Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CH RBC CMV NEG LEUKORED

Facility

$990.90

Service Code	HCPCS P9051
Hospital Charge Code	397031167
Hospital Revenue Code	390
Min. Negotiated Rate	$148.63
Max. Negotiated Rate	$148.63
Rate for Payer: Qualcare PPO/HMO/WC	$148.63

CH RBC LEUKO IRRAD CMV NEG

Facility

$1,430.80

Service Code	HCPCS P9058
Hospital Charge Code	397031173
Hospital Revenue Code	390
Min. Negotiated Rate	$40.63
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$788.83
Rate for Payer: Aetna Medicare Advantage	$939.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,052.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,052.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$290.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,052.01
Rate for Payer: Cigna Commercial	$581.32
Rate for Payer: Cigna Medicare Advantage	$290.01
Rate for Payer: Clover Medicare Advantage	$275.51
Rate for Payer: EmblemHealth Commercial	$870.03
Rate for Payer: Humana Medicare Advantage	$298.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$290.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.01
Rate for Payer: Oxford Commercial	$1,028.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.62
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$45.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$290.01
Rate for Payer: Wellcare Medicare Advantage	$290.01
Rate for Payer: Wellpoint Medicaid Managed Care	$40.63

CH RBC LEUKO IRRAD CMV NEG

Facility

$1,430.80

Service Code	HCPCS P9058
Hospital Charge Code	397031173
Hospital Revenue Code	390
Min. Negotiated Rate	$214.62
Max. Negotiated Rate	$214.62
Rate for Payer: Qualcare PPO/HMO/WC	$214.62

CH RHOGAM

Facility

$139.25

Service Code	HCPCS J2792
Hospital Charge Code	397031022
Hospital Revenue Code	636
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$124.28
Rate for Payer: Aetna Commercial	$93.19
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.28
Rate for Payer: Cigna Medicare Advantage	$34.26
Rate for Payer: Clover Medicare Advantage	$32.55
Rate for Payer: EmblemHealth Commercial	$102.78
Rate for Payer: Humana Medicare Advantage	$35.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.26
Rate for Payer: Wellcare Medicare Advantage	$34.26
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

CH RHOGAM

Facility

$139.25

Service Code	HCPCS J2792
Hospital Charge Code	397031022
Hospital Revenue Code	636
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$33.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

CH RIFAMPIN (SERUM) HPLC

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	397073660
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH RIFAMPIN (SERUM) HPLC

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	397073660
Hospital Revenue Code	301
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
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	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CHROM ANALYSIS ADDL CELLS EA S

Facility

$134.00

Service Code	HCPCS 88285
Hospital Charge Code	38477154
Hospital Revenue Code	311
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$73.20
Rate for Payer: Aetna Medicare Advantage	$87.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.62
Rate for Payer: Cigna Commercial	$67.00
Rate for Payer: Cigna Medicare Advantage	$26.91
Rate for Payer: Clover Medicare Advantage	$25.56
Rate for Payer: EmblemHealth Commercial	$80.73
Rate for Payer: Humana Medicare Advantage	$27.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.84
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$21.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.91
Rate for Payer: Wellcare Medicare Advantage	$26.91
Rate for Payer: Wellpoint Medicaid Managed Care	$3.81

CHROM ANALYSIS ADDL CELLS EA S

Facility

$134.00

Service Code	HCPCS 88285
Hospital Charge Code	38477154
Hospital Revenue Code	311
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

CHROM ANALYSIS ADDL HIGH RESOL

Facility

$242.00

Service Code	HCPCS 88289
Hospital Charge Code	38477191
Hospital Revenue Code	311
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

CHROM ANALYSIS ADDL HIGH RESOL

Facility

$242.00

Service Code	HCPCS 88289
Hospital Charge Code	38477191
Hospital Revenue Code	311
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$93.65
Rate for Payer: Aetna Medicare Advantage	$111.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.89
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: Cigna Medicare Advantage	$34.43
Rate for Payer: Clover Medicare Advantage	$32.71
Rate for Payer: EmblemHealth Commercial	$103.29
Rate for Payer: Humana Medicare Advantage	$35.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$27.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.43
Rate for Payer: Wellcare Medicare Advantage	$34.43
Rate for Payer: Wellpoint Medicaid Managed Care	$6.87

