Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VITAMIN B12 250MG TABLET

Facility

$4.00

Service Code	NDC 50268085315
Hospital Charge Code	606390158
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

VITAMIN B12 BINDING CAPAC

Facility

$98.40

Service Code	HCPCS 82608
Hospital Charge Code	39900070
Hospital Revenue Code	301
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare Advantage	$46.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.32
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	$51.69
Rate for Payer: Cigna Commercial	$49.20
Rate for Payer: Cigna Medicare Advantage	$14.32
Rate for Payer: Clover Medicare Advantage	$13.60
Rate for Payer: EmblemHealth Commercial	$42.96
Rate for Payer: Humana Medicare Advantage	$14.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.52
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.76
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.32
Rate for Payer: Wellcare Medicare Advantage	$14.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.61

VITAMIN B12 BINDING CAPAC

Facility

$98.40

Service Code	HCPCS 82608
Hospital Charge Code	39900070
Hospital Revenue Code	301
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$14.76
Rate for Payer: Qualcare PPO/HMO/WC	$14.76

VITAMIN B12 (CYANOCBALAMIN)

Facility

$309.95

Service Code	HCPCS 82607
Hospital Charge Code	3002763
Hospital Revenue Code	301
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$154.97
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
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	$54.43
Rate for Payer: Cigna Commercial	$154.97
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

VITAMIN B12 (CYANOCBALAMIN)

Facility

$309.95

Service Code	HCPCS 82607
Hospital Charge Code	3002763
Hospital Revenue Code	301
Min. Negotiated Rate	$46.49
Max. Negotiated Rate	$46.49
Rate for Payer: Qualcare PPO/HMO/WC	$46.49

VITAMIN B12,SERUM

Facility

$103.60

Service Code	HCPCS 82607
Hospital Charge Code	39900069
Hospital Revenue Code	301
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$15.54
Rate for Payer: Qualcare PPO/HMO/WC	$15.54

VITAMIN B12,SERUM

Facility

$103.60

Service Code	HCPCS 82607
Hospital Charge Code	39900069
Hospital Revenue Code	301
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
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	$54.43
Rate for Payer: Cigna Commercial	$51.80
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.54
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.75

VITAMIN B1 (ERYTHROCYTE TRANSK

Facility

$588.00

Service Code	HCPCS 84425
Hospital Charge Code	38472683
Hospital Revenue Code	301
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$88.20
Rate for Payer: Qualcare PPO/HMO/WC	$88.20

VITAMIN B1 (ERYTHROCYTE TRANSK

Facility

$588.00

Service Code	HCPCS 84425
Hospital Charge Code	38472683
Hospital Revenue Code	301
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$294.00
Rate for Payer: Aetna Commercial	$57.75
Rate for Payer: Aetna Medicare Advantage	$68.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.63
Rate for Payer: Cigna Commercial	$294.00
Rate for Payer: Cigna Medicare Advantage	$21.23
Rate for Payer: Clover Medicare Advantage	$20.17
Rate for Payer: EmblemHealth Commercial	$63.69
Rate for Payer: Humana Medicare Advantage	$21.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.23
Rate for Payer: Wellcare Medicare Advantage	$21.23
Rate for Payer: Wellpoint Medicaid Managed Care	$15.58

VITAMIN B1 (THIAMINE)

Facility

$192.85

Service Code	HCPCS 84425
Hospital Charge Code	3002748
Hospital Revenue Code	301
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$57.75
Rate for Payer: Aetna Medicare Advantage	$68.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.63
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: Cigna Medicare Advantage	$21.23
Rate for Payer: Clover Medicare Advantage	$20.17
Rate for Payer: EmblemHealth Commercial	$63.69
Rate for Payer: Humana Medicare Advantage	$21.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.23
Rate for Payer: Wellcare Medicare Advantage	$21.23
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

VITAMIN B1 (THIAMINE)

Facility

$192.85

Service Code	HCPCS 84425
Hospital Charge Code	3002748
Hospital Revenue Code	301
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

VITAMIN B1 (THIAMINE), B

Facility

$667.59

Service Code	HCPCS 84425
Hospital Charge Code	39900138
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

VITAMIN B1 (THIAMINE), B

Facility

$667.59

Service Code	HCPCS 84425
Hospital Charge Code	39900138
Hospital Revenue Code	301
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$57.75
Rate for Payer: Aetna Medicare Advantage	$68.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.63
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$21.23
Rate for Payer: Clover Medicare Advantage	$20.17
Rate for Payer: EmblemHealth Commercial	$63.69
Rate for Payer: Humana Medicare Advantage	$21.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.23
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	$16.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.23
Rate for Payer: Wellcare Medicare Advantage	$21.23
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

VITAMIN B2 (ERYTHROCYTE GLUT.R

Facility

$304.00

Service Code	HCPCS 84252
Hospital Charge Code	38472686
Hospital Revenue Code	301
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$152.00
Rate for Payer: Aetna Commercial	$55.05
Rate for Payer: Aetna Medicare Advantage	$65.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.06
Rate for Payer: Cigna Commercial	$152.00
Rate for Payer: Cigna Medicare Advantage	$20.24
Rate for Payer: Clover Medicare Advantage	$19.23
Rate for Payer: EmblemHealth Commercial	$60.72
Rate for Payer: Humana Medicare Advantage	$20.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.24
Rate for Payer: Wellcare Medicare Advantage	$20.24
Rate for Payer: Wellpoint Medicaid Managed Care	$8.06

VITAMIN B2 (ERYTHROCYTE GLUT.R

Facility

$304.00

Service Code	HCPCS 84252
Hospital Charge Code	38472686
Hospital Revenue Code	301
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$45.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.60

VITAMIN B2,PLASMA

Facility

$390.00

Service Code	HCPCS 84252
Hospital Charge Code	39900129
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN B2,PLASMA

Facility

$390.00

Service Code	HCPCS 84252
Hospital Charge Code	39900129
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$55.05
Rate for Payer: Aetna Medicare Advantage	$65.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.06
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.24
Rate for Payer: Clover Medicare Advantage	$19.23
Rate for Payer: EmblemHealth Commercial	$60.72
Rate for Payer: Humana Medicare Advantage	$20.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.24
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	$16.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.24
Rate for Payer: Wellcare Medicare Advantage	$20.24
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VITAMIN B2 (RIBOFLAVIN)

Facility

$179.25

Service Code	HCPCS 84252
Hospital Charge Code	3007754
Hospital Revenue Code	301
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$55.05
Rate for Payer: Aetna Medicare Advantage	$65.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.06
Rate for Payer: Cigna Commercial	$89.62
Rate for Payer: Cigna Medicare Advantage	$20.24
Rate for Payer: Clover Medicare Advantage	$19.23
Rate for Payer: EmblemHealth Commercial	$60.72
Rate for Payer: Humana Medicare Advantage	$20.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.24
Rate for Payer: Wellcare Medicare Advantage	$20.24
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

VITAMIN B2 (RIBOFLAVIN)

Facility

$179.25

Service Code	HCPCS 84252
Hospital Charge Code	3007754
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

VITAMIN B3

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39900518
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.40
Rate for Payer: Aetna Medicare Advantage	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.58
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.06
Rate for Payer: Clover Medicare Advantage	$16.21
Rate for Payer: EmblemHealth Commercial	$51.18
Rate for Payer: Humana Medicare Advantage	$17.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.06
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	$13.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.06
Rate for Payer: Wellcare Medicare Advantage	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VITAMIN B3

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39900518
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN B5 (PANTOTHENC AC)

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39708040
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.40
Rate for Payer: Aetna Medicare Advantage	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.58
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.06
Rate for Payer: Clover Medicare Advantage	$16.21
Rate for Payer: EmblemHealth Commercial	$51.18
Rate for Payer: Humana Medicare Advantage	$17.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.06
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	$13.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.06
Rate for Payer: Wellcare Medicare Advantage	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VITAMIN B5 (PANTOTHENC AC)

Facility

$390.00

Service Code	HCPCS 84591
Hospital Charge Code	39708040
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN B6 (PIRIDOXAL PHOSPH)

Facility

$278.45

Service Code	HCPCS 84207
Hospital Charge Code	3007762
Hospital Revenue Code	301
Min. Negotiated Rate	$41.77
Max. Negotiated Rate	$41.77
Rate for Payer: Qualcare PPO/HMO/WC	$41.77

VITAMIN B6 (PIRIDOXAL PHOSPH)

Facility

$278.45

Service Code	HCPCS 84207
Hospital Charge Code	3007762
Hospital Revenue Code	301
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$24,078.00
Rate for Payer: Aetna Commercial	$76.43
Rate for Payer: Aetna Medicare Advantage	$91.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.43
Rate for Payer: Cigna Commercial	$139.22
Rate for Payer: Cigna Medicare Advantage	$28.10
Rate for Payer: Clover Medicare Advantage	$26.70
Rate for Payer: EmblemHealth Commercial	$84.30
Rate for Payer: Humana Medicare Advantage	$28.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.10
Rate for Payer: Wellcare Medicare Advantage	$28.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,078.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

Know your out-of-pocket cost for care.

All Charges