Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$62,410.73

Service Code	MSDRG 559
Min. Negotiated Rate	$19,003.27
Max. Negotiated Rate	$62,410.73
Rate for Payer: Aetna Commercial	$43,140.59
Rate for Payer: Aetna Medicare Advantage	$62,410.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,032.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,032.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,003.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,032.85
Rate for Payer: Cigna Commercial	$34,899.74
Rate for Payer: Cigna Medicare Advantage	$20,003.44
Rate for Payer: Clover Medicare Advantage	$19,003.27
Rate for Payer: EmblemHealth Commercial	$60,010.32
Rate for Payer: Humana Medicare Advantage	$20,603.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,003.44
Rate for Payer: Oxford Commercial	$25,082.90
Rate for Payer: UnitedHealthcare Commercial	$43,983.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,003.44
Rate for Payer: Wellcare Medicare Advantage	$20,003.44

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$28,117.47

Service Code	MSDRG 561
Min. Negotiated Rate	$8,561.41
Max. Negotiated Rate	$28,117.47
Rate for Payer: Aetna Commercial	$19,577.22
Rate for Payer: Aetna Medicare Advantage	$28,117.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,012.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,143.58
Rate for Payer: Cigna Commercial	$15,044.18
Rate for Payer: Cigna Medicare Advantage	$9,012.01
Rate for Payer: Clover Medicare Advantage	$8,561.41
Rate for Payer: EmblemHealth Commercial	$27,036.03
Rate for Payer: Humana Medicare Advantage	$9,282.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,012.01
Rate for Payer: Oxford Commercial	$10,812.45
Rate for Payer: UnitedHealthcare Commercial	$18,959.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,012.01
Rate for Payer: Wellcare Medicare Advantage	$9,012.01

AFTERCARE WITH CC/MCC

Facility

$40,587.18

Service Code	MSDRG 949
Min. Negotiated Rate	$12,358.27
Max. Negotiated Rate	$40,587.18
Rate for Payer: Aetna Commercial	$28,145.33
Rate for Payer: Aetna Medicare Advantage	$40,587.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,889.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,889.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,008.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,889.27
Rate for Payer: Cigna Commercial	$22,264.05
Rate for Payer: Cigna Medicare Advantage	$13,008.71
Rate for Payer: Clover Medicare Advantage	$12,358.27
Rate for Payer: EmblemHealth Commercial	$39,026.13
Rate for Payer: Humana Medicare Advantage	$13,398.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,008.71
Rate for Payer: Oxford Commercial	$16,001.47
Rate for Payer: UnitedHealthcare Commercial	$28,059.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,008.71
Rate for Payer: Wellcare Medicare Advantage	$13,008.71

AFTERCARE WITHOUT CC/MCC

Facility

$22,422.38

Service Code	MSDRG 950
Min. Negotiated Rate	$6,827.33
Max. Negotiated Rate	$22,422.38
Rate for Payer: Aetna Commercial	$15,664.07
Rate for Payer: Aetna Medicare Advantage	$22,422.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,887.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,887.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,186.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,887.04
Rate for Payer: Cigna Commercial	$11,746.78
Rate for Payer: Cigna Medicare Advantage	$7,186.66
Rate for Payer: Clover Medicare Advantage	$6,827.33
Rate for Payer: EmblemHealth Commercial	$21,559.98
Rate for Payer: Humana Medicare Advantage	$7,402.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,186.66
Rate for Payer: Oxford Commercial	$8,442.57
Rate for Payer: UnitedHealthcare Commercial	$14,804.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,186.66
Rate for Payer: Wellcare Medicare Advantage	$7,186.66

AFX BIFURCATED BODY

Facility

$65,795.00

Hospital Charge Code	270678375
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

AFX BIFURCATED BODY

Facility

$65,795.00

Hospital Charge Code	270678375
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

AG DIRECT ARC

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100520
Hospital Revenue Code	309
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.31

AG DIRECT ARC

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100520
Hospital Revenue Code	309
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.92
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$6.35
Rate for Payer: Clover Medicare Advantage	$6.03
Rate for Payer: EmblemHealth Commercial	$19.05
Rate for Payer: Humana Medicare Advantage	$6.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.35
Rate for Payer: Wellcare Medicare Advantage	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

AG DIRECT BAY

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100521
Hospital Revenue Code	309
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.31

AG DIRECT BAY

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100521
Hospital Revenue Code	309
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.92
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$6.35
Rate for Payer: Clover Medicare Advantage	$6.03
Rate for Payer: EmblemHealth Commercial	$19.05
Rate for Payer: Humana Medicare Advantage	$6.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.35
Rate for Payer: Wellcare Medicare Advantage	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

