Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RECONSTR MCP JNT COLL LIGAM W

Facility

$12,831.32

Service Code	HCPCS 26542
Hospital Charge Code	16000854
Hospital Revenue Code	360
Min. Negotiated Rate	$309.23
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	$3,849.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.70
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$309.23
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	$340.03

RECONSTR QUAD/HAMSTRING MSCL R

Facility

$28,042.44

Service Code	HCPCS 27386
Hospital Charge Code	16000883
Hospital Revenue Code	360
Min. Negotiated Rate	$4,206.37
Max. Negotiated Rate	$4,206.37
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.37

RECONSTR QUAD/HAMSTRING MSCL R

Facility

$28,042.44

Service Code	HCPCS 27386
Hospital Charge Code	16000883
Hospital Revenue Code	360
Min. Negotiated Rate	$675.82
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,412.73
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.37
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$675.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$743.12

RECONSTR RC AVULSION CHRONIC

Facility

$44,916.00

Service Code	HCPCS 23420
Hospital Charge Code	16000677
Hospital Revenue Code	360
Min. Negotiated Rate	$6,737.40
Max. Negotiated Rate	$6,737.40
Rate for Payer: Qualcare PPO/HMO/WC	$6,737.40

RECONSTR RC AVULSION CHRONIC

Facility

$44,916.00

Service Code	HCPCS 23420
Hospital Charge Code	16000677
Hospital Revenue Code	360
Min. Negotiated Rate	$1,082.48
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,474.80
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,737.40
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,082.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,190.27

RECONSTRUCTION KNEE

Facility

$60,854.80

Service Code	HCPCS 27429
Hospital Charge Code	1600000884
Hospital Revenue Code	360
Min. Negotiated Rate	$9,128.22
Max. Negotiated Rate	$9,128.22
Rate for Payer: Qualcare PPO/HMO/WC	$9,128.22

RECONSTRUCTION KNEE

Facility

$60,854.80

Service Code	HCPCS 27429
Hospital Charge Code	1600000884
Hospital Revenue Code	360
Min. Negotiated Rate	$1,466.60
Max. Negotiated Rate	$55,057.64
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,057.64
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,256.44
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,128.22
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,466.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,612.65

RECONSTRUCT TOE(S), SYNDACTYLY

Facility

$19,998.60

Service Code	HCPCS 28345
Hospital Charge Code	16000911
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$8,157.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
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	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

RECONSTRUCT TOE(S), SYNDACTYLY

Facility

$19,998.60

Service Code	HCPCS 28345
Hospital Charge Code	16000911
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

Reconstruct ulna/radioulnar

Facility

$33,092.48

Service Code	HCPCS 25337
Hospital Charge Code	16000835
Hospital Revenue Code	360
Min. Negotiated Rate	$4,963.87
Max. Negotiated Rate	$4,963.87
Rate for Payer: Qualcare PPO/HMO/WC	$4,963.87

Reconstruct ulna/radioulnar

Facility

$33,092.48

Service Code	HCPCS 25337
Hospital Charge Code	16000835
Hospital Revenue Code	360
Min. Negotiated Rate	$797.53
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,927.74
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,963.87
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$797.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$876.95

RECONSTRUCT VENA CAVA

Facility

$16,048.50

Service Code	HCPCS 34502
Hospital Charge Code	1600000688
Hospital Revenue Code	360
Min. Negotiated Rate	$2,407.28
Max. Negotiated Rate	$2,407.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,407.28

RECONSTRUCT VENA CAVA

Facility

$16,048.50

Service Code	HCPCS 34502
Hospital Charge Code	1600000688
Hospital Revenue Code	360
Min. Negotiated Rate	$386.77
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$6,098.43
Rate for Payer: Aetna Medicare Advantage	$4,814.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,092.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,092.37
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	$4,092.37
Rate for Payer: Cigna Commercial	$8,024.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,814.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,407.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$386.77
Rate for Payer: Wellpoint Medicaid Managed Care	$425.29

RECORDER LOOP

Facility

$21,500.00

Service Code	HCPCS C1764
Hospital Charge Code	270696573S
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

RECORDER LOOP

Facility

$21,500.00

Service Code	HCPCS C1764
Hospital Charge Code	270696573S
Hospital Revenue Code	278
Min. Negotiated Rate	$518.15
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$518.15
Rate for Payer: Wellpoint Medicaid Managed Care	$569.75

