Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLS ENTEROSTOMY LG/SM INTESTIN

Facility

$9,689.00

Service Code	HCPCS 44620
Hospital Charge Code	16000977
Hospital Revenue Code	360
Min. Negotiated Rate	$233.50
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$3,681.82
Rate for Payer: Aetna Medicare Advantage	$2,906.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,470.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,470.70
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	$2,470.70
Rate for Payer: Cigna Commercial	$4,844.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,906.70
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.35
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$233.50
Rate for Payer: Wellpoint Medicaid Managed Care	$256.76

CLS ENTERSTMY,W RESECT&ANASTOM

Facility

$11,385.30

Service Code	HCPCS 44625
Hospital Charge Code	16000978
Hospital Revenue Code	360
Min. Negotiated Rate	$1,707.80
Max. Negotiated Rate	$1,707.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,707.80

CLS ENTERSTMY,W RESECT&ANASTOM

Facility

$11,385.30

Service Code	HCPCS 44625
Hospital Charge Code	16000978
Hospital Revenue Code	360
Min. Negotiated Rate	$274.39
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$4,326.41
Rate for Payer: Aetna Medicare Advantage	$3,415.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,903.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,903.25
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	$2,903.25
Rate for Payer: Cigna Commercial	$5,692.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,415.59
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,707.80
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$274.39
Rate for Payer: Wellpoint Medicaid Managed Care	$301.71

CL TX ARTCLR FX W/O MANIPUL

Facility

$645.00

Service Code	HCPCS 26740
Hospital Charge Code	5780075
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CL TX ARTCLR FX W/O MANIPUL

Facility

$645.00

Service Code	HCPCS 26740
Hospital Charge Code	5780075
Hospital Revenue Code	450
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$1,057.82
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$17.09

CL TX ARTFX MCP/IP JNT; W MANI

Facility

$6,353.84

Service Code	HCPCS 26742
Hospital Charge Code	16000702
Hospital Revenue Code	360
Min. Negotiated Rate	$953.08
Max. Negotiated Rate	$953.08
Rate for Payer: Qualcare PPO/HMO/WC	$953.08

CL TX ARTFX MCP/IP JNT; W MANI

Facility

$6,353.84

Service Code	HCPCS 26742
Hospital Charge Code	16000702
Hospital Revenue Code	360
Min. Negotiated Rate	$153.13
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,906.15
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$953.08
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$153.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$168.38

CLTX BIMALLEOLAR ANKLE FRACT W

Facility

$6,728.28

Service Code	HCPCS 27810
Hospital Charge Code	16000629
Hospital Revenue Code	360
Min. Negotiated Rate	$1,009.24
Max. Negotiated Rate	$1,009.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.24

CLTX BIMALLEOLAR ANKLE FRACT W

Facility

$6,728.28

Service Code	HCPCS 27810
Hospital Charge Code	16000629
Hospital Revenue Code	360
Min. Negotiated Rate	$162.15
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,018.48
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.24
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$162.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$178.30

CLTX BOMALLEOLAR ANKL FX WO M

Facility

$2,285.27

Service Code	HCPCS 27808
Hospital Charge Code	1600000542
Hospital Revenue Code	360
Min. Negotiated Rate	$342.79
Max. Negotiated Rate	$342.79
Rate for Payer: Qualcare PPO/HMO/WC	$342.79

CLTX BOMALLEOLAR ANKL FX WO M

Facility

$2,285.27

Service Code	HCPCS 27808
Hospital Charge Code	1600000542
Hospital Revenue Code	360
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$685.58
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$342.79
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$55.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02
Rate for Payer: Wellpoint Medicaid Managed Care	$708.84

CL TX CALCANEAL FX,W MANIP BL

Facility

$5,332.00

Service Code	HCPCS 28405
Hospital Charge Code	16000912
Hospital Revenue Code	360
Min. Negotiated Rate	$128.50
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,599.60
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$799.80
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$128.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$141.30

CL TX CALCANEAL FX,W MANIP BL

Facility

$5,332.00

Service Code	HCPCS 28405
Hospital Charge Code	16000912
Hospital Revenue Code	360
Min. Negotiated Rate	$799.80
Max. Negotiated Rate	$799.80
Rate for Payer: Qualcare PPO/HMO/WC	$799.80

CL TX CARPL SCAPHOID FX W MANI

Facility

$12,932.20

Service Code	HCPCS 25624
Hospital Charge Code	16000693
Hospital Revenue Code	360
Min. Negotiated Rate	$311.67
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,879.66
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.83
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$311.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$342.70

CL TX CARPL SCAPHOID FX W MANI

Facility

$12,932.20

Service Code	HCPCS 25624
Hospital Charge Code	16000693
Hospital Revenue Code	360
Min. Negotiated Rate	$1,939.83
Max. Negotiated Rate	$1,939.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.83

CL TX DSTL RADLNR DISLC W MANP

Facility

$2,060.30

Service Code	HCPCS 25675
Hospital Charge Code	16000696
Hospital Revenue Code	360
Min. Negotiated Rate	$309.05
Max. Negotiated Rate	$309.05
Rate for Payer: Qualcare PPO/HMO/WC	$309.05

CL TX DSTL RADLNR DISLC W MANP

Facility

$2,060.30

Service Code	HCPCS 25675
Hospital Charge Code	16000696
Hospital Revenue Code	360
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.09
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.05
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$49.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$54.60

CLTX DSTL RDL FX/EPIPHYSL SEP

Facility

$5,332.00

Service Code	HCPCS 25605
Hospital Charge Code	1600000561
Hospital Revenue Code	360
Min. Negotiated Rate	$799.80
Max. Negotiated Rate	$799.80
Rate for Payer: Qualcare PPO/HMO/WC	$799.80

CLTX DSTL RDL FX/EPIPHYSL SEP

Facility

$5,332.00

Service Code	HCPCS 25605
Hospital Charge Code	1600000561
Hospital Revenue Code	360
Min. Negotiated Rate	$128.50
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,599.60
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$799.80
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$128.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$141.30

CL TX FX GT PHALANX(S),W MANIP

Facility

$2,060.30

Service Code	HCPCS 28495
Hospital Charge Code	16000636
Hospital Revenue Code	360
Min. Negotiated Rate	$309.05
Max. Negotiated Rate	$309.05
Rate for Payer: Qualcare PPO/HMO/WC	$309.05

CL TX FX GT PHALANX(S),W MANIP

Facility

$2,060.30

Service Code	HCPCS 28495
Hospital Charge Code	16000636
Hospital Revenue Code	360
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.09
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.05
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$49.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$54.60

CL TX HUMERUS FX W MANIP

Facility

$2,060.30

Service Code	HCPCS 24505
Hospital Charge Code	16000824
Hospital Revenue Code	360
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.09
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.05
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$49.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$54.60

CL TX HUMERUS FX W MANIP

Facility

$2,060.30

Service Code	HCPCS 24505
Hospital Charge Code	16000824
Hospital Revenue Code	360
Min. Negotiated Rate	$309.05
Max. Negotiated Rate	$309.05
Rate for Payer: Qualcare PPO/HMO/WC	$309.05

CLTX MED ANKLE FX W/MNPJ

Facility

$10,964.50

Service Code	HCPCS 27762
Hospital Charge Code	1600000481
Hospital Revenue Code	360
Min. Negotiated Rate	$264.24
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,289.35
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.67
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$264.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$290.56

CLTX MED ANKLE FX W/MNPJ

Facility

$10,964.50

Service Code	HCPCS 27762
Hospital Charge Code	1600000481
Hospital Revenue Code	360
Min. Negotiated Rate	$1,644.67
Max. Negotiated Rate	$1,644.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.67

Know your out-of-pocket cost for care.

All Charges