Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IMMUNOASSAY INFECTIOUS AGENT

Facility

$390.00

Service Code	HCPCS 86317
Hospital Charge Code	39990243A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.77
Rate for Payer: Aetna Medicare Advantage	$48.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.99
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	$54.38
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.99
Rate for Payer: Clover Medicare Advantage	$14.24
Rate for Payer: EmblemHealth Commercial	$44.97
Rate for Payer: Humana Medicare Advantage	$15.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.99
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	$11.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.99
Rate for Payer: Wellcare Medicare Advantage	$14.99
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

IMMUNOASSAY INFECTIOUS AGENT

Facility

$667.59

Service Code	HCPCS 86317
Hospital Charge Code	401986317A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$40.77
Rate for Payer: Aetna Medicare Advantage	$48.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.99
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	$54.38
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$14.99
Rate for Payer: Clover Medicare Advantage	$14.24
Rate for Payer: EmblemHealth Commercial	$44.97
Rate for Payer: Humana Medicare Advantage	$15.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.99
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	$11.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.99
Rate for Payer: Wellcare Medicare Advantage	$14.99
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

IMMUNOASSAY INFECTIOUS AGENT

Facility

$667.59

Service Code	HCPCS 86317
Hospital Charge Code	401986317A
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

IMMUNOASSAY INFECTIOUS AGENT

Facility

$390.00

Service Code	HCPCS 86317
Hospital Charge Code	39990243A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IMMUNOASSAY NONANTIBODY

Facility

$57.65

Service Code	HCPCS 83516
Hospital Charge Code	401383516C
Hospital Revenue Code	301
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

IMMUNOASSAY NONANTIBODY

Facility

$57.65

Service Code	HCPCS 83516
Hospital Charge Code	401383516C
Hospital Revenue Code	301
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$156.00
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	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$28.82
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	$14.99
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
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	$1.64

IMMUNOASSAY PLUS TRILEVEL

Facility

$589.80

Hospital Charge Code	270653738
Hospital Revenue Code	272
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$294.90
Rate for Payer: Aetna Commercial	$224.12
Rate for Payer: Aetna Medicare Advantage	$176.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.40
Rate for Payer: Cigna Commercial	$294.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.35
Rate for Payer: Oxford Commercial	$117.96
Rate for Payer: Qualcare PPO/HMO/WC	$88.47
Rate for Payer: UnitedHealthcare Commercial	$117.96
Rate for Payer: UnitedHealthcare Community & State	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$16.75

IMMUNOASSAY PLUS TRILEVEL

Facility

$589.80

Hospital Charge Code	270653738
Hospital Revenue Code	272
Min. Negotiated Rate	$88.47
Max. Negotiated Rate	$88.47
Rate for Payer: Qualcare PPO/HMO/WC	$88.47

IMMUNOASSAY PROTEIN CA 125

Facility

$390.00

Service Code	HCPCS 86304
Hospital Charge Code	401086304
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IMMUNOASSAY PROTEIN CA 125

Facility

$390.00

Service Code	HCPCS 86304
Hospital Charge Code	401086304
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
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	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

IMMUNOASSAY QUANT BY RIA

Facility

$166.00

Service Code	HCPCS 83519
Hospital Charge Code	38478083
Hospital Revenue Code	301
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.75
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4.71

IMMUNOASSAY QUANT BY RIA

Facility

$166.00

Service Code	HCPCS 83519
Hospital Charge Code	38478083
Hospital Revenue Code	301
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

IMMUNOASSAY QUANTITATIVE NOS

Facility

$91.00

Service Code	HCPCS 83520
Hospital Charge Code	38478108
Hospital Revenue Code	301
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

IMMUNOASSAY QUANTITATIVE NOS

Facility

$91.00

Service Code	HCPCS 83520
Hospital Charge Code	38478108
Hospital Revenue Code	301
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
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	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

IMMUNOASSAY TUMOR ANTIGEN

Facility

$115.00

Service Code	HCPCS 86294
Hospital Charge Code	38477136
Hospital Revenue Code	302
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.55
Rate for Payer: Aetna Medicare Advantage	$82.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.76
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: Cigna Medicare Advantage	$25.57
Rate for Payer: Clover Medicare Advantage	$24.29
Rate for Payer: EmblemHealth Commercial	$76.71
Rate for Payer: Humana Medicare Advantage	$26.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.90
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.57
Rate for Payer: Wellcare Medicare Advantage	$25.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

IMMUNOASSAY TUMOR ANTIGEN

Facility

$115.00

Service Code	HCPCS 86294
Hospital Charge Code	38477136
Hospital Revenue Code	302
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

IMMUNO COMPLEX DETECTION BY C1

Facility

$390.00

Service Code	HCPCS 86332
Hospital Charge Code	39900438
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$66.29
Rate for Payer: Aetna Medicare Advantage	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.40
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.37
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.37
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	$19.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Medicare Advantage	$24.37
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

IMMUNO COMPLEX DETECTION BY C1

Facility

$390.00

Service Code	HCPCS 86332
Hospital Charge Code	39900438
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IMMUNOCYTOCHEMISTRY STAIN 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	3005338
Hospital Revenue Code	310
Min. Negotiated Rate	$30.74
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$30.74

IMMUNOCYTOCHEMISTRY STAIN 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	3005338
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

IMMUNOFIXATION ELECTROPHORESIS

Facility

$552.00

Service Code	HCPCS 86334
Hospital Charge Code	38479105
Hospital Revenue Code	302
Min. Negotiated Rate	$82.80
Max. Negotiated Rate	$82.80
Rate for Payer: Qualcare PPO/HMO/WC	$82.80

IMMUNOFIXATION ELECTROPHORESIS

Facility

$552.00

Service Code	HCPCS 86334
Hospital Charge Code	38479105
Hospital Revenue Code	302
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$276.00
Rate for Payer: Aetna Commercial	$60.76
Rate for Payer: Aetna Medicare Advantage	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.04
Rate for Payer: Cigna Commercial	$276.00
Rate for Payer: Cigna Medicare Advantage	$22.34
Rate for Payer: Clover Medicare Advantage	$21.22
Rate for Payer: EmblemHealth Commercial	$67.02
Rate for Payer: Humana Medicare Advantage	$23.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$17.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.34
Rate for Payer: Wellcare Medicare Advantage	$22.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.68

IMMUNOFIXATION,SERUM

Facility

$390.00

Service Code	HCPCS 86334
Hospital Charge Code	39900214
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$60.76
Rate for Payer: Aetna Medicare Advantage	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.04
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.34
Rate for Payer: Clover Medicare Advantage	$21.22
Rate for Payer: EmblemHealth Commercial	$67.02
Rate for Payer: Humana Medicare Advantage	$23.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.34
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	$17.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.34
Rate for Payer: Wellcare Medicare Advantage	$22.34
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

IMMUNOFIXATION,SERUM

Facility

$390.00

Service Code	HCPCS 86334
Hospital Charge Code	39900214
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IMMUNOFIXATION,URINE

Facility

$390.00

Service Code	HCPCS 86335
Hospital Charge Code	39900215
Hospital Revenue Code	302
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