Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CIRCUMCISION-BY CLAMP

Facility

$9,810.16

Service Code	HCPCS 54150
Hospital Charge Code	83080015
Hospital Revenue Code	361
Min. Negotiated Rate	$236.42
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,943.05
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,471.52
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$236.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$259.97

CIRCUMCISION BY SLIT

Facility

$9,810.16

Service Code	HCPCS 54160
Hospital Charge Code	83091015
Hospital Revenue Code	723
Min. Negotiated Rate	$1,471.52
Max. Negotiated Rate	$1,471.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,471.52

CIRCUMCISION BY SLIT

Facility

$9,810.16

Service Code	HCPCS 54160
Hospital Charge Code	83091015
Hospital Revenue Code	723
Min. Negotiated Rate	$135.52
Max. Negotiated Rate	$2,990.31
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,990.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,990.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,990.31
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,943.05
Rate for Payer: Oxford Commercial	$1,962.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,471.52
Rate for Payer: UnitedHealthcare Commercial	$1,962.03
Rate for Payer: UnitedHealthcare Community & State	$236.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$259.97

CIRCUMCISION-BY SLIT

Facility

$10,847.54

Service Code	HCPCS 54160
Hospital Charge Code	83080020
Hospital Revenue Code	723
Min. Negotiated Rate	$1,627.13
Max. Negotiated Rate	$1,627.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.13

CIRCUMCISION-BY SLIT

Facility

$10,847.54

Service Code	HCPCS 54160
Hospital Charge Code	83080020
Hospital Revenue Code	723
Min. Negotiated Rate	$135.52
Max. Negotiated Rate	$3,254.26
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,990.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,990.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,990.31
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,254.26
Rate for Payer: Oxford Commercial	$2,169.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.13
Rate for Payer: UnitedHealthcare Commercial	$2,169.51
Rate for Payer: UnitedHealthcare Community & State	$261.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$287.46

CIRCUMCISION W CLAMP AND BLOCK

Facility

$9,705.00

Service Code	HCPCS 54150
Hospital Charge Code	87502605
Hospital Revenue Code	361
Min. Negotiated Rate	$1,455.75
Max. Negotiated Rate	$1,455.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.75

CIRCUMCISION W CLAMP AND BLOCK

Facility

$9,705.00

Service Code	HCPCS 54150
Hospital Charge Code	87502605
Hospital Revenue Code	361
Min. Negotiated Rate	$233.89
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,911.50
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.75
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$233.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$257.18

CIRCUMCISION W/REGIONL BLOCK

Facility

$4,952.46

Service Code	HCPCS 54150
Hospital Charge Code	1600000606
Hospital Revenue Code	360
Min. Negotiated Rate	$742.87
Max. Negotiated Rate	$742.87
Rate for Payer: Qualcare PPO/HMO/WC	$742.87

CIRCUMCISION W/REGIONL BLOCK

Facility

$4,952.46

Service Code	HCPCS 54150
Hospital Charge Code	1600000606
Hospital Revenue Code	360
Min. Negotiated Rate	$119.35
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.74
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.87
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$119.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$131.24

CIRCUMSICISON-ADULT

Facility

$20,610.70

Service Code	HCPCS 54161
Hospital Charge Code	16000167
Hospital Revenue Code	360
Min. Negotiated Rate	$3,091.61
Max. Negotiated Rate	$3,091.61
Rate for Payer: Qualcare PPO/HMO/WC	$3,091.61

CIRCUMSICISON-ADULT

Facility

$20,610.70

Service Code	HCPCS 54161
Hospital Charge Code	16000167
Hospital Revenue Code	360
Min. Negotiated Rate	$496.72
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,183.21
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,091.61
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$496.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$546.18

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$36,272.25

Service Code	MSDRG 433
Min. Negotiated Rate	$11,044.43
Max. Negotiated Rate	$36,272.25
Rate for Payer: Aetna Commercial	$25,180.47
Rate for Payer: Aetna Medicare Advantage	$36,272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,958.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,958.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,625.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,958.83
Rate for Payer: Cigna Commercial	$19,765.73
Rate for Payer: Cigna Medicare Advantage	$11,625.72
Rate for Payer: Clover Medicare Advantage	$11,044.43
Rate for Payer: EmblemHealth Commercial	$34,877.16
Rate for Payer: Humana Medicare Advantage	$11,974.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,625.72
Rate for Payer: Oxford Commercial	$14,205.89
Rate for Payer: UnitedHealthcare Commercial	$24,910.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,625.72
Rate for Payer: Wellcare Medicare Advantage	$11,625.72

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$65,749.51

Service Code	MSDRG 432
Min. Negotiated Rate	$20,019.88
Max. Negotiated Rate	$65,749.51
Rate for Payer: Aetna Commercial	$45,434.74
Rate for Payer: Aetna Medicare Advantage	$65,749.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,661.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,661.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,073.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,661.12
Rate for Payer: Cigna Commercial	$36,832.89
Rate for Payer: Cigna Medicare Advantage	$21,073.56
Rate for Payer: Clover Medicare Advantage	$20,019.88
Rate for Payer: EmblemHealth Commercial	$63,220.68
Rate for Payer: Humana Medicare Advantage	$21,705.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,073.56
Rate for Payer: Oxford Commercial	$26,472.29
Rate for Payer: UnitedHealthcare Commercial	$46,420.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,073.56
Rate for Payer: Wellcare Medicare Advantage	$21,073.56

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$25,163.24

Service Code	MSDRG 434
Min. Negotiated Rate	$7,661.88
Max. Negotiated Rate	$25,163.24
Rate for Payer: Aetna Commercial	$17,547.34
Rate for Payer: Aetna Medicare Advantage	$25,163.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,584.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,584.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,065.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,584.87
Rate for Payer: Cigna Commercial	$13,333.73
Rate for Payer: Cigna Medicare Advantage	$8,065.14
Rate for Payer: Clover Medicare Advantage	$7,661.88
Rate for Payer: EmblemHealth Commercial	$24,195.42
Rate for Payer: Humana Medicare Advantage	$8,307.09
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,065.14
Rate for Payer: Oxford Commercial	$9,583.12
Rate for Payer: UnitedHealthcare Commercial	$16,804.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,065.14
Rate for Payer: Wellcare Medicare Advantage	$8,065.14

CISAPRIDE SSP 1MG/ML

Facility

$78.10

Hospital Charge Code	60628157
Hospital Revenue Code	250
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$11.71
Rate for Payer: Qualcare PPO/HMO/WC	$11.71

CISAPRIDE SSP 1MG/ML

Facility

$78.10

Hospital Charge Code	60628157
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$39.05
Rate for Payer: Aetna Commercial	$29.68
Rate for Payer: Aetna Medicare Advantage	$23.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.92
Rate for Payer: Cigna Commercial	$39.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.43
Rate for Payer: Oxford Commercial	$15.62
Rate for Payer: Qualcare PPO/HMO/WC	$11.71
Rate for Payer: UnitedHealthcare Commercial	$15.62
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

CISAPRIDE TAB 10MG

Facility

$5.80

Hospital Charge Code	6014146
Hospital Revenue Code	252
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

CISAPRIDE TAB 10MG

Facility

$5.80

Hospital Charge Code	6014146
Hospital Revenue Code	252
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.20
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

CISAPRIDE TAB 10MG

Facility

$4.50

Hospital Charge Code	60628156
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

CISAPRIDE TAB 10MG

Facility

$4.50

Hospital Charge Code	60628156
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

CISATRACURIUM 10MG/5ML

Facility

$126.03

Service Code	NDC 74437805
Hospital Charge Code	60635765
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$63.02
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.14
Rate for Payer: Cigna Commercial	$63.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.81
Rate for Payer: Oxford Commercial	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.21
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.34

CISATRACURIUM 10MG/5ML

Facility

$126.03

Service Code	NDC 74437805
Hospital Charge Code	60635765
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CISATRACURIUM INJ 20MG/10ML

Facility

$221.17

Service Code	NDC 74438010
Hospital Charge Code	6017636
Hospital Revenue Code	250
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$110.58
Rate for Payer: Aetna Commercial	$84.04
Rate for Payer: Aetna Medicare Advantage	$66.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.40
Rate for Payer: Cigna Commercial	$110.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.35
Rate for Payer: Oxford Commercial	$44.23
Rate for Payer: Qualcare PPO/HMO/WC	$33.18
Rate for Payer: UnitedHealthcare Commercial	$44.23
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.86

CISATRACURIUM INJ 20MG/10ML

Facility

$221.17

Service Code	NDC 74438010
Hospital Charge Code	6017636
Hospital Revenue Code	250
Min. Negotiated Rate	$33.18
Max. Negotiated Rate	$33.18
Rate for Payer: Qualcare PPO/HMO/WC	$33.18

CISCO CATAKYST 24 ETHERNET

Facility

$5,838.75

Hospital Charge Code	270659108
Hospital Revenue Code	278
Min. Negotiated Rate	$140.71
Max. Negotiated Rate	$2,919.38
Rate for Payer: Aetna Commercial	$2,218.72
Rate for Payer: Aetna Medicare Advantage	$1,751.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,488.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,488.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,167.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,488.88
Rate for Payer: Cigna Commercial	$2,919.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,284.53
Rate for Payer: Qualcare PPO/HMO/WC	$875.81
Rate for Payer: UnitedHealthcare Community & State	$140.71
Rate for Payer: Wellpoint Medicaid Managed Care	$154.73

Know your out-of-pocket cost for care.

All Charges