Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CHEMO IV PUSH-1ST MD INFU

Facility

$788.25

Service Code	HCPCS 96409
Hospital Charge Code	93500083
Hospital Revenue Code	331
Min. Negotiated Rate	$22.39
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,423.47
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.94
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.24
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$24.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$22.39

CHEMO IV PUSH-1ST MD INFU

Facility

$788.25

Service Code	HCPCS 96409
Hospital Charge Code	93500083
Hospital Revenue Code	331
Min. Negotiated Rate	$118.24
Max. Negotiated Rate	$118.24
Rate for Payer: Qualcare PPO/HMO/WC	$118.24

CHEMO, IV PUSH, ADDL DRUG

Facility

$1,140.00

Service Code	HCPCS 96411
Hospital Charge Code	3401095
Hospital Revenue Code	331
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$171.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

CHEMO, IV PUSH, ADDL DRUG

Facility

$1,140.00

Service Code	HCPCS 96411
Hospital Charge Code	3401095
Hospital Revenue Code	331
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.30
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$59.88
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.40
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

CHEMO IV PUSH EACH ADDT MED

Facility

$402.60

Service Code	HCPCS 96411
Hospital Charge Code	93500085
Hospital Revenue Code	331
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.30
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$59.88
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.68
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.39
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$12.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$11.43

CHEMO IV PUSH EACH ADDT MED

Facility

$402.60

Service Code	HCPCS 96411
Hospital Charge Code	93500085
Hospital Revenue Code	331
Min. Negotiated Rate	$60.39
Max. Negotiated Rate	$60.39
Rate for Payer: Qualcare PPO/HMO/WC	$60.39

CHEMO IV PUSH INITIAL MED

Facility

$431.00

Service Code	HCPCS 96409
Hospital Charge Code	93500081
Hospital Revenue Code	331
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,423.47
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.06
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.65
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$13.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$12.24

CHEMO IV PUSH INITIAL MED

Facility

$431.00

Service Code	HCPCS 96409
Hospital Charge Code	93500081
Hospital Revenue Code	331
Min. Negotiated Rate	$64.65
Max. Negotiated Rate	$64.65
Rate for Payer: Qualcare PPO/HMO/WC	$64.65

CHEMO, IV PUSH, SNGL DRUG

Facility

$762.00

Service Code	HCPCS 96409
Hospital Charge Code	3401090
Hospital Revenue Code	331
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,423.47
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.12
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.30
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$24.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$21.64

CHEMO, IV PUSH, SNGL DRUG

Facility

$762.00

Service Code	HCPCS 96409
Hospital Charge Code	3401090
Hospital Revenue Code	331
Min. Negotiated Rate	$114.30
Max. Negotiated Rate	$114.30
Rate for Payer: Qualcare PPO/HMO/WC	$114.30

CHEMO NEW PATIENT VISIT

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	3408035
Hospital Revenue Code	510
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$201.00
Rate for Payer: Aetna Commercial	$152.76
Rate for Payer: Aetna Medicare Advantage	$120.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.51
Rate for Payer: Cigna Commercial	$201.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.52
Rate for Payer: Qualcare PPO/HMO/WC	$60.30
Rate for Payer: UnitedHealthcare Community & State	$12.70
Rate for Payer: Wellpoint Medicaid Managed Care	$11.42

CHEMO NEW PATIENT VISIT

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	3408035
Hospital Revenue Code	510
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$8,198.80

Service Code	APR-DRG 6951
Min. Negotiated Rate	$8,038.04
Max. Negotiated Rate	$8,198.80
Rate for Payer: UnitedHealthcare Community & State	$8,038.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,198.80
Rate for Payer: Wellpoint Medicaid Managed Care	$8,038.04

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$10,601.65

Service Code	APR-DRG 6952
Min. Negotiated Rate	$10,393.77
Max. Negotiated Rate	$10,601.65
Rate for Payer: UnitedHealthcare Community & State	$10,393.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,601.65
Rate for Payer: Wellpoint Medicaid Managed Care	$10,393.77

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$65,104.34

Service Code	APR-DRG 6954
Min. Negotiated Rate	$63,827.78
Max. Negotiated Rate	$65,104.34
Rate for Payer: UnitedHealthcare Community & State	$63,827.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$65,104.34
Rate for Payer: Wellpoint Medicaid Managed Care	$63,827.78

CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$20,551.70

Service Code	APR-DRG 6953
Min. Negotiated Rate	$20,148.73
Max. Negotiated Rate	$20,551.70
Rate for Payer: UnitedHealthcare Community & State	$20,148.73
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,551.70
Rate for Payer: Wellpoint Medicaid Managed Care	$20,148.73

CHEMOTHERAPY INTRACAVITARY

Facility

$1,292.00

Service Code	HCPCS 96446
Hospital Charge Code	3401106
Hospital Revenue Code	331
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$193.80
Rate for Payer: Qualcare PPO/HMO/WC	$193.80

CHEMOTHERAPY INTRACAVITARY

Facility

$1,292.00

Service Code	HCPCS 96446
Hospital Charge Code	3401106
Hospital Revenue Code	331
Min. Negotiated Rate	$36.69
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,423.47
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.92
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.80
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$40.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$36.69

