Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH HEPATITIS B DNA(QUAN)

Facility

$510.00

Service Code	HCPCS 87517
Hospital Charge Code	397073193
Hospital Revenue Code	306
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

CH HEPATITIS B E AG

Facility

$71.00

Service Code	HCPCS 87350
Hospital Charge Code	397072081
Hospital Revenue Code	306
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

CH HEPATITIS B E AG

Facility

$71.00

Service Code	HCPCS 87350
Hospital Charge Code	397072081
Hospital Revenue Code	306
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

CH HEPATITIS BE ANTIBODY

Facility

$71.00

Service Code	HCPCS 86707
Hospital Charge Code	397071095
Hospital Revenue Code	302
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.47
Rate for Payer: Aetna Medicare Advantage	$37.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.76
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: Cigna Medicare Advantage	$11.57
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Medicare Advantage	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

CH HEPATITIS BE ANTIBODY

Facility

$71.00

Service Code	HCPCS 86707
Hospital Charge Code	397071095
Hospital Revenue Code	302
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

CH HEPATITIS B SURFACE AB

Facility

$557.01

Service Code	HCPCS 86706
Hospital Charge Code	397072082
Hospital Revenue Code	302
Min. Negotiated Rate	$83.55
Max. Negotiated Rate	$83.55
Rate for Payer: Qualcare PPO/HMO/WC	$83.55

CH HEPATITIS B SURFACE AB

Facility

$557.01

Service Code	HCPCS 86706
Hospital Charge Code	397072082
Hospital Revenue Code	302
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$278.50
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.77
Rate for Payer: Cigna Commercial	$278.50
Rate for Payer: Cigna Medicare Advantage	$10.74
Rate for Payer: Clover Medicare Advantage	$10.20
Rate for Payer: EmblemHealth Commercial	$32.22
Rate for Payer: Humana Medicare Advantage	$11.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.74
Rate for Payer: Wellcare Medicare Advantage	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$14.76

CH HEPATITIS B SURFACE AG

Facility

$667.59

Service Code	HCPCS 87340
Hospital Charge Code	397071158
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH HEPATITIS B SURFACE AG

Facility

$667.59

Service Code	HCPCS 87340
Hospital Charge Code	397071158
Hospital Revenue Code	306
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$28.10
Rate for Payer: Aetna Medicare Advantage	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.29
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$10.33
Rate for Payer: Clover Medicare Advantage	$9.81
Rate for Payer: EmblemHealth Commercial	$30.99
Rate for Payer: Humana Medicare Advantage	$10.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.33
Rate for Payer: Wellcare Medicare Advantage	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

CH HEPATITIS B SURF AG CONF

Facility

$390.00

Service Code	HCPCS 8734091
Hospital Charge Code	397072009
Hospital Revenue Code	306
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH HEPATITIS B SURF AG CONF

Facility

$390.00

Service Code	HCPCS 8734091
Hospital Charge Code	397072009
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH HEPATITIS C AB

Facility

$667.59

Service Code	HCPCS 86803
Hospital Charge Code	397072083
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH HEPATITIS C AB

Facility

$667.59

Service Code	HCPCS 86803
Hospital Charge Code	397072083
Hospital Revenue Code	302
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.51
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

CH HEPATITIS C AB (RIBA)

Facility

$146.00

Service Code	HCPCS 86804
Hospital Charge Code	397073191
Hospital Revenue Code	302
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.13
Rate for Payer: Aetna Medicare Advantage	$50.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.49
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	$55.91
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: Cigna Medicare Advantage	$15.49
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.47
Rate for Payer: Humana Medicare Advantage	$15.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.49
Rate for Payer: Wellcare Medicare Advantage	$15.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.87

CH HEPATITIS C AB (RIBA)

Facility

$146.00

Service Code	HCPCS 86804
Hospital Charge Code	397073191
Hospital Revenue Code	302
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

CH HEPATITIS C CONF

Facility

$324.00

Service Code	HCPCS 86804
Hospital Charge Code	397073035
Hospital Revenue Code	302
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

CH HEPATITIS C CONF

Facility

$324.00

Service Code	HCPCS 86804
Hospital Charge Code	397073035
Hospital Revenue Code	302
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$42.13
Rate for Payer: Aetna Medicare Advantage	$50.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.49
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	$55.91
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$15.49
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.47
Rate for Payer: Humana Medicare Advantage	$15.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.49
Rate for Payer: Wellcare Medicare Advantage	$15.49
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

CH HEPATITIS C DNA BY PCR

Facility

$824.00

Service Code	HCPCS 87522
Hospital Charge Code	397072162
Hospital Revenue Code	306
Min. Negotiated Rate	$123.60
Max. Negotiated Rate	$123.60
Rate for Payer: Qualcare PPO/HMO/WC	$123.60

CH HEPATITIS C DNA BY PCR

Facility

$824.00

Service Code	HCPCS 87522
Hospital Charge Code	397072162
Hospital Revenue Code	306
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$412.00
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$412.00
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$21.84

CH HEPATITIS C GENOTYPE

Facility

$1,587.00

Service Code	HCPCS 87902
Hospital Charge Code	397073603
Hospital Revenue Code	306
Min. Negotiated Rate	$238.05
Max. Negotiated Rate	$238.05
Rate for Payer: Qualcare PPO/HMO/WC	$238.05

CH HEPATITIS C GENOTYPE

Facility

$1,587.00

Service Code	HCPCS 87902
Hospital Charge Code	397073603
Hospital Revenue Code	306
Min. Negotiated Rate	$42.06
Max. Negotiated Rate	$929.32
Rate for Payer: Aetna Commercial	$700.26
Rate for Payer: Aetna Medicare Advantage	$834.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$929.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$929.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$929.32
Rate for Payer: Cigna Commercial	$793.50
Rate for Payer: Cigna Medicare Advantage	$257.45
Rate for Payer: Clover Medicare Advantage	$244.58
Rate for Payer: EmblemHealth Commercial	$772.35
Rate for Payer: Humana Medicare Advantage	$265.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$257.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$238.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$205.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.45
Rate for Payer: Wellcare Medicare Advantage	$257.45
Rate for Payer: Wellpoint Medicaid Managed Care	$42.06

CH HEPATITIS C RNA:PCR (QUAN

Facility

$824.00

Service Code	HCPCS 87522
Hospital Charge Code	397073192
Hospital Revenue Code	306
Min. Negotiated Rate	$123.60
Max. Negotiated Rate	$123.60
Rate for Payer: Qualcare PPO/HMO/WC	$123.60

CH HEPATITIS C RNA:PCR (QUAN

Facility

$824.00

Service Code	HCPCS 87522
Hospital Charge Code	397073192
Hospital Revenue Code	306
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$412.00
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$412.00
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$21.84

CH HEPATITIS D AB

Facility

$170.00

Service Code	HCPCS 86692
Hospital Charge Code	397073034
Hospital Revenue Code	302
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

CH HEPATITIS D AB

Facility

$170.00

Service Code	HCPCS 86692
Hospital Charge Code	397073034
Hospital Revenue Code	302
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.68
Rate for Payer: Aetna Medicare Advantage	$55.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.16
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	$61.94
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: Cigna Medicare Advantage	$17.16
Rate for Payer: Clover Medicare Advantage	$16.30
Rate for Payer: EmblemHealth Commercial	$51.48
Rate for Payer: Humana Medicare Advantage	$17.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.16
Rate for Payer: Wellcare Medicare Advantage	$17.16
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

Know your out-of-pocket cost for care.

All Charges