Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HD 5 US BAGLESS

Facility

$0.01

Hospital Charge Code	270703400
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

HD FEM BIOLOX DELTA OPT 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270699207
Hospital Revenue Code	278
Min. Negotiated Rate	$1,710.00
Max. Negotiated Rate	$2,758.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,508.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00

HD FEM BIOLOX DELTA OPT 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270699207
Hospital Revenue Code	278
Min. Negotiated Rate	$274.74
Max. Negotiated Rate	$5,700.00
Rate for Payer: Aetna Commercial	$4,332.00
Rate for Payer: Aetna Medicare Advantage	$3,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,907.00
Rate for Payer: Cigna Commercial	$5,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,508.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00
Rate for Payer: UnitedHealthcare Community & State	$274.74
Rate for Payer: Wellpoint Medicaid Managed Care	$302.10

HD FEM BIOLOX D OPT 28MM OD

Facility

$8,286.00

Service Code	HCPCS C1776
Hospital Charge Code	270697542
Hospital Revenue Code	278
Min. Negotiated Rate	$1,242.90
Max. Negotiated Rate	$2,005.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,657.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,005.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,822.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,242.90

HD FEM BIOLOX D OPT 28MM OD

Facility

$8,286.00

Service Code	HCPCS C1776
Hospital Charge Code	270697542
Hospital Revenue Code	278
Min. Negotiated Rate	$199.69
Max. Negotiated Rate	$4,143.00
Rate for Payer: Aetna Commercial	$3,148.68
Rate for Payer: Aetna Medicare Advantage	$2,485.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,112.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,112.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,657.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,112.93
Rate for Payer: Cigna Commercial	$4,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,005.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,822.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,242.90
Rate for Payer: UnitedHealthcare Community & State	$199.69
Rate for Payer: Wellpoint Medicaid Managed Care	$219.58

HDL CHOLESTEROL

Facility

$390.00

Service Code	HCPCS 83718
Hospital Charge Code	3030194
Hospital Revenue Code	301
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$22.28
Rate for Payer: Aetna Medicare Advantage	$26.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.56
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.19
Rate for Payer: Clover Medicare Advantage	$7.78
Rate for Payer: EmblemHealth Commercial	$24.57
Rate for Payer: Humana Medicare Advantage	$8.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.19
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	$6.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.19
Rate for Payer: Wellcare Medicare Advantage	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HDL CHOLESTEROL

Facility

$390.00

Service Code	HCPCS 83718
Hospital Charge Code	3030194
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HDL CHOLESTEROL PANEL

Facility

$39.60

Service Code	HCPCS 83718
Hospital Charge Code	3030194P
Hospital Revenue Code	301
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$5.94
Rate for Payer: Qualcare PPO/HMO/WC	$5.94

HDL CHOLESTEROL PANEL

Facility

$39.60

Service Code	HCPCS 83718
Hospital Charge Code	3030194P
Hospital Revenue Code	301
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.28
Rate for Payer: Aetna Medicare Advantage	$26.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.56
Rate for Payer: Cigna Commercial	$19.80
Rate for Payer: Cigna Medicare Advantage	$8.19
Rate for Payer: Clover Medicare Advantage	$7.78
Rate for Payer: EmblemHealth Commercial	$24.57
Rate for Payer: Humana Medicare Advantage	$8.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.94
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.19
Rate for Payer: Wellcare Medicare Advantage	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

HDL CHOLESTEROL PANEL***

Facility

$30.00

Service Code	HCPCS 83718
Hospital Charge Code	30301394P
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

HDL CHOLESTEROL PANEL***

Facility

$30.00

Service Code	HCPCS 83718
Hospital Charge Code	30301394P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.28
Rate for Payer: Aetna Medicare Advantage	$26.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.56
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: Cigna Medicare Advantage	$8.19
Rate for Payer: Clover Medicare Advantage	$7.78
Rate for Payer: EmblemHealth Commercial	$24.57
Rate for Payer: Humana Medicare Advantage	$8.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.19
Rate for Payer: Wellcare Medicare Advantage	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

HD MODLR 58mm M2A MAGNM 157458

Facility

$6,140.00

Hospital Charge Code	270639185
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

HD MODLR 58mm M2A MAGNM 157458

Facility

$6,140.00

Hospital Charge Code	270639185
Hospital Revenue Code	278
Min. Negotiated Rate	$147.97
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$2,333.20
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00
Rate for Payer: UnitedHealthcare Community & State	$147.97
Rate for Payer: Wellpoint Medicaid Managed Care	$162.71

HD SCORPION NEEDLE

Facility

$1,000.00

Hospital Charge Code	270702938
Hospital Revenue Code	270
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) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

HD SCORPION NEEDLE

Facility

$1,000.00

Hospital Charge Code	270702938
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

HDV AB

Facility

$231.25

Service Code	HCPCS 86692
Hospital Charge Code	3035154
Hospital Revenue Code	302
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

HDV AB

Facility

$231.25

Service Code	HCPCS 86692
Hospital Charge Code	3035154
Hospital Revenue Code	302
Min. Negotiated Rate	$6.13
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	$115.62
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	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
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	$6.13

HE4 OVARIAN CA

Facility

$143.05

Service Code	HCPCS 86305
Hospital Charge Code	39900208
Hospital Revenue Code	302
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

HE4 OVARIAN CA

Facility

$143.05

Service Code	HCPCS 86305
Hospital Charge Code	39900208
Hospital Revenue Code	302
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

HE4 OVARIAN CANCER MONITORING

Facility

$390.00

Service Code	HCPCS 86305
Hospital Charge Code	401086305
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
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	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HE4 OVARIAN CANCER MONITORING

Facility

$390.00

Service Code	HCPCS 86305
Hospital Charge Code	401086305
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HE AB IGG

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035070
Hospital Revenue Code	300
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

HE AB IGG

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035070
Hospital Revenue Code	300
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$459.20
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

HE AB IGM

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035069
Hospital Revenue Code	300
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

HE AB IGM

Facility

$93.65

Service Code	HCPCS 86790
Hospital Charge Code	3035069
Hospital Revenue Code	300
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$459.20
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.49
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

Know your out-of-pocket cost for care.

All Charges