Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANTIBODY;FRANCISELLA TULARENSI

Facility

$73.64

Service Code	HCPCS 86668
Hospital Charge Code	38477073
Hospital Revenue Code	302
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.52
Rate for Payer: Aetna Medicare Advantage	$45.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.11
Rate for Payer: Cigna Commercial	$36.82
Rate for Payer: Cigna Medicare Advantage	$14.16
Rate for Payer: Clover Medicare Advantage	$13.45
Rate for Payer: EmblemHealth Commercial	$42.48
Rate for Payer: Humana Medicare Advantage	$14.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.16
Rate for Payer: Wellcare Medicare Advantage	$14.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.95

ANTIBODY;FRANCISELLA TULARENSI

Facility

$73.64

Service Code	HCPCS 86668
Hospital Charge Code	38477073
Hospital Revenue Code	302
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.05

ANTIBODY,GIARDIA LAMBIA

Facility

$104.00

Service Code	HCPCS 86674
Hospital Charge Code	38477126
Hospital Revenue Code	302
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

ANTIBODY,GIARDIA LAMBIA

Facility

$104.00

Service Code	HCPCS 86674
Hospital Charge Code	38477126
Hospital Revenue Code	302
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.04
Rate for Payer: Aetna Medicare Advantage	$47.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.13
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: Cigna Medicare Advantage	$14.72
Rate for Payer: Clover Medicare Advantage	$13.98
Rate for Payer: EmblemHealth Commercial	$44.16
Rate for Payer: Humana Medicare Advantage	$15.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.72
Rate for Payer: Wellcare Medicare Advantage	$14.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

ANTIBODY;HAEMOPHILUS INFLUENZA

Facility

$112.00

Service Code	HCPCS 86684
Hospital Charge Code	38477133
Hospital Revenue Code	302
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

ANTIBODY;HAEMOPHILUS INFLUENZA

Facility

$112.00

Service Code	HCPCS 86684
Hospital Charge Code	38477133
Hospital Revenue Code	302
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.08
Rate for Payer: Aetna Medicare Advantage	$51.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.84
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	$57.18
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: Cigna Medicare Advantage	$15.84
Rate for Payer: Clover Medicare Advantage	$15.05
Rate for Payer: EmblemHealth Commercial	$47.52
Rate for Payer: Humana Medicare Advantage	$16.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84
Rate for Payer: Wellcare Medicare Advantage	$15.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

ANTIBODY,HERPES SIMPLEX,NON

Facility

$101.94

Service Code	HCPCS 86694
Hospital Charge Code	38476303
Hospital Revenue Code	302
Min. Negotiated Rate	$15.29
Max. Negotiated Rate	$15.29
Rate for Payer: Qualcare PPO/HMO/WC	$15.29

ANTIBODY,HERPES SIMPLEX,NON

Facility

$101.94

Service Code	HCPCS 86694
Hospital Charge Code	38476303
Hospital Revenue Code	302
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$50.97
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.29
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

ANTIBODY;HIV-1 & HIV-2-SINGLA

Facility

$97.00

Service Code	HCPCS 86703
Hospital Charge Code	38477119
Hospital Revenue Code	302
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

ANTIBODY;HIV-1 & HIV-2-SINGLA

Facility

$97.00

Service Code	HCPCS 86703
Hospital Charge Code	38477119
Hospital Revenue Code	302
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.29
Rate for Payer: Aetna Medicare Advantage	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.49
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: Cigna Medicare Advantage	$13.71
Rate for Payer: Clover Medicare Advantage	$13.02
Rate for Payer: EmblemHealth Commercial	$41.13
Rate for Payer: Humana Medicare Advantage	$14.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.71
Rate for Payer: Wellcare Medicare Advantage	$13.71
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

ANTIBODY IDENTIFICATION

Facility

$229.00

Service Code	HCPCS 86870
Hospital Charge Code	38471007
Hospital Revenue Code	302
Min. Negotiated Rate	$34.35
Max. Negotiated Rate	$34.35
Rate for Payer: Qualcare PPO/HMO/WC	$34.35

ANTIBODY IDENTIFICATION

Facility

$667.59

Service Code	HCPCS 86870
Hospital Charge Code	3100542
Hospital Revenue Code	300
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ANTIBODY IDENTIFICATION

Facility

$229.00

Service Code	HCPCS 86870
Hospital Charge Code	38471007
Hospital Revenue Code	302
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$1,537.15
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,537.15
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$6.07

ANTIBODY IDENTIFICATION

Facility

$667.59

Service Code	HCPCS 86870
Hospital Charge Code	3100542
Hospital Revenue Code	300
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$1,537.15
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,537.15
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
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	$9.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

ANTIBODY IDENTIFICATION COLD

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100543
Hospital Revenue Code	309
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.85

ANTIBODY IDENTIFICATION COLD

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100543
Hospital Revenue Code	309
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$33.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

ANTIBODY ID - LEUKOCYTE AB

Facility

$390.00

Service Code	HCPCS 86021
Hospital Charge Code	3032059A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.33
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
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	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANTIBODY ID - LEUKOCYTE AB

Facility

$390.00

Service Code	HCPCS 86021
Hospital Charge Code	3032059A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTIBODY ID PLATELET ASCT/IMMO

Facility

$88.00

Service Code	HCPCS 86023
Hospital Charge Code	38477105
Hospital Revenue Code	302
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$33.89
Rate for Payer: Aetna Medicare Advantage	$40.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.46
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	$44.98
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: Cigna Medicare Advantage	$12.46
Rate for Payer: Clover Medicare Advantage	$11.84
Rate for Payer: EmblemHealth Commercial	$37.38
Rate for Payer: Humana Medicare Advantage	$12.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.46
Rate for Payer: Wellcare Medicare Advantage	$12.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

ANTIBODY ID PLATELET ASCT/IMMO

Facility

$88.00

Service Code	HCPCS 86023
Hospital Charge Code	38477105
Hospital Revenue Code	302
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

ANTIBODY INDENTIFICATION ENZ

Facility

$88.75

Service Code	HCPCS 86971
Hospital Charge Code	3100188
Hospital Revenue Code	300
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.31

ANTIBODY INDENTIFICATION ENZ

Facility

$88.75

Service Code	HCPCS 86971
Hospital Charge Code	3100188
Hospital Revenue Code	300
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

ANTIBODY; LEPTOSPIRA

Facility

$93.00

Service Code	HCPCS 86720
Hospital Charge Code	38477113
Hospital Revenue Code	302
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.06
Rate for Payer: Aetna Medicare Advantage	$52.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.20
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	$58.48
Rate for Payer: Cigna Commercial	$46.50
Rate for Payer: Cigna Medicare Advantage	$16.20
Rate for Payer: Clover Medicare Advantage	$15.39
Rate for Payer: EmblemHealth Commercial	$48.60
Rate for Payer: Humana Medicare Advantage	$16.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20
Rate for Payer: Wellcare Medicare Advantage	$16.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.46

ANTIBODY; LEPTOSPIRA

Facility

$93.00

Service Code	HCPCS 86720
Hospital Charge Code	38477113
Hospital Revenue Code	302
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$13.95
Rate for Payer: Qualcare PPO/HMO/WC	$13.95

ANTIBODY,RICKETTSIA

Facility

$137.49

Service Code	HCPCS 86757
Hospital Charge Code	38476305
Hospital Revenue Code	302
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$20.62
Rate for Payer: Qualcare PPO/HMO/WC	$20.62

Know your out-of-pocket cost for care.

All Charges