: Cigna Medicare Advantage	$64.41
Rate for Payer: Clover Medicare Advantage	$61.19
Rate for Payer: EmblemHealth Commercial	$193.23
Rate for Payer: Humana Medicare Advantage	$66.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.42
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.41
Rate for Payer: Wellcare Medicare Advantage	$64.41
Rate for Payer: Wellpoint Medicaid Managed Care	$12.95

FETAL NON-STRESS EA ADDTL FETU

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	74308345
Hospital Revenue Code	920
Min. Negotiated Rate	$53.91
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.58
Rate for Payer: Oxford Commercial	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.76
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$59.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$53.91

FETAL NON-STRESS EA ADDTL FETU

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	74308345
Hospital Revenue Code	920
Min. Negotiated Rate	$284.76
Max. Negotiated Rate	$284.76
Rate for Payer: Qualcare PPO/HMO/WC	$284.76

FETAL NON-STRESS EA ADDTL FETU

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	83653015
Hospital Revenue Code	920
Min. Negotiated Rate	$53.91
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.58
Rate for Payer: Oxford Commercial	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.76
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$59.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$53.91

FETAL NON-STRESS EA ADDTL FETU

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	83653015
Hospital Revenue Code	920
Min. Negotiated Rate	$284.76
Max. Negotiated Rate	$284.76
Rate for Payer: Qualcare PPO/HMO/WC	$284.76

FETAL NON-STRESS TEST

Facility

$752.25

Service Code	HCPCS 59025
Hospital Charge Code	73190139
Hospital Revenue Code	720
Min. Negotiated Rate	$21.36
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.59
Rate for Payer: Oxford Commercial	$4,053.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.84
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$23.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$21.36

FETAL NON-STRESS TEST

Facility

$752.25

Service Code	HCPCS 59025
Hospital Charge Code	73190139
Hospital Revenue Code	720
Min. Negotiated Rate	$112.84
Max. Negotiated Rate	$112.84
Rate for Payer: Qualcare PPO/HMO/WC	$112.84

FETAL SCREEN (K-B)

Facility

$85.00

Service Code	HCPCS 85460
Hospital Charge Code	38473124
Hospital Revenue Code	305
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$21.03
Rate for Payer: Aetna Medicare Advantage	$25.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.04
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: Cigna Medicare Advantage	$7.73
Rate for Payer: Clover Medicare Advantage	$7.34
Rate for Payer: EmblemHealth Commercial	$23.19
Rate for Payer: Humana Medicare Advantage	$7.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.73
Rate for Payer: Wellcare Medicare Advantage	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

FETAL SCREEN (K-B)

Facility

$85.00

Service Code	HCPCS 85460
Hospital Charge Code	38473124
Hospital Revenue Code	305
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

FETAL SCREEN,ROSETTE

Facility

$99.00

Service Code	HCPCS 86905
Hospital Charge Code	38476278
Hospital Revenue Code	309
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$10.42
Rate for Payer: Aetna Medicare Advantage	$12.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.89
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$3.83
Rate for Payer: Clover Medicare Advantage	$3.64
Rate for Payer: EmblemHealth Commercial	$11.49
Rate for Payer: Humana Medicare Advantage	$3.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.83
Rate for Payer: Wellcare Medicare Advantage	$3.83
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

FETAL SCREEN,ROSETTE

Facility

$99.00

Service Code	HCPCS 86905
Hospital Charge Code	38476278
Hospital Revenue Code	309
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

FETOMATERNAL BLEED FC

Facility

$390.00

Service Code	HCPCS 86849
Hospital Charge Code	397043301
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FETOMATERNAL BLEED FC

Facility

$390.00

Service Code	HCPCS 86849
Hospital Charge Code	397043301
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges