Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Hawk One LX

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270677280N
Hospital Revenue Code	278
Min. Negotiated Rate	$439.22
Max. Negotiated Rate	$9,112.50
Rate for Payer: Aetna Commercial	$6,925.50
Rate for Payer: Aetna Medicare Advantage	$5,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,647.38
Rate for Payer: Cigna Commercial	$9,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75
Rate for Payer: UnitedHealthcare Community & State	$439.22
Rate for Payer: Wellpoint Medicaid Managed Care	$482.96

Hawk One LX

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270677280
Hospital Revenue Code	278
Min. Negotiated Rate	$2,733.75
Max. Negotiated Rate	$4,410.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75

Hawk One LX

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270677280
Hospital Revenue Code	278
Min. Negotiated Rate	$439.22
Max. Negotiated Rate	$9,112.50
Rate for Payer: Aetna Commercial	$6,925.50
Rate for Payer: Aetna Medicare Advantage	$5,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,647.38
Rate for Payer: Cigna Commercial	$9,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75
Rate for Payer: UnitedHealthcare Community & State	$439.22
Rate for Payer: Wellpoint Medicaid Managed Care	$482.96

Hawk One M 6F 2.2 135

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683844N
Hospital Revenue Code	278
Min. Negotiated Rate	$439.22
Max. Negotiated Rate	$9,112.50
Rate for Payer: Aetna Commercial	$6,925.50
Rate for Payer: Aetna Medicare Advantage	$5,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,647.38
Rate for Payer: Cigna Commercial	$9,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75
Rate for Payer: UnitedHealthcare Community & State	$439.22
Rate for Payer: Wellpoint Medicaid Managed Care	$482.96

Hawk One M 6F 2.2 135

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683844
Hospital Revenue Code	278
Min. Negotiated Rate	$2,733.75
Max. Negotiated Rate	$4,410.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75

Hawk One M 6F 2.2 135

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683844N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,733.75
Max. Negotiated Rate	$4,410.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75

Hawk One M 6F 2.2 135

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683844
Hospital Revenue Code	278
Min. Negotiated Rate	$439.22
Max. Negotiated Rate	$9,112.50
Rate for Payer: Aetna Commercial	$6,925.50
Rate for Payer: Aetna Medicare Advantage	$5,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,647.38
Rate for Payer: Cigna Commercial	$9,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75
Rate for Payer: UnitedHealthcare Community & State	$439.22
Rate for Payer: Wellpoint Medicaid Managed Care	$482.96

HAWK ONE M 6F 2.2 135

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683844S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,733.75
Max. Negotiated Rate	$4,410.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75

HAWK ONE M 6F 2.2 135

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683844S
Hospital Revenue Code	278
Min. Negotiated Rate	$439.22
Max. Negotiated Rate	$9,112.50
Rate for Payer: Aetna Commercial	$6,925.50
Rate for Payer: Aetna Medicare Advantage	$5,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,647.38
Rate for Payer: Cigna Commercial	$9,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75
Rate for Payer: UnitedHealthcare Community & State	$439.22
Rate for Payer: Wellpoint Medicaid Managed Care	$482.96

Hawk One S

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683845
Hospital Revenue Code	278
Min. Negotiated Rate	$439.22
Max. Negotiated Rate	$9,112.50
Rate for Payer: Aetna Commercial	$6,925.50
Rate for Payer: Aetna Medicare Advantage	$5,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,647.38
Rate for Payer: Cigna Commercial	$9,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75
Rate for Payer: UnitedHealthcare Community & State	$439.22
Rate for Payer: Wellpoint Medicaid Managed Care	$482.96

Hawk One S

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683845
Hospital Revenue Code	278
Min. Negotiated Rate	$2,733.75
Max. Negotiated Rate	$4,410.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75

Hawk One S

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683845N
Hospital Revenue Code	278
Min. Negotiated Rate	$439.22
Max. Negotiated Rate	$9,112.50
Rate for Payer: Aetna Commercial	$6,925.50
Rate for Payer: Aetna Medicare Advantage	$5,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,647.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,647.38
Rate for Payer: Cigna Commercial	$9,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75
Rate for Payer: UnitedHealthcare Community & State	$439.22
Rate for Payer: Wellpoint Medicaid Managed Care	$482.96

Hawk One S

Facility

$18,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270683845N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,733.75
Max. Negotiated Rate	$4,410.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,410.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,009.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,733.75

HB CORE AB (IGM)

Facility

$192.85

Service Code	HCPCS 86705
Hospital Charge Code	3035119
Hospital Revenue Code	300
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.01
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.49
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: Cigna Medicare Advantage	$11.77
Rate for Payer: Clover Medicare Advantage	$11.18
Rate for Payer: EmblemHealth Commercial	$35.31
Rate for Payer: Humana Medicare Advantage	$12.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.77
Rate for Payer: Wellcare Medicare Advantage	$11.77
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

HB CORE AB (IGM)

Facility

$192.85

Service Code	HCPCS 86705
Hospital Charge Code	3035119
Hospital Revenue Code	300
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

HB CORE AB (IGM)

Facility

$80.90

Service Code	HCPCS 86705
Hospital Charge Code	39900245
Hospital Revenue Code	302
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.01
Rate for Payer: Aetna Medicare Advantage	$38.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.49
Rate for Payer: Cigna Commercial	$40.45
Rate for Payer: Cigna Medicare Advantage	$11.77
Rate for Payer: Clover Medicare Advantage	$11.18
Rate for Payer: EmblemHealth Commercial	$35.31
Rate for Payer: Humana Medicare Advantage	$12.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.77
Rate for Payer: Wellcare Medicare Advantage	$11.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

HB CORE AB (IGM)

Facility

$80.90

Service Code	HCPCS 86705
Hospital Charge Code	39900245
Hospital Revenue Code	302
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$12.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.13

HB CORE AB,TOTAL

Facility

$82.85

Service Code	HCPCS 86704
Hospital Charge Code	39900244
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

HB CORE AB,TOTAL

Facility

$82.85

Service Code	HCPCS 86704
Hospital Charge Code	39900244
Hospital Revenue Code	302
Min. Negotiated Rate	$2.20
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	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$41.42
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	$24.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
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	$2.20

HB DNA PCR

Facility

$296.95

Service Code	HCPCS 87517
Hospital Charge Code	3035101
Hospital Revenue Code	306
Min. Negotiated Rate	$44.54
Max. Negotiated Rate	$44.54
Rate for Payer: Qualcare PPO/HMO/WC	$44.54

HB DNA PCR

Facility

$296.95

Service Code	HCPCS 87517
Hospital Charge Code	3035101
Hospital Revenue Code	306
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$154.64
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	$148.47
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	$89.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.54
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	$7.87

HB E AB

Facility

$79.50

Service Code	HCPCS 86707
Hospital Charge Code	39900246
Hospital Revenue Code	302
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$11.93
Rate for Payer: Qualcare PPO/HMO/WC	$11.93

HB E AB

Facility

$79.50

Service Code	HCPCS 86707
Hospital Charge Code	39900246
Hospital Revenue Code	302
Min. Negotiated Rate	$2.11
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	$39.75
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	$23.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.93
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	$2.11

HB E AG

Facility

$79.20

Service Code	HCPCS 87350
Hospital Charge Code	39900287
Hospital Revenue Code	306
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.88

HB E AG

Facility

$79.20

Service Code	HCPCS 87350
Hospital Charge Code	39900287
Hospital Revenue Code	306
Min. Negotiated Rate	$2.10
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	$39.60
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	$23.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.88
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	$2.10

Know your out-of-pocket cost for care.

All Charges