Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NJX B1 SUB MTRL SBCHDRL DFCT

Facility

$14,284.88

Service Code	HCPCS 0707T
Hospital Charge Code	1600000696
Hospital Revenue Code	360
Min. Negotiated Rate	$2,142.73
Max. Negotiated Rate	$2,142.73
Rate for Payer: Qualcare PPO/HMO/WC	$2,142.73

NJX INTERLAMINAR CRV/THRC

Facility

$3,865.20

Service Code	HCPCS 62321
Hospital Charge Code	321562321
Hospital Revenue Code	361
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,159.56
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$579.78
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$93.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$102.43

NJX INTERLAMINAR CRV/THRC

Facility

$3,865.20

Service Code	HCPCS 62321
Hospital Charge Code	321562321
Hospital Revenue Code	361
Min. Negotiated Rate	$579.78
Max. Negotiated Rate	$579.78
Rate for Payer: Qualcare PPO/HMO/WC	$579.78

NJX INTERLAMINAR CRV/THRC

Facility

$5,965.40

Service Code	HCPCS 62321
Hospital Charge Code	16001017
Hospital Revenue Code	360
Min. Negotiated Rate	$894.81
Max. Negotiated Rate	$894.81
Rate for Payer: Qualcare PPO/HMO/WC	$894.81

NJX INTERLAMINAR CRV/THRC

Facility

$5,965.40

Service Code	HCPCS 62321
Hospital Charge Code	16001017
Hospital Revenue Code	360
Min. Negotiated Rate	$143.77
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,789.62
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$894.81
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$143.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$158.08

NJX INTERLAMINAR LMBR/SAC

Facility

$3,865.20

Service Code	HCPCS 62323
Hospital Charge Code	321562323
Hospital Revenue Code	361
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$42,635.69
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,159.56
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$579.78
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$93.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$42,635.69
Rate for Payer: Wellpoint Medicaid Managed Care	$41,799.70

NJX INTERLAMINAR LMBR/SAC

Facility

$5,965.40

Service Code	HCPCS 62323
Hospital Charge Code	16000356
Hospital Revenue Code	360
Min. Negotiated Rate	$894.81
Max. Negotiated Rate	$894.81
Rate for Payer: Qualcare PPO/HMO/WC	$894.81

NJX INTERLAMINAR LMBR/SAC

Facility

$5,965.40

Service Code	HCPCS 62322
Hospital Charge Code	16000433
Hospital Revenue Code	360
Min. Negotiated Rate	$894.81
Max. Negotiated Rate	$894.81
Rate for Payer: Qualcare PPO/HMO/WC	$894.81

NJX INTERLAMINAR LMBR/SAC

Facility

$3,865.20

Service Code	HCPCS 62323
Hospital Charge Code	321562323
Hospital Revenue Code	361
Min. Negotiated Rate	$579.78
Max. Negotiated Rate	$579.78
Rate for Payer: Qualcare PPO/HMO/WC	$579.78

NJX INTERLAMINAR LMBR/SAC

Facility

$5,965.40

Service Code	HCPCS 62323
Hospital Charge Code	16000356
Hospital Revenue Code	360
Min. Negotiated Rate	$143.77
Max. Negotiated Rate	$42,635.69
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,789.62
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$894.81
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$143.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$42,635.69
Rate for Payer: Wellpoint Medicaid Managed Care	$41,799.70

NJX INTERLAMINAR LMBR/SAC

Facility

$5,965.40

Service Code	HCPCS 62322
Hospital Charge Code	16000433
Hospital Revenue Code	360
Min. Negotiated Rate	$143.77
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
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	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,789.62
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$894.81
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$143.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,835.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,799.10

NJX NONCMPND SCLRSNT 1 VEIN

Facility

$10,544.70

Service Code	HCPCS 36465
Hospital Charge Code	421036465
Hospital Revenue Code	761
Min. Negotiated Rate	$254.13
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,620.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,163.41
Rate for Payer: Oxford Commercial	$2,108.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.70
Rate for Payer: UnitedHealthcare Commercial	$2,108.94
Rate for Payer: UnitedHealthcare Community & State	$254.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$279.43

NJX NONCMPND SCLRSNT 1 VEIN

Facility

$10,544.70

Service Code	HCPCS 36465
Hospital Charge Code	421036465
Hospital Revenue Code	761
Min. Negotiated Rate	$1,581.70
Max. Negotiated Rate	$1,581.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.70

NJX NONCMPND SCLRSNT MLT VN

Facility

$6,273.72

Service Code	HCPCS 36446
Hospital Charge Code	1600000792
Hospital Revenue Code	360
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$3,136.86
Rate for Payer: Aetna Commercial	$2,384.01
Rate for Payer: Aetna Medicare Advantage	$1,882.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,599.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,599.80
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	$1,599.80
Rate for Payer: Cigna Commercial	$3,136.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.12
Rate for Payer: Qualcare PPO/HMO/WC	$941.06
Rate for Payer: UnitedHealthcare Community & State	$151.20
Rate for Payer: Wellpoint Medicaid Managed Care	$166.25

NJX NONCMPND SCLRSNT MLT VN

Facility

$6,273.72

Service Code	HCPCS 36446
Hospital Charge Code	1600000792
Hospital Revenue Code	360
Min. Negotiated Rate	$941.06
Max. Negotiated Rate	$941.06
Rate for Payer: Qualcare PPO/HMO/WC	$941.06

NJX NONCMPND SCLRSNT MLT VN

Facility

$10,544.70

Service Code	HCPCS 36466
Hospital Charge Code	1600000828
Hospital Revenue Code	360
Min. Negotiated Rate	$254.13
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,163.41
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.70
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$254.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$279.43

NJX NONCMPND SCLRSNT MLT VN

Facility

$10,544.70

Service Code	HCPCS 36466
Hospital Charge Code	1600000828
Hospital Revenue Code	360
Min. Negotiated Rate	$1,581.70
Max. Negotiated Rate	$1,581.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.70

NJX NONCMPND SCLRSNT MLT VN

Facility

$10,544.70

Service Code	HCPCS 36466
Hospital Charge Code	421036466
Hospital Revenue Code	761
Min. Negotiated Rate	$1,581.70
Max. Negotiated Rate	$1,581.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.70

NJX NONCMPND SCLRSNT MLT VN

Facility

$10,544.70

Service Code	HCPCS 36466
Hospital Charge Code	421036466
Hospital Revenue Code	761
Min. Negotiated Rate	$254.13
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,692.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,163.41
Rate for Payer: Oxford Commercial	$2,108.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.70
Rate for Payer: UnitedHealthcare Commercial	$2,108.94
Rate for Payer: UnitedHealthcare Community & State	$254.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$279.43

NJX PLATELET PLASMA

Facility

$9,053.98

Service Code	HCPCS 0232T
Hospital Charge Code	1600000280
Hospital Revenue Code	360
Min. Negotiated Rate	$1,358.10
Max. Negotiated Rate	$1,358.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.10

NJX PLATELET PLASMA

Facility

$9,053.98

Service Code	HCPCS 0232T
Hospital Charge Code	1600000280
Hospital Revenue Code	360
Min. Negotiated Rate	$218.20
Max. Negotiated Rate	$2,716.19
Rate for Payer: Aetna Commercial	$1,443.56
Rate for Payer: Aetna Medicare Advantage	$1,719.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,915.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,915.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$530.72
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	$1,915.74
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: Cigna Medicare Advantage	$530.72
Rate for Payer: Clover Medicare Advantage	$504.18
Rate for Payer: EmblemHealth Commercial	$1,592.16
Rate for Payer: Humana Medicare Advantage	$546.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$530.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,716.19
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$218.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$530.72
Rate for Payer: Wellcare Medicare Advantage	$530.72
Rate for Payer: Wellpoint Medicaid Managed Care	$935.08

NJX SCLRSNT SPIDER VEINS

Facility

$2,127.90

Service Code	HCPCS 36468
Hospital Charge Code	421036468
Hospital Revenue Code	761
Min. Negotiated Rate	$319.19
Max. Negotiated Rate	$319.19
Rate for Payer: Qualcare PPO/HMO/WC	$319.19

NJX SCLRSNT SPIDER VEINS

Facility

$2,127.90

Service Code	HCPCS 36468
Hospital Charge Code	421036468
Hospital Revenue Code	761
Min. Negotiated Rate	$28.48
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.37
Rate for Payer: Oxford Commercial	$425.58
Rate for Payer: Qualcare PPO/HMO/WC	$319.19
Rate for Payer: UnitedHealthcare Commercial	$425.58
Rate for Payer: UnitedHealthcare Community & State	$51.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$56.39

NL FEM IM 12mD 36c RT225736012

Facility

$5,562.95

Hospital Charge Code	270636584
Hospital Revenue Code	278
Min. Negotiated Rate	$134.07
Max. Negotiated Rate	$2,781.47
Rate for Payer: Aetna Commercial	$2,113.92
Rate for Payer: Aetna Medicare Advantage	$1,668.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,418.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,418.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,112.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,418.55
Rate for Payer: Cigna Commercial	$2,781.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,346.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,223.85
Rate for Payer: Qualcare PPO/HMO/WC	$834.44
Rate for Payer: UnitedHealthcare Community & State	$134.07
Rate for Payer: Wellpoint Medicaid Managed Care	$147.42

NL FEM IM 12mD 36c RT225736012

Facility

$5,562.95

Hospital Charge Code	270636584
Hospital Revenue Code	278
Min. Negotiated Rate	$834.44
Max. Negotiated Rate	$1,346.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,112.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,346.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,223.85
Rate for Payer: Qualcare PPO/HMO/WC	$834.44

Know your out-of-pocket cost for care.

All Charges