Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

C1 ESTERASE INHIBITOR,TOT II

Facility

$82.50

Hospital Charge Code	39990025B
Hospital Revenue Code	306
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

C1Q IMMUNE COMPLEX DETECTION

Facility

$387.00

Service Code	HCPCS 86332
Hospital Charge Code	38476218
Hospital Revenue Code	302
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

C1Q IMMUNE COMPLEX DETECTION

Facility

$387.00

Service Code	HCPCS 86332
Hospital Charge Code	38476218
Hospital Revenue Code	302
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$66.29
Rate for Payer: Aetna Medicare Advantage	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
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	$87.97
Rate for Payer: Cigna Commercial	$193.50
Rate for Payer: Cigna Medicare Advantage	$24.37
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Medicare Advantage	$24.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.26

C1Q,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900360
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C1Q,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900360
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.32
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

C2 SERUM

Facility

$158.05

Service Code	HCPCS 86160
Hospital Charge Code	3035152
Hospital Revenue Code	302
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.32
Rate for Payer: Cigna Commercial	$79.03
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.71
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

C2 SERUM

Facility

$158.05

Service Code	HCPCS 86160
Hospital Charge Code	3035152
Hospital Revenue Code	302
Min. Negotiated Rate	$23.71
Max. Negotiated Rate	$23.71
Rate for Payer: Qualcare PPO/HMO/WC	$23.71

C2,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900196
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.32
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

C2,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900196
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C5 COMPLEMENT

Facility

$158.05

Service Code	HCPCS 86160
Hospital Charge Code	3009131
Hospital Revenue Code	302
Min. Negotiated Rate	$23.71
Max. Negotiated Rate	$23.71
Rate for Payer: Qualcare PPO/HMO/WC	$23.71

C5 COMPLEMENT

Facility

$158.05

Service Code	HCPCS 86160
Hospital Charge Code	3009131
Hospital Revenue Code	302
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.32
Rate for Payer: Cigna Commercial	$79.03
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.71
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

CA 125, SERUM

Facility

$261.65

Service Code	HCPCS 86304
Hospital Charge Code	3006491
Hospital Revenue Code	302
Min. Negotiated Rate	$39.25
Max. Negotiated Rate	$39.25
Rate for Payer: Qualcare PPO/HMO/WC	$39.25

CA 125, SERUM

Facility

$261.65

Service Code	HCPCS 86304
Hospital Charge Code	3006491
Hospital Revenue Code	302
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$130.82
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$130.82
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$6.93

CA 15-3

Facility

$240.00

Service Code	HCPCS 86300
Hospital Charge Code	3007241
Hospital Revenue Code	302
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

CA 15-3

Facility

$240.00

Service Code	HCPCS 86300
Hospital Charge Code	3007241
Hospital Revenue Code	302
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

CA 15-3

Facility

$390.00

Service Code	HCPCS 86300
Hospital Charge Code	39900426
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
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	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CA 15-3

Facility

$390.00

Service Code	HCPCS 86300
Hospital Charge Code	39900426
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CA 19-9

Facility

$143.05

Service Code	HCPCS 86301
Hospital Charge Code	39900421
Hospital Revenue Code	302
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

CA 19-9

Facility

$143.05

Service Code	HCPCS 86301
Hospital Charge Code	39900421
Hospital Revenue Code	302
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

CA 19-9 (SERUM)

Facility

$179.25

Service Code	HCPCS 86301
Hospital Charge Code	3007242
Hospital Revenue Code	302
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$89.62
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
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	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

CA 19-9 (SERUM)

Facility

$179.25

Service Code	HCPCS 86301
Hospital Charge Code	3007242
Hospital Revenue Code	302
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

CA 27 - 29

Facility

$493.00

Service Code	HCPCS 86300
Hospital Charge Code	38476249
Hospital Revenue Code	302
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$73.95
Rate for Payer: Qualcare PPO/HMO/WC	$73.95

CA 27 - 29

Facility

$493.00

Service Code	HCPCS 86300
Hospital Charge Code	38476249
Hospital Revenue Code	302
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$246.50
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$246.50
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$13.06

CA 27.29

Facility

$390.00

Service Code	HCPCS 86300
Hospital Charge Code	39990029EX
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CA 27.29

Facility

$390.00

Service Code	HCPCS 86300
Hospital Charge Code	39990029EX
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
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	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges