Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS B SURFACE AG CONF

Facility

$390.00

Service Code	HCPCS 87340
Hospital Charge Code	3006442B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS B SURFACE AG CONF

Facility

$390.00

Service Code	HCPCS 87340
Hospital Charge Code	3006442B
Hospital Revenue Code	306
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$28.10
Rate for Payer: Aetna Medicare Advantage	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.47
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$10.33
Rate for Payer: Clover Medicare Advantage	$9.81
Rate for Payer: EmblemHealth Commercial	$30.99
Rate for Payer: Humana Medicare Advantage	$10.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.33
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	$10.33
Rate for Payer: Wellcare Medicare Advantage	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

HEPATITIS B SURFACE ANTIBODY

Facility

$559.00

Service Code	HCPCS 86706
Hospital Charge Code	38472347
Hospital Revenue Code	302
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$279.50
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
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	$38.96
Rate for Payer: Cigna Commercial	$279.50
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
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	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$15.88

HEPATITIS B SURFACE ANTIBODY

Facility

$559.00

Service Code	HCPCS 86706
Hospital Charge Code	38472347
Hospital Revenue Code	302
Min. Negotiated Rate	$83.85
Max. Negotiated Rate	$83.85
Rate for Payer: Qualcare PPO/HMO/WC	$83.85

Hepatitis B Surface Antigen

Facility

$153.65

Service Code	HCPCS 87340
Hospital Charge Code	39888009
Hospital Revenue Code	306
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.10
Rate for Payer: Aetna Medicare Advantage	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.47
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: Cigna Medicare Advantage	$10.33
Rate for Payer: Clover Medicare Advantage	$9.81
Rate for Payer: EmblemHealth Commercial	$30.99
Rate for Payer: Humana Medicare Advantage	$10.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.95
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.33
Rate for Payer: Wellcare Medicare Advantage	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

Hepatitis B Surface Antigen

Facility

$153.65

Service Code	HCPCS 87340
Hospital Charge Code	39888009
Hospital Revenue Code	306
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

HEPATITIS B SURFACE ANTIGEN

Facility

$153.65

Service Code	HCPCS 87340
Hospital Charge Code	39900419
Hospital Revenue Code	306
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.10
Rate for Payer: Aetna Medicare Advantage	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.47
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: Cigna Medicare Advantage	$10.33
Rate for Payer: Clover Medicare Advantage	$9.81
Rate for Payer: EmblemHealth Commercial	$30.99
Rate for Payer: Humana Medicare Advantage	$10.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.95
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.33
Rate for Payer: Wellcare Medicare Advantage	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

HEPATITIS B SURFACE ANTIGEN

Facility

$153.65

Service Code	HCPCS 87340
Hospital Charge Code	39900419
Hospital Revenue Code	306
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

HEPATITIS B SURFACE ANTIGEN, H

Facility

$311.00

Service Code	HCPCS 87340
Hospital Charge Code	38472344
Hospital Revenue Code	306
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.10
Rate for Payer: Aetna Medicare Advantage	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.47
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: Cigna Medicare Advantage	$10.33
Rate for Payer: Clover Medicare Advantage	$9.81
Rate for Payer: EmblemHealth Commercial	$30.99
Rate for Payer: Humana Medicare Advantage	$10.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.86
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.33
Rate for Payer: Wellcare Medicare Advantage	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

HEPATITIS B SURFACE ANTIGEN, H

Facility

$311.00

Service Code	HCPCS 87340
Hospital Charge Code	38472344
Hospital Revenue Code	306
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

HEPATITIS B VACCINE 20MCG/ML

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	60631545
Hospital Revenue Code	636
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

HEPATITIS B VACCINE 20MCG/ML

Facility

$128.00

Service Code	HCPCS 90744
Hospital Charge Code	60631545
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

HEPATITIS B VACCINE PED 5MCG

Facility

$373.12

Service Code	HCPCS 90744
Hospital Charge Code	60628646
Hospital Revenue Code	636
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$186.56
Rate for Payer: Aetna Commercial	$141.79
Rate for Payer: Aetna Medicare Advantage	$111.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.15
Rate for Payer: Cigna Commercial	$186.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$55.97
Rate for Payer: UnitedHealthcare Community & State	$11.79
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

HEPATITIS B VACCINE PED 5MCG

Facility

$373.12

Service Code	HCPCS 90744
Hospital Charge Code	60628646
Hospital Revenue Code	636
Min. Negotiated Rate	$55.97
Max. Negotiated Rate	$90.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$55.97

HEPATITIS B VIRAL PCR

Facility

$390.00

Service Code	HCPCS 87517
Hospital Charge Code	39900298
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS B VIRAL PCR

Facility

$390.00

Service Code	HCPCS 87517
Hospital Charge Code	39900298
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.40
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
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	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

HEPATITIS C AB (RIBA)

Facility

$873.00

Service Code	HCPCS 86804
Hospital Charge Code	38476254
Hospital Revenue Code	302
Min. Negotiated Rate	$130.95
Max. Negotiated Rate	$130.95
Rate for Payer: Qualcare PPO/HMO/WC	$130.95

HEPATITIS C AB (RIBA)

Facility

$873.00

Service Code	HCPCS 86804
Hospital Charge Code	38476254
Hospital Revenue Code	302
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$436.50
Rate for Payer: Aetna Commercial	$42.13
Rate for Payer: Aetna Medicare Advantage	$50.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.19
Rate for Payer: Cigna Commercial	$436.50
Rate for Payer: Cigna Medicare Advantage	$15.49
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.47
Rate for Payer: Humana Medicare Advantage	$15.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.49
Rate for Payer: Wellcare Medicare Advantage	$15.49
Rate for Payer: Wellpoint Medicaid Managed Care	$24.79

HEPATITIS C AB W RFLX TO HCV

Facility

$3,410.19

Service Code	HCPCS 86803
Hospital Charge Code	401086803
Hospital Revenue Code	302
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$1,705.10
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.76
Rate for Payer: Cigna Commercial	$1,705.10
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$886.65
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$511.53
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$96.85

HEPATITIS C AB W RFLX TO HCV

Facility

$3,410.19

Service Code	HCPCS 86803
Hospital Charge Code	401086803
Hospital Revenue Code	302
Min. Negotiated Rate	$511.53
Max. Negotiated Rate	$511.53
Rate for Payer: Qualcare PPO/HMO/WC	$511.53

HEPATITIS C ANTIBODY

Facility

$871.00

Service Code	HCPCS 86803
Hospital Charge Code	38472332
Hospital Revenue Code	302
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$435.50
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.76
Rate for Payer: Cigna Commercial	$435.50
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.46
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$24.74

HEPATITIS C ANTIBODY

Facility

$871.00

Service Code	HCPCS 86803
Hospital Charge Code	38472332
Hospital Revenue Code	302
Min. Negotiated Rate	$130.65
Max. Negotiated Rate	$130.65
Rate for Payer: Qualcare PPO/HMO/WC	$130.65

HEPATITIS C,DNA OR RNA

Facility

$876.00

Service Code	HCPCS 87522
Hospital Charge Code	38475112
Hospital Revenue Code	306
Min. Negotiated Rate	$131.40
Max. Negotiated Rate	$131.40
Rate for Payer: Qualcare PPO/HMO/WC	$131.40

HEPATITIS C,DNA OR RNA

Facility

$876.00

Service Code	HCPCS 87522
Hospital Charge Code	38475112
Hospital Revenue Code	306
Min. Negotiated Rate	$24.88
Max. Negotiated Rate	$438.00
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.40
Rate for Payer: Cigna Commercial	$438.00
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.76
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$24.88

HEPATITIS C RNA, PCR

Facility

$2,335.00

Service Code	HCPCS 87522
Hospital Charge Code	38475107
Hospital Revenue Code	306
Min. Negotiated Rate	$34.27
Max. Negotiated Rate	$1,167.50
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.40
Rate for Payer: Cigna Commercial	$1,167.50
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$607.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$350.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$66.31

Know your out-of-pocket cost for care.

All Charges