CHROM ANALYSIS ADDL KARYOTYPES

Facility

$177.00

Service Code	HCPCS 88280
Hospital Charge Code	38477179
Hospital Revenue Code	311
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$91.04
Rate for Payer: Aetna Medicare Advantage	$108.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.41
Rate for Payer: Cigna Commercial	$88.50
Rate for Payer: Cigna Medicare Advantage	$33.47
Rate for Payer: Clover Medicare Advantage	$31.80
Rate for Payer: EmblemHealth Commercial	$100.41
Rate for Payer: Humana Medicare Advantage	$34.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$26.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.47
Rate for Payer: Wellcare Medicare Advantage	$33.47
Rate for Payer: Wellpoint Medicaid Managed Care	$5.03

CHROM ANALYSIS ADDL KARYOTYPES

Facility

$177.00

Service Code	HCPCS 88280
Hospital Charge Code	38477179
Hospital Revenue Code	311
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$26.55
Rate for Payer: Qualcare PPO/HMO/WC	$26.55

CHROMATIN NUCLEOSOMAL AB

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	401186235
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CHROMATIN NUCLEOSOMAL AB

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	401186235
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.04
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
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	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CHROMATOGRAPHY,QUANT,COLUMN

Facility

$127.00

Service Code	HCPCS 82542
Hospital Charge Code	38476780
Hospital Revenue Code	301
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.39
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

CHROMATOGRAPHY,QUANT,COLUMN

Facility

$127.00

Service Code	HCPCS 82542
Hospital Charge Code	38476780
Hospital Revenue Code	301
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

CHROMATOGRAPHY,QUANT,COLUMN

Facility

$127.00

Service Code	HCPCS 82542
Hospital Charge Code	38476779
Hospital Revenue Code	301
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.39
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

CHROMATOGRAPHY,QUANT,COLUMN

Facility

$127.00

Service Code	HCPCS 82542
Hospital Charge Code	38476779
Hospital Revenue Code	301
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

CHROMATOGRAPHY QUANT COLUMN M

Facility

$127.00

Service Code	HCPCS 82542
Hospital Charge Code	38477149
Hospital Revenue Code	301
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.39
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

CHROMATOGRAPHY QUANT COLUMN M

Facility

$127.00

Service Code	HCPCS 82542
Hospital Charge Code	38477149
Hospital Revenue Code	301
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

CH ROMI

Facility

$1,013.58

Service Code	HCPCS 84484
Hospital Charge Code	397073189
Hospital Revenue Code	301
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$506.79
Rate for Payer: Aetna Commercial	$33.92
Rate for Payer: Aetna Medicare Advantage	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.23
Rate for Payer: Cigna Commercial	$506.79
Rate for Payer: Cigna Medicare Advantage	$12.47
Rate for Payer: Clover Medicare Advantage	$11.85
Rate for Payer: EmblemHealth Commercial	$37.41
Rate for Payer: Humana Medicare Advantage	$12.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.53
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$152.04
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.47
Rate for Payer: Wellcare Medicare Advantage	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$28.79

CH ROMI

Facility

$1,013.58

Service Code	HCPCS 84484
Hospital Charge Code	397073189
Hospital Revenue Code	301
Min. Negotiated Rate	$152.04
Max. Negotiated Rate	$152.04
Rate for Payer: Qualcare PPO/HMO/WC	$152.04

CHROMIUM

Facility

$139.40

Service Code	HCPCS 82495
Hospital Charge Code	39900061
Hospital Revenue Code	301
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$55.16
Rate for Payer: Aetna Medicare Advantage	$65.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.57
Rate for Payer: Cigna Commercial	$69.70
Rate for Payer: Cigna Medicare Advantage	$20.28
Rate for Payer: Clover Medicare Advantage	$19.27
Rate for Payer: EmblemHealth Commercial	$60.84
Rate for Payer: Humana Medicare Advantage	$20.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.91
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.28
Rate for Payer: Wellcare Medicare Advantage	$20.28
Rate for Payer: Wellpoint Medicaid Managed Care	$3.96

CHROMIUM

Facility

$139.40

Service Code	HCPCS 82495
Hospital Charge Code	39900061
Hospital Revenue Code	301
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$20.91
Rate for Payer: Qualcare PPO/HMO/WC	$20.91

Know your out-of-pocket cost for care.

All Charges