Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

UNLSTD PROC SKIN MM & SQ TISS

Facility

$5,068.40

Service Code	HCPCS 17999
Hospital Charge Code	16000262
Hospital Revenue Code	360
Min. Negotiated Rate	$143.94
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.78
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$760.26
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$160.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$143.94

UNLST PROC MATERNITY CARE&DEL

Facility

$642.80

Service Code	HCPCS 59899
Hospital Charge Code	16001015
Hospital Revenue Code	360
Min. Negotiated Rate	$18.26
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.13
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.42
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$20.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$18.26

UNLST PROC MATERNITY CARE&DEL

Facility

$642.80

Service Code	HCPCS 59899
Hospital Charge Code	16001015
Hospital Revenue Code	360
Min. Negotiated Rate	$96.42
Max. Negotiated Rate	$96.42
Rate for Payer: Qualcare PPO/HMO/WC	$96.42

UNNA BOOT 4

Facility

$5.85

Service Code	HCPCS A6456
Hospital Charge Code	9808106
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: Aetna Medicare Advantage	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.52
Rate for Payer: Oxford Commercial	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$1.17
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

UNNA BOOT 4

Facility

$5.85

Service Code	HCPCS A6456
Hospital Charge Code	9808106
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

UNNA BOOT 4X10YD

Facility

$27.48

Hospital Charge Code	270653063
Hospital Revenue Code	270
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$4.12
Rate for Payer: Qualcare PPO/HMO/WC	$4.12

UNNA BOOT 4X10YD

Facility

$27.48

Hospital Charge Code	270653063
Hospital Revenue Code	270
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.74
Rate for Payer: Aetna Commercial	$10.44
Rate for Payer: Aetna Medicare Advantage	$8.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.01
Rate for Payer: Cigna Commercial	$13.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.14
Rate for Payer: Oxford Commercial	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.12
Rate for Payer: UnitedHealthcare Commercial	$5.50
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

UNNA BOOT APPLICATION

Facility

$476.00

Service Code	HCPCS 29580
Hospital Charge Code	421029580
Hospital Revenue Code	761
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$71.40

UNNA BOOT APPLICATION

Facility

$476.00

Service Code	HCPCS 29580
Hospital Charge Code	9108030
Hospital Revenue Code	420
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$700.29
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$135.13
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.76
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.40
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$15.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.52

UNNA BOOT APPLICATION

Facility

$476.00

Service Code	HCPCS 29580
Hospital Charge Code	421029580
Hospital Revenue Code	761
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$700.29
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$700.29
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.76
Rate for Payer: Oxford Commercial	$95.20
Rate for Payer: Qualcare PPO/HMO/WC	$71.40
Rate for Payer: UnitedHealthcare Commercial	$95.20
Rate for Payer: UnitedHealthcare Community & State	$15.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.52

UNNA BOOT APPLICATION

Facility

$476.00

Service Code	HCPCS 29580
Hospital Charge Code	9108030
Hospital Revenue Code	420
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$71.40

UNSCHED DIALYSIS ESRD PT HOS

Facility

$3,624.15

Service Code	HCPCS G0257
Hospital Charge Code	93626001
Hospital Revenue Code	829
Min. Negotiated Rate	$543.62
Max. Negotiated Rate	$543.62
Rate for Payer: Qualcare PPO/HMO/WC	$543.62

UNSCHED DIALYSIS ESRD PT HOS

Facility

$3,624.15

Service Code	HCPCS G0257
Hospital Charge Code	93626001
Hospital Revenue Code	829
Min. Negotiated Rate	$102.93
Max. Negotiated Rate	$4,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,957.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,957.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$815.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,957.72
Rate for Payer: Cigna Commercial	$1,634.39
Rate for Payer: Clover Medicare Advantage	$774.59
Rate for Payer: EmblemHealth Commercial	$2,446.08
Rate for Payer: Humana Medicare Advantage	$839.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$815.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$942.28
Rate for Payer: Oxford Commercial	$3,933.00
Rate for Payer: Qualcare PPO/HMO/WC	$543.62
Rate for Payer: UnitedHealthcare Commercial	$4,468.00
Rate for Payer: UnitedHealthcare Community & State	$114.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$815.36
Rate for Payer: Wellcare Medicare Advantage	$815.36
Rate for Payer: Wellpoint Medicaid Managed Care	$102.93

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$73,107.40

Service Code	MSDRG 256
Min. Negotiated Rate	$22,260.27
Max. Negotiated Rate	$73,107.40
Rate for Payer: Aetna Commercial	$53,926.44
Rate for Payer: Aetna Medicare Advantage	$73,107.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,436.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,436.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,431.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,436.20
Rate for Payer: Cigna Commercial	$37,851.28
Rate for Payer: Cigna Medicare Advantage	$23,431.86
Rate for Payer: Clover Medicare Advantage	$22,260.27
Rate for Payer: EmblemHealth Commercial	$70,295.58
Rate for Payer: Humana Medicare Advantage	$24,134.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,431.86
Rate for Payer: Oxford Commercial	$29,917.00
Rate for Payer: UnitedHealthcare Commercial	$40,044.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,431.86
Rate for Payer: Wellcare Medicare Advantage	$23,431.86

