Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MITOCHONDRIAL ANTIBODIES

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38476054
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$257.00
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	$257.00
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	$154.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.10
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	$13.62

MITOCHONDRIAL ANTIBODY TI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39900207
Hospital Revenue Code	302
Min. Negotiated Rate	$2.20
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	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$41.42
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	$24.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
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	$2.20

MITOCHONDRIAL ANTIBODY TI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39900207
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

MITOCHRONDRIAL

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38479075
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$257.00
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	$257.00
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	$154.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.10
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	$13.62

MITOCHRONDRIAL

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38479075
Hospital Revenue Code	302
Min. Negotiated Rate	$77.10
Max. Negotiated Rate	$77.10
Rate for Payer: Qualcare PPO/HMO/WC	$77.10

MITOMYCIN 0.02% SYRINGE

Facility

$224.00

Hospital Charge Code	60635775
Hospital Revenue Code	636
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$85.12
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.21
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

MITOMYCIN 0.02% SYRINGE

Facility

$224.00

Hospital Charge Code	60635775
Hospital Revenue Code	636
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$54.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.21
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

MITOMYCIN 20 MG INJ

Facility

$4,742.39

Service Code	HCPCS J9280
Hospital Charge Code	60627402
Hospital Revenue Code	636
Min. Negotiated Rate	$711.36
Max. Negotiated Rate	$1,147.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.66
Rate for Payer: Qualcare PPO/HMO/WC	$711.36

MITOMYCIN 20 MG INJ

Facility

$4,742.39

Service Code	HCPCS J9280
Hospital Charge Code	60627402
Hospital Revenue Code	636
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$1,147.66
Rate for Payer: Aetna Commercial	$77.41
Rate for Payer: Aetna Medicare Advantage	$92.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.73
Rate for Payer: Cigna Medicare Advantage	$28.46
Rate for Payer: Clover Medicare Advantage	$27.04
Rate for Payer: EmblemHealth Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$29.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.66
Rate for Payer: Qualcare PPO/HMO/WC	$711.36
Rate for Payer: UnitedHealthcare Community & State	$114.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.46
Rate for Payer: Wellcare Medicare Advantage	$28.46
Rate for Payer: Wellpoint Medicaid Managed Care	$125.67

MITOMYCIN 40 MG INJ

Facility

$9,484.79

Service Code	HCPCS J9280
Hospital Charge Code	6007686
Hospital Revenue Code	636
Min. Negotiated Rate	$1,422.72
Max. Negotiated Rate	$2,295.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,295.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.72

MITOMYCIN 40 MG INJ

Facility

$9,484.79

Service Code	HCPCS J9280
Hospital Charge Code	6007686
Hospital Revenue Code	636
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$2,295.32
Rate for Payer: Aetna Commercial	$77.41
Rate for Payer: Aetna Medicare Advantage	$92.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.73
Rate for Payer: Cigna Medicare Advantage	$28.46
Rate for Payer: Clover Medicare Advantage	$27.04
Rate for Payer: EmblemHealth Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$29.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,295.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.72
Rate for Payer: UnitedHealthcare Community & State	$228.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.46
Rate for Payer: Wellcare Medicare Advantage	$28.46
Rate for Payer: Wellpoint Medicaid Managed Care	$251.35

MITOMYCIN 5 MG INJ

Facility

$1,825.48

Service Code	HCPCS J9280
Hospital Charge Code	6003792
Hospital Revenue Code	636
Min. Negotiated Rate	$273.82
Max. Negotiated Rate	$441.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.77
Rate for Payer: Qualcare PPO/HMO/WC	$273.82

MITOMYCIN 5 MG INJ

Facility

$1,825.48

Service Code	HCPCS J9280
Hospital Charge Code	6003792
Hospital Revenue Code	636
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$441.77
Rate for Payer: Aetna Commercial	$77.41
Rate for Payer: Aetna Medicare Advantage	$92.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.73
Rate for Payer: Cigna Medicare Advantage	$28.46
Rate for Payer: Clover Medicare Advantage	$27.04
Rate for Payer: EmblemHealth Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$29.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.77
Rate for Payer: Qualcare PPO/HMO/WC	$273.82
Rate for Payer: UnitedHealthcare Community & State	$43.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.46
Rate for Payer: Wellcare Medicare Advantage	$28.46
Rate for Payer: Wellpoint Medicaid Managed Care	$48.38

MITOMYCIN INJ 20MG

Facility

$3,453.45

Hospital Charge Code	6003800
Hospital Revenue Code	636
Min. Negotiated Rate	$518.02
Max. Negotiated Rate	$835.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$835.73
Rate for Payer: Qualcare PPO/HMO/WC	$518.02

MITOMYCIN INJ 20MG

Facility

$3,453.45

Hospital Charge Code	6003800
Hospital Revenue Code	636
Min. Negotiated Rate	$83.23
Max. Negotiated Rate	$1,726.72
Rate for Payer: Aetna Commercial	$1,312.31
Rate for Payer: Aetna Medicare Advantage	$1,036.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$880.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$880.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$880.63
Rate for Payer: Cigna Commercial	$1,726.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$835.73
Rate for Payer: Qualcare PPO/HMO/WC	$518.02
Rate for Payer: UnitedHealthcare Community & State	$83.23
Rate for Payer: Wellpoint Medicaid Managed Care	$91.52

MITO/SMTH W/RFLX

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088B
Hospital Revenue Code	300
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

MITO/SMTH W/RFLX

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088C
Hospital Revenue Code	300
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

MITO/SMTH W/RFLX

Facility

$98.00

Service Code	HCPCS 86256
Hospital Charge Code	3035088D
Hospital Revenue Code	300
Min. Negotiated Rate	$2.60
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	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$49.00
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	$29.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
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	$2.60

MITO/SMTH W/RFLX

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088B
Hospital Revenue Code	300
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

MITO/SMTH W/RFLX

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088A
Hospital Revenue Code	300
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

MITO/SMTH W/RFLX

Facility

$98.00

Service Code	HCPCS 86256
Hospital Charge Code	3035088D
Hospital Revenue Code	300
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

MITO/SMTH W/RFLX

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088C
Hospital Revenue Code	300
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

MITO/SMTH W/RFLX

Facility

$121.00

Service Code	HCPCS 86255
Hospital Charge Code	3035088A
Hospital Revenue Code	300
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

MITOXANTRONE 2 MG/ML INJ

Facility

$1,740.46

Service Code	HCPCS J9293
Hospital Charge Code	60627403
Hospital Revenue Code	636
Min. Negotiated Rate	$261.07
Max. Negotiated Rate	$421.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.19
Rate for Payer: Qualcare PPO/HMO/WC	$261.07

MITOXANTRONE 2 MG/ML INJ

Facility

$1,740.46

Service Code	HCPCS J9293
Hospital Charge Code	60627403
Hospital Revenue Code	636
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$421.19
Rate for Payer: Aetna Commercial	$105.02
Rate for Payer: Aetna Medicare Advantage	$125.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.37
Rate for Payer: Cigna Medicare Advantage	$38.61
Rate for Payer: Clover Medicare Advantage	$36.68
Rate for Payer: EmblemHealth Commercial	$115.83
Rate for Payer: Humana Medicare Advantage	$39.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.19
Rate for Payer: Qualcare PPO/HMO/WC	$261.07
Rate for Payer: UnitedHealthcare Community & State	$41.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.61
Rate for Payer: Wellcare Medicare Advantage	$38.61
Rate for Payer: Wellpoint Medicaid Managed Care	$46.12

Know your out-of-pocket cost for care.

All Charges