Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LYME DISEASE WITH REFLEX TO WE

Facility

$667.59

Service Code	HCPCS 86618
Hospital Charge Code	39900370
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LYME DISEASE WITH REFLEX TO WE

Facility

$667.59

Service Code	HCPCS 86618
Hospital Charge Code	39900370
Hospital Revenue Code	302
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$46.32
Rate for Payer: Aetna Medicare Advantage	$55.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.47
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$17.03
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.03
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	$13.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Medicare Advantage	$17.03
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

LYME IMMUNOBLOT

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3006830
Hospital Revenue Code	302
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

LYME IMMUNOBLOT

Facility

$128.75

Service Code	HCPCS 86618
Hospital Charge Code	3006830
Hospital Revenue Code	302
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.32
Rate for Payer: Aetna Medicare Advantage	$55.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.47
Rate for Payer: Cigna Commercial	$64.38
Rate for Payer: Cigna Medicare Advantage	$17.03
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Medicare Advantage	$17.03
Rate for Payer: Wellpoint Medicaid Managed Care	$3.41

LYME PCR - B. BURGDORFERI

Facility

$614.45

Service Code	HCPCS 87476
Hospital Charge Code	3009785
Hospital Revenue Code	306
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$307.23
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	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$307.23
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	$184.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.17
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	$16.28

LYME PCR - B. BURGDORFERI

Facility

$614.45

Service Code	HCPCS 87476
Hospital Charge Code	3009785
Hospital Revenue Code	306
Min. Negotiated Rate	$92.17
Max. Negotiated Rate	$92.17
Rate for Payer: Qualcare PPO/HMO/WC	$92.17

LYMPHANGIOGRAPHY EXTREM BILAT

Facility

$2,525.90

Service Code	HCPCS 75803
Hospital Charge Code	7411705
Hospital Revenue Code	320
Min. Negotiated Rate	$60.87
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$66.94

LYMPHANGIOGRAPHY EXTREM BILAT

Facility

$2,525.90

Service Code	HCPCS 75803
Hospital Charge Code	2680340
Hospital Revenue Code	320
Min. Negotiated Rate	$60.87
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$66.94

LYMPHANGIOGRAPHY EXTREM BILAT

Facility

$2,525.90

Service Code	HCPCS 75803
Hospital Charge Code	7411705
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY EXTREM BILAT

Facility

$2,525.90

Service Code	HCPCS 75803
Hospital Charge Code	2680340
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY EXT UNIL RSI

Facility

$2,525.90

Service Code	HCPCS 75801
Hospital Charge Code	2680335
Hospital Revenue Code	320
Min. Negotiated Rate	$60.87
Max. Negotiated Rate	$2,690.13
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$521.67
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.94

LYMPHANGIOGRAPHY EXT UNIL RSI

Facility

$2,525.90

Service Code	HCPCS 75801
Hospital Charge Code	7411704
Hospital Revenue Code	320
Min. Negotiated Rate	$60.87
Max. Negotiated Rate	$2,690.13
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$521.67
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.94

LYMPHANGIOGRAPHY EXT UNIL RSI

Facility

$2,525.90

Service Code	HCPCS 75801
Hospital Charge Code	2680335
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY EXT UNIL RSI

Facility

$2,525.90

Service Code	HCPCS 75801
Hospital Charge Code	7411704
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD BILA

Facility

$2,525.90

Service Code	HCPCS 75807
Hospital Charge Code	2680350
Hospital Revenue Code	320
Min. Negotiated Rate	$60.87
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$221.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$2,625.82
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$66.94

LYMPHANGIOGRAPHY PELV/ABD BILA

Facility

$2,525.90

Service Code	HCPCS 75807
Hospital Charge Code	7411707
Hospital Revenue Code	320
Min. Negotiated Rate	$60.87
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$221.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$2,625.82
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$66.94

LYMPHANGIOGRAPHY PELV/ABD BILA

Facility

$2,525.90

Service Code	HCPCS 75807
Hospital Charge Code	7411707
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD BILA

Facility

$2,525.90

Service Code	HCPCS 75807
Hospital Charge Code	2680350
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD UNIL

Facility

$2,525.90

Service Code	HCPCS 75805
Hospital Charge Code	2680345
Hospital Revenue Code	320
Min. Negotiated Rate	$60.87
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$2,625.82
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$66.94

LYMPHANGIOGRAPHY PELV/ABD UNIL

Facility

$2,525.90

Service Code	HCPCS 75805
Hospital Charge Code	7411706
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD UNIL

Facility

$2,525.90

Service Code	HCPCS 75805
Hospital Charge Code	2680345
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

LYMPHANGIOGRAPHY PELV/ABD UNIL

Facility

$2,525.90

Service Code	HCPCS 75805
Hospital Charge Code	7411706
Hospital Revenue Code	320
Min. Negotiated Rate	$60.87
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$2,625.82
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$66.94

LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$7,546.63

Service Code	APR-DRG 6941
Min. Negotiated Rate	$7,398.66
Max. Negotiated Rate	$7,546.63
Rate for Payer: UnitedHealthcare Community & State	$7,398.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,546.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7,398.66

LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$14,277.41

Service Code	APR-DRG 6943
Min. Negotiated Rate	$13,997.46
Max. Negotiated Rate	$14,277.41
Rate for Payer: UnitedHealthcare Community & State	$13,997.46
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,277.41
Rate for Payer: Wellpoint Medicaid Managed Care	$13,997.46

LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$25,516.32

Service Code	APR-DRG 6944
Min. Negotiated Rate	$25,016.00
Max. Negotiated Rate	$25,516.32
Rate for Payer: UnitedHealthcare Community & State	$25,016.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,516.32
Rate for Payer: Wellpoint Medicaid Managed Care	$25,016.00

Know your out-of-pocket cost for care.

All Charges