Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS C AB W RFLX TO HCV

Facility

$3,410.19

Service Code	HCPCS 86803
Hospital Charge Code	401086803
Hospital Revenue Code	302
Min. Negotiated Rate	$511.53
Max. Negotiated Rate	$511.53
Rate for Payer: Qualcare PPO/HMO/WC	$511.53

HEPATITIS C AB W RFLX TO HCV

Facility

$3,410.19

Service Code	HCPCS 86803
Hospital Charge Code	401086803
Hospital Revenue Code	302
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$1,705.10
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.51
Rate for Payer: Cigna Commercial	$1,705.10
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,023.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$511.53
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$90.37

HEPATITIS C ANTIBODY

Facility

$871.00

Service Code	HCPCS 86803
Hospital Charge Code	38472332
Hospital Revenue Code	302
Min. Negotiated Rate	$130.65
Max. Negotiated Rate	$130.65
Rate for Payer: Qualcare PPO/HMO/WC	$130.65

HEPATITIS C ANTIBODY

Facility

$871.00

Service Code	HCPCS 86803
Hospital Charge Code	38472332
Hospital Revenue Code	302
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$435.50
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.51
Rate for Payer: Cigna Commercial	$435.50
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$23.08

HEPATITIS C,DNA OR RNA

Facility

$876.00

Service Code	HCPCS 87522
Hospital Charge Code	38475112
Hospital Revenue Code	306
Min. Negotiated Rate	$131.40
Max. Negotiated Rate	$131.40
Rate for Payer: Qualcare PPO/HMO/WC	$131.40

HEPATITIS C,DNA OR RNA

Facility

$876.00

Service Code	HCPCS 87522
Hospital Charge Code	38475112
Hospital Revenue Code	306
Min. Negotiated Rate	$23.21
Max. Negotiated Rate	$438.00
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	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$438.00
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	$262.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.40
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	$23.21

HEPATITIS C RIBA RECOMBINANT

Facility

$383.25

Service Code	HCPCS 86803
Hospital Charge Code	3009875
Hospital Revenue Code	302
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEPATITIS C RIBA RECOMBINANT

Facility

$383.25

Service Code	HCPCS 86803
Hospital Charge Code	3009875
Hospital Revenue Code	302
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$191.62
Rate for Payer: Aetna Commercial	$38.81
Rate for Payer: Aetna Medicare Advantage	$46.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.51
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: Cigna Medicare Advantage	$14.27
Rate for Payer: Clover Medicare Advantage	$13.56
Rate for Payer: EmblemHealth Commercial	$42.81
Rate for Payer: Humana Medicare Advantage	$14.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.27
Rate for Payer: Wellcare Medicare Advantage	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

HEPATITIS C RNA AMP PROBE

Facility

$383.25

Service Code	HCPCS 87522
Hospital Charge Code	3009388
Hospital Revenue Code	306
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$236.19
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	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$191.62
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	$114.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
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	$10.16

HEPATITIS C RNA AMP PROBE

Facility

$383.25

Service Code	HCPCS 87522
Hospital Charge Code	3009388
Hospital Revenue Code	306
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEPATITIS C RNA, PCR

Facility

$2,335.00

Service Code	HCPCS 87522
Hospital Charge Code	38475107
Hospital Revenue Code	306
Min. Negotiated Rate	$34.27
Max. Negotiated Rate	$1,167.50
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	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$1,167.50
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	$700.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$350.25
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	$61.88

HEPATITIS C RNA, PCR

Facility

$2,335.00

Service Code	HCPCS 87522
Hospital Charge Code	38475107
Hospital Revenue Code	306
Min. Negotiated Rate	$350.25
Max. Negotiated Rate	$350.25
Rate for Payer: Qualcare PPO/HMO/WC	$350.25

HEPATITIS C,RNA,PCR,QUAL

Facility

$1,853.00

Service Code	HCPCS 87521
Hospital Charge Code	38475111
Hospital Revenue Code	306
Min. Negotiated Rate	$277.95
Max. Negotiated Rate	$277.95
Rate for Payer: Qualcare PPO/HMO/WC	$277.95

HEPATITIS C,RNA,PCR,QUAL

Facility

$1,853.00

Service Code	HCPCS 87521
Hospital Charge Code	38475111
Hospital Revenue Code	306
Min. Negotiated Rate	$28.07
Max. Negotiated Rate	$926.50
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$926.50
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$277.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$49.10

HEPATITIS C RNA (PCR QUANT)

Facility

$383.25

Service Code	HCPCS 87522
Hospital Charge Code	3009387
Hospital Revenue Code	306
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$236.19
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	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$191.62
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	$114.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
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	$10.16

HEPATITIS C RNA (PCR QUANT)

Facility

$383.25

Service Code	HCPCS 87522
Hospital Charge Code	3009387
Hospital Revenue Code	306
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEPATITIS C RNA QUANT WITH REF

Facility

$294.40

Service Code	HCPCS 87522
Hospital Charge Code	39900459
Hospital Revenue Code	306
Min. Negotiated Rate	$44.16
Max. Negotiated Rate	$44.16
Rate for Payer: Qualcare PPO/HMO/WC	$44.16

HEPATITIS C RNA QUANT WITH REF

Facility

$294.40

Service Code	HCPCS 87522
Hospital Charge Code	39900459
Hospital Revenue Code	306
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$236.19
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	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$147.20
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	$88.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.16
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	$7.80

HEPATITIS C VIRAL RNA QUAL TMA

Facility

$390.00

Service Code	HCPCS 87521
Hospital Charge Code	38479740
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HEPATITIS C VIRAL RNA QUAL TMA

Facility

$390.00

Service Code	HCPCS 87521
Hospital Charge Code	38479740
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HEPATITIS C VIRUS

Facility

$2,584.20

Service Code	HCPCS 87902
Hospital Charge Code	3036004
Hospital Revenue Code	306
Min. Negotiated Rate	$68.48
Max. Negotiated Rate	$1,292.10
Rate for Payer: Aetna Commercial	$700.26
Rate for Payer: Aetna Medicare Advantage	$834.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$929.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$929.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$929.32
Rate for Payer: Cigna Commercial	$1,292.10
Rate for Payer: Cigna Medicare Advantage	$257.45
Rate for Payer: Clover Medicare Advantage	$244.58
Rate for Payer: EmblemHealth Commercial	$772.35
Rate for Payer: Humana Medicare Advantage	$265.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$257.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$387.63
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$205.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.45
Rate for Payer: Wellcare Medicare Advantage	$257.45
Rate for Payer: Wellpoint Medicaid Managed Care	$68.48

HEPATITIS C VIRUS

Facility

$2,584.20

Service Code	HCPCS 87902
Hospital Charge Code	3036004
Hospital Revenue Code	306
Min. Negotiated Rate	$387.63
Max. Negotiated Rate	$387.63
Rate for Payer: Qualcare PPO/HMO/WC	$387.63

HEPATITIS-D AB (DELTA)

Facility

$231.25

Service Code	HCPCS 86692
Hospital Charge Code	3032174
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

HEPATITIS-D AB (DELTA)

Facility

$231.25

Service Code	HCPCS 86692
Hospital Charge Code	3032174
Hospital Revenue Code	302
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

HEPATITIS D AB,TOTAL

Facility

$390.00

Service Code	HCPCS 86692
Hospital Charge Code	39900240
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges