Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EPSTEIN-BARR VIRUS AB PNL I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990095A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EPSTEIN-BARR VIRUS AB PNL I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990095A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.29
Rate for Payer: Clover Medicare Advantage	$14.53
Rate for Payer: EmblemHealth Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.29
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	$12.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.29
Rate for Payer: Wellcare Medicare Advantage	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

EPSTEIN-BARR VIRUS AB PNL II

Facility

$390.00

Service Code	HCPCS 8666591
Hospital Charge Code	39990095B
Hospital Revenue Code	302
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

EPSTEIN-BARR VIRUS AB PNL II

Facility

$390.00

Service Code	HCPCS 8666591
Hospital Charge Code	39990095B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EPSTEIN-BARR VIRUS AB PNL III

Facility

$390.00

Service Code	HCPCS 8666591
Hospital Charge Code	39990095C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EPSTEIN-BARR VIRUS AB PNL III

Facility

$390.00

Service Code	HCPCS 8666591
Hospital Charge Code	39990095C
Hospital Revenue Code	302
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

EPSTEIN-BARR VIRUS ANTI, EA,IG

Facility

$245.00

Service Code	HCPCS 86256
Hospital Charge Code	38476102
Hospital Revenue Code	302
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

EPSTEIN-BARR VIRUS ANTI, EA,IG

Facility

$245.00

Service Code	HCPCS 86256
Hospital Charge Code	38476102
Hospital Revenue Code	302
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

EPSTEIN-BARR VIRUS ANTI,EA IGG

Facility

$156.00

Service Code	HCPCS 86663
Hospital Charge Code	38476105
Hospital Revenue Code	302
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

EPSTEIN-BARR VIRUS ANTI,EA IGG

Facility

$156.00

Service Code	HCPCS 86663
Hospital Charge Code	38476105
Hospital Revenue Code	302
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.69
Rate for Payer: Aetna Medicare Advantage	$42.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.36
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: Cigna Medicare Advantage	$13.12
Rate for Payer: Clover Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Humana Medicare Advantage	$13.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.12
Rate for Payer: Wellcare Medicare Advantage	$13.12
Rate for Payer: Wellpoint Medicaid Managed Care	$4.13

EPSTEIN-BARR VIRUS ANTI,VCA, I

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38476111
Hospital Revenue Code	302
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
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	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

EPSTEIN-BARR VIRUS ANTI,VCA, I

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38476111
Hospital Revenue Code	302
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

EPSTEIN-BARR VIRUS ANTI,VCA,I

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38479427
Hospital Revenue Code	302
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

EPSTEIN-BARR VIRUS ANTI,VCA,I

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38479427
Hospital Revenue Code	302
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
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	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

EPSTEIN-BARR VIRUS ANTI VCA,IG

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38476108
Hospital Revenue Code	302
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

EPSTEIN-BARR VIRUS ANTI VCA,IG

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38476108
Hospital Revenue Code	302
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
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	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

EPSTEIN-BARR VIRUS ANTI VCA,IG

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38479426
Hospital Revenue Code	302
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

EPSTEIN-BARR VIRUS ANTI VCA,IG

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38479426
Hospital Revenue Code	302
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
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	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

EPSTEIN BARR VIRUS DNA QNT PCR

Facility

$1,897.40

Service Code	HCPCS 87799
Hospital Charge Code	401087799
Hospital Revenue Code	301
Min. Negotiated Rate	$284.61
Max. Negotiated Rate	$284.61
Rate for Payer: Qualcare PPO/HMO/WC	$284.61

EPSTEIN BARR VIRUS DNA QNT PCR

Facility

$1,897.40

Service Code	HCPCS 87799
Hospital Charge Code	401087799
Hospital Revenue Code	301
Min. Negotiated Rate	$34.27
Max. Negotiated Rate	$948.70
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	$46.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$948.70
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	$569.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.61
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	$50.28

EPSTEIN BARR VIRUS EBV AB

Facility

$127.85

Service Code	HCPCS 86663
Hospital Charge Code	3004768
Hospital Revenue Code	302
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

EPSTEIN BARR VIRUS EBV AB

Facility

$127.85

Service Code	HCPCS 86663
Hospital Charge Code	3004768
Hospital Revenue Code	302
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.69
Rate for Payer: Aetna Medicare Advantage	$42.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.36
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: Cigna Medicare Advantage	$13.12
Rate for Payer: Clover Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Humana Medicare Advantage	$13.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.12
Rate for Payer: Wellcare Medicare Advantage	$13.12
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

EPTIFIBATIDE 20 MG/10ML INJ

Facility

$1,271.79

Service Code	HCPCS J1327
Hospital Charge Code	60628970
Hospital Revenue Code	636
Min. Negotiated Rate	$190.77
Max. Negotiated Rate	$307.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.77
Rate for Payer: Qualcare PPO/HMO/WC	$190.77

EPTIFIBATIDE 20 MG/10ML INJ

Facility

$1,271.79

Service Code	HCPCS J1327
Hospital Charge Code	60628970
Hospital Revenue Code	636
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$307.77
Rate for Payer: Aetna Commercial	$8.87
Rate for Payer: Aetna Medicare Advantage	$10.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.77
Rate for Payer: Cigna Medicare Advantage	$3.26
Rate for Payer: Clover Medicare Advantage	$3.10
Rate for Payer: EmblemHealth Commercial	$9.78
Rate for Payer: Humana Medicare Advantage	$3.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.77
Rate for Payer: Qualcare PPO/HMO/WC	$190.77
Rate for Payer: UnitedHealthcare Community & State	$30.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.26
Rate for Payer: Wellcare Medicare Advantage	$3.26
Rate for Payer: Wellpoint Medicaid Managed Care	$33.70

EPTIFIBATIDE 75 MG/100ML INJ

Facility

$2,923.81

Service Code	HCPCS J1327
Hospital Charge Code	60628969
Hospital Revenue Code	636
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$707.56
Rate for Payer: Aetna Commercial	$8.87
Rate for Payer: Aetna Medicare Advantage	$10.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.77
Rate for Payer: Cigna Medicare Advantage	$3.26
Rate for Payer: Clover Medicare Advantage	$3.10
Rate for Payer: EmblemHealth Commercial	$9.78
Rate for Payer: Humana Medicare Advantage	$3.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$707.56
Rate for Payer: Qualcare PPO/HMO/WC	$438.57
Rate for Payer: UnitedHealthcare Community & State	$70.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.26
Rate for Payer: Wellcare Medicare Advantage	$3.26
Rate for Payer: Wellpoint Medicaid Managed Care	$77.48

Know your out-of-pocket cost for care.

All Charges