Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ANTI HU ANTIBODY

Facility

$329.00

Service Code	HCPCS 86316
Hospital Charge Code	38476232
Hospital Revenue Code	302
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

ANTI HU ANTIBODY

Facility

$329.00

Service Code	HCPCS 86316
Hospital Charge Code	38476232
Hospital Revenue Code	302
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$164.50
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	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
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	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$164.50
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	$85.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$9.34

ANTI KERATIN

Facility

$1,259.35

Hospital Charge Code	270655021
Hospital Revenue Code	270
Min. Negotiated Rate	$35.77
Max. Negotiated Rate	$629.67
Rate for Payer: Aetna Commercial	$478.55
Rate for Payer: Aetna Medicare Advantage	$377.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$321.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$321.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$321.13
Rate for Payer: Cigna Commercial	$629.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.43
Rate for Payer: Oxford Commercial	$251.87
Rate for Payer: Qualcare PPO/HMO/WC	$188.90
Rate for Payer: UnitedHealthcare Commercial	$251.87
Rate for Payer: UnitedHealthcare Community & State	$39.80
Rate for Payer: Wellpoint Medicaid Managed Care	$35.77

ANTI KERATIN

Facility

$1,259.35

Hospital Charge Code	270655021
Hospital Revenue Code	270
Min. Negotiated Rate	$188.90
Max. Negotiated Rate	$188.90
Rate for Payer: Qualcare PPO/HMO/WC	$188.90

ANTI-MULLERIAN HORMONE

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900337
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ANTI-MULLERIAN HORMONE

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900337
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTI-MYELOPEROXIDASE AB

Facility

$308.00

Service Code	HCPCS 86021
Hospital Charge Code	38476055
Hospital Revenue Code	302
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$46.20

ANTI-MYELOPEROXIDASE AB

Facility

$308.00

Service Code	HCPCS 86021
Hospital Charge Code	38476055
Hospital Revenue Code	302
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$154.00
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.08
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$8.75

ANTI-NEUTROPHIL CYTOPLASMIC AB

Facility

$405.00

Service Code	HCPCS 86021
Hospital Charge Code	38476008
Hospital Revenue Code	302
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

ANTI-NEUTROPHIL CYTOPLASMIC AB

Facility

$405.00

Service Code	HCPCS 86021
Hospital Charge Code	38476008
Hospital Revenue Code	302
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.30
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

ANTINUCLEAR ANTIBODIES

Facility

$60.45

Service Code	HCPCS 86038
Hospital Charge Code	401386038C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$9.07
Rate for Payer: Qualcare PPO/HMO/WC	$9.07

ANTINUCLEAR ANTIBODIES

Facility

$60.45

Service Code	HCPCS 86038
Hospital Charge Code	401386038C
Hospital Revenue Code	302
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.88
Rate for Payer: Aetna Medicare Advantage	$39.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.86
Rate for Payer: Cigna Commercial	$30.23
Rate for Payer: Cigna Medicare Advantage	$12.09
Rate for Payer: Clover Medicare Advantage	$11.49
Rate for Payer: EmblemHealth Commercial	$36.27
Rate for Payer: Humana Medicare Advantage	$12.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.07
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.09
Rate for Payer: Wellcare Medicare Advantage	$12.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

ANTI-NUCLEAR ANTIBODIES (ANA)

Facility

$244.00

Service Code	HCPCS 86255
Hospital Charge Code	38476057
Hospital Revenue Code	302
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

ANTI-NUCLEAR ANTIBODIES (ANA)

Facility

$244.00

Service Code	HCPCS 86255
Hospital Charge Code	38476057
Hospital Revenue Code	302
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$122.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.44
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.93

ANTI-PHOSPHATIDYLSERINE (PHOSP

Facility

$113.00

Service Code	HCPCS 86148
Hospital Charge Code	38477135
Hospital Revenue Code	302
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.29
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.38
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

ANTI-PHOSPHATIDYLSERINE (PHOSP

Facility

$113.00

Service Code	HCPCS 86148
Hospital Charge Code	38477135
Hospital Revenue Code	302
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

ANTI-PLATELET ANTIBODIES

Facility

$567.00

Service Code	HCPCS 86022
Hospital Charge Code	38476060
Hospital Revenue Code	302
Min. Negotiated Rate	$85.05
Max. Negotiated Rate	$85.05
Rate for Payer: Qualcare PPO/HMO/WC	$85.05

ANTI-PLATELET ANTIBODIES

Facility

$567.00

Service Code	HCPCS 86022
Hospital Charge Code	38476060
Hospital Revenue Code	302
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$59.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.64
Rate for Payer: Cigna Commercial	$283.50
Rate for Payer: Cigna Medicare Advantage	$18.37
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.42
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Medicare Advantage	$18.37
Rate for Payer: Wellpoint Medicaid Managed Care	$16.10

ANTI PM 1 ANTIBODY

Facility

$388.00

Service Code	HCPCS 86331
Hospital Charge Code	38476251
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$194.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$194.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.88
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$11.02

ANTI PM 1 ANTIBODY

Facility

$388.00

Service Code	HCPCS 86331
Hospital Charge Code	38476251
Hospital Revenue Code	302
Min. Negotiated Rate	$58.20
Max. Negotiated Rate	$58.20
Rate for Payer: Qualcare PPO/HMO/WC	$58.20

ANTI-PM/SCL-100AB (EIA)

Facility

$667.59

Service Code	HCPCS 86235
Hospital Charge Code	3847977
Hospital Revenue Code	302
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.04
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

ANTI-PM/SCL-100AB (EIA)

Facility

$667.59

Service Code	HCPCS 86235
Hospital Charge Code	3847977
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	3039022
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	38430022
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	3039022
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

Know your out-of-pocket cost for care.

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