Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PS FEM STAB COMP TRIATH SZ2 LT

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270694193
Hospital Revenue Code	278
Min. Negotiated Rate	$259.66
Max. Negotiated Rate	$5,387.18
Rate for Payer: Aetna Commercial	$4,094.25
Rate for Payer: Aetna Medicare Advantage	$3,232.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,747.46
Rate for Payer: Cigna Commercial	$5,387.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,370.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15
Rate for Payer: UnitedHealthcare Community & State	$259.66
Rate for Payer: Wellpoint Medicaid Managed Care	$285.52

PS FEM STAB COMP TRIATH SZ2 LT

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270694193
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.15
Max. Negotiated Rate	$2,607.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,370.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15

PSF TRIATHLON PS RT #4

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270695677
Hospital Revenue Code	278
Min. Negotiated Rate	$253.76
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$253.76
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

PSF TRIATHLON PS RT #4

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270695677
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

PSG 1-3

Facility

$4,688.00

Service Code	HCPCS 95808
Hospital Charge Code	90000030
Hospital Revenue Code	920
Min. Negotiated Rate	$112.98
Max. Negotiated Rate	$18,046.00
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,682.65
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,406.40
Rate for Payer: Oxford Commercial	$10,292.00
Rate for Payer: Qualcare PPO/HMO/WC	$703.20
Rate for Payer: UnitedHealthcare Commercial	$18,046.00
Rate for Payer: UnitedHealthcare Community & State	$112.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$124.23

PSG 1-3

Facility

$4,688.00

Service Code	HCPCS 95808
Hospital Charge Code	90000030
Hospital Revenue Code	920
Min. Negotiated Rate	$703.20
Max. Negotiated Rate	$703.20
Rate for Payer: Qualcare PPO/HMO/WC	$703.20

PSG STUDY 4 OR MORE

Facility

$40,000.00

Service Code	HCPCS 95810
Hospital Charge Code	90000035
Hospital Revenue Code	920
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PSG STUDY 4 OR MORE

Facility

$40,000.00

Service Code	HCPCS 95810
Hospital Charge Code	90000035
Hospital Revenue Code	920
Min. Negotiated Rate	$964.00
Max. Negotiated Rate	$18,046.00
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,723.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,682.65
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,000.00
Rate for Payer: Oxford Commercial	$10,292.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$18,046.00
Rate for Payer: UnitedHealthcare Community & State	$964.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,060.00

PSG W/CPAP OR BIPAP

Facility

$40,000.00

Service Code	HCPCS 95811
Hospital Charge Code	90000040
Hospital Revenue Code	920
Min. Negotiated Rate	$964.00
Max. Negotiated Rate	$18,046.00
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,682.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,723.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,682.65
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,000.00
Rate for Payer: Oxford Commercial	$10,292.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$18,046.00
Rate for Payer: UnitedHealthcare Community & State	$964.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,060.00

PSG W/CPAP OR BIPAP

Facility

$40,000.00

Service Code	HCPCS 95811
Hospital Charge Code	90000040
Hospital Revenue Code	920
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PSITTACOSIS AB

Facility

$100.85

Service Code	HCPCS 86171
Hospital Charge Code	3006863
Hospital Revenue Code	302
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

PSITTACOSIS AB

Facility

$100.85

Service Code	HCPCS 86171
Hospital Charge Code	3006863
Hospital Revenue Code	302
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna Medicare Advantage	$32.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.13
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: Cigna Medicare Advantage	$10.01
Rate for Payer: Clover Medicare Advantage	$9.51
Rate for Payer: EmblemHealth Commercial	$30.03
Rate for Payer: Humana Medicare Advantage	$10.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.01
Rate for Payer: Wellcare Medicare Advantage	$10.01
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

PSN ALL POLY PAT PLY 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689982
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ALL POLY PAT PLY 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689982
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PSN ALL POLY PAT PLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681302
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ALL POLY PAT PLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681302
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PSN ALL POLY PAT PLY 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689623
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PSN ALL POLY PAT PLY 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689623
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ASFB CPS 12MM VE L 6-9CD

Facility

$6,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270700205
Hospital Revenue Code	278
Min. Negotiated Rate	$148.94
Max. Negotiated Rate	$3,090.00
Rate for Payer: Aetna Commercial	$2,348.40
Rate for Payer: Aetna Medicare Advantage	$1,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,575.90
Rate for Payer: Cigna Commercial	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,359.60
Rate for Payer: Qualcare PPO/HMO/WC	$927.00
Rate for Payer: UnitedHealthcare Community & State	$148.94
Rate for Payer: Wellpoint Medicaid Managed Care	$163.77

PSN ASFB CPS 12MM VE L 6-9CD

Facility

$6,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270700205
Hospital Revenue Code	278
Min. Negotiated Rate	$927.00
Max. Negotiated Rate	$1,495.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,359.60
Rate for Payer: Qualcare PPO/HMO/WC	$927.00

PSN ASF CPS 10 MM VE L

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692693
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10 MM VE L

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692693
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

PSN ASF CPS 10MM VEL 10-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693241
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

PSN ASF CPS 10MM VEL 10-11 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693241
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF CPS 10MMVE L-6 9CD

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691312
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

Know your out-of-pocket cost for care.

All Charges