Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC

Facility

$94,266.96

Service Code	MSDRG 240
Min. Negotiated Rate	$28,703.08
Max. Negotiated Rate	$94,266.96
Rate for Payer: Aetna Commercial	$65,029.48
Rate for Payer: Aetna Medicare Advantage	$94,266.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65,363.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65,363.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30,213.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65,363.41
Rate for Payer: Cigna Commercial	$53,344.26
Rate for Payer: Cigna Medicare Advantage	$30,213.77
Rate for Payer: Clover Medicare Advantage	$28,703.08
Rate for Payer: EmblemHealth Commercial	$90,641.31
Rate for Payer: Humana Medicare Advantage	$31,120.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30,213.77
Rate for Payer: Oxford Commercial	$38,339.22
Rate for Payer: UnitedHealthcare Commercial	$67,229.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$30,213.77
Rate for Payer: Wellcare Medicare Advantage	$30,213.77

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC

Facility

$161,211.52

Service Code	MSDRG 239
Min. Negotiated Rate	$49,086.84
Max. Negotiated Rate	$161,211.52
Rate for Payer: Aetna Commercial	$111,028.02
Rate for Payer: Aetna Medicare Advantage	$161,211.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111,885.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111,885.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$51,670.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111,885.41
Rate for Payer: Cigna Commercial	$92,104.69
Rate for Payer: Cigna Medicare Advantage	$51,670.36
Rate for Payer: Clover Medicare Advantage	$49,086.84
Rate for Payer: EmblemHealth Commercial	$155,011.08
Rate for Payer: Humana Medicare Advantage	$53,220.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$51,670.36
Rate for Payer: Oxford Commercial	$66,196.87
Rate for Payer: UnitedHealthcare Commercial	$116,078.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$51,670.36
Rate for Payer: Wellcare Medicare Advantage	$51,670.36

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC

Facility

$46,880.15

Service Code	MSDRG 241
Min. Negotiated Rate	$14,274.41
Max. Negotiated Rate	$46,880.15
Rate for Payer: Aetna Commercial	$32,469.32
Rate for Payer: Aetna Medicare Advantage	$46,880.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32,332.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32,332.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,025.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32,332.79
Rate for Payer: Cigna Commercial	$25,907.66
Rate for Payer: Cigna Medicare Advantage	$15,025.69
Rate for Payer: Clover Medicare Advantage	$14,274.41
Rate for Payer: EmblemHealth Commercial	$45,077.07
Rate for Payer: Humana Medicare Advantage	$15,476.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,025.69
Rate for Payer: Oxford Commercial	$18,620.18
Rate for Payer: UnitedHealthcare Commercial	$32,651.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,025.69
Rate for Payer: Wellcare Medicare Advantage	$15,025.69

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$75,688.45

Service Code	MSDRG 475
Min. Negotiated Rate	$23,046.16
Max. Negotiated Rate	$75,688.45
Rate for Payer: Aetna Commercial	$52,263.92
Rate for Payer: Aetna Medicare Advantage	$75,688.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,778.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,778.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,259.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,778.54
Rate for Payer: Cigna Commercial	$42,587.45
Rate for Payer: Cigna Medicare Advantage	$24,259.12
Rate for Payer: Clover Medicare Advantage	$23,046.16
Rate for Payer: EmblemHealth Commercial	$72,777.36
Rate for Payer: Humana Medicare Advantage	$24,986.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,259.12
Rate for Payer: Oxford Commercial	$30,608.17
Rate for Payer: UnitedHealthcare Commercial	$53,672.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,259.12
Rate for Payer: Wellcare Medicare Advantage	$24,259.12

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$140,887.66

Service Code	MSDRG 474
Min. Negotiated Rate	$42,898.49
Max. Negotiated Rate	$140,887.66
Rate for Payer: Aetna Commercial	$97,063.22
Rate for Payer: Aetna Medicare Advantage	$140,887.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100,022.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100,022.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$45,156.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100,022.30
Rate for Payer: Cigna Commercial	$80,337.33
Rate for Payer: Cigna Medicare Advantage	$45,156.30
Rate for Payer: Clover Medicare Advantage	$42,898.49
Rate for Payer: EmblemHealth Commercial	$135,468.90
Rate for Payer: Humana Medicare Advantage	$46,510.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$45,156.30
Rate for Payer: Oxford Commercial	$57,739.50
Rate for Payer: UnitedHealthcare Commercial	$101,248.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$45,156.30
Rate for Payer: Wellcare Medicare Advantage	$45,156.30

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$40,280.14

Service Code	MSDRG 476
Min. Negotiated Rate	$12,264.78
Max. Negotiated Rate	$40,280.14
Rate for Payer: Aetna Commercial	$27,934.35
Rate for Payer: Aetna Medicare Advantage	$40,280.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,447.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,447.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,910.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,447.98
Rate for Payer: Cigna Commercial	$22,086.26
Rate for Payer: Cigna Medicare Advantage	$12,910.30
Rate for Payer: Clover Medicare Advantage	$12,264.78
Rate for Payer: EmblemHealth Commercial	$38,730.90
Rate for Payer: Humana Medicare Advantage	$13,297.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,910.30
Rate for Payer: Oxford Commercial	$15,873.69
Rate for Payer: UnitedHealthcare Commercial	$27,835.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,910.30
Rate for Payer: Wellcare Medicare Advantage	$12,910.30

AMPUTATION MC W FING/THUMB

Facility

$26,471.80

Service Code	HCPCS 26910
Hospital Charge Code	16000861
Hospital Revenue Code	360
Min. Negotiated Rate	$637.97
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	$1,355.00
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	$7,941.54
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$637.97
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	$701.50

AMPUTATION MC W FING/THUMB

Facility

$26,471.80

Service Code	HCPCS 26910
Hospital Charge Code	16000861
Hospital Revenue Code	360
Min. Negotiated Rate	$3,970.77
Max. Negotiated Rate	$3,970.77
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77

AMPUTATION MID FOOT

Facility

$15,871.38

Service Code	HCPCS 28800
Hospital Charge Code	1600000456
Hospital Revenue Code	360
Min. Negotiated Rate	$2,380.71
Max. Negotiated Rate	$2,380.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,380.71

AMPUTATION MID FOOT

Facility

$15,871.38

Service Code	HCPCS 28800
Hospital Charge Code	1600000456
Hospital Revenue Code	360
Min. Negotiated Rate	$382.50
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	$4,761.41
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,380.71
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$382.50
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	$420.59

AMPUTATION OF FINGER/THUMB

Facility

$17,164.20

Service Code	HCPCS 26952
Hospital Charge Code	1600000869
Hospital Revenue Code	360
Min. Negotiated Rate	$2,574.63
Max. Negotiated Rate	$2,574.63
Rate for Payer: Qualcare PPO/HMO/WC	$2,574.63

AMPUTATION OF FINGER/THUMB

Facility

$17,164.20

Service Code	HCPCS 26952
Hospital Charge Code	1600000869
Hospital Revenue Code	360
Min. Negotiated Rate	$413.66
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	$5,149.26
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,574.63
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$413.66
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	$454.85

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$25,922.32

Service Code	APR-DRG 3053
Min. Negotiated Rate	$25,414.04
Max. Negotiated Rate	$25,922.32
Rate for Payer: UnitedHealthcare Community & State	$25,414.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,922.32
Rate for Payer: Wellpoint Medicaid Managed Care	$25,414.04

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$17,300.70

Service Code	APR-DRG 3052
Min. Negotiated Rate	$16,961.47
Max. Negotiated Rate	$17,300.70
Rate for Payer: UnitedHealthcare Community & State	$16,961.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,300.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16,961.47

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$13,000.71

Service Code	APR-DRG 3051
Min. Negotiated Rate	$12,745.79
Max. Negotiated Rate	$13,000.71
Rate for Payer: UnitedHealthcare Community & State	$12,745.79
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,000.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12,745.79

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$46,440.33

Service Code	APR-DRG 3054
Min. Negotiated Rate	$45,529.74
Max. Negotiated Rate	$46,440.33
Rate for Payer: UnitedHealthcare Community & State	$45,529.74
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$46,440.33
Rate for Payer: Wellpoint Medicaid Managed Care	$45,529.74

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$62,585.27

Service Code	MSDRG 617
Min. Negotiated Rate	$19,056.41
Max. Negotiated Rate	$62,585.27
Rate for Payer: Aetna Commercial	$43,260.54
Rate for Payer: Aetna Medicare Advantage	$62,585.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,056.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,056.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,059.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,056.78
Rate for Payer: Cigna Commercial	$35,000.79
Rate for Payer: Cigna Medicare Advantage	$20,059.38
Rate for Payer: Clover Medicare Advantage	$19,056.41
Rate for Payer: EmblemHealth Commercial	$60,178.14
Rate for Payer: Humana Medicare Advantage	$20,661.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,059.38
Rate for Payer: Oxford Commercial	$25,155.53
Rate for Payer: UnitedHealthcare Commercial	$44,111.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,059.38
Rate for Payer: Wellcare Medicare Advantage	$20,059.38

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$114,852.60

Service Code	MSDRG 616
Min. Negotiated Rate	$34,971.14
Max. Negotiated Rate	$114,852.60
Rate for Payer: Aetna Commercial	$79,174.14
Rate for Payer: Aetna Medicare Advantage	$114,852.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92,113.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92,113.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36,811.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92,113.56
Rate for Payer: Cigna Commercial	$65,263.20
Rate for Payer: Cigna Medicare Advantage	$36,811.73
Rate for Payer: Clover Medicare Advantage	$34,971.14
Rate for Payer: EmblemHealth Commercial	$110,435.19
Rate for Payer: Humana Medicare Advantage	$37,916.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$36,811.73
Rate for Payer: Oxford Commercial	$46,905.53
Rate for Payer: UnitedHealthcare Commercial	$82,250.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$36,811.73
Rate for Payer: Wellcare Medicare Advantage	$36,811.73

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$47,975.90

Service Code	MSDRG 618
Min. Negotiated Rate	$14,608.05
Max. Negotiated Rate	$47,975.90
Rate for Payer: Aetna Commercial	$33,222.24
Rate for Payer: Aetna Medicare Advantage	$47,975.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,982.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,982.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,376.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,982.76
Rate for Payer: Cigna Commercial	$26,542.07
Rate for Payer: Cigna Medicare Advantage	$15,376.89
Rate for Payer: Clover Medicare Advantage	$14,608.05
Rate for Payer: EmblemHealth Commercial	$46,130.67
Rate for Payer: Humana Medicare Advantage	$15,838.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,376.89
Rate for Payer: Oxford Commercial	$19,076.13
Rate for Payer: UnitedHealthcare Commercial	$33,450.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,376.89
Rate for Payer: Wellcare Medicare Advantage	$15,376.89

AMPUTATION OF THE LOWER LEG

Facility

$12,406.91

Service Code	HCPCS 27882
Hospital Charge Code	160000210
Hospital Revenue Code	360
Min. Negotiated Rate	$299.01
Max. Negotiated Rate	$14,834.00
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	$3,722.07
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,861.04
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$299.01
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	$328.78

AMPUTATION OF THE LOWER LEG

Facility

$12,406.91

Service Code	HCPCS 27882
Hospital Charge Code	160000210
Hospital Revenue Code	360
Min. Negotiated Rate	$1,861.04
Max. Negotiated Rate	$1,861.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,861.04

AMPUTATION,TOE & METATARSAL

Facility

$19,998.60

Service Code	HCPCS 28810
Hospital Charge Code	16000352
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

AMPUTATION,TOE & METATARSAL

Facility

$19,998.60

Service Code	HCPCS 28810
Hospital Charge Code	16000352
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
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	$1,016.00
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	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
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	$529.96

AMRINONE INJ 100MG/20ML

Facility

$523.55

Hospital Charge Code	60627546
Hospital Revenue Code	250
Min. Negotiated Rate	$78.53
Max. Negotiated Rate	$78.53
Rate for Payer: Qualcare PPO/HMO/WC	$78.53

AMRINONE INJ 100MG/20ML

Facility

$523.55

Hospital Charge Code	60627546
Hospital Revenue Code	250
Min. Negotiated Rate	$12.62
Max. Negotiated Rate	$261.77
Rate for Payer: Aetna Commercial	$198.95
Rate for Payer: Aetna Medicare Advantage	$157.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.51
Rate for Payer: Cigna Commercial	$261.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.06
Rate for Payer: Oxford Commercial	$104.71
Rate for Payer: Qualcare PPO/HMO/WC	$78.53
Rate for Payer: UnitedHealthcare Commercial	$104.71
Rate for Payer: UnitedHealthcare Community & State	$12.62
Rate for Payer: Wellpoint Medicaid Managed Care	$13.87

Know your out-of-pocket cost for care.

All Charges