Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CORTICAL SCREW 3.5 X 55MM

Facility

$247.50

Service Code	HCPCS C1713
Hospital Charge Code	270676100
Hospital Revenue Code	278
Min. Negotiated Rate	$7.03
Max. Negotiated Rate	$123.75
Rate for Payer: Aetna Commercial	$94.05
Rate for Payer: Aetna Medicare Advantage	$74.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.11
Rate for Payer: Cigna Commercial	$123.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.90
Rate for Payer: Qualcare PPO/HMO/WC	$37.12
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: Wellpoint Medicaid Managed Care	$7.03

CORTICAL STRUT

Facility

$1,263.00

Hospital Charge Code	270335630
Hospital Revenue Code	278
Min. Negotiated Rate	$189.45
Max. Negotiated Rate	$305.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.65
Rate for Payer: Qualcare PPO/HMO/WC	$189.45

CORTICAL STRUT

Facility

$1,263.00

Hospital Charge Code	270335630
Hospital Revenue Code	278
Min. Negotiated Rate	$35.87
Max. Negotiated Rate	$631.50
Rate for Payer: Aetna Commercial	$479.94
Rate for Payer: Aetna Medicare Advantage	$378.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$252.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.06
Rate for Payer: Cigna Commercial	$631.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.65
Rate for Payer: Qualcare PPO/HMO/WC	$189.45
Rate for Payer: UnitedHealthcare Community & State	$39.91
Rate for Payer: Wellpoint Medicaid Managed Care	$35.87

CORTICAL STRUT FEMORAL

Facility

$2,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270681921
Hospital Revenue Code	278
Min. Negotiated Rate	$61.91
Max. Negotiated Rate	$1,090.00
Rate for Payer: Aetna Commercial	$828.40
Rate for Payer: Aetna Medicare Advantage	$654.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$555.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$555.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$555.90
Rate for Payer: Cigna Commercial	$1,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$527.56
Rate for Payer: Qualcare PPO/HMO/WC	$327.00
Rate for Payer: UnitedHealthcare Community & State	$68.89
Rate for Payer: Wellpoint Medicaid Managed Care	$61.91

CORTICAL STRUT FEMORAL

Facility

$2,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270681921
Hospital Revenue Code	278
Min. Negotiated Rate	$327.00
Max. Negotiated Rate	$527.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$527.56
Rate for Payer: Qualcare PPO/HMO/WC	$327.00

Cortisol

Facility

$667.59

Service Code	HCPCS 82533
Hospital Charge Code	39888016
Hospital Revenue Code	301
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$44.34
Rate for Payer: Aetna Medicare Advantage	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.13
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$16.30
Rate for Payer: Clover Medicare Advantage	$15.48
Rate for Payer: EmblemHealth Commercial	$48.90
Rate for Payer: Humana Medicare Advantage	$16.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.30
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	$13.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.30
Rate for Payer: Wellcare Medicare Advantage	$16.30
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

Cortisol

Facility

$667.59

Service Code	HCPCS 82533
Hospital Charge Code	39888016
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CORTISOL BINDING GLOBULIN

Facility

$390.00

Service Code	HCPCS 84449
Hospital Charge Code	39900475
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.96
Rate for Payer: Aetna Medicare Advantage	$58.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.30
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.00
Rate for Payer: Clover Medicare Advantage	$17.10
Rate for Payer: EmblemHealth Commercial	$54.00
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.00
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	$14.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00
Rate for Payer: Wellcare Medicare Advantage	$18.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CORTISOL BINDING GLOBULIN

Facility

$390.00

Service Code	HCPCS 84449
Hospital Charge Code	39900475
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CORTISOL, FREE

Facility

$682.00

Service Code	HCPCS 82530
Hospital Charge Code	38472024
Hospital Revenue Code	301
Min. Negotiated Rate	$13.37
Max. Negotiated Rate	$341.00
Rate for Payer: Aetna Commercial	$45.45
Rate for Payer: Aetna Medicare Advantage	$54.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.62
Rate for Payer: Cigna Commercial	$341.00
Rate for Payer: Cigna Medicare Advantage	$16.71
Rate for Payer: Clover Medicare Advantage	$15.87
Rate for Payer: EmblemHealth Commercial	$50.13
Rate for Payer: Humana Medicare Advantage	$17.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.32
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.71
Rate for Payer: Wellcare Medicare Advantage	$16.71
Rate for Payer: Wellpoint Medicaid Managed Care	$19.37

CORTISOL, FREE

Facility

$682.00

Service Code	HCPCS 82530
Hospital Charge Code	38472024
Hospital Revenue Code	301
Min. Negotiated Rate	$102.30
Max. Negotiated Rate	$102.30
Rate for Payer: Qualcare PPO/HMO/WC	$102.30

CORTISOL FREE LCM/MS SERUM

Facility

$188.79

Service Code	HCPCS 82530
Hospital Charge Code	401382530
Hospital Revenue Code	301
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$45.45
Rate for Payer: Aetna Medicare Advantage	$54.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.62
Rate for Payer: Cigna Commercial	$94.39
Rate for Payer: Cigna Medicare Advantage	$16.71
Rate for Payer: Clover Medicare Advantage	$15.87
Rate for Payer: EmblemHealth Commercial	$50.13
Rate for Payer: Humana Medicare Advantage	$17.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.09
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.32
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.71
Rate for Payer: Wellcare Medicare Advantage	$16.71
Rate for Payer: Wellpoint Medicaid Managed Care	$5.36

