Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INJ PX CHOLANG NEW ACCESS

Facility

$12,827.31

Service Code	HCPCS 47532
Hospital Charge Code	2011563
Hospital Revenue Code	361
Min. Negotiated Rate	$1,924.10
Max. Negotiated Rate	$1,924.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10

INJ PX CHOLANG NEW ACCESS

Facility

$12,827.31

Service Code	HCPCS 47532
Hospital Charge Code	7411561
Hospital Revenue Code	361
Min. Negotiated Rate	$1,924.10
Max. Negotiated Rate	$1,924.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10

INJ PX CHOLANG NEW ACCESS

Facility

$18,206.00

Service Code	HCPCS 47532
Hospital Charge Code	2600223
Hospital Revenue Code	361
Min. Negotiated Rate	$2,730.90
Max. Negotiated Rate	$2,730.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,730.90

INJ PX CHOLANG NEW ACCESS

Facility

$12,827.31

Service Code	HCPCS 47532
Hospital Charge Code	7411561
Hospital Revenue Code	361
Min. Negotiated Rate	$309.14
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,848.19
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$309.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$339.92

INJ PX CHOLANG NEW ACCESS

Facility

$12,827.31

Service Code	HCPCS 47532
Hospital Charge Code	2011563
Hospital Revenue Code	361
Min. Negotiated Rate	$309.14
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,848.19
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$309.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$339.92

INJ PX CHOLANG NEW ACCESS

Facility

$18,206.00

Service Code	HCPCS 47532
Hospital Charge Code	2600223
Hospital Revenue Code	361
Min. Negotiated Rate	$438.76
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,461.80
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,730.90
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$438.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$482.46

INJ PX SACROILIAC W IMAGE/ARTH

Facility

$3,185.50

Service Code	HCPCS 27096
Hospital Charge Code	420827096
Hospital Revenue Code	361
Min. Negotiated Rate	$76.77
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,210.49
Rate for Payer: Aetna Medicare Advantage	$955.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$812.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$812.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$812.30
Rate for Payer: Cigna Commercial	$1,592.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.65
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$477.82
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$76.77
Rate for Payer: Wellpoint Medicaid Managed Care	$84.42

INJ PX SACROILIAC W IMAGE/ARTH

Facility

$3,185.50

Service Code	HCPCS 27096
Hospital Charge Code	420827096
Hospital Revenue Code	361
Min. Negotiated Rate	$477.82
Max. Negotiated Rate	$477.82
Rate for Payer: Qualcare PPO/HMO/WC	$477.82

INJ.SCLEROSING SOL.SINGLE VEIN

Facility

$623.14

Service Code	HCPCS 36470
Hospital Charge Code	75190140
Hospital Revenue Code	510
Min. Negotiated Rate	$93.47
Max. Negotiated Rate	$93.47
Rate for Payer: Qualcare PPO/HMO/WC	$93.47

INJ.SCLEROSING SOL.SINGLE VEIN

Facility

$623.14

Service Code	HCPCS 36470
Hospital Charge Code	75190140
Hospital Revenue Code	510
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.94
Rate for Payer: Qualcare PPO/HMO/WC	$93.47
Rate for Payer: UnitedHealthcare Community & State	$15.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$16.51

INJ.SCLEROSONG SOL.MULT.VEINS

Facility

$623.14

Service Code	HCPCS 36471
Hospital Charge Code	75190145
Hospital Revenue Code	510
Min. Negotiated Rate	$93.47
Max. Negotiated Rate	$93.47
Rate for Payer: Qualcare PPO/HMO/WC	$93.47

INJ.SCLEROSONG SOL.MULT.VEINS

Facility

$623.14

Service Code	HCPCS 36471
Hospital Charge Code	75190145
Hospital Revenue Code	510
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.94
Rate for Payer: Qualcare PPO/HMO/WC	$93.47
Rate for Payer: UnitedHealthcare Community & State	$15.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$16.51

INJ SGL TENDON SHTH/LIGAMENT

Facility

$2,521.79

Service Code	HCPCS 20550
Hospital Charge Code	1600000316
Hospital Revenue Code	360
Min. Negotiated Rate	$60.78
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.54
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.27
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$60.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$66.83

INJ SGL TENDON SHTH/LIGAMENT

Facility

$2,521.79

Service Code	HCPCS 20550
Hospital Charge Code	1600000316
Hospital Revenue Code	360
Min. Negotiated Rate	$378.27
Max. Negotiated Rate	$378.27
Rate for Payer: Qualcare PPO/HMO/WC	$378.27

INJ SPINE DISK X-R CERV/THOR

Facility

$8,254.60

Service Code	HCPCS 62291
Hospital Charge Code	1600000424
Hospital Revenue Code	360
Min. Negotiated Rate	$1,238.19
Max. Negotiated Rate	$1,238.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,238.19

INJ SPINE DISK X-R CERV/THOR

Facility

$8,254.60

Service Code	HCPCS 62291
Hospital Charge Code	1600000424
Hospital Revenue Code	360
Min. Negotiated Rate	$198.94
Max. Negotiated Rate	$4,127.30
Rate for Payer: Aetna Commercial	$3,136.75
Rate for Payer: Aetna Medicare Advantage	$2,476.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,104.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,104.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,104.92
Rate for Payer: Cigna Commercial	$4,127.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,476.38
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,238.19
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$198.94

INJ TENDON, LIGAMENT, GANGLION

Facility

$1,091.00

Service Code	HCPCS 20550
Hospital Charge Code	84506001
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

INJ TENDON, LIGAMENT, GANGLION

Facility

$1,091.00

Service Code	HCPCS 20550
Hospital Charge Code	84506001
Hospital Revenue Code	361
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$26.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$28.91

INJ TENDON OGIN/INSERT

Facility

$2,401.70

Service Code	HCPCS 20551
Hospital Charge Code	16000539
Hospital Revenue Code	360
Min. Negotiated Rate	$360.25
Max. Negotiated Rate	$360.25
Rate for Payer: Qualcare PPO/HMO/WC	$360.25

INJ TENDON OGIN/INSERT

Facility

$2,401.70

Service Code	HCPCS 20551
Hospital Charge Code	16000539
Hospital Revenue Code	360
Min. Negotiated Rate	$57.88
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.51
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.25
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$57.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$63.65

INJ TENDON ORIGIN/INSERTION

Facility

$1,630.99

Service Code	HCPCS 20551
Hospital Charge Code	321520551
Hospital Revenue Code	361
Min. Negotiated Rate	$39.31
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$489.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$39.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$43.22

INJ TENDON ORIGIN/INSERTION

Facility

$1,630.99

Service Code	HCPCS 20551
Hospital Charge Code	321520551
Hospital Revenue Code	361
Min. Negotiated Rate	$244.65
Max. Negotiated Rate	$244.65
Rate for Payer: Qualcare PPO/HMO/WC	$244.65

INJ TENDON SHEATH/LIGAMENT

Facility

$1,630.99

Service Code	HCPCS 20550
Hospital Charge Code	321520550
Hospital Revenue Code	361
Min. Negotiated Rate	$244.65
Max. Negotiated Rate	$244.65
Rate for Payer: Qualcare PPO/HMO/WC	$244.65

INJ TENDON SHEATH/LIGAMENT

Facility

$1,630.99

Service Code	HCPCS 20550
Hospital Charge Code	321520550
Hospital Revenue Code	361
Min. Negotiated Rate	$39.31
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$489.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$39.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$43.22

INJ THIETHYLPRAZINE 5MG/ML 2M

Facility

$34.60

Hospital Charge Code	6005300
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

Know your out-of-pocket cost for care.

All Charges