AG DIRECT BCNJ

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100525
Hospital Revenue Code	309
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.31

AG DIRECT BCNJ

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100525
Hospital Revenue Code	309
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.92
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$6.35
Rate for Payer: Clover Medicare Advantage	$6.03
Rate for Payer: EmblemHealth Commercial	$19.05
Rate for Payer: Humana Medicare Advantage	$6.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.35
Rate for Payer: Wellcare Medicare Advantage	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

AGENERASE 150 MG TAB

Facility

$6.00

Hospital Charge Code	60635331
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

AGENERASE 150 MG TAB

Facility

$6.00

Hospital Charge Code	60635331
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

AGENT BSC DEBULKING INJ 890201

Facility

$883.25

Hospital Charge Code	270627958
Hospital Revenue Code	272
Min. Negotiated Rate	$132.49
Max. Negotiated Rate	$132.49
Rate for Payer: Qualcare PPO/HMO/WC	$132.49

AGENT BSC DEBULKING INJ 890201

Facility

$883.25

Hospital Charge Code	270627958
Hospital Revenue Code	272
Min. Negotiated Rate	$21.29
Max. Negotiated Rate	$441.62
Rate for Payer: Aetna Commercial	$335.63
Rate for Payer: Aetna Medicare Advantage	$264.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.23
Rate for Payer: Cigna Commercial	$441.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.98
Rate for Payer: Oxford Commercial	$176.65
Rate for Payer: Qualcare PPO/HMO/WC	$132.49
Rate for Payer: UnitedHealthcare Commercial	$176.65
Rate for Payer: UnitedHealthcare Community & State	$21.29
Rate for Payer: Wellpoint Medicaid Managed Care	$23.41

AGILON 12CC

Facility

$37,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270695756
Hospital Revenue Code	278
Min. Negotiated Rate	$5,696.25
Max. Negotiated Rate	$9,189.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,189.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,354.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,696.25

AGILON 12CC

Facility

$37,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270695756
Hospital Revenue Code	278
Min. Negotiated Rate	$915.20
Max. Negotiated Rate	$18,987.50
Rate for Payer: Aetna Commercial	$14,430.50
Rate for Payer: Aetna Medicare Advantage	$11,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,683.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,683.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,683.62
Rate for Payer: Cigna Commercial	$18,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,189.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,354.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,696.25
Rate for Payer: UnitedHealthcare Community & State	$915.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1,006.34

AGILON MOLDABLE BONE GRAFT 6CC

Facility

$20,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695865
Hospital Revenue Code	278
Min. Negotiated Rate	$500.07
Max. Negotiated Rate	$10,375.00
Rate for Payer: Aetna Commercial	$7,885.00
Rate for Payer: Aetna Medicare Advantage	$6,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,291.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,291.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,291.25
Rate for Payer: Cigna Commercial	$10,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,021.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,565.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,112.50
Rate for Payer: UnitedHealthcare Community & State	$500.07
Rate for Payer: Wellpoint Medicaid Managed Care	$549.88

AGILON MOLDABLE BONE GRAFT 6CC

Facility

$20,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695865
Hospital Revenue Code	278
Min. Negotiated Rate	$3,112.50
Max. Negotiated Rate	$5,021.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,021.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,565.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,112.50

AG INDIRECT ARC

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100522
Hospital Revenue Code	309
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.31

AG INDIRECT ARC

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100522
Hospital Revenue Code	309
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.92
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$6.35
Rate for Payer: Clover Medicare Advantage	$6.03
Rate for Payer: EmblemHealth Commercial	$19.05
Rate for Payer: Humana Medicare Advantage	$6.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.35
Rate for Payer: Wellcare Medicare Advantage	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

AG INDIRECT BAY

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100523
Hospital Revenue Code	309
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.31

AG INDIRECT BAY

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100523
Hospital Revenue Code	309
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.92
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$6.35
Rate for Payer: Clover Medicare Advantage	$6.03
Rate for Payer: EmblemHealth Commercial	$19.05
Rate for Payer: Humana Medicare Advantage	$6.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.35
Rate for Payer: Wellcare Medicare Advantage	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

AG INDIRECT BCNJ

Facility

$88.75

Service Code	HCPCS 86902
Hospital Charge Code	3100527
Hospital Revenue Code	309
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.31

Know your out-of-pocket cost for care.

All Charges