Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHRT ARM SPLNT FRRM TO HN

Facility

$614.91

Service Code	HCPCS 29125
Hospital Charge Code	412329125
Hospital Revenue Code	361
Min. Negotiated Rate	$92.24
Max. Negotiated Rate	$92.24
Rate for Payer: Qualcare PPO/HMO/WC	$92.24

SHRT ARM SPLNT FRRM TO HN

Facility

$288.00

Service Code	HCPCS 29125
Hospital Charge Code	94186040
Hospital Revenue Code	361
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.20
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$6.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06

SHRT ARM SPLNT FRRM TO HN

Facility

$614.91

Service Code	HCPCS 29125
Hospital Charge Code	412329125
Hospital Revenue Code	361
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.24
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$14.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06

SHRT HUMERAL DIAPHYS CMNTLS -7

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686877
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

SHRT HUMERAL DIAPHYS CMNTLS -7

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686877
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

SHRT LG CST BLW KN TO TOE

Facility

$618.00

Service Code	HCPCS 29405
Hospital Charge Code	94186060
Hospital Revenue Code	361
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$92.70
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

SHRT LG CST BLW KN TO TOE

Facility

$618.00

Service Code	HCPCS 29405
Hospital Charge Code	94186060
Hospital Revenue Code	361
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,199.43
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.70
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$14.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$16.38

SHRT LG SPLNT CLF TO FOOT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	412329515
Hospital Revenue Code	361
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

SHRT LG SPLNT CLF TO FOOT

Facility

$288.00

Service Code	HCPCS 29515
Hospital Charge Code	94186075
Hospital Revenue Code	361
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$696.85
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.20
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$6.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$7.63

SHRT LG SPLNT CLF TO FOOT

Facility

$288.00

Service Code	HCPCS 29515
Hospital Charge Code	94186075
Hospital Revenue Code	361
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

SHRT LG SPLNT CLF TO FOOT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	412329515
Hospital Revenue Code	361
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$696.85
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.23
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.61
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$18.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$20.60

SHT 1.5m RAP RESOR 851.532.015

Facility

$2,926.45

Service Code	HCPCS C1776
Hospital Charge Code	270635018
Hospital Revenue Code	278
Min. Negotiated Rate	$438.97
Max. Negotiated Rate	$708.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$585.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$708.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$643.82
Rate for Payer: Qualcare PPO/HMO/WC	$438.97

SHT 1.5m RAP RESOR 851.532.015

Facility

$2,926.45

Service Code	HCPCS C1776
Hospital Charge Code	270635018
Hospital Revenue Code	278
Min. Negotiated Rate	$70.53
Max. Negotiated Rate	$1,463.22
Rate for Payer: Aetna Commercial	$1,112.05
Rate for Payer: Aetna Medicare Advantage	$877.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$746.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$746.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$585.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$746.24
Rate for Payer: Cigna Commercial	$1,463.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$708.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$643.82
Rate for Payer: Qualcare PPO/HMO/WC	$438.97
Rate for Payer: UnitedHealthcare Community & State	$70.53
Rate for Payer: Wellpoint Medicaid Managed Care	$77.55

SHTH GDING PINNCLE7F 65X35X2.5

Facility

$580.00

Service Code	HCPCS C1766
Hospital Charge Code	270642217
Hospital Revenue Code	278
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$220.40
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00
Rate for Payer: UnitedHealthcare Community & State	$13.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15.37

SHTH GDING PINNCLE7F 65X35X2.5

Facility

$580.00

Service Code	HCPCS C1766
Hospital Charge Code	270642217S
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

SHTH GDING PINNCLE7F 65X35X2.5

Facility

$580.00

Service Code	HCPCS C1766
Hospital Charge Code	270642217S
Hospital Revenue Code	278
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$220.40
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00
Rate for Payer: UnitedHealthcare Community & State	$13.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15.37

SHTH GDING PINNCLE7F 65X35X2.5

Facility

$580.00

Service Code	HCPCS C1766
Hospital Charge Code	270642217
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

SHTH GUIDING PIN 6FR 65X35X2.5

Facility

$580.00

Service Code	HCPCS C1766
Hospital Charge Code	270642215S
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

SHTH GUIDING PIN 6FR 65X35X2.5

Facility

$580.00

Service Code	HCPCS C1766
Hospital Charge Code	270642215S
Hospital Revenue Code	278
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$220.40
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00
Rate for Payer: UnitedHealthcare Community & State	$13.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15.37

SHTH GUIDING PIN 6FR 65X35X2.5

Facility

$722.50

Hospital Charge Code	270642215
Hospital Revenue Code	278
Min. Negotiated Rate	$17.41
Max. Negotiated Rate	$361.25
Rate for Payer: Aetna Commercial	$274.55
Rate for Payer: Aetna Medicare Advantage	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.24
Rate for Payer: Cigna Commercial	$361.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.95
Rate for Payer: Qualcare PPO/HMO/WC	$108.38
Rate for Payer: UnitedHealthcare Community & State	$17.41
Rate for Payer: Wellpoint Medicaid Managed Care	$19.15

SHTH GUIDING PIN 6FR 65X35X2.5