Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH CHICKEN FEATH IGE SERUM

Facility

$153.00

Service Code	HCPCS 86003
Hospital Charge Code	397072159
Hospital Revenue Code	305
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

CH CHICKEN MEAT IGE SERUM

Facility

$153.00

Service Code	HCPCS 86003
Hospital Charge Code	397072160
Hospital Revenue Code	305
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

CH CHICKEN MEAT IGE SERUM

Facility

$153.00

Service Code	HCPCS 86003
Hospital Charge Code	397072160
Hospital Revenue Code	305
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

CH CHLAM/N GONO PROBE W/REFL

Facility

$239.00

Service Code	HCPCS 87800
Hospital Charge Code	397071519
Hospital Revenue Code	306
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

CH CHLAM/N GONO PROBE W/REFL

Facility

$239.00

Service Code	HCPCS 87800
Hospital Charge Code	397071519
Hospital Revenue Code	306
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$157.64
Rate for Payer: Aetna Commercial	$118.78
Rate for Payer: Aetna Medicare Advantage	$141.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$43.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.64
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$43.67
Rate for Payer: Clover Medicare Advantage	$41.49
Rate for Payer: EmblemHealth Commercial	$131.01
Rate for Payer: Humana Medicare Advantage	$44.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$43.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$34.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$43.67
Rate for Payer: Wellcare Medicare Advantage	$43.67
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

CH CHLAMYDIA/CHLAMYDO P1 IGG

Facility

$166.00

Service Code	HCPCS 86631
Hospital Charge Code	397071503
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$124.00
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	$42.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.67
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	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.67
Rate for Payer: Cigna Commercial	$83.00
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	$49.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
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	$4.40

CH CHLAMYDIA/CHLAMYDO P1 IGG

Facility

$166.00

Service Code	HCPCS 86631
Hospital Charge Code	397071503
Hospital Revenue Code	302
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

CH CHLAMYDIA TRACHOMATIS

Facility

$223.00

Service Code	HCPCS 87491
Hospital Charge Code	397073668
Hospital Revenue Code	306
Min. Negotiated Rate	$33.45
Max. Negotiated Rate	$33.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.45

CH CHLAMYDIA TRACHOMATIS

Facility

$223.00

Service Code	HCPCS 87491
Hospital Charge Code	397073668
Hospital Revenue Code	306
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$126.66
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	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
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	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$111.50
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	$66.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
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	$5.91

CH CHLAMYDIA TRACHOMATIS AG

Facility

$196.00

Service Code	HCPCS 87270
Hospital Charge Code	397041319
Hospital Revenue Code	309
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$29.40
Rate for Payer: Qualcare PPO/HMO/WC	$29.40

CH CHLAMYDIA TRACHOMATIS AG

Facility

$196.00

Service Code	HCPCS 87270
Hospital Charge Code	397041319
Hospital Revenue Code	309
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$98.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

CH CHLORAL HYDRATE

Facility

$86.00

Service Code	HCPCS 80299
Hospital Charge Code	397072044
Hospital Revenue Code	301
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$124.00
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	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
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	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$43.00
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	$25.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
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	$2.28

CH CHLORAL HYDRATE

Facility

$86.00

Service Code	HCPCS 80299
Hospital Charge Code	397072044
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$12.90
Rate for Payer: Qualcare PPO/HMO/WC	$12.90

CH CHLORDIAZEPOXIDE, QT

Facility

$225.00

Service Code	HCPCS 80299
Hospital Charge Code	397073063
Hospital Revenue Code	301
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$124.00
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	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
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	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$112.50
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	$67.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
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	$5.96

CH CHLORDIAZEPOXIDE, QT

Facility

$225.00

Service Code	HCPCS 80299
Hospital Charge Code	397073063
Hospital Revenue Code	301
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CH CHLORIDE

Facility

$28.00

Service Code	HCPCS 82435
Hospital Charge Code	397071144
Hospital Revenue Code	301
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.51
Rate for Payer: Aetna Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.60
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: Cigna Medicare Advantage	$4.60
Rate for Payer: Clover Medicare Advantage	$4.37
Rate for Payer: EmblemHealth Commercial	$13.80
Rate for Payer: Humana Medicare Advantage	$4.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.60
Rate for Payer: Wellcare Medicare Advantage	$4.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

CH CHLORIDE

Facility

$28.00

Service Code	HCPCS 82435
Hospital Charge Code	397071144
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

CH CHLORIDE RANDOM URINE

Facility

$71.25

Service Code	HCPCS 82436
Hospital Charge Code	397073112
Hospital Revenue Code	301
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$10.69
Rate for Payer: Qualcare PPO/HMO/WC	$10.69

CH CHLORIDE RANDOM URINE

Facility

$71.25

Service Code	HCPCS 82436
Hospital Charge Code	397073112
Hospital Revenue Code	301
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.64
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.76
Rate for Payer: Cigna Commercial	$35.62
Rate for Payer: Cigna Medicare Advantage	$5.75
Rate for Payer: Clover Medicare Advantage	$5.46
Rate for Payer: EmblemHealth Commercial	$17.25
Rate for Payer: Humana Medicare Advantage	$5.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.75
Rate for Payer: Wellcare Medicare Advantage	$5.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

CH CHLORIDES SPINAL FLUID

Facility

$43.00

Service Code	HCPCS 82438
Hospital Charge Code	397071324
Hospital Revenue Code	301
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

CH CHLORIDES SPINAL FLUID

Facility

$43.00

Service Code	HCPCS 82438
Hospital Charge Code	397071324
Hospital Revenue Code	301
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.60
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.05
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: Cigna Medicare Advantage	$5.00
Rate for Payer: Clover Medicare Advantage	$4.75
Rate for Payer: EmblemHealth Commercial	$15.00
Rate for Payer: Humana Medicare Advantage	$5.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.00
Rate for Payer: Wellcare Medicare Advantage	$5.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

CH CHLORIDE URINE 24 HR

Facility

$57.00

Service Code	HCPCS 82436
Hospital Charge Code	397071291
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

CH CHLORIDE URINE 24 HR

Facility

$57.00

Service Code	HCPCS 82436
Hospital Charge Code	397071291
Hospital Revenue Code	301
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.64
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.76
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare Advantage	$5.75
Rate for Payer: Clover Medicare Advantage	$5.46
Rate for Payer: EmblemHealth Commercial	$17.25
Rate for Payer: Humana Medicare Advantage	$5.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.75
Rate for Payer: Wellcare Medicare Advantage	$5.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

CH CHLORPROMAZINES

Facility

$225.00

Service Code	HCPCS 80299
Hospital Charge Code	397073064
Hospital Revenue Code	301
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$124.00
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	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
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	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$112.50
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	$67.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
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	$5.96

CH CHLORPROMAZINES

Facility

$225.00

Service Code	HCPCS 80299
Hospital Charge Code	397073064
Hospital Revenue Code	301
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

Know your out-of-pocket cost for care.

All Charges