Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT ALLO MAT DR 3c 86DR-0300

Facility

$3,596.00

Hospital Charge Code	270635668
Hospital Revenue Code	278
Min. Negotiated Rate	$86.66
Max. Negotiated Rate	$1,798.00
Rate for Payer: Aetna Commercial	$1,366.48
Rate for Payer: Aetna Medicare Advantage	$1,078.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$719.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.98
Rate for Payer: Cigna Commercial	$1,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$870.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$791.12
Rate for Payer: Qualcare PPO/HMO/WC	$539.40
Rate for Payer: UnitedHealthcare Community & State	$86.66
Rate for Payer: Wellpoint Medicaid Managed Care	$95.29

GRAFT ALLOSYNC 2.5CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693888
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

GRAFT ALLOSYNC 2.5CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693888
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

GRAFT ALLOSYNC DBM PUTTY 1CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690969
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

GRAFT ALLOSYNC DBM PUTTY 1CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690969
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

GRAFT ALLOSYNE 10 CC PURE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270688461
Hospital Revenue Code	278
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

GRAFT ALLOSYNE 10 CC PURE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270688461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

GRAFTALTAPOREBNMATRIX15.80ML

Facility

$17,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270692787
Hospital Revenue Code	278
Min. Negotiated Rate	$2,562.00
Max. Negotiated Rate	$4,133.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,133.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,757.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,562.00

GRAFTALTAPOREBNMATRIX15.80ML

Facility

$17,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270692787
Hospital Revenue Code	278
Min. Negotiated Rate	$411.63
Max. Negotiated Rate	$8,540.00
Rate for Payer: Aetna Commercial	$6,490.40
Rate for Payer: Aetna Medicare Advantage	$5,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,355.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,355.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,355.40
Rate for Payer: Cigna Commercial	$8,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,133.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,757.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,562.00
Rate for Payer: UnitedHealthcare Community & State	$411.63
Rate for Payer: Wellpoint Medicaid Managed Care	$452.62

GRAFT ALTAPORE BN MATRIX 2.6ML

Facility

$4,441.90

Service Code	HCPCS C1713
Hospital Charge Code	270698820
Hospital Revenue Code	278
Min. Negotiated Rate	$666.28
Max. Negotiated Rate	$1,074.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$977.22
Rate for Payer: Qualcare PPO/HMO/WC	$666.28

GRAFT ALTAPORE BN MATRIX 2.6ML

Facility

$4,441.90

Service Code	HCPCS C1713
Hospital Charge Code	270698820
Hospital Revenue Code	278
Min. Negotiated Rate	$107.05
Max. Negotiated Rate	$2,220.95
Rate for Payer: Aetna Commercial	$1,687.92
Rate for Payer: Aetna Medicare Advantage	$1,332.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,132.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,132.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,132.68
Rate for Payer: Cigna Commercial	$2,220.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$977.22
Rate for Payer: Qualcare PPO/HMO/WC	$666.28
Rate for Payer: UnitedHealthcare Community & State	$107.05
Rate for Payer: Wellpoint Medicaid Managed Care	$117.71

GRAFT ALTAPORE BN MATRIX 8ML

Facility

$9,179.90

Service Code	HCPCS C1713
Hospital Charge Code	270698821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.98
Max. Negotiated Rate	$2,221.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,221.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,019.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.98

GRAFT ALTAPORE BN MATRIX 8ML

Facility

$9,179.90

Service Code	HCPCS C1713
Hospital Charge Code	270698821
Hospital Revenue Code	278
Min. Negotiated Rate	$221.24
Max. Negotiated Rate	$4,589.95
Rate for Payer: Aetna Commercial	$3,488.36
Rate for Payer: Aetna Medicare Advantage	$2,753.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,340.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,340.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,340.87
Rate for Payer: Cigna Commercial	$4,589.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,221.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,019.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.98
Rate for Payer: UnitedHealthcare Community & State	$221.24
Rate for Payer: Wellpoint Medicaid Managed Care	$243.27

GRAFT ALTO ABD STENT 26 MM

Facility

$74,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270690553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,789.42
Max. Negotiated Rate	$37,125.00
Rate for Payer: Aetna Commercial	$28,215.00
Rate for Payer: Aetna Medicare Advantage	$22,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,933.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,933.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,933.75
Rate for Payer: Cigna Commercial	$37,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,968.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,137.50
Rate for Payer: UnitedHealthcare Community & State	$1,789.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1,967.62

GRAFT ALTO ABD STENT 26 MM

Facility

$74,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270690553
Hospital Revenue Code	278
Min. Negotiated Rate	$11,137.50
Max. Negotiated Rate	$17,968.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,968.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,137.50

GRAFT AMBIO 52 X 3CM

Facility

$3,375.00

Service Code	HCPCS C1762
Hospital Charge Code	270653917
Hospital Revenue Code	810
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

GRAFT AMBIO 52 X 3CM

Facility

$3,375.00

Service Code	HCPCS C1762
Hospital Charge Code	270653917
Hospital Revenue Code	810
Min. Negotiated Rate	$81.34
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,012.50
Rate for Payer: Oxford Commercial	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Commercial	$675.00
Rate for Payer: UnitedHealthcare Community & State	$81.34
Rate for Payer: Wellpoint Medicaid Managed Care	$89.44

GRAFT AMINO EXCEL 15 MM

Facility

$1,050.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684014
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

GRAFT AMINO EXCEL 15 MM

Facility

$1,050.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684014
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$533.66
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

GRAFT AMINO MAX 4 X 8 CM

Facility

$15,705.00

Service Code	HCPCS Q4100
Hospital Charge Code	270686265
Hospital Revenue Code	636
Min. Negotiated Rate	$2,355.75
Max. Negotiated Rate	$3,800.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,800.61
Rate for Payer: Qualcare PPO/HMO/WC	$2,355.75

GRAFT AMINO MAX 4 X 8 CM

Facility

$15,705.00

Service Code	HCPCS Q4100
Hospital Charge Code	270686265
Hospital Revenue Code	636
Min. Negotiated Rate	$378.49
Max. Negotiated Rate	$7,852.50
Rate for Payer: Aetna Commercial	$5,967.90
Rate for Payer: Aetna Medicare Advantage	$4,711.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,004.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,004.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,004.78
Rate for Payer: Cigna Commercial	$7,852.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,800.61
Rate for Payer: Qualcare PPO/HMO/WC	$2,355.75
Rate for Payer: UnitedHealthcare Community & State	$378.49
Rate for Payer: Wellpoint Medicaid Managed Care	$416.18

GRAFT AMNIO EXCEL 10CMX10CM

Facility

$18,480.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684035
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,472.16
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,065.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,772.00
Rate for Payer: UnitedHealthcare Community & State	$445.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$489.72

GRAFT AMNIO EXCEL 10CMX10CM

Facility

$18,480.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684035
Hospital Revenue Code	278
Min. Negotiated Rate	$2,772.00
Max. Negotiated Rate	$4,472.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,065.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,772.00

GRAFT AMNIO EXCEL 1.5 CM X 1.5

Facility

$2,310.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684015
Hospital Revenue Code	278
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$559.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$346.50

GRAFT AMNIO EXCEL 1.5 CM X 1.5

Facility

$2,310.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684015
Hospital Revenue Code	278
Min. Negotiated Rate	$55.67
Max. Negotiated Rate	$559.02
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$462.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$346.50
Rate for Payer: UnitedHealthcare Community & State	$55.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$61.22

Know your out-of-pocket cost for care.

All Charges