Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS A ANTIBODY IGM

Facility

$54.45

Service Code	HCPCS 86709
Hospital Charge Code	3007456
Hospital Revenue Code	302
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.17

HEPATITIS A ANTIBODY TOTAL

Facility

$116.00

Service Code	HCPCS 86708
Hospital Charge Code	3007457
Hospital Revenue Code	302
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.72
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

HEPATITIS A ANTIBODY TOTAL

Facility

$116.00

Service Code	HCPCS 86708
Hospital Charge Code	3007457
Hospital Revenue Code	302
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

HEPATITIS A ANTIBODY TOTAL

Facility

$116.00

Service Code	HCPCS 86708
Hospital Charge Code	3006442A
Hospital Revenue Code	302
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

HEPATITIS A ANTIBODY TOTAL

Facility

$116.00

Service Code	HCPCS 86708
Hospital Charge Code	3006442A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.72
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

HEPATITIS A IGM

Facility

$76.80

Service Code	HCPCS 86709
Hospital Charge Code	39900517
Hospital Revenue Code	302
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$11.52
Rate for Payer: Qualcare PPO/HMO/WC	$11.52

HEPATITIS A IGM

Facility

$76.80

Service Code	HCPCS 86709
Hospital Charge Code	39900517
Hospital Revenue Code	302
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$30.63
Rate for Payer: Aetna Medicare Advantage	$36.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.65
Rate for Payer: Cigna Commercial	$38.40
Rate for Payer: Cigna Medicare Advantage	$11.26
Rate for Payer: Clover Medicare Advantage	$10.70
Rate for Payer: EmblemHealth Commercial	$33.78
Rate for Payer: Humana Medicare Advantage	$11.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.52
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.26
Rate for Payer: Wellcare Medicare Advantage	$11.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

HEPATITIS A (PEDS)

Facility

$150.01

Service Code	HCPCS 90633
Hospital Charge Code	93950067
Hospital Revenue Code	636
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$79.26
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

HEPATITIS A (PEDS)

Facility

$150.01

Service Code	HCPCS 90633
Hospital Charge Code	93950067
Hospital Revenue Code	636
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$36.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

HEPATITIS A TOTAL

Facility

$667.59

Service Code	HCPCS 86708
Hospital Charge Code	39900516
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

HEPATITIS A TOTAL

Facility

$667.59

Service Code	HCPCS 86708
Hospital Charge Code	39900516
Hospital Revenue Code	302
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.72
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

HEPATITIS A VIR ANTIBODY

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38479434
Hospital Revenue Code	302
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$63.90

HEPATITIS A VIR ANTIBODY

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38479434
Hospital Revenue Code	302
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$213.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.72
Rate for Payer: Cigna Commercial	$213.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.29

HEPATITIS A VIRUS ANTIBODY, IG

Facility

$410.00

Service Code	HCPCS 86709
Hospital Charge Code	38472338
Hospital Revenue Code	302
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$30.63
Rate for Payer: Aetna Medicare Advantage	$36.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.65
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: Cigna Medicare Advantage	$11.26
Rate for Payer: Clover Medicare Advantage	$10.70
Rate for Payer: EmblemHealth Commercial	$33.78
Rate for Payer: Humana Medicare Advantage	$11.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.26
Rate for Payer: Wellcare Medicare Advantage	$11.26
Rate for Payer: Wellpoint Medicaid Managed Care	$10.87

HEPATITIS A VIRUS ANTIBODY, IG

Facility

$410.00

Service Code	HCPCS 86709
Hospital Charge Code	38472338
Hospital Revenue Code	302
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

HEPATITIS A VIRUS ANTIBODY IGG

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38472335
Hospital Revenue Code	302
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$63.90

HEPATITIS A VIRUS ANTIBODY IGG

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38472335
Hospital Revenue Code	302
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$213.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.72
Rate for Payer: Cigna Commercial	$213.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.29

HEPATITIS A VIRUS ANTIBODY, TO

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38472341
Hospital Revenue Code	302
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$63.90

HEPATITIS A VIRUS ANTIBODY, TO

Facility

$426.00

Service Code	HCPCS 86708
Hospital Charge Code	38472341
Hospital Revenue Code	302
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$213.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.72
Rate for Payer: Cigna Commercial	$213.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.29

HEPATITIS B CORE AB

Facility

$383.00

Service Code	HCPCS 86704
Hospital Charge Code	38476017
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$191.50
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	$191.50
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	$114.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.45
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	$10.15

HEPATITIS B CORE AB

Facility

$383.00

Service Code	HCPCS 86704
Hospital Charge Code	38476017
Hospital Revenue Code	302
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$57.45
Rate for Payer: Qualcare PPO/HMO/WC	$57.45

HEPATITIS B CORE AB IGM

Facility

$192.85

Service Code	HCPCS 86705
Hospital Charge Code	3007466
Hospital Revenue Code	302
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

HEPATITIS B CORE AB IGM

Facility

$192.85

Service Code	HCPCS 86705
Hospital Charge Code	3007466
Hospital Revenue Code	302
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

HEPATITIS B CORE AB TOTAL

Facility

$116.00

Service Code	HCPCS 86704
Hospital Charge Code	3007465
Hospital Revenue Code	302
Min. Negotiated Rate	$3.07
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	$58.00
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	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
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	$3.07

HEPATITIS B CORE AB TOTAL

Facility

$116.00

Service Code	HCPCS 86704
Hospital Charge Code	3006442C
Hospital Revenue Code	302
Min. Negotiated Rate	$3.07
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	$58.00
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	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
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	$3.07

Know your out-of-pocket cost for care.

All Charges