Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR BONE AGE WRISTS

Facility

$5,100.00

Service Code	HCPCS 77072
Hospital Charge Code	2002061
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BONE SURVEY COMPLETE

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2000909
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BONE SURVEY COMPLETE

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2000909
Hospital Revenue Code	320
Min. Negotiated Rate	$36.24
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR BONE SURVEY LIMITED

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2011150
Hospital Revenue Code	320
Min. Negotiated Rate	$36.24
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR BONE SURVEY LIMITED

Facility

$5,100.00

Service Code	HCPCS 77074
Hospital Charge Code	2011150
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BREAST NEEDLE LOCALIZATION

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2002210
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

XR BREAST NEEDLE LOCALIZATION

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2002210
Hospital Revenue Code	361
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

XR BREAST NEEDLE LOC EA ADD'Ly

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2002517
Hospital Revenue Code	361
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

XR BREAST NEEDLE LOC EA ADD'Ly

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2002517
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

XR BREAST PLACE LOC WIRE INIT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2004430
Hospital Revenue Code	361
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

XR BREAST PLACE LOC WIRE INIT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2004430
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

XR BREAST SPECIMEN

Facility

$5,100.00

Service Code	HCPCS 76098
Hospital Charge Code	94064037
Hospital Revenue Code	320
Min. Negotiated Rate	$29.04
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
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	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR BREAST SPECIMEN

Facility

$5,100.00

Service Code	HCPCS 76098
Hospital Charge Code	94064037
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BREAST SPECIMEN EA ADDL>1

Facility

$2,974.75

Service Code	HCPCS 7609859
Hospital Charge Code	2200932
Hospital Revenue Code	320
Min. Negotiated Rate	$71.69
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,130.40
Rate for Payer: Aetna Medicare Advantage	$892.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.56
Rate for Payer: Cigna Commercial	$1,487.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.42
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.21
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$71.69
Rate for Payer: Wellpoint Medicaid Managed Care	$78.83

XR BREAST SPECIMEN EA ADDL>1

Facility

$2,974.75

Service Code	HCPCS 7609859
Hospital Charge Code	2200932
Hospital Revenue Code	320
Min. Negotiated Rate	$446.21
Max. Negotiated Rate	$446.21
Rate for Payer: Qualcare PPO/HMO/WC	$446.21

XR BREAST SPECIMEN LT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002285
Hospital Revenue Code	320
Min. Negotiated Rate	$446.21
Max. Negotiated Rate	$446.21
Rate for Payer: Qualcare PPO/HMO/WC	$446.21

XR BREAST SPECIMEN LT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002285
Hospital Revenue Code	320
Min. Negotiated Rate	$29.04
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
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	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.42
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.21
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$71.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$78.83

XR BREAST SPECIMEN LT CHARGE

Facility

$497.65

Service Code	HCPCS 76098
Hospital Charge Code	2000930
Hospital Revenue Code	320
Min. Negotiated Rate	$74.65
Max. Negotiated Rate	$74.65
Rate for Payer: Qualcare PPO/HMO/WC	$74.65

XR BREAST SPECIMEN LT CHARGE

Facility

$497.65

Service Code	HCPCS 76098
Hospital Charge Code	2000930
Hospital Revenue Code	320
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
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	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$11.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$13.19

XR BREAST SPECIMEN RT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002286
Hospital Revenue Code	320
Min. Negotiated Rate	$29.04
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
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	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.42
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.21
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$71.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$78.83

XR BREAST SPECIMEN RT

Facility

$2,974.75

Service Code	HCPCS 76098
Hospital Charge Code	2002286
Hospital Revenue Code	320
Min. Negotiated Rate	$446.21
Max. Negotiated Rate	$446.21
Rate for Payer: Qualcare PPO/HMO/WC	$446.21

XR BREAST SPECIMEN RT CHARGE

Facility

$2,318.20

Service Code	HCPCS 76098
Hospital Charge Code	2000928
Hospital Revenue Code	320
Min. Negotiated Rate	$29.04
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
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	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.46
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$347.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$55.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$61.43

XR BREAST SPECIMEN RT CHARGE

Facility

$2,318.20

Service Code	HCPCS 76098
Hospital Charge Code	2000928
Hospital Revenue Code	320
Min. Negotiated Rate	$347.73
Max. Negotiated Rate	$347.73
Rate for Payer: Qualcare PPO/HMO/WC	$347.73

XR BRONCHOGRAM BI

Facility

$375.00

Service Code	HCPCS 71060
Hospital Charge Code	2000594
Hospital Revenue Code	329
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

XR BRONCHOGRAM BI

Facility

$375.00

Service Code	HCPCS 71060
Hospital Charge Code	2000594
Hospital Revenue Code	329
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

Know your out-of-pocket cost for care.

All Charges