Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BETA-2 GLYCOPROTEIN IGG

Facility

$302.45

Service Code	HCPCS 86146
Hospital Charge Code	3007219A
Hospital Revenue Code	302
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$45.37
Rate for Payer: Qualcare PPO/HMO/WC	$45.37

BETA-2 GLYCOPROTEIN IGG

Facility

$302.45

Service Code	HCPCS 86146
Hospital Charge Code	3007219A
Hospital Revenue Code	302
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$151.22
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$151.22
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$8.01

BETA-2 GLYCOPROTEIN IGM

Facility

$302.45

Service Code	HCPCS 86146
Hospital Charge Code	3007219C
Hospital Revenue Code	302
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$45.37
Rate for Payer: Qualcare PPO/HMO/WC	$45.37

BETA-2 GLYCOPROTEIN IGM

Facility

$302.45

Service Code	HCPCS 86146
Hospital Charge Code	3007219C
Hospital Revenue Code	302
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$151.22
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.87
Rate for Payer: Cigna Commercial	$151.22
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.73
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$8.01

BETA-2 MICROGLOBIN, CSF

Facility

$167.25

Service Code	HCPCS 82232
Hospital Charge Code	3007217
Hospital Revenue Code	301
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

BETA-2 MICROGLOBIN, CSF

Facility

$167.25

Service Code	HCPCS 82232
Hospital Charge Code	3007217
Hospital Revenue Code	301
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.01
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.40
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: Cigna Medicare Advantage	$16.18
Rate for Payer: Clover Medicare Advantage	$15.37
Rate for Payer: EmblemHealth Commercial	$48.54
Rate for Payer: Humana Medicare Advantage	$16.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.18
Rate for Payer: Wellcare Medicare Advantage	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

BETA-2 MICROGLOBIN, URINE

Facility

$167.25

Service Code	HCPCS 82232
Hospital Charge Code	3007216
Hospital Revenue Code	301
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

BETA-2 MICROGLOBIN, URINE

Facility

$167.25

Service Code	HCPCS 82232
Hospital Charge Code	3007216
Hospital Revenue Code	301
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.01
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.40
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: Cigna Medicare Advantage	$16.18
Rate for Payer: Clover Medicare Advantage	$15.37
Rate for Payer: EmblemHealth Commercial	$48.54
Rate for Payer: Humana Medicare Advantage	$16.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.18
Rate for Payer: Wellcare Medicare Advantage	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

BETA-2 MICROGLOBULIN

Facility

$390.00

Service Code	HCPCS 82232
Hospital Charge Code	401082232
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.01
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.40
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.18
Rate for Payer: Clover Medicare Advantage	$15.37
Rate for Payer: EmblemHealth Commercial	$48.54
Rate for Payer: Humana Medicare Advantage	$16.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.18
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	$12.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.18
Rate for Payer: Wellcare Medicare Advantage	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BETA-2 MICROGLOBULIN

Facility

$390.00

Service Code	HCPCS 82232
Hospital Charge Code	401082232
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BETA-2-MICROGLOBULIN

Facility

$174.00

Service Code	HCPCS 82232
Hospital Charge Code	38473077
Hospital Revenue Code	301
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

BETA-2-MICROGLOBULIN

Facility

$174.00

Service Code	HCPCS 82232
Hospital Charge Code	38473077
Hospital Revenue Code	301
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.01
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.40
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: Cigna Medicare Advantage	$16.18
Rate for Payer: Clover Medicare Advantage	$15.37
Rate for Payer: EmblemHealth Commercial	$48.54
Rate for Payer: Humana Medicare Advantage	$16.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.18
Rate for Payer: Wellcare Medicare Advantage	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

BETA-2-MICROGLOBULIN,CSF

Facility

$390.00

Service Code	HCPCS 82232
Hospital Charge Code	39900327
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.01
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.40
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.18
Rate for Payer: Clover Medicare Advantage	$15.37
Rate for Payer: EmblemHealth Commercial	$48.54
Rate for Payer: Humana Medicare Advantage	$16.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.18
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	$12.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.18
Rate for Payer: Wellcare Medicare Advantage	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BETA-2-MICROGLOBULIN,CSF

Facility

$390.00

Service Code	HCPCS 82232
Hospital Charge Code	39900327
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BETA-2 MICROGLOBULIN, SERUM