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$171,249.59

Service Code	MSDRG 837
Min. Negotiated Rate	$52,143.31
Max. Negotiated Rate	$171,249.59
Rate for Payer: Aetna Commercial	$123,824.43
Rate for Payer: Aetna Medicare Advantage	$171,249.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134,092.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134,092.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$54,887.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134,092.20
Rate for Payer: Cigna Commercial	$107,102.26
Rate for Payer: Cigna Medicare Advantage	$54,887.69
Rate for Payer: Clover Medicare Advantage	$52,143.31
Rate for Payer: EmblemHealth Commercial	$164,663.07
Rate for Payer: Humana Medicare Advantage	$56,534.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$54,887.69
Rate for Payer: Oxford Commercial	$84,651.77
Rate for Payer: UnitedHealthcare Commercial	$113,309.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$54,887.69
Rate for Payer: Wellcare Medicare Advantage	$54,887.69

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$85,413.09

Service Code	MSDRG 838
Min. Negotiated Rate	$26,007.19
Max. Negotiated Rate	$85,413.09
Rate for Payer: Aetna Commercial	$62,690.70
Rate for Payer: Aetna Medicare Advantage	$85,413.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,375.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,410.00
Rate for Payer: Cigna Commercial	$46,534.41
Rate for Payer: Cigna Medicare Advantage	$27,375.99
Rate for Payer: Clover Medicare Advantage	$26,007.19
Rate for Payer: EmblemHealth Commercial	$82,127.97
Rate for Payer: Humana Medicare Advantage	$28,197.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,375.99
Rate for Payer: Oxford Commercial	$36,779.99
Rate for Payer: UnitedHealthcare Commercial	$49,231.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,375.99
Rate for Payer: Wellcare Medicare Advantage	$27,375.99

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$65,082.58

Service Code	MSDRG 839
Min. Negotiated Rate	$19,816.81
Max. Negotiated Rate	$65,082.58
Rate for Payer: Aetna Commercial	$48,211.05
Rate for Payer: Aetna Medicare Advantage	$65,082.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,016.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,016.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,859.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,016.50
Rate for Payer: Cigna Commercial	$32,188.86
Rate for Payer: Cigna Medicare Advantage	$20,859.80
Rate for Payer: Clover Medicare Advantage	$19,816.81
Rate for Payer: EmblemHealth Commercial	$62,579.40
Rate for Payer: Humana Medicare Advantage	$21,485.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,859.80
Rate for Payer: Oxford Commercial	$25,441.52
Rate for Payer: UnitedHealthcare Commercial	$34,054.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,859.80
Rate for Payer: Wellcare Medicare Advantage	$20,859.80

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$60,795.35

Service Code	MSDRG 847
Min. Negotiated Rate	$18,511.41
Max. Negotiated Rate	$60,795.35
Rate for Payer: Aetna Commercial	$45,157.64
Rate for Payer: Aetna Medicare Advantage	$60,795.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,523.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,523.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,485.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,523.05
Rate for Payer: Cigna Commercial	$29,163.70
Rate for Payer: Cigna Medicare Advantage	$19,485.69
Rate for Payer: Clover Medicare Advantage	$18,511.41
Rate for Payer: EmblemHealth Commercial	$58,457.07
Rate for Payer: Humana Medicare Advantage	$20,070.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,485.69
Rate for Payer: Oxford Commercial	$23,050.48
Rate for Payer: UnitedHealthcare Commercial	$30,853.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,485.69
Rate for Payer: Wellcare Medicare Advantage	$19,485.69

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$101,370.92

Service Code	MSDRG 846
Min. Negotiated Rate	$30,866.15
Max. Negotiated Rate	$101,370.92
Rate for Payer: Aetna Commercial	$74,056.05
Rate for Payer: Aetna Medicare Advantage	$101,370.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67,600.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67,600.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$32,490.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67,600.20
Rate for Payer: Cigna Commercial	$57,794.60
Rate for Payer: Cigna Medicare Advantage	$32,490.68
Rate for Payer: Clover Medicare Advantage	$30,866.15
Rate for Payer: EmblemHealth Commercial	$97,472.04
Rate for Payer: Humana Medicare Advantage	$33,465.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$32,490.68
Rate for Payer: Oxford Commercial	$45,679.85
Rate for Payer: UnitedHealthcare Commercial	$61,144.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$32,490.68
Rate for Payer: Wellcare Medicare Advantage	$32,490.68

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$46,300.24

Service Code	MSDRG 848
Min. Negotiated Rate	$14,097.83
Max. Negotiated Rate	$46,300.24
Rate for Payer: Aetna Commercial	$34,834.06
Rate for Payer: Aetna Medicare Advantage	$46,300.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,272.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,272.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,839.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,272.20
Rate for Payer: Cigna Commercial	$18,935.67
Rate for Payer: Cigna Medicare Advantage	$14,839.82
Rate for Payer: Clover Medicare Advantage	$14,097.83
Rate for Payer: EmblemHealth Commercial	$44,519.46
Rate for Payer: Humana Medicare Advantage	$15,285.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,839.82
Rate for Payer: Oxford Commercial	$14,966.43
Rate for Payer: UnitedHealthcare Commercial	$20,033.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,839.82
Rate for Payer: Wellcare Medicare Advantage	$14,839.82

CH EOSINOPHILE COUNT

Facility

$390.00

Service Code	HCPCS 85048
Hospital Charge Code	397021036
Hospital Revenue Code	301
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