Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS A (PEDS)

Facility

$150.01

Service Code	HCPCS 90633
Hospital Charge Code	93950067
Hospital Revenue Code	636
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$36.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

HEPATITIS A (PEDS)

Facility

$150.01

Service Code	HCPCS 90633
Hospital Charge Code	93950067
Hospital Revenue Code	636
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

HEPATITIS A TOTAL

Facility

$667.59

Service Code	HCPCS 86708
Hospital Charge Code	39900516
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

HEPATITIS A TOTAL

Facility

$667.59

Service Code	HCPCS 86708
Hospital Charge Code	39900516
Hospital Revenue Code	302
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.94
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
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	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

HEPATITIS A VIR ANTIBODY

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38479434
Hospital Revenue Code	302
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$63.90

HEPATITIS A VIR ANTIBODY

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38479434
Hospital Revenue Code	302
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$213.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.94
Rate for Payer: Cigna Commercial	$213.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.76
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$12.10

HEPATITIS A VIRUS ANTIBODY, IG

Facility

$410.00

Service Code	HCPCS 86709
Hospital Charge Code	38472338
Hospital Revenue Code	302
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

HEPATITIS A VIRUS ANTIBODY, IG

Facility

$410.00

Service Code	HCPCS 86709
Hospital Charge Code	38472338
Hospital Revenue Code	302
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$30.63
Rate for Payer: Aetna Medicare Advantage	$36.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.85
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: Cigna Medicare Advantage	$11.26
Rate for Payer: Clover Medicare Advantage	$10.70
Rate for Payer: EmblemHealth Commercial	$33.78
Rate for Payer: Humana Medicare Advantage	$11.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.26
Rate for Payer: Wellcare Medicare Advantage	$11.26
Rate for Payer: Wellpoint Medicaid Managed Care	$11.64

HEPATITIS A VIRUS ANTIBODY IGG

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38472335
Hospital Revenue Code	302
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$213.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.94
Rate for Payer: Cigna Commercial	$213.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.76
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$12.10

HEPATITIS A VIRUS ANTIBODY IGG

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38472335
Hospital Revenue Code	302
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$63.90

HEPATITIS A VIRUS ANTIBODY, TO

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38472341
Hospital Revenue Code	302
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$63.90

HEPATITIS A VIRUS ANTIBODY, TO

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38472341
Hospital Revenue Code	302
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$213.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.94
Rate for Payer: Cigna Commercial	$213.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.76
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$12.10

HEPATITIS B CORE AB

Facility

$383.00

Service Code	HCPCS 86704
Hospital Charge Code	38476017
Hospital Revenue Code	302
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$57.45
Rate for Payer: Qualcare PPO/HMO/WC	$57.45

HEPATITIS B CORE AB

Facility

$383.00

Service Code	HCPCS 86704
Hospital Charge Code	38476017
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$191.50
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$191.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.58
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.88

HEPATITIS B CORE AB TOTAL

Facility

$390.00

Service Code	HCPCS 86704
Hospital Charge Code	39900382
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
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	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

HEPATITIS B CORE AB TOTAL

Facility

$390.00

Service Code	HCPCS 86704
Hospital Charge Code	39900382
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS B CORE ANTIBODY

Facility

$574.00

Service Code	HCPCS 87350
Hospital Charge Code	38479436
Hospital Revenue Code	306
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$86.10

HEPATITIS B CORE ANTIBODY

Facility

$574.00

Service Code	HCPCS 87350
Hospital Charge Code	38479436
Hospital Revenue Code	306
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$287.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$287.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$16.30

HEPATITIS B CORE ANTIBODY HBCA

Facility

$574.00

Service Code	HCPCS 87350
Hospital Charge Code	38472350
Hospital Revenue Code	306
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$287.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$287.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$16.30

HEPATITIS B CORE ANTIBODY HBCA

Facility

$574.00

Service Code	HCPCS 87350
Hospital Charge Code	38472350
Hospital Revenue Code	306
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$86.10

HEPATITIS B CORE ANTIBODY HBCA

Facility

$559.00

Service Code	HCPCS 87350
Hospital Charge Code	38479432
Hospital Revenue Code	306
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$279.50
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$279.50
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.34
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$15.88

HEPATITIS B CORE ANTIBODY HBCA

Facility

$559.00

Service Code	HCPCS 87350
Hospital Charge Code	38479432
Hospital Revenue Code	306
Min. Negotiated Rate	$83.85
Max. Negotiated Rate	$83.85
Rate for Payer: Qualcare PPO/HMO/WC	$83.85

HEPATITIS B CORE ANTIBODY, IGM

Facility

$763.00

Service Code	HCPCS 86705
Hospital Charge Code	38472353
Hospital Revenue Code	302
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$381.50
Rate for Payer: Aetna Commercial	$32.01
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.70
Rate for Payer: Cigna Commercial	$381.50
Rate for Payer: Cigna Medicare Advantage	$11.77
Rate for Payer: Clover Medicare Advantage	$11.18
Rate for Payer: EmblemHealth Commercial	$35.31
Rate for Payer: Humana Medicare Advantage	$12.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.38
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.77
Rate for Payer: Wellcare Medicare Advantage	$11.77
Rate for Payer: Wellpoint Medicaid Managed Care	$21.67

HEPATITIS B CORE ANTIBODY, IGM

Facility

$763.00

Service Code	HCPCS 86705
Hospital Charge Code	38472353
Hospital Revenue Code	302
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$114.45
Rate for Payer: Qualcare PPO/HMO/WC	$114.45

HEPATITIS B CORE ANTIBODY,IGM

Facility

$763.00

Service Code	HCPCS 86705
Hospital Charge Code	38479433
Hospital Revenue Code	302
Min. Negotiated Rate	$114.45
Max. Negotiated Rate	$114.45
Rate for Payer: Qualcare PPO/HMO/WC	$114.45

Know your out-of-pocket cost for care.

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