Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FTA -ABS

Facility

$124.00

Service Code	HCPCS 86780
Hospital Charge Code	38476210
Hospital Revenue Code	302
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.03
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$3.52

FTA-ABS,SERUM

Facility

$667.59

Service Code	HCPCS 86780
Hospital Charge Code	39990049EX
Hospital Revenue Code	302
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.03
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

FTA-ABS,SERUM

Facility

$667.59

Service Code	HCPCS 86780
Hospital Charge Code	39990049EX
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

FTA-ABS,SERUM, I

Facility

$91.00

Service Code	HCPCS 86780
Hospital Charge Code	39990049A
Hospital Revenue Code	306
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

FTA-ABS,SERUM, I

Facility

$91.00

Service Code	HCPCS 86780
Hospital Charge Code	39990049A
Hospital Revenue Code	306
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.03
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

F.TULARENSIS AB,DA (SERUM)

Facility

$390.00

Service Code	HCPCS 86000
Hospital Charge Code	397080011
Hospital Revenue Code	305
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.99
Rate for Payer: Aetna Medicare Advantage	$22.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.32
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.98
Rate for Payer: Clover Medicare Advantage	$6.63
Rate for Payer: EmblemHealth Commercial	$20.94
Rate for Payer: Humana Medicare Advantage	$7.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.98
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	$5.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.98
Rate for Payer: Wellcare Medicare Advantage	$6.98
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

F.TULARENSIS AB,DA (SERUM)

Facility

$390.00

Service Code	HCPCS 86000
Hospital Charge Code	397080011
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FULL CORE BIOPSY 16GX15CM

Facility

$235.00

Hospital Charge Code	270670786
Hospital Revenue Code	272
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

FULL CORE BIOPSY 16GX15CM

Facility

$235.00

Hospital Charge Code	270670786
Hospital Revenue Code	272
Min. Negotiated Rate	$6.67
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.10
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$47.00
Rate for Payer: UnitedHealthcare Community & State	$7.43
Rate for Payer: Wellpoint Medicaid Managed Care	$6.67

FULL RAD BONECUTTER 4.5MM PLAT

Facility

$400.00

Hospital Charge Code	270692790
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

FULL RAD BONECUTTER 4.5MM PLAT

Facility

$400.00

Hospital Charge Code	270692790
Hospital Revenue Code	272
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$12.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

FULL RING 155MM

Facility

$8,025.00

Hospital Charge Code	270674285
Hospital Revenue Code	272
Min. Negotiated Rate	$227.91
Max. Negotiated Rate	$4,012.50
Rate for Payer: Aetna Commercial	$3,049.50
Rate for Payer: Aetna Medicare Advantage	$2,407.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,046.38
Rate for Payer: Cigna Commercial	$4,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,086.50
Rate for Payer: Oxford Commercial	$1,605.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75
Rate for Payer: UnitedHealthcare Commercial	$1,605.00
Rate for Payer: UnitedHealthcare Community & State	$253.59
Rate for Payer: Wellpoint Medicaid Managed Care	$227.91

FULL RING 155MM

Facility

$8,025.00

Hospital Charge Code	270674285
Hospital Revenue Code	272
Min. Negotiated Rate	$1,203.75
Max. Negotiated Rate	$1,203.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75

FULL RING LRF CARBON 155MM

Facility

$11,410.05

Service Code	HCPCS C1713
Hospital Charge Code	270699597
Hospital Revenue Code	278
Min. Negotiated Rate	$1,711.51
Max. Negotiated Rate	$2,761.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,282.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,761.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,711.51

FULL RING LRF CARBON 155MM

Facility

$11,410.05

Service Code	HCPCS C1713
Hospital Charge Code	270699597
Hospital Revenue Code	278
Min. Negotiated Rate	$324.05
Max. Negotiated Rate	$5,705.02
Rate for Payer: Aetna Commercial	$4,335.82
Rate for Payer: Aetna Medicare Advantage	$3,423.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,909.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,909.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,282.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,909.56
Rate for Payer: Cigna Commercial	$5,705.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,761.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,711.51
Rate for Payer: UnitedHealthcare Community & State	$360.56
Rate for Payer: Wellpoint Medicaid Managed Care	$324.05

FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility

$151,197.13

Service Code	MSDRG 793
Min. Negotiated Rate	$5,458.00
Max. Negotiated Rate	$151,197.13
Rate for Payer: Aetna Commercial	$109,542.84
Rate for Payer: Aetna Medicare Advantage	$151,197.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116,638.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116,638.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$48,460.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116,638.05
Rate for Payer: Cigna Commercial	$92,952.89
Rate for Payer: Cigna Medicare Advantage	$48,460.62
Rate for Payer: Clover Medicare Advantage	$46,037.59
Rate for Payer: EmblemHealth Commercial	$145,381.86
Rate for Payer: Humana Medicare Advantage	$49,914.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$48,460.62
Rate for Payer: Oxford Commercial	$5,458.00
Rate for Payer: UnitedHealthcare Commercial	$6,193.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$48,460.62
Rate for Payer: Wellcare Medicare Advantage	$48,460.62

FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY

Facility

$89,305.35

Service Code	MSDRG 934
Min. Negotiated Rate	$27,192.33
Max. Negotiated Rate	$89,305.35
Rate for Payer: Aetna Commercial	$65,462.77
Rate for Payer: Aetna Medicare Advantage	$89,305.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57,903.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57,903.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,623.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57,903.45
Rate for Payer: Cigna Commercial	$49,280.91
Rate for Payer: Cigna Medicare Advantage	$28,623.51
Rate for Payer: Clover Medicare Advantage	$27,192.33
Rate for Payer: EmblemHealth Commercial	$85,870.53
Rate for Payer: Humana Medicare Advantage	$29,482.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28,623.51
Rate for Payer: Oxford Commercial	$38,950.77
Rate for Payer: UnitedHealthcare Commercial	$52,137.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,623.51
Rate for Payer: Wellcare Medicare Advantage	$28,623.51

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC

Facility

$246,075.74

Service Code	MSDRG 928
Min. Negotiated Rate	$74,926.91
Max. Negotiated Rate	$246,075.74
Rate for Payer: Aetna Commercial	$177,116.49
Rate for Payer: Aetna Medicare Advantage	$246,075.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191,718.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191,718.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$78,870.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191,718.60
Rate for Payer: Cigna Commercial	$159,901.00
Rate for Payer: Cigna Medicare Advantage	$78,870.43
Rate for Payer: Clover Medicare Advantage	$74,926.91
Rate for Payer: EmblemHealth Commercial	$236,611.29
Rate for Payer: Humana Medicare Advantage	$81,236.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$78,870.43
Rate for Payer: Oxford Commercial	$126,382.97
Rate for Payer: UnitedHealthcare Commercial	$169,168.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$78,870.43
Rate for Payer: Wellcare Medicare Advantage	$78,870.43

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC

Facility

$121,221.17

Service Code	MSDRG 929
Min. Negotiated Rate	$36,910.29
Max. Negotiated Rate	$121,221.17
Rate for Payer: Aetna Commercial	$88,193.62
Rate for Payer: Aetna Medicare Advantage	$121,221.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89,210.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89,210.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38,852.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89,210.10
Rate for Payer: Cigna Commercial	$71,801.29
Rate for Payer: Cigna Medicare Advantage	$38,852.94
Rate for Payer: Clover Medicare Advantage	$36,910.29
Rate for Payer: EmblemHealth Commercial	$116,558.82
Rate for Payer: Humana Medicare Advantage	$40,018.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38,852.94
Rate for Payer: Oxford Commercial	$56,750.50
Rate for Payer: UnitedHealthcare Commercial	$75,962.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$38,852.94
Rate for Payer: Wellcare Medicare Advantage	$38,852.94

FUNCT ACT @ COMPLMT/COMPONENT

Facility

$84.00

Service Code	HCPCS 86161
Hospital Charge Code	38478079
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

FUNCT ACT @ COMPLMT/COMPONENT

Facility

$84.00

Service Code	HCPCS 86161
Hospital Charge Code	38478079
Hospital Revenue Code	300
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.84
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.39

FUNGAL ANTIBODIES

Facility

$339.00

Service Code	HCPCS 86671
Hospital Charge Code	38476190
Hospital Revenue Code	302
Min. Negotiated Rate	$9.63
Max. Negotiated Rate	$169.50
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna Medicare Advantage	$39.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.44
Rate for Payer: Cigna Commercial	$169.50
Rate for Payer: Cigna Medicare Advantage	$12.25
Rate for Payer: Clover Medicare Advantage	$11.64
Rate for Payer: EmblemHealth Commercial	$36.75
Rate for Payer: Humana Medicare Advantage	$12.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.25
Rate for Payer: Wellcare Medicare Advantage	$12.25
Rate for Payer: Wellpoint Medicaid Managed Care	$9.63

FUNGAL ANTIBODIES

Facility

$339.00

Service Code	HCPCS 86671
Hospital Charge Code	38476190
Hospital Revenue Code	302
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$50.85
Rate for Payer: Qualcare PPO/HMO/WC	$50.85

FUNGAL ID

Facility

$390.00

Service Code	HCPCS 87106
Hospital Charge Code	39900488
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FUNGAL ID

Facility

$390.00

Service Code	HCPCS 87106
Hospital Charge Code	39900488
Hospital Revenue Code	309
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$28.07
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.44
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$10.32
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.32
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	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Medicare Advantage	$10.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges