Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EXC LEG/ANKLE LES SC 3 CM/> 50

Facility

$20,625.50

Service Code	HCPCS 27632
Hospital Charge Code	16000354
Hospital Revenue Code	360
Min. Negotiated Rate	$497.07
Max. Negotiated Rate	$12,456.64
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,456.64
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,187.65
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$497.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$546.58

EXC LEG/ANKLE TUM < 3 CM

Facility

$13,615.50

Service Code	HCPCS 27618
Hospital Charge Code	16000426
Hospital Revenue Code	360
Min. Negotiated Rate	$328.13
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,084.65
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$328.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$360.81

EXC LEG/ANKLE TUM < 3 CM

Facility

$13,615.50

Service Code	HCPCS 27618
Hospital Charge Code	16000426
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

EXC LEG/ANKLE TUM DEEP<5 CM RT

Facility

$13,615.50

Service Code	HCPCS 27619
Hospital Charge Code	16000624
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

EXC LEG/ANKLE TUM DEEP<5 CM RT

Facility

$13,615.50

Service Code	HCPCS 27619
Hospital Charge Code	16000624
Hospital Revenue Code	360
Min. Negotiated Rate	$328.13
Max. Negotiated Rate	$12,456.64
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
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	$12,456.64
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,084.65
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$328.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$360.81

EXC LEG/ANKLE TUM DEP 5 CM/>

Facility

$10,870.60

Service Code	HCPCS 27634
Hospital Charge Code	16000711
Hospital Revenue Code	360
Min. Negotiated Rate	$1,630.59
Max. Negotiated Rate	$1,630.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,630.59

EXC LEG/ANKLE TUM DEP 5 CM/>

Facility

$10,870.60

Service Code	HCPCS 27634
Hospital Charge Code	16000711
Hospital Revenue Code	360
Min. Negotiated Rate	$261.98
Max. Negotiated Rate	$12,456.64
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,456.64
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,261.18
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,630.59
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$261.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$288.07

EXC LESION MENISCUS/CAPSULE

Facility

$19,467.90

Service Code	HCPCS 27347
Hospital Charge Code	16000881
Hospital Revenue Code	360
Min. Negotiated Rate	$469.18
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	$1,626.00
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	$5,840.37
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$469.18
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	$515.90

EXC LESION MENISCUS/CAPSULE

Facility

$19,467.90

Service Code	HCPCS 27347
Hospital Charge Code	16000881
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

EXCLUDER CONTRA LEG 12X10

Facility

$19,325.00

Hospital Charge Code	270639871
Hospital Revenue Code	278
Min. Negotiated Rate	$465.73
Max. Negotiated Rate	$9,662.50
Rate for Payer: Aetna Commercial	$7,343.50
Rate for Payer: Aetna Medicare Advantage	$5,797.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,927.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,927.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,927.88
Rate for Payer: Cigna Commercial	$9,662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,676.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,251.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.75
Rate for Payer: UnitedHealthcare Community & State	$465.73
Rate for Payer: Wellpoint Medicaid Managed Care	$512.11

EXCLUDER CONTRA LEG 12X10

Facility

$19,325.00

Hospital Charge Code	270639871
Hospital Revenue Code	278
Min. Negotiated Rate	$2,898.75
Max. Negotiated Rate	$4,676.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,865.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,676.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,251.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.75

EXCLUDER CONTRA LEG 14X14

Facility

$19,900.00

Hospital Charge Code	270645825
Hospital Revenue Code	278
Min. Negotiated Rate	$479.59
Max. Negotiated Rate	$9,950.00
Rate for Payer: Aetna Commercial	$7,562.00
Rate for Payer: Aetna Medicare Advantage	$5,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,074.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,074.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,074.50
Rate for Payer: Cigna Commercial	$9,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,815.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,378.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,985.00
Rate for Payer: UnitedHealthcare Community & State	$479.59
Rate for Payer: Wellpoint Medicaid Managed Care	$527.35

EXCLUDER CONTRA LEG 14X14

Facility

$19,900.00

Hospital Charge Code	270645825
Hospital Revenue Code	278
Min. Negotiated Rate	$2,985.00
Max. Negotiated Rate	$4,815.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,815.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,378.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,985.00

EXCLUDER CONTRA LEG 18X14

Facility

$17,955.00

Hospital Charge Code	270639670
Hospital Revenue Code	278
Min. Negotiated Rate	$432.72
Max. Negotiated Rate	$8,977.50
Rate for Payer: Aetna Commercial	$6,822.90
Rate for Payer: Aetna Medicare Advantage	$5,386.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,578.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,578.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,591.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,578.52
Rate for Payer: Cigna Commercial	$8,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,345.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,950.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,693.25
Rate for Payer: UnitedHealthcare Community & State	$432.72
Rate for Payer: Wellpoint Medicaid Managed Care	$475.81

EXCLUDER CONTRA LEG 18X14

Facility

$17,955.00

Hospital Charge Code	270639670
Hospital Revenue Code	278
Min. Negotiated Rate	$2,693.25
Max. Negotiated Rate	$4,345.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,591.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,345.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,950.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,693.25

EXCLUDER CONTRA LEG 20X12

Facility

$18,850.00

Hospital Charge Code	270641853
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$4,561.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,147.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

EXCLUDER CONTRA LEG 20X12

Facility

$18,850.00

Hospital Charge Code	270641853
Hospital Revenue Code	278
Min. Negotiated Rate	$454.29
Max. Negotiated Rate	$9,425.00
Rate for Payer: Aetna Commercial	$7,163.00
Rate for Payer: Aetna Medicare Advantage	$5,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,806.75
Rate for Payer: Cigna Commercial	$9,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,147.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50
Rate for Payer: UnitedHealthcare Community & State	$454.29
Rate for Payer: Wellpoint Medicaid Managed Care	$499.52

EXCLUDER ENDOP 12x12 PXC121200

Facility

$19,325.00

Hospital Charge Code	270638294V
Hospital Revenue Code	278
Min. Negotiated Rate	$465.73
Max. Negotiated Rate	$9,662.50
Rate for Payer: Aetna Commercial	$7,343.50
Rate for Payer: Aetna Medicare Advantage	$5,797.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,927.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,927.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,927.88
Rate for Payer: Cigna Commercial	$9,662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,676.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,251.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.75
Rate for Payer: UnitedHealthcare Community & State	$465.73
Rate for Payer: Wellpoint Medicaid Managed Care	$512.11

EXCLUDER ENDOP 12x12 PXC121200

Facility

$19,325.00

Hospital Charge Code	270638294V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,898.75
Max. Negotiated Rate	$4,676.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,865.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,676.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,251.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.75

EXCLUDER MAIN BODY

Facility

$38,895.00

Hospital Charge Code	270640223
Hospital Revenue Code	278
Min. Negotiated Rate	$5,834.25
Max. Negotiated Rate	$9,412.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,779.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,412.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,556.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,834.25

EXCLUDER MAIN BODY

Facility

$38,895.00

Hospital Charge Code	270640223
Hospital Revenue Code	278
Min. Negotiated Rate	$937.37
Max. Negotiated Rate	$19,447.50
Rate for Payer: Aetna Commercial	$14,780.10
Rate for Payer: Aetna Medicare Advantage	$11,668.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,918.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,918.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,779.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,918.23
Rate for Payer: Cigna Commercial	$19,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,412.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,556.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,834.25
Rate for Payer: UnitedHealthcare Community & State	$937.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1,030.72

EXCLUDER MAIN BODY 26X14X18

Facility

$40,825.00

Hospital Charge Code	270641852
Hospital Revenue Code	278
Min. Negotiated Rate	$983.88
Max. Negotiated Rate	$20,412.50
Rate for Payer: Aetna Commercial	$15,513.50
Rate for Payer: Aetna Medicare Advantage	$12,247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,410.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,410.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,410.38
Rate for Payer: Cigna Commercial	$20,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,879.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,981.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,123.75
Rate for Payer: UnitedHealthcare Community & State	$983.88
Rate for Payer: Wellpoint Medicaid Managed Care	$1,081.86

EXCLUDER MAIN BODY 26X14X18

Facility

$40,825.00

Hospital Charge Code	270641852
Hospital Revenue Code	278
Min. Negotiated Rate	$6,123.75
Max. Negotiated Rate	$9,879.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,879.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,981.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,123.75

EXCLUDER MAIN BODY 28X12X18

Facility

$41,850.00

Hospital Charge Code	270644343
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.59
Max. Negotiated Rate	$20,925.00
Rate for Payer: Aetna Commercial	$15,903.00
Rate for Payer: Aetna Medicare Advantage	$12,555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,671.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,671.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,671.75
Rate for Payer: Cigna Commercial	$20,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,127.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,207.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,277.50
Rate for Payer: UnitedHealthcare Community & State	$1,008.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1,109.03

EXCLUDER MAIN BODY 28X12X18

Facility

$41,850.00

Hospital Charge Code	270644343
Hospital Revenue Code	278
Min. Negotiated Rate	$6,277.50
Max. Negotiated Rate	$10,127.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,127.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,207.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,277.50

Know your out-of-pocket cost for care.

All Charges