Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CHLAMYDIA/GC, SPA I

Facility

$241.20

Service Code	HCPCS 87491
Hospital Charge Code	39990114A
Hospital Revenue Code	306
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.71
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.85

CHLAMYDIA/GC, SPA I

Facility

$241.20

Service Code	HCPCS 87491
Hospital Charge Code	39990114A
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

CHLAMYDIA/GC, SPA II

Facility

$241.20

Service Code	HCPCS 87591
Hospital Charge Code	39990114B
Hospital Revenue Code	306
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.71
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.85

CHLAMYDIA/GC, SPA II

Facility

$241.20

Service Code	HCPCS 87591
Hospital Charge Code	39990114B
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

CHLAMYDIA/GC TMA I

Facility

$667.59

Service Code	HCPCS 87491
Hospital Charge Code	39990115A
Hospital Revenue Code	306
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHLAMYDIA/GC TMA I

Facility

$667.59

Service Code	HCPCS 87491
Hospital Charge Code	39990115A
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHLAMYDIA/GC TMA II

Facility

$667.59

Service Code	HCPCS 87591
Hospital Charge Code	39990115B
Hospital Revenue Code	306
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHLAMYDIA/GC TMA II

Facility

$667.59

Service Code	HCPCS 87591
Hospital Charge Code	39990115B
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHLAMYDIA IGM AB

Facility

$390.00

Service Code	HCPCS 86632
Hospital Charge Code	401386631B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CHLAMYDIA IGM AB

Facility

$390.00

Service Code	HCPCS 86632
Hospital Charge Code	401386631B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: Aetna Medicare Advantage	$41.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.68
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	$46.00
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.68
Rate for Payer: Clover Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$38.04
Rate for Payer: Humana Medicare Advantage	$13.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.68
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	$10.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.68
Rate for Payer: Wellcare Medicare Advantage	$12.68
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CHLAMYDIA PANEL I

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141A
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHLAMYDIA PANEL I

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.15
Rate for Payer: Aetna Medicare Advantage	$38.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.82
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	$42.88
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$11.82
Rate for Payer: Clover Medicare Advantage	$11.23
Rate for Payer: EmblemHealth Commercial	$35.46
Rate for Payer: Humana Medicare Advantage	$12.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.82
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	$9.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.82
Rate for Payer: Wellcare Medicare Advantage	$11.82
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHLAMYDIA PANEL II

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.15
Rate for Payer: Aetna Medicare Advantage	$38.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.82
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	$42.88
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$11.82
Rate for Payer: Clover Medicare Advantage	$11.23
Rate for Payer: EmblemHealth Commercial	$35.46
Rate for Payer: Humana Medicare Advantage	$12.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.82
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	$9.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.82
Rate for Payer: Wellcare Medicare Advantage	$11.82
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHLAMYDIA PANEL II

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141B
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHLAMYDIA PANEL III

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141C
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHLAMYDIA PANEL III

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.15
Rate for Payer: Aetna Medicare Advantage	$38.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.82
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	$42.88
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$11.82
Rate for Payer: Clover Medicare Advantage	$11.23
Rate for Payer: EmblemHealth Commercial	$35.46
Rate for Payer: Humana Medicare Advantage	$12.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.82
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	$9.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.82
Rate for Payer: Wellcare Medicare Advantage	$11.82
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHLAMYDIA PANEL IV

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141D
Hospital Revenue Code	302
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.15
Rate for Payer: Aetna Medicare Advantage	$38.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.82
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	$42.88
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$11.82
Rate for Payer: Clover Medicare Advantage	$11.23
Rate for Payer: EmblemHealth Commercial	$35.46
Rate for Payer: Humana Medicare Advantage	$12.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.82
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	$9.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.82
Rate for Payer: Wellcare Medicare Advantage	$11.82
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHLAMYDIA PANEL IV

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141D
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHLAMYDIA PANEL IX

Facility

$667.59

Service Code	HCPCS 86632
Hospital Charge Code	39990141I
Hospital Revenue Code	302
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: Aetna Medicare Advantage	$41.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.68
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	$46.00
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$12.68
Rate for Payer: Clover Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$38.04
Rate for Payer: Humana Medicare Advantage	$13.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.68
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	$10.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.68
Rate for Payer: Wellcare Medicare Advantage	$12.68
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHLAMYDIA PANEL IX

Facility

$667.59

Service Code	HCPCS 86632
Hospital Charge Code	39990141I
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHLAMYDIA PANEL V

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141E
Hospital Revenue Code	302
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.15
Rate for Payer: Aetna Medicare Advantage	$38.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.82
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	$42.88
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$11.82
Rate for Payer: Clover Medicare Advantage	$11.23
Rate for Payer: EmblemHealth Commercial	$35.46
Rate for Payer: Humana Medicare Advantage	$12.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.82
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	$9.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.82
Rate for Payer: Wellcare Medicare Advantage	$11.82
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHLAMYDIA PANEL V

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141E
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHLAMYDIA PANEL VI

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141F
Hospital Revenue Code	302
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.15
Rate for Payer: Aetna Medicare Advantage	$38.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.82
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	$42.88
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$11.82
Rate for Payer: Clover Medicare Advantage	$11.23
Rate for Payer: EmblemHealth Commercial	$35.46
Rate for Payer: Humana Medicare Advantage	$12.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.82
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	$9.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.82
Rate for Payer: Wellcare Medicare Advantage	$11.82
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CHLAMYDIA PANEL VI

Facility

$667.59

Service Code	HCPCS 86631
Hospital Charge Code	39990141F
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CHLAMYDIA PANEL VII

Facility

$667.59

Service Code	HCPCS 86632
Hospital Charge Code	39990141G
Hospital Revenue Code	302
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