Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CL TX METATARSAL FX; W MANIP

Facility

$2,519.70

Service Code	HCPCS 28475
Hospital Charge Code	16000429
Hospital Revenue Code	360
Min. Negotiated Rate	$377.95
Max. Negotiated Rate	$377.95
Rate for Payer: Qualcare PPO/HMO/WC	$377.95

CL TX METATARSAL FX; W MANIP

Facility

$2,519.70

Service Code	HCPCS 28475
Hospital Charge Code	16000429
Hospital Revenue Code	360
Min. Negotiated Rate	$60.72
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	$755.91
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$377.95
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$60.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$66.77

CL TX NASAL SEPTAL FX

Facility

$14,464.70

Service Code	HCPCS 21337
Hospital Charge Code	16000604
Hospital Revenue Code	360
Min. Negotiated Rate	$2,169.70
Max. Negotiated Rate	$2,169.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,169.70

CL TX NASAL SEPTAL FX

Facility

$14,464.70

Service Code	HCPCS 21337
Hospital Charge Code	16000604
Hospital Revenue Code	360
Min. Negotiated Rate	$348.60
Max. Negotiated Rate	$14,218.07
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
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	$14,218.07
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,339.41
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,169.70
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$348.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$383.31

CL TX NAVICULAR FX W/MANIP

Facility

$6,087.10

Service Code	HCPCS 25624
Hospital Charge Code	5780060
Hospital Revenue Code	450
Min. Negotiated Rate	$913.07
Max. Negotiated Rate	$913.07
Rate for Payer: Qualcare PPO/HMO/WC	$913.07

CL TX NAVICULAR FX W/MANIP

Facility

$6,087.10

Service Code	HCPCS 25624
Hospital Charge Code	5780060
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
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	$231.74
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	$1,826.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$913.07
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$161.31

CL TX OF NASAL BNE FX,W STILZ

Facility

$19,264.86

Service Code	HCPCS 21320
Hospital Charge Code	1600000710
Hospital Revenue Code	360
Min. Negotiated Rate	$2,889.73
Max. Negotiated Rate	$2,889.73
Rate for Payer: Qualcare PPO/HMO/WC	$2,889.73

CL TX OF NASAL BNE FX,W STILZ

Facility

$19,264.86

Service Code	HCPCS 21320
Hospital Charge Code	1600000710
Hospital Revenue Code	360
Min. Negotiated Rate	$464.28
Max. Negotiated Rate	$14,218.07
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
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	$14,218.07
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,779.46
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,889.73
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$464.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$510.52

CL TX OF NSL BNE FX,WO STABILZ

Facility

$15,651.38

Service Code	HCPCS 21315
Hospital Charge Code	16000672
Hospital Revenue Code	360
Min. Negotiated Rate	$2,347.71
Max. Negotiated Rate	$2,347.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,347.71

CL TX OF NSL BNE FX,WO STABILZ

Facility

$15,651.38

Service Code	HCPCS 21315
Hospital Charge Code	16000672
Hospital Revenue Code	360
Min. Negotiated Rate	$377.20
Max. Negotiated Rate	$6,653.83
Rate for Payer: Aetna Commercial	$5,013.83
Rate for Payer: Aetna Medicare Advantage	$5,972.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,653.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,653.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,843.32
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	$6,653.83
Rate for Payer: Cigna Commercial	$3,694.94
Rate for Payer: Cigna Medicare Advantage	$1,843.32
Rate for Payer: Clover Medicare Advantage	$1,751.15
Rate for Payer: EmblemHealth Commercial	$5,529.96
Rate for Payer: Humana Medicare Advantage	$1,898.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,843.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,695.41
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,347.71
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$377.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,843.32
Rate for Payer: Wellcare Medicare Advantage	$1,843.32
Rate for Payer: Wellpoint Medicaid Managed Care	$414.76

CL TX OLECRN-COROND PROC FX W/

Facility

$6,749.20

Service Code	HCPCS 24675
Hospital Charge Code	5780055
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
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	$370.67
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	$2,024.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.38
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$178.85

CL TX OLECRN-COROND PROC FX W/

Facility

$6,749.20

Service Code	HCPCS 24675
Hospital Charge Code	5780055
Hospital Revenue Code	450
Min. Negotiated Rate	$1,012.38
Max. Negotiated Rate	$1,012.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.38

CLTXPOSTHIPARTHROPDISLREQANES

Facility

$8,757.05

Service Code	HCPCS 27266
Hospital Charge Code	323027266
Hospital Revenue Code	450
Min. Negotiated Rate	$1,313.56
Max. Negotiated Rate	$1,313.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,313.56

CLTXPOSTHIPARTHROPDISLREQANES

Facility

$8,757.05

Service Code	HCPCS 27266
Hospital Charge Code	323027266
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
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	$485.72
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	$2,627.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,313.56
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$232.06

CL TX POSTOP HIP DISLC W ANSTH

Facility

$13,711.90

Service Code	HCPCS 27266
Hospital Charge Code	16000707
Hospital Revenue Code	360
Min. Negotiated Rate	$330.46
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	$4,113.57
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,056.78
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$330.46
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	$363.37

CL TX POSTOP HIP DISLC W ANSTH

Facility

$13,711.90

Service Code	HCPCS 27266
Hospital Charge Code	16000707
Hospital Revenue Code	360
Min. Negotiated Rate	$2,056.78
Max. Negotiated Rate	$2,056.78
Rate for Payer: Qualcare PPO/HMO/WC	$2,056.78

CL TX PROX FIB/SHAFT FX WMANIP

Facility

$5,332.00

Service Code	HCPCS 27781
Hospital Charge Code	16000627
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	$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	$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 PROX FIB/SHAFT FX WMANIP

Facility

$5,332.00

Service Code	HCPCS 27781
Hospital Charge Code	16000627
Hospital Revenue Code	360
Min. Negotiated Rate	$799.80
Max. Negotiated Rate	$799.80
Rate for Payer: Qualcare PPO/HMO/WC	$799.80

CLTXPROXTIBFIB JTDISLC WO ANES

Facility

$1,241.80

Service Code	HCPCS 27830
Hospital Charge Code	323027830
Hospital Revenue Code	450
Min. Negotiated Rate	$186.27
Max. Negotiated Rate	$186.27
Rate for Payer: Qualcare PPO/HMO/WC	$186.27

CLTXPROXTIBFIB JTDISLC WO ANES

Facility

$1,241.80

Service Code	HCPCS 27830
Hospital Charge Code	323027830
Hospital Revenue Code	450
Min. Negotiated Rate	$32.91
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	$210.83
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	$372.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.27
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	$32.91

CL TX PROX TIBIAL FX W SK TRCN

Facility

$14,872.30

Service Code	HCPCS 27532
Hospital Charge Code	16000887
Hospital Revenue Code	360
Min. Negotiated Rate	$358.42
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,461.69
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,230.84
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$358.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$394.12

CL TX PROX TIBIAL FX W SK TRCN

Facility

$14,872.30

Service Code	HCPCS 27532
Hospital Charge Code	16000887
Hospital Revenue Code	360
Min. Negotiated Rate	$2,230.84
Max. Negotiated Rate	$2,230.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,230.84

CL TX RADIAL HD/NK FX: W MANIP

Facility

$2,063.00

Service Code	HCPCS 24655
Hospital Charge Code	16000684
Hospital Revenue Code	360
Min. Negotiated Rate	$49.72
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	$618.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.45
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$49.72
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	$54.67

CL TX RADIAL HD/NK FX: W MANIP

Facility

$2,063.00

Service Code	HCPCS 24655
Hospital Charge Code	16000684
Hospital Revenue Code	360
Min. Negotiated Rate	$309.45
Max. Negotiated Rate	$309.45
Rate for Payer: Qualcare PPO/HMO/WC	$309.45

CLTX RADL&ULNA FX W MANIP

Facility

$2,244.48

Service Code	HCPCS 25565
Hospital Charge Code	1600000647
Hospital Revenue Code	360
Min. Negotiated Rate	$54.09
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	$673.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$336.67
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$54.09
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	$59.48

Know your out-of-pocket cost for care.

All Charges