Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CHEMO ADMIN IV PUSH LEVEL 2

Facility

$376.25

Service Code	HCPCS 96405
Hospital Charge Code	3401038
Hospital Revenue Code	331
Min. Negotiated Rate	$9.07
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	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
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	$308.77
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	$112.88
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.44
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$9.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9.97

CHEMO ADMIN IV PUSH LEVEL 2

Facility

$376.25

Service Code	HCPCS 96405
Hospital Charge Code	3401038
Hospital Revenue Code	331
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$56.44
Rate for Payer: Qualcare PPO/HMO/WC	$56.44

CHEMO ADMIN IV PUSH LEVEL 3

Facility

$327.00

Service Code	HCPCS 96405
Hospital Charge Code	3401039
Hospital Revenue Code	331
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

CHEMO ADMIN IV PUSH LEVEL 3

Facility

$327.00

Service Code	HCPCS 96405
Hospital Charge Code	3401039
Hospital Revenue Code	331
Min. Negotiated Rate	$7.88
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	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
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	$308.77
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	$98.10
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.05
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$8.67

CHEMO ADMIN PERIT CAVITY IMPL

Facility

$1,158.00

Service Code	HCPCS 96446
Hospital Charge Code	93500095
Hospital Revenue Code	335
Min. Negotiated Rate	$27.91
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	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
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	$1,416.48
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	$347.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$173.70
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$27.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$30.69

CHEMO ADMIN PERIT CAVITY IMPL

Facility

$1,158.00

Service Code	HCPCS 96446
Hospital Charge Code	93500095
Hospital Revenue Code	335
Min. Negotiated Rate	$173.70
Max. Negotiated Rate	$173.70
Rate for Payer: Qualcare PPO/HMO/WC	$173.70

CHEMO ADMIN SUBQ/IM****

Facility

$49.00

Hospital Charge Code	3401006
Hospital Revenue Code	289
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

CHEMO ADMIN SUBQ/IM****

Facility

$49.00

Hospital Charge Code	3401006
Hospital Revenue Code	289
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

CHEMO ADMN IV ADDT INFS TO 1HR

Facility

$402.60

Service Code	HCPCS 96417
Hospital Charge Code	93500093
Hospital Revenue Code	335
Min. Negotiated Rate	$60.39
Max. Negotiated Rate	$60.39
Rate for Payer: Qualcare PPO/HMO/WC	$60.39

CHEMO ADMN IV ADDT INFS TO 1HR

Facility

$402.60

Service Code	HCPCS 96417
Hospital Charge Code	93500093
Hospital Revenue Code	335
Min. Negotiated Rate	$9.70
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	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
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	$308.77
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	$120.78
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.39
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$9.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$10.67

CHEMO ADMN IV INFS ECH ADD HR

Facility

$210.90

Service Code	HCPCS 96415
Hospital Charge Code	93500091
Hospital Revenue Code	335
Min. Negotiated Rate	$31.64
Max. Negotiated Rate	$31.64
Rate for Payer: Qualcare PPO/HMO/WC	$31.64

CHEMO ADMN IV INFS ECH ADD HR

Facility

$210.90

Service Code	HCPCS 96415
Hospital Charge Code	93500091
Hospital Revenue Code	335
Min. Negotiated Rate	$5.08
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	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
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	$308.77
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	$63.27
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.64
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$5.59

CHEMO, ANTI-NEOPL, SQ/IM

Facility

$293.10

Service Code	HCPCS 96401
Hospital Charge Code	3401080
Hospital Revenue Code	331
Min. Negotiated Rate	$7.06
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	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
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	$308.77
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	$87.93
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7.77

CHEMO, ANTI-NEOPL, SQ/IM

Facility

$293.10

Service Code	HCPCS 96401
Hospital Charge Code	3401080
Hospital Revenue Code	331
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMODENERVATION ANAL MUSC

Facility

$16,865.10

Service Code	HCPCS 46505
Hospital Charge Code	16000750
Hospital Revenue Code	360
Min. Negotiated Rate	$406.45
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,131.69
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,059.53
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$406.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$446.93

CHEMODENERVATION ANAL MUSC

Facility

$16,865.10

Service Code	HCPCS 46505
Hospital Charge Code	1600000603
Hospital Revenue Code	360
Min. Negotiated Rate	$406.45
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,131.69
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,059.53
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$406.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$446.93

CHEMODENERVATION ANAL MUSC

Facility

$16,865.10

Service Code	HCPCS 46505
Hospital Charge Code	1600000603
Hospital Revenue Code	360
Min. Negotiated Rate	$2,529.76
Max. Negotiated Rate	$2,529.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76

CHEMODENERVATION ANAL MUSC

Facility

$16,865.10

Service Code	HCPCS 46505
Hospital Charge Code	16000750
Hospital Revenue Code	360
Min. Negotiated Rate	$2,529.76
Max. Negotiated Rate	$2,529.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,529.76

CHEMODENERV TRUNK MUSC 1-5

Facility

$4,077.75

Service Code	HCPCS 64646
Hospital Charge Code	1600000550
Hospital Revenue Code	360
Min. Negotiated Rate	$611.66
Max. Negotiated Rate	$611.66
Rate for Payer: Qualcare PPO/HMO/WC	$611.66

CHEMODENERV TRUNK MUSC 1-5

Facility

$4,077.75

Service Code	HCPCS 64646
Hospital Charge Code	1600000550
Hospital Revenue Code	360
Min. Negotiated Rate	$98.27
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,223.33
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$611.66
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$98.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$108.06

CHEMO,HARMON ANTI-NEOPL, SQ/IM

Facility

$293.10

Service Code	HCPCS 96402
Hospital Charge Code	3401085
Hospital Revenue Code	331
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO,HARMON ANTI-NEOPL, SQ/IM

Facility

$293.10

Service Code	HCPCS 96402
Hospital Charge Code	3401085
Hospital Revenue Code	331
Min. Negotiated Rate	$7.06
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	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
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	$308.77
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	$87.93
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7.77

CHEMO HORMON ANTI-NEOPL SQ/IM

Facility

$260.00

Service Code	HCPCS 96402
Hospital Charge Code	93500181
Hospital Revenue Code	331
Min. Negotiated Rate	$6.27
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	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
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	$308.77
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	$78.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$6.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

CHEMO HORMON ANTI-NEOPL SQ/IM

Facility

$260.00

Service Code	HCPCS 96402
Hospital Charge Code	93500181
Hospital Revenue Code	331
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

CHEMO IM/SQ NON HORM

Facility

$210.90

Service Code	HCPCS 96401
Hospital Charge Code	93500079
Hospital Revenue Code	331
Min. Negotiated Rate	$5.08
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	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
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	$308.77
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	$63.27
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.64
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$5.59

Know your out-of-pocket cost for care.

All Charges