Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANTG DET IMMN.FLUORINFLUENZA A

Facility

$77.95

Service Code	HCPCS 87276
Hospital Charge Code	38477084
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTG DET IMMN.FLUORINFLUENZA A

Facility

$77.95

Service Code	HCPCS 87276
Hospital Charge Code	38477084
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTG DET IMMUFL-PNEUMOCYSTIS

Facility

$77.95

Service Code	HCPCS 87281
Hospital Charge Code	38477088
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTG DET IMMUFL-PNEUMOCYSTIS

Facility

$77.95

Service Code	HCPCS 87281
Hospital Charge Code	38477088
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTG DET-IMMUNFL CYTOMEGALOVIR

Facility

$77.95

Service Code	HCPCS 87271
Hospital Charge Code	38477080
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTG DET-IMMUNFL CYTOMEGALOVIR

Facility

$77.95

Service Code	HCPCS 87271
Hospital Charge Code	38477080
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.50
Rate for Payer: Aetna Medicare Advantage	$43.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.44
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$13.42
Rate for Payer: Clover Medicare Advantage	$12.75
Rate for Payer: EmblemHealth Commercial	$40.26
Rate for Payer: Humana Medicare Advantage	$13.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.42
Rate for Payer: Wellcare Medicare Advantage	$13.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTG DET IMMUNFL.LEGIONELLA PN

Facility

$77.95

Service Code	HCPCS 87278
Hospital Charge Code	38477085
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTG DET IMMUNFL.LEGIONELLA PN

Facility

$77.95

Service Code	HCPCS 87278
Hospital Charge Code	38477085
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.43
Rate for Payer: Aetna Medicare Advantage	$50.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.31
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$15.60
Rate for Payer: Clover Medicare Advantage	$14.82
Rate for Payer: EmblemHealth Commercial	$46.80
Rate for Payer: Humana Medicare Advantage	$16.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.60
Rate for Payer: Wellcare Medicare Advantage	$15.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTG.DET.IMMUNFL RESP SYNCYTIA

Facility

$77.95

Service Code	HCPCS 87280
Hospital Charge Code	38477087
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTG.DET.IMMUNFL RESP SYNCYTIA

Facility

$77.95

Service Code	HCPCS 87280
Hospital Charge Code	38477087
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.50
Rate for Payer: Aetna Medicare Advantage	$43.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.44
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$13.42
Rate for Payer: Clover Medicare Advantage	$12.75
Rate for Payer: EmblemHealth Commercial	$40.26
Rate for Payer: Humana Medicare Advantage	$13.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.42
Rate for Payer: Wellcare Medicare Advantage	$13.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTG DET IMMUNFL VARICE ZOSTER

Facility

$77.95

Service Code	HCPCS 87290
Hospital Charge Code	38477089
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTG DET IMMUNFL VARICE ZOSTER

Facility

$77.95

Service Code	HCPCS 87290
Hospital Charge Code	38477089
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.50
Rate for Payer: Aetna Medicare Advantage	$43.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.44
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$13.42
Rate for Payer: Clover Medicare Advantage	$12.75
Rate for Payer: EmblemHealth Commercial	$40.26
Rate for Payer: Humana Medicare Advantage	$13.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.42
Rate for Payer: Wellcare Medicare Advantage	$13.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTG.DET.IMMUN.PARAINFLUENZA

Facility

$77.95

Service Code	HCPCS 87279
Hospital Charge Code	38477086
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.69
Rate for Payer: Aetna Medicare Advantage	$53.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.31
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$16.43
Rate for Payer: Clover Medicare Advantage	$15.61
Rate for Payer: EmblemHealth Commercial	$49.29
Rate for Payer: Humana Medicare Advantage	$16.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.43
Rate for Payer: Wellcare Medicare Advantage	$16.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTG.DET.IMMUN.PARAINFLUENZA

Facility

$77.95

Service Code	HCPCS 87279
Hospital Charge Code	38477086
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTG-D.IMMNFL-HERPES SIMPL VIR

Facility

$77.95

Service Code	HCPCS 87273
Hospital Charge Code	38477081
Hospital Revenue Code	309
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$11.69
Rate for Payer: Qualcare PPO/HMO/WC	$11.69

ANTG-D.IMMNFL-HERPES SIMPL VIR

Facility

$77.95

Service Code	HCPCS 87273
Hospital Charge Code	38477081
Hospital Revenue Code	309
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$38.98
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

ANTIADRENAL AB, QUANTITATIVE

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3009805
Hospital Revenue Code	302
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

ANTIADRENAL AB, QUANTITATIVE

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3009805
Hospital Revenue Code	302
Min. Negotiated Rate	$3.21
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	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$60.50
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	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
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	$3.21

ANTIB,HERPES SIMPLEX,TYPE 2

Facility

$137.49

Service Code	HCPCS 86696
Hospital Charge Code	38476304
Hospital Revenue Code	302
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$52.63
Rate for Payer: Aetna Medicare Advantage	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.85
Rate for Payer: Cigna Commercial	$68.75
Rate for Payer: Cigna Medicare Advantage	$19.35
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Medicare Advantage	$19.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

ANTIB,HERPES SIMPLEX,TYPE 2

Facility

$137.49

Service Code	HCPCS 86696
Hospital Charge Code	38476304
Hospital Revenue Code	302
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$20.62
Rate for Payer: Qualcare PPO/HMO/WC	$20.62

ANTIBIOTIC BONE CEMENT

Facility

$2,785.00

Hospital Charge Code	270656476
Hospital Revenue Code	270
Min. Negotiated Rate	$417.75
Max. Negotiated Rate	$417.75
Rate for Payer: Qualcare PPO/HMO/WC	$417.75

ANTIBIOTIC BONE CEMENT

Facility

$2,785.00

Hospital Charge Code	270656476
Hospital Revenue Code	270
Min. Negotiated Rate	$67.12
Max. Negotiated Rate	$1,392.50
Rate for Payer: Aetna Commercial	$1,058.30
Rate for Payer: Aetna Medicare Advantage	$835.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$710.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$710.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$710.17
Rate for Payer: Cigna Commercial	$1,392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$835.50
Rate for Payer: Oxford Commercial	$557.00
Rate for Payer: Qualcare PPO/HMO/WC	$417.75
Rate for Payer: UnitedHealthcare Commercial	$557.00
Rate for Payer: UnitedHealthcare Community & State	$67.12
Rate for Payer: Wellpoint Medicaid Managed Care	$73.80

ANTIBIOTIC LEVEL

Facility

$272.00

Service Code	HCPCS 87186
Hospital Charge Code	38472022
Hospital Revenue Code	309
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$40.80

ANTIBIOTIC LEVEL

Facility

$272.00

Service Code	HCPCS 87186
Hospital Charge Code	38472022
Hospital Revenue Code	309
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Commercial	$23.53
Rate for Payer: Aetna Medicare Advantage	$28.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.22
Rate for Payer: Cigna Commercial	$136.00
Rate for Payer: Cigna Medicare Advantage	$8.65
Rate for Payer: Clover Medicare Advantage	$8.22
Rate for Payer: EmblemHealth Commercial	$25.95
Rate for Payer: Humana Medicare Advantage	$8.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.65
Rate for Payer: Wellcare Medicare Advantage	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$7.21

ANTIB;LYMPHOCYTC CHORIOMENINGI

Facility

$91.00

Service Code	HCPCS 86727
Hospital Charge Code	38477108
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

Know your out-of-pocket cost for care.

All Charges