Facility

$167.25

Service Code	HCPCS 82232
Hospital Charge Code	3007218
Hospital Revenue Code	301
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.01
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.40
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: Cigna Medicare Advantage	$16.18
Rate for Payer: Clover Medicare Advantage	$15.37
Rate for Payer: EmblemHealth Commercial	$48.54
Rate for Payer: Humana Medicare Advantage	$16.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.18
Rate for Payer: Wellcare Medicare Advantage	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

BETA-2 MICROGLOBULIN, SERUM

Facility

$167.25

Service Code	HCPCS 82232
Hospital Charge Code	3007218
Hospital Revenue Code	301
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

BETA-2 MICROGLOBULIN, URINE***

Facility

$209.00

Service Code	HCPCS 82232
Hospital Charge Code	3007200
Hospital Revenue Code	301
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.01
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.40
Rate for Payer: Cigna Commercial	$104.50
Rate for Payer: Cigna Medicare Advantage	$16.18
Rate for Payer: Clover Medicare Advantage	$15.37
Rate for Payer: EmblemHealth Commercial	$48.54
Rate for Payer: Humana Medicare Advantage	$16.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.18
Rate for Payer: Wellcare Medicare Advantage	$16.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

BETA-2 MICROGLOBULIN, URINE***

Facility

$209.00

Service Code	HCPCS 82232
Hospital Charge Code	3007200
Hospital Revenue Code	301
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$31.35
Rate for Payer: Qualcare PPO/HMO/WC	$31.35

BETA-2 TRANSFERRIN I

Facility

$153.55

Service Code	HCPCS 86334
Hospital Charge Code	3038517A
Hospital Revenue Code	300
Min. Negotiated Rate	$23.03
Max. Negotiated Rate	$23.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.03

BETA-2 TRANSFERRIN I

Facility

$153.55

Service Code	HCPCS 86334
Hospital Charge Code	3038517A
Hospital Revenue Code	300
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$60.76
Rate for Payer: Aetna Medicare Advantage	$72.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.64
Rate for Payer: Cigna Commercial	$76.78
Rate for Payer: Cigna Medicare Advantage	$22.34
Rate for Payer: Clover Medicare Advantage	$21.22
Rate for Payer: EmblemHealth Commercial	$67.02
Rate for Payer: Humana Medicare Advantage	$23.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.03
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.34
Rate for Payer: Wellcare Medicare Advantage	$22.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

BETA-2 TRANSFERRIN II

Facility

$226.45

Service Code	HCPCS 86335
Hospital Charge Code	3038517B
Hospital Revenue Code	300
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$79.83
Rate for Payer: Aetna Medicare Advantage	$95.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.94
Rate for Payer: Cigna Commercial	$113.22
Rate for Payer: Cigna Medicare Advantage	$29.35
Rate for Payer: Clover Medicare Advantage	$27.88
Rate for Payer: EmblemHealth Commercial	$88.05
Rate for Payer: Humana Medicare Advantage	$30.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.97
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$23.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.35
Rate for Payer: Wellcare Medicare Advantage	$29.35
Rate for Payer: Wellpoint Medicaid Managed Care	$6.00

BETA-2 TRANSFERRIN II

Facility

$226.45

Service Code	HCPCS 86335
Hospital Charge Code	3038517B
Hospital Revenue Code	300
Min. Negotiated Rate	$33.97
Max. Negotiated Rate	$33.97
Rate for Payer: Qualcare PPO/HMO/WC	$33.97

BETA CAROTENE 25,000 IU SGL

Facility

$4.00

Service Code	NDC 10135012801
Hospital Charge Code	6063943185
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BETA CAROTENE 25,000 IU SGL

Facility

$4.00

Service Code	NDC 10135012801
Hospital Charge Code	6063943185
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

BETA CAROTENE, SERUM***

Facility

$32.00

Service Code	HCPCS 82380
Hospital Charge Code	3030764
Hospital Revenue Code	301
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$29.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.28
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: Cigna Medicare Advantage	$9.22
Rate for Payer: Clover Medicare Advantage	$8.76
Rate for Payer: EmblemHealth Commercial	$27.66
Rate for Payer: Humana Medicare Advantage	$9.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.22
Rate for Payer: Wellcare Medicare Advantage	$9.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

Know your out-of-pocket cost for care.

All Charges