Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PRQ REVASC BYP GRAFT ADDL

Facility

$35,998.44

Service Code	HCPCS 92938
Hospital Charge Code	74110088
Hospital Revenue Code	481
Min. Negotiated Rate	$5,399.77
Max. Negotiated Rate	$5,399.77
Rate for Payer: Qualcare PPO/HMO/WC	$5,399.77

PRQ REVASC BYP GRAFT ADDL

Facility

$92,938.00

Service Code	HCPCS 92938
Hospital Charge Code	5100795
Hospital Revenue Code	481
Min. Negotiated Rate	$2,239.81
Max. Negotiated Rate	$46,469.00
Rate for Payer: Aetna Commercial	$35,316.44
Rate for Payer: Aetna Medicare Advantage	$27,881.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,699.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,699.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,699.19
Rate for Payer: Cigna Commercial	$46,469.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,881.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,940.70
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$2,239.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,462.86

PRQ REVASC BYP GRAFT ADDL

Facility

$35,998.44

Service Code	HCPCS 92938
Hospital Charge Code	74110088
Hospital Revenue Code	481
Min. Negotiated Rate	$867.56
Max. Negotiated Rate	$17,999.22
Rate for Payer: Aetna Commercial	$13,679.41
Rate for Payer: Aetna Medicare Advantage	$10,799.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,179.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,179.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,179.60
Rate for Payer: Cigna Commercial	$17,999.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,799.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,399.77
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$867.56
Rate for Payer: Wellpoint Medicaid Managed Care	$953.96

PRQ SKL FXTN CRPL/MTCL FX THMB

Facility

$23,899.60

Service Code	HCPCS 26650
Hospital Charge Code	16000557
Hospital Revenue Code	360
Min. Negotiated Rate	$3,584.94
Max. Negotiated Rate	$3,584.94
Rate for Payer: Qualcare PPO/HMO/WC	$3,584.94

PRQ SKL FXTN CRPL/MTCL FX THMB

Facility

$23,899.60

Service Code	HCPCS 26650
Hospital Charge Code	16000557
Hospital Revenue Code	360
Min. Negotiated Rate	$575.98
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	$7,169.88
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,584.94
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$575.98
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	$633.34

PRQ TCAT PLMT NTRAC ST 2+LES

Facility

$35,998.44

Service Code	HCPCS 92930
Hospital Charge Code	403492930
Hospital Revenue Code	481
Min. Negotiated Rate	$867.56
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,799.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,399.77
Rate for Payer: UnitedHealthcare Community & State	$867.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$953.96

PRQ TCAT PLMT NTRAC ST 2+LES

Facility

$35,998.44

Service Code	HCPCS 92930
Hospital Charge Code	403492930
Hospital Revenue Code	481
Min. Negotiated Rate	$5,399.77
Max. Negotiated Rate	$5,399.77
Rate for Payer: Qualcare PPO/HMO/WC	$5,399.77

PRQ TCAT PLMT NTRAC ST 2+LES

Facility

$35,998.44

Service Code	HCPCS 92930
Hospital Charge Code	404692930
Hospital Revenue Code	481
Min. Negotiated Rate	$867.56
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,799.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,399.77
Rate for Payer: UnitedHealthcare Community & State	$867.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$953.96

PRQ TCAT PLMT NTRAC ST 2+LES

Facility

$35,998.44

Service Code	HCPCS 92930
Hospital Charge Code	404692930
Hospital Revenue Code	481
Min. Negotiated Rate	$5,399.77
Max. Negotiated Rate	$5,399.77
Rate for Payer: Qualcare PPO/HMO/WC	$5,399.77

PRSHEATH INTRO4FR 11CM .035X50

Facility

$9.30

Service Code	HCPCS C1766
Hospital Charge Code	270658188N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.40

PRSHEATH INTRO4FR 11CM .035X50

Facility

$46.50

Service Code	HCPCS C1766
Hospital Charge Code	270658188S
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

PRSHEATH INTRO4FR 11CM .035X50

Facility

$46.50

Service Code	HCPCS C1766
Hospital Charge Code	270658188
Hospital Revenue Code	278
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$11.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

PRSHEATH INTRO4FR 11CM .035X50

Facility

$9.30

Service Code	HCPCS C1766
Hospital Charge Code	270658188N
Hospital Revenue Code	278
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.65
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna Medicare Advantage	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.37
Rate for Payer: Cigna Commercial	$4.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