RECORDER LOOP DM5300 ASSERT

Facility

$19,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270704451
Hospital Revenue Code	278
Min. Negotiated Rate	$469.95
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$469.95
Rate for Payer: Wellpoint Medicaid Managed Care	$516.75

RECORDER LOOP DM5300 ASSERT

Facility

$19,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270704451
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

RECORDER LP REVEAL MEDT 9526

Facility

$19,024.00

Service Code	HCPCS C1764
Hospital Charge Code	270625754
Hospital Revenue Code	278
Min. Negotiated Rate	$458.48
Max. Negotiated Rate	$9,512.00
Rate for Payer: Aetna Commercial	$7,229.12
Rate for Payer: Aetna Medicare Advantage	$5,707.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,851.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,851.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,804.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,851.12
Rate for Payer: Cigna Commercial	$9,512.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,603.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,185.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,853.60
Rate for Payer: UnitedHealthcare Community & State	$458.48
Rate for Payer: Wellpoint Medicaid Managed Care	$504.14

RECORDER LP REVEAL MEDT 9526

Facility

$19,024.00

Service Code	HCPCS C1764
Hospital Charge Code	270625754
Hospital Revenue Code	278
Min. Negotiated Rate	$2,853.60
Max. Negotiated Rate	$4,603.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,804.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,603.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,185.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,853.60

RECORDER REVEAL LNQ LOOP

Facility

$24,975.00

Service Code	HCPCS C1764
Hospital Charge Code	270669999S
Hospital Revenue Code	278
Min. Negotiated Rate	$3,746.25
Max. Negotiated Rate	$6,043.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,043.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,494.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.25

RECORDER REVEAL LNQ LOOP

Facility

$24,975.00

Service Code	HCPCS C1764
Hospital Charge Code	270669999S
Hospital Revenue Code	278
Min. Negotiated Rate	$601.90
Max. Negotiated Rate	$12,487.50
Rate for Payer: Aetna Commercial	$9,490.50
Rate for Payer: Aetna Medicare Advantage	$7,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,368.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,368.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,368.62
Rate for Payer: Cigna Commercial	$12,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,043.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,494.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.25
Rate for Payer: UnitedHealthcare Community & State	$601.90
Rate for Payer: Wellpoint Medicaid Managed Care	$661.84

RECORDER REVEAL LNQ LOOP

Facility

$24,975.00

Service Code	HCPCS C1764
Hospital Charge Code	270669999
Hospital Revenue Code	278
Min. Negotiated Rate	$3,746.25
Max. Negotiated Rate	$6,043.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,043.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,494.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.25

RECORDER REVEAL LNQ LOOP

Facility

$24,975.00

Service Code	HCPCS C1764
Hospital Charge Code	270669999
Hospital Revenue Code	278
Min. Negotiated Rate	$601.90
Max. Negotiated Rate	$12,487.50
Rate for Payer: Aetna Commercial	$9,490.50
Rate for Payer: Aetna Medicare Advantage	$7,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,368.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,368.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,368.62
Rate for Payer: Cigna Commercial	$12,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,043.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,494.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.25
Rate for Payer: UnitedHealthcare Community & State	$601.90
Rate for Payer: Wellpoint Medicaid Managed Care	$661.84

RECORDER REVEAL LNQ LOOP

Facility

$26,475.00

Service Code	HCPCS C1764
Hospital Charge Code	270669999N
Hospital Revenue Code	278
Min. Negotiated Rate	$3,971.25
Max. Negotiated Rate	$6,406.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,406.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,824.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,971.25

RECORDER REVEAL LNQ LOOP

Facility

$26,475.00

Service Code	HCPCS C1764
Hospital Charge Code	270669999N
Hospital Revenue Code	278
Min. Negotiated Rate	$638.05
Max. Negotiated Rate	$13,237.50
Rate for Payer: Aetna Commercial	$10,060.50
Rate for Payer: Aetna Medicare Advantage	$7,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,751.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,751.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,751.12
Rate for Payer: Cigna Commercial	$13,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,406.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,824.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,971.25
Rate for Payer: UnitedHealthcare Community & State	$638.05
Rate for Payer: Wellpoint Medicaid Managed Care	$701.59

Know your out-of-pocket cost for care.

All Charges