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$104,685.14

Service Code	MSDRG 255
Min. Negotiated Rate	$31,875.28
Max. Negotiated Rate	$104,685.14
Rate for Payer: Aetna Commercial	$76,416.48
Rate for Payer: Aetna Medicare Advantage	$104,685.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76,188.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76,188.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33,552.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76,188.75
Rate for Payer: Cigna Commercial	$60,133.14
Rate for Payer: Cigna Medicare Advantage	$33,552.93
Rate for Payer: Clover Medicare Advantage	$31,875.28
Rate for Payer: EmblemHealth Commercial	$100,658.79
Rate for Payer: Humana Medicare Advantage	$34,559.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33,552.93
Rate for Payer: Oxford Commercial	$47,528.19
Rate for Payer: UnitedHealthcare Commercial	$63,618.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$33,552.93
Rate for Payer: Wellcare Medicare Advantage	$33,552.93

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$53,971.16

Service Code	MSDRG 257
Min. Negotiated Rate	$16,433.53
Max. Negotiated Rate	$53,971.16
Rate for Payer: Aetna Commercial	$40,297.40
Rate for Payer: Aetna Medicare Advantage	$53,971.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,427.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,427.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,298.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,427.95
Rate for Payer: Cigna Commercial	$24,348.41
Rate for Payer: Cigna Medicare Advantage	$17,298.45
Rate for Payer: Clover Medicare Advantage	$16,433.53
Rate for Payer: EmblemHealth Commercial	$51,895.35
Rate for Payer: Humana Medicare Advantage	$17,817.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,298.45
Rate for Payer: Oxford Commercial	$19,244.56
Rate for Payer: UnitedHealthcare Commercial	$25,759.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,298.45
Rate for Payer: Wellcare Medicare Advantage	$17,298.45

UPPER MINOR KIT

Facility

$145.00

Hospital Charge Code	270338758
Hospital Revenue Code	272
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Oxford Commercial	$29.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$29.00
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$4.12

UPPER MINOR KIT

Facility

$145.00

Hospital Charge Code	270338758
Hospital Revenue Code	272
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

UREA NITROGEN, 24 HOUR URINE

Facility

$390.00

Service Code	HCPCS 84540
Hospital Charge Code	3030864
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

UREA NITROGEN, 24 HOUR URINE

Facility

$390.00

Service Code	HCPCS 84540
Hospital Charge Code	3030864
Hospital Revenue Code	301
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.12
Rate for Payer: Aetna Medicare Advantage	$18.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.17
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.56
Rate for Payer: Clover Medicare Advantage	$5.28
Rate for Payer: EmblemHealth Commercial	$16.68
Rate for Payer: Humana Medicare Advantage	$5.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.56
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	$4.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.56
Rate for Payer: Wellcare Medicare Advantage	$5.56
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

UREA NITROGEN, CLEARANCE

Facility

$46.00

Service Code	HCPCS 84545
Hospital Charge Code	38477047
Hospital Revenue Code	301
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

UREA NITROGEN, CLEARANCE

Facility

$46.00

Service Code	HCPCS 84545
Hospital Charge Code	38477047
Hospital Revenue Code	301
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$19.58
Rate for Payer: Aetna Medicare Advantage	$23.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.12
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$6.84
Rate for Payer: EmblemHealth Commercial	$21.60
Rate for Payer: Humana Medicare Advantage	$7.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20
Rate for Payer: Wellcare Medicare Advantage	$7.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

UREA NITROGEN PERITONEAL FLUID

Facility

$51.11

Service Code	HCPCS 84520
Hospital Charge Code	401184520
Hospital Revenue Code	306
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$7.67
Rate for Payer: Qualcare PPO/HMO/WC	$7.67

UREA NITROGEN PERITONEAL FLUID

Facility

$51.11

Service Code	HCPCS 84520
Hospital Charge Code	401184520
Hospital Revenue Code	306
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$10.74
Rate for Payer: Aetna Medicare Advantage	$12.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.33
Rate for Payer: Cigna Commercial	$25.55
Rate for Payer: Cigna Medicare Advantage	$3.95
Rate for Payer: Clover Medicare Advantage	$3.75
Rate for Payer: EmblemHealth Commercial	$11.85
Rate for Payer: Humana Medicare Advantage	$4.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.29
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.67
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.95
Rate for Payer: Wellcare Medicare Advantage	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

UREA NITROGEN, URINE

Facility

$160.00

Service Code	HCPCS 84540
Hospital Charge Code	38472655
Hospital Revenue Code	301
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

Know your out-of-pocket cost for care.

All Charges