Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEURON SPECIFIC ENOLASE II

Facility

$143.05

Service Code	HCPCS 86316
Hospital Charge Code	39990012B
Hospital Revenue Code	306
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

NEURON SPECIFIC ENOLASE II

Facility

$143.05

Service Code	HCPCS 86316
Hospital Charge Code	39990012B
Hospital Revenue Code	306
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

NEURON SPECIFIC ENOLASE (RIA)

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3031457
Hospital Revenue Code	301
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$87.78

NEURON SPECIFIC ENOLASE (RIA)

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3031457
Hospital Revenue Code	301
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$292.58
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$292.58
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.78
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$15.51

NEURONTIN/300MG

Facility

$3.00

Hospital Charge Code	60634964
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

NEURONTIN/300MG

Facility

$3.00

Hospital Charge Code	60634964
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

NEURONTIN,800MG,TAB

Facility

$18.43

Service Code	NDC 68084080211
Hospital Charge Code	60635448
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$2.76
Rate for Payer: Qualcare PPO/HMO/WC	$2.76

NEURONTIN,800MG,TAB

Facility

$18.43

Service Code	NDC 68084080211
Hospital Charge Code	60635448
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.21
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: Aetna Medicare Advantage	$5.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.53
Rate for Payer: Oxford Commercial	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.76
Rate for Payer: UnitedHealthcare Commercial	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

NEUROPLASTY,ULNAR NERVE AT ELB

Facility

$16,437.00

Service Code	HCPCS 64718
Hospital Charge Code	16000527
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEUROPLASTY,ULNAR NERVE AT ELB

Facility

$16,437.00

Service Code	HCPCS 64718
Hospital Charge Code	16000527
Hospital Revenue Code	360
Min. Negotiated Rate	$396.13
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,931.10
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$396.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$435.58

NEUROPLASTY,ULNAR NERVE AT WST

Facility

$17,836.55

Service Code	HCPCS 64719
Hospital Charge Code	16000772
Hospital Revenue Code	360
Min. Negotiated Rate	$429.86
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,350.97
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,675.48
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$429.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$472.67

NEUROPLASTY,ULNAR NERVE AT WST

Facility

$17,836.55

Service Code	HCPCS 64719
Hospital Charge Code	16000772
Hospital Revenue Code	360
Min. Negotiated Rate	$2,675.48
Max. Negotiated Rate	$2,675.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,675.48

NEUROPLST,NERVE OF HND OR FOOT

Facility

$16,437.00

Service Code	HCPCS 64704
Hospital Charge Code	16000771
Hospital Revenue Code	360
Min. Negotiated Rate	$396.13
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,931.10
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$396.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$435.58

NEUROPLST,NERVE OF HND OR FOOT

Facility

$16,437.00

Service Code	HCPCS 64704
Hospital Charge Code	16000771
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEUROPLSTY MA PEPH NRV A/L,NOS

Facility

$16,437.00

Service Code	HCPCS 64708
Hospital Charge Code	16000490
Hospital Revenue Code	360
Min. Negotiated Rate	$396.13
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,931.10
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$396.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$435.58

NEUROPLSTY MA PEPH NRV A/L,NOS

Facility

$16,437.00

Service Code	HCPCS 64708
Hospital Charge Code	16000490
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEURORRAPHY W/VEIN AUTOGRAFT

Facility

$37,709.10

Service Code	HCPCS 64911
Hospital Charge Code	1600000061
Hospital Revenue Code	360
Min. Negotiated Rate	$5,656.36
Max. Negotiated Rate	$5,656.36
Rate for Payer: Qualcare PPO/HMO/WC	$5,656.36

NEURORRAPHY W/VEIN AUTOGRAFT

Facility

$37,709.10

Service Code	HCPCS 64911
Hospital Charge Code	1600000061
Hospital Revenue Code	360
Min. Negotiated Rate	$908.79
Max. Negotiated Rate	$37,634.52
Rate for Payer: Aetna Commercial	$28,358.56
Rate for Payer: Aetna Medicare Advantage	$33,780.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,634.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,634.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,425.94
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	$37,634.52
Rate for Payer: Cigna Commercial	$20,898.76
Rate for Payer: Cigna Medicare Advantage	$10,425.94
Rate for Payer: Clover Medicare Advantage	$9,904.64
Rate for Payer: EmblemHealth Commercial	$31,277.82
Rate for Payer: Humana Medicare Advantage	$10,738.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,425.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,312.73
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,656.36
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$908.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,425.94
Rate for Payer: Wellcare Medicare Advantage	$10,425.94
Rate for Payer: Wellpoint Medicaid Managed Care	$999.29

NEUROSES EXCEPT DEPRESSIVE

Facility

$36,841.08

Service Code	MSDRG 882
Min. Negotiated Rate	$3,330.00
Max. Negotiated Rate	$36,841.08
Rate for Payer: Aetna Commercial	$25,571.35
Rate for Payer: Aetna Medicare Advantage	$36,841.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,865.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,865.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,808.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,865.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,606.00
Rate for Payer: Cigna Commercial	$20,095.09
Rate for Payer: Cigna Medicare Advantage	$11,808.04
Rate for Payer: Clover Medicare Advantage	$11,217.64
Rate for Payer: EmblemHealth Commercial	$35,424.12
Rate for Payer: Humana Medicare Advantage	$12,162.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,808.04
Rate for Payer: Oxford Commercial	$14,442.61
Rate for Payer: UnitedHealthcare Commercial	$25,325.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,808.04
Rate for Payer: Wellcare Medicare Advantage	$11,808.04

NEUROSHIELD MEMBRANE 40X30

Facility

$8,000.00

Service Code	HCPCS C9353
Hospital Charge Code	270699482
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

NEUROSHIELD MEMBRANE 40X30

Facility

$8,000.00

Service Code	HCPCS C9353
Hospital Charge Code	270699482
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

NEURO STIMULATOR F15

Facility

$60,750.00

Service Code	HCPCS C1778
Hospital Charge Code	270703589
Hospital Revenue Code	278
Min. Negotiated Rate	$1,464.08
Max. Negotiated Rate	$30,375.00
Rate for Payer: Aetna Commercial	$23,085.00
Rate for Payer: Aetna Medicare Advantage	$18,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,491.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,491.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,491.25
Rate for Payer: Cigna Commercial	$30,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,701.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,112.50
Rate for Payer: UnitedHealthcare Community & State	$1,464.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,609.88

NEURO STIMULATOR F15

Facility

$60,750.00

Service Code	HCPCS C1778
Hospital Charge Code	270703589
Hospital Revenue Code	278
Min. Negotiated Rate	$9,112.50
Max. Negotiated Rate	$14,701.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,701.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,112.50

NEUROSTIMULATOR FREEDOM 8A

Facility

$112,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270679255
Hospital Revenue Code	278
Min. Negotiated Rate	$16,875.00
Max. Negotiated Rate	$27,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00

NEUROSTIMULATOR FREEDOM 8A

Facility

$112,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270679255
Hospital Revenue Code	278
Min. Negotiated Rate	$2,711.25
Max. Negotiated Rate	$56,250.00
Rate for Payer: Aetna Commercial	$42,750.00
Rate for Payer: Aetna Medicare Advantage	$33,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,687.50
Rate for Payer: Cigna Commercial	$56,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00
Rate for Payer: UnitedHealthcare Community & State	$2,711.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2,981.25

Know your out-of-pocket cost for care.

All Charges