PRSHEATH INTRO4FR 11CM .035X50

Facility

$46.50

Service Code	HCPCS C1766
Hospital Charge Code	270658188
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$17.67
Rate for Payer: Aetna Medicare Advantage	$13.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.86
Rate for Payer: Cigna Commercial	$23.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

PRSHEATH INTRO4FR 11CM .035X50

Facility

$46.50

Service Code	HCPCS C1766
Hospital Charge Code	270658188S
Hospital Revenue Code	278
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$11.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

PRTL REM FT BONE,MTRSL HD1-5EA

Facility

$9,331.45

Service Code	HCPCS 28288
Hospital Charge Code	16000327
Hospital Revenue Code	360
Min. Negotiated Rate	$1,399.72
Max. Negotiated Rate	$1,399.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,399.72

PRTL REM FT BONE,MTRSL HD1-5EA

Facility

$9,331.45

Service Code	HCPCS 28288
Hospital Charge Code	16000327
Hospital Revenue Code	360
Min. Negotiated Rate	$224.89
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	$2,799.43
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,399.72
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$224.89
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	$247.28

PRX HUM LO PLT 2H 73MM

Facility

$6,957.50

Service Code	HCPCS C1776
Hospital Charge Code	270680682
Hospital Revenue Code	278
Min. Negotiated Rate	$1,043.62
Max. Negotiated Rate	$1,683.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,391.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,683.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,530.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,043.62

PRX HUM LO PLT 2H 73MM

Facility

$6,957.50

Service Code	HCPCS C1776
Hospital Charge Code	270680682
Hospital Revenue Code	278
Min. Negotiated Rate	$167.68
Max. Negotiated Rate	$3,478.75
Rate for Payer: Aetna Commercial	$2,643.85
Rate for Payer: Aetna Medicare Advantage	$2,087.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,774.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,774.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,774.16
Rate for Payer: Cigna Commercial	$3,478.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,683.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,530.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,043.62
Rate for Payer: UnitedHealthcare Community & State	$167.68
Rate for Payer: Wellpoint Medicaid Managed Care	$184.37

PRX HUM LO PLT LT 11H 190MM

Facility

$8,580.00

Service Code	HCPCS C1713
Hospital Charge Code	270680847
Hospital Revenue Code	278
Min. Negotiated Rate	$1,287.00
Max. Negotiated Rate	$2,076.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,716.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,076.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,287.00

PRX HUM LO PLT LT 11H 190MM

Facility

$8,580.00

Service Code	HCPCS C1713
Hospital Charge Code	270680847
Hospital Revenue Code	278
Min. Negotiated Rate	$206.78
Max. Negotiated Rate	$4,290.00
Rate for Payer: Aetna Commercial	$3,260.40
Rate for Payer: Aetna Medicare Advantage	$2,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,187.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,187.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,187.90
Rate for Payer: Cigna Commercial	$4,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,076.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,287.00
Rate for Payer: UnitedHealthcare Community & State	$206.78
Rate for Payer: Wellpoint Medicaid Managed Care	$227.37

PRXMALHUMERLNAILT2LONGRT240MM

Facility

$13,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270663838
Hospital Revenue Code	278
Min. Negotiated Rate	$337.16
Max. Negotiated Rate	$6,995.00
Rate for Payer: Aetna Commercial	$5,316.20
Rate for Payer: Aetna Medicare Advantage	$4,197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,567.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,567.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,798.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,567.45
Rate for Payer: Cigna Commercial	$6,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,385.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,077.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,098.50
Rate for Payer: UnitedHealthcare Community & State	$337.16
Rate for Payer: Wellpoint Medicaid Managed Care	$370.74

PRXMALHUMERLNAILT2LONGRT240MM

Facility

$13,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270663838
Hospital Revenue Code	278
Min. Negotiated Rate	$2,098.50
Max. Negotiated Rate	$3,385.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,385.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,077.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,098.50

PR Z1 ST/OSS LH CP/XL AA DM LN

Facility

$32,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704914
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

PR Z1 ST/OSS LH CP/XL AA DM LN

Facility

$32,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704914
Hospital Revenue Code	278
Min. Negotiated Rate	$783.25
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Community & State	$783.25
Rate for Payer: Wellpoint Medicaid Managed Care	$861.25

Know your out-of-pocket cost for care.

All Charges