CORTISOL FREE LCM/MS SERUM

Facility

$188.79

Service Code	HCPCS 82530
Hospital Charge Code	401382530
Hospital Revenue Code	301
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$28.32
Rate for Payer: Qualcare PPO/HMO/WC	$28.32

CORTISOL, FREE, LC/MS/MS

Facility

$519.00

Service Code	HCPCS 82530
Hospital Charge Code	397071495
Hospital Revenue Code	301
Min. Negotiated Rate	$13.37
Max. Negotiated Rate	$259.50
Rate for Payer: Aetna Commercial	$45.45
Rate for Payer: Aetna Medicare Advantage	$54.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.62
Rate for Payer: Cigna Commercial	$259.50
Rate for Payer: Cigna Medicare Advantage	$16.71
Rate for Payer: Clover Medicare Advantage	$15.87
Rate for Payer: EmblemHealth Commercial	$50.13
Rate for Payer: Humana Medicare Advantage	$17.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.71
Rate for Payer: Wellcare Medicare Advantage	$16.71
Rate for Payer: Wellpoint Medicaid Managed Care	$14.74

CORTISOL, FREE, LC/MS/MS

Facility

$519.00

Service Code	HCPCS 82530
Hospital Charge Code	397071495
Hospital Revenue Code	301
Min. Negotiated Rate	$77.85
Max. Negotiated Rate	$77.85
Rate for Payer: Qualcare PPO/HMO/WC	$77.85

CORTISOL,FREE,LC/MS/MS

Facility

$390.00

Service Code	HCPCS 82530
Hospital Charge Code	39900065
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$45.45
Rate for Payer: Aetna Medicare Advantage	$54.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.71
Rate for Payer: Clover Medicare Advantage	$15.87
Rate for Payer: EmblemHealth Commercial	$50.13
Rate for Payer: Humana Medicare Advantage	$17.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.71
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	$13.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.71
Rate for Payer: Wellcare Medicare Advantage	$16.71
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CORTISOL,FREE,LC/MS/MS

Facility

$390.00

Service Code	HCPCS 82530
Hospital Charge Code	39900065
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CORTISOL SERUM

Facility

$112.05

Service Code	HCPCS 82533
Hospital Charge Code	39900474
Hospital Revenue Code	301
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.34
Rate for Payer: Aetna Medicare Advantage	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.13
Rate for Payer: Cigna Commercial	$56.02
Rate for Payer: Cigna Medicare Advantage	$16.30
Rate for Payer: Clover Medicare Advantage	$15.48
Rate for Payer: EmblemHealth Commercial	$48.90
Rate for Payer: Humana Medicare Advantage	$16.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.13
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.81
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.30
Rate for Payer: Wellcare Medicare Advantage	$16.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

CORTISOL SERUM

Facility

$112.05

Service Code	HCPCS 82533
Hospital Charge Code	39900474
Hospital Revenue Code	301
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$16.81
Rate for Payer: Qualcare PPO/HMO/WC	$16.81

CORTISOL TOTAL

Facility

$746.00

Service Code	HCPCS 82533
Hospital Charge Code	38479110
Hospital Revenue Code	301
Min. Negotiated Rate	$111.90
Max. Negotiated Rate	$111.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.90

CORTISOL TOTAL

Facility

$746.00

Service Code	HCPCS 82533
Hospital Charge Code	38479110
Hospital Revenue Code	301
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$373.00
Rate for Payer: Aetna Commercial	$44.34
Rate for Payer: Aetna Medicare Advantage	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.13
Rate for Payer: Cigna Commercial	$373.00
Rate for Payer: Cigna Medicare Advantage	$16.30
Rate for Payer: Clover Medicare Advantage	$15.48
Rate for Payer: EmblemHealth Commercial	$48.90
Rate for Payer: Humana Medicare Advantage	$16.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.30
Rate for Payer: Wellcare Medicare Advantage	$16.30
Rate for Payer: Wellpoint Medicaid Managed Care	$21.19

CORTISOL,TOTAL

Facility

$746.00

Service Code	HCPCS 82533
Hospital Charge Code	38472224
Hospital Revenue Code	301
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$373.00
Rate for Payer: Aetna Commercial	$44.34
Rate for Payer: Aetna Medicare Advantage	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.13
Rate for Payer: Cigna Commercial	$373.00
Rate for Payer: Cigna Medicare Advantage	$16.30
Rate for Payer: Clover Medicare Advantage	$15.48
Rate for Payer: EmblemHealth Commercial	$48.90
Rate for Payer: Humana Medicare Advantage	$16.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.30
Rate for Payer: Wellcare Medicare Advantage	$16.30
Rate for Payer: Wellpoint Medicaid Managed Care	$21.19

CORTISOL,TOTAL

Facility

$746.00

Service Code	HCPCS 82533
Hospital Charge Code	38472224
Hospital Revenue Code	301
Min. Negotiated Rate	$111.90
Max. Negotiated Rate	$111.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.90

CORTISONE 25 MG TAB

Facility

$4.00

Service Code	NDC 143120201
Hospital Charge Code	60628183
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CORTISONE 25 MG TAB

Facility

$4.00

Service Code	NDC 143120201
Hospital Charge Code	60628183
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges