Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

MOD SED SAME MD >5YO 1ST 15MIN

Facility

IP

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	7412070
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

IP

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	5792286
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

OP

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	7412070
Hospital Revenue Code	370
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

MOD SED SAME MD >5YO 1ST 15MIN

Facility

IP

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	5100849
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

IP

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	366899152
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

OP

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	321099152
Hospital Revenue Code	370
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

MOD SED SAME MD >5YO 1ST 15MIN

Facility

OP

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	2692141
Hospital Revenue Code	370
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

MOD SED SAME MD EA ADD 15MIN

Facility

OP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	2692142
Hospital Revenue Code	370
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$24.85
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$32.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.62
Rate for Payer: Oxford Commercial	$13.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$13.08
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

MOD SED SAME MD EA ADD 15MIN

Facility

IP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	2692142
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

OP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	321099153
Hospital Revenue Code	370
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$24.85
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$32.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.62
Rate for Payer: Oxford Commercial	$13.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$13.08
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

MOD SED SAME MD EA ADD 15MIN

Facility

IP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	7412071
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

OP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	366899153
Hospital Revenue Code	370
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$24.85
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$32.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.62
Rate for Payer: Oxford Commercial	$13.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$13.08
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

MOD SED SAME MD EA ADD 15MIN

Facility

OP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	2500266
Hospital Revenue Code	370
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$24.85
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$32.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.62
Rate for Payer: Oxford Commercial	$13.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$13.08
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

MOD SED SAME MD EA ADD 15MIN

Facility

IP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	5100850
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

OP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	7412071
Hospital Revenue Code	370
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$24.85
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$32.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.62
Rate for Payer: Oxford Commercial	$13.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$13.08
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

MOD SED SAME MD EA ADD 15MIN

Facility

OP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	5792287
Hospital Revenue Code	370
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$24.85
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$32.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.62
Rate for Payer: Oxford Commercial	$13.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$13.08
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

MOD SED SAME MD EA ADD 15MIN

Facility

IP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	2500266
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

IP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	321099153
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

IP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	5792287
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

IP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	366899153
Hospital Revenue Code	370
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$9.81

MOD SED SAME MD EA ADD 15MIN

Facility

OP

$65.40

Service Code	HCPCS 99153
Hospital Charge Code	5100850
Hospital Revenue Code	370
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.70
Rate for Payer: Aetna Commercial	$24.85
Rate for Payer: Aetna Medicare Advantage	$19.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.68
Rate for Payer: Cigna Commercial	$32.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.62
Rate for Payer: Oxford Commercial	$13.08
Rate for Payer: Qualcare PPO/HMO/WC	$9.81
Rate for Payer: UnitedHealthcare Commercial	$13.08
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

MODULAR BROACHED BODY SZ 5

Facility

OP

$36,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270675959
Hospital Revenue Code	278
Min. Negotiated Rate	$870.01
Max. Negotiated Rate	$18,050.00
Rate for Payer: Aetna Commercial	$13,718.00
Rate for Payer: Aetna Medicare Advantage	$10,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,205.50
Rate for Payer: Cigna Commercial	$18,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,736.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,942.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,415.00
Rate for Payer: UnitedHealthcare Community & State	$870.01
Rate for Payer: Wellpoint Medicaid Managed Care	$956.65

MODULAR BROACHED BODY SZ 5

Facility

IP

$36,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270675959
Hospital Revenue Code	278
Min. Negotiated Rate	$5,415.00
Max. Negotiated Rate	$8,736.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,736.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,942.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,415.00

MODULAR CUP 10 DEG LINER 62

Facility

IP

$6,220.00

Hospital Charge Code	270666713
Hospital Revenue Code	278
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$1,505.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.40
Rate for Payer: Qualcare PPO/HMO/WC	$933.00

MODULAR CUP 10 DEG LINER 62

Facility

OP

$6,220.00

Hospital Charge Code	270666713
Hospital Revenue Code	278
Min. Negotiated Rate	$149.90
Max. Negotiated Rate	$3,110.00
Rate for Payer: Aetna Commercial	$2,363.60
Rate for Payer: Aetna Medicare Advantage	$1,866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.10
Rate for Payer: Cigna Commercial	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.40
Rate for Payer: Qualcare PPO/HMO/WC	$933.00
Rate for Payer: UnitedHealthcare Community & State	$149.90
Rate for Payer: Wellpoint Medicaid Managed Care	$164.83