Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AMS CX MS PENILE PROS 12MMX24C

Facility

$73,850.00

Service Code	HCPCS C1889
Hospital Charge Code	270705408
Hospital Revenue Code	278
Min. Negotiated Rate	$2,097.34
Max. Negotiated Rate	$36,925.00
Rate for Payer: Aetna Commercial	$28,063.00
Rate for Payer: Aetna Medicare Advantage	$22,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,831.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,831.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,831.75
Rate for Payer: Cigna Commercial	$36,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,871.70
Rate for Payer: Qualcare PPO/HMO/WC	$11,077.50
Rate for Payer: UnitedHealthcare Community & State	$2,333.66
Rate for Payer: Wellpoint Medicaid Managed Care	$2,097.34

AMYLASE

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38472101
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$124.60
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.79
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

AMYLASE

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38472101
Hospital Revenue Code	301
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$37.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.38

AMYLASE,24HR

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479011
Hospital Revenue Code	301
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$37.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.38

AMYLASE,24HR

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479011
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$124.60
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.79
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

AMYLASE,34HR URINE

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479012
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$124.60
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.79
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

AMYLASE,34HR URINE

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479012
Hospital Revenue Code	301
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$37.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.38

AMYLASE,FLUID

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479009
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$124.60
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.79
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

AMYLASE,FLUID

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479009
Hospital Revenue Code	301
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$37.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.38

AMYLASE ISOENZEYMES SERUM

Facility

$390.00

Service Code	HCPCS 82150XU
Hospital Charge Code	3000288B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMYLASE ISOENZEYMES SERUM

Facility

$390.00

Service Code	HCPCS 82150XU
Hospital Charge Code	3000288B
Hospital Revenue Code	301
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

AMYLASE/LIPASE/PROTEASE CAP

Facility

$5.36

Service Code	NDC 23611501
Hospital Charge Code	60632329
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

AMYLASE/LIPASE/PROTEASE CAP

Facility

$5.36

Service Code	NDC 23611501
Hospital Charge Code	60632329
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

AMYLASE PANCREATIC CYST

Facility

$855.60

Service Code	HCPCS 82150
Hospital Charge Code	3038543
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$427.80
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$427.80
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.46
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.34
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$24.30

AMYLASE PANCREATIC CYST

Facility

$855.60

Service Code	HCPCS 82150
Hospital Charge Code	3038543
Hospital Revenue Code	301
Min. Negotiated Rate	$128.34
Max. Negotiated Rate	$128.34
Rate for Payer: Qualcare PPO/HMO/WC	$128.34

AMYLASE PERITONEAL FLUID

Facility

$390.00

Service Code	HCPCS 82150
Hospital Charge Code	3031013
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
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	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

AMYLASE PERITONEAL FLUID

Facility

$390.00

Service Code	HCPCS 82150
Hospital Charge Code	3031013
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMYLASE SERUM

Facility

$667.59

Service Code	HCPCS 82150
Hospital Charge Code	3000288
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

AMYLASE SERUM

Facility

$667.59

Service Code	HCPCS 82150
Hospital Charge Code	3000288
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
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	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

AMYLASE URINE

Facility

$390.00

Service Code	HCPCS 82150
Hospital Charge Code	3004900
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
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	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

AMYLASE URINE

Facility

$390.00

Service Code	HCPCS 82150
Hospital Charge Code	3004900
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMYLASE,URINE RANDOM

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479014
Hospital Revenue Code	301
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$37.38
Rate for Payer: Qualcare PPO/HMO/WC	$37.38

AMYLASE,URINE RANDOM

Facility

$249.20

Service Code	HCPCS 82150
Hospital Charge Code	38479014
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.63
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.51
Rate for Payer: Cigna Commercial	$124.60
Rate for Payer: Cigna Medicare Advantage	$6.48
Rate for Payer: Clover Medicare Advantage	$6.16
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Humana Medicare Advantage	$6.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.79
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48
Rate for Payer: Wellcare Medicare Advantage	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

ANA

Facility

$667.59

Service Code	HCPCS 86038
Hospital Charge Code	39708042B
Hospital Revenue Code	306
Min. Negotiated Rate	$9.67
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.88
Rate for Payer: Aetna Medicare Advantage	$39.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.86
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$12.09
Rate for Payer: Clover Medicare Advantage	$11.49
Rate for Payer: EmblemHealth Commercial	$36.27
Rate for Payer: Humana Medicare Advantage	$12.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.09
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	$9.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.09
Rate for Payer: Wellcare Medicare Advantage	$12.09
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

ANA

Facility

$667.59

Service Code	HCPCS 86038
Hospital Charge Code	39708042B
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Know your out-of-pocket cost for care.

All Charges