Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ANTIB,HERPES SIMPLEX,TYPE 2

Facility

$136.00

Service Code	HCPCS 86696
Hospital Charge Code	38476304
Hospital Revenue Code	302
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$20.40
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

ANTIBIOTIC BONE CEMENT

Facility

$745.00

Hospital Charge Code	270656476
Hospital Revenue Code	270
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$111.75
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

ANTIBIOTIC BONE CEMENT

Facility

$745.00

Hospital Charge Code	270656476
Hospital Revenue Code	270
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.70
Rate for Payer: Oxford Commercial	$149.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Commercial	$149.00
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

ANTIBIOTIC LEVEL

Facility

$272.00

Service Code	HCPCS 87186
Hospital Charge Code	38472022
Hospital Revenue Code	309
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$23.53
Rate for Payer: Aetna Medicare Advantage	$28.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.38
Rate for Payer: Cigna Commercial	$136.00
Rate for Payer: Cigna Medicare Advantage	$8.65
Rate for Payer: Clover Medicare Advantage	$8.22
Rate for Payer: EmblemHealth Commercial	$25.95
Rate for Payer: Humana Medicare Advantage	$8.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.65
Rate for Payer: Wellcare Medicare Advantage	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$7.72

ANTIBIOTIC LEVEL

Facility

$272.00

Service Code	HCPCS 87186
Hospital Charge Code	38472022
Hospital Revenue Code	309
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$40.80

ANTIB;LYMPHOCYTC CHORIOMENINGI

Facility

$91.00

Service Code	HCPCS 86727
Hospital Charge Code	38477108
Hospital Revenue Code	302
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
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	$46.69
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
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	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

ANTIB;LYMPHOCYTC CHORIOMENINGI

Facility

$91.00

Service Code	HCPCS 86727
Hospital Charge Code	38477108
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

ANTIBODY,ACTINOMYCES

Facility

$72.00

Service Code	HCPCS 86602
Hospital Charge Code	38477066
Hospital Revenue Code	302
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

ANTIBODY,ACTINOMYCES

Facility

$72.00

Service Code	HCPCS 86602
Hospital Charge Code	38477066
Hospital Revenue Code	302
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.93
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

ANTIBODY,BACTERIUM,NOT SPEC (1

Facility

$91.00

Service Code	HCPCS 86609
Hospital Charge Code	38476264
Hospital Revenue Code	302
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.72
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
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	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

ANTIBODY,BACTERIUM,NOT SPEC (1

Facility

$91.00

Service Code	HCPCS 86609
Hospital Charge Code	38476264
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

ANTIBODY,BACTERIUM,NOT SPEC(2)

Facility

$91.00

Service Code	HCPCS 86609
Hospital Charge Code	38476265
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

ANTIBODY,BACTERIUM,NOT SPEC(2)

Facility

$91.00

Service Code	HCPCS 86609
Hospital Charge Code	38476265
Hospital Revenue Code	302
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.72
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
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	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

ANTIBODY, BARTONELLA

Facility

$72.00

Service Code	HCPCS 86611
Hospital Charge Code	38476307
Hospital Revenue Code	302
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

ANTIBODY, BARTONELLA

Facility

$72.00

Service Code	HCPCS 86611
Hospital Charge Code	38476307
Hospital Revenue Code	302
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.93
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

ANTIBODY,COCCIDIODES

Facility

$116.00

Service Code	HCPCS 86635
Hospital Charge Code	38479403
Hospital Revenue Code	302
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$31.20
Rate for Payer: Aetna Medicare Advantage	$37.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.61
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: Cigna Medicare Advantage	$11.47
Rate for Payer: Clover Medicare Advantage	$10.90
Rate for Payer: EmblemHealth Commercial	$34.41
Rate for Payer: Humana Medicare Advantage	$11.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.16
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.47
Rate for Payer: Wellcare Medicare Advantage	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

ANTIBODY,COCCIDIODES

Facility

$116.00

Service Code	HCPCS 86635
Hospital Charge Code	38479403
Hospital Revenue Code	302
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

ANTIBODY;DIPHTHERIA

Facility

$107.00

Service Code	HCPCS 86648
Hospital Charge Code	38477129
Hospital Revenue Code	302
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$41.37
Rate for Payer: Aetna Medicare Advantage	$49.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.17
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: Cigna Medicare Advantage	$15.21
Rate for Payer: Clover Medicare Advantage	$14.45
Rate for Payer: EmblemHealth Commercial	$45.63
Rate for Payer: Humana Medicare Advantage	$15.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.21
Rate for Payer: Wellcare Medicare Advantage	$15.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

ANTIBODY;DIPHTHERIA

Facility

$107.00

Service Code	HCPCS 86648
Hospital Charge Code	38477129
Hospital Revenue Code	302
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

ANTIBODY, EHRLICHIA

Facility

$72.00

Service Code	HCPCS 86666
Hospital Charge Code	38476302
Hospital Revenue Code	302
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.93
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

ANTIBODY, EHRLICHIA

Facility

$72.00

Service Code	HCPCS 86666
Hospital Charge Code	38476302
Hospital Revenue Code	302
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

ANTIBODY ELUTION

Facility

$667.59

Service Code	HCPCS 86860
Hospital Charge Code	3100187
Hospital Revenue Code	300
Min. Negotiated Rate	$4.20
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) NJ Health	$7.62
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	$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	$4.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

ANTIBODY ELUTION

Facility

$223.00

Service Code	HCPCS 86860
Hospital Charge Code	38471041
Hospital Revenue Code	300
Min. Negotiated Rate	$4.20
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) NJ Health	$7.62
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	$57.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

ANTIBODY ELUTION

Facility

$223.00

Service Code	HCPCS 86860
Hospital Charge Code	38471041
Hospital Revenue Code	300
Min. Negotiated Rate	$33.45
Max. Negotiated Rate	$33.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.45

ANTIBODY ELUTION

Facility

$667.59

Service Code	HCPCS 86860
Hospital Charge Code	3100187
Hospital Revenue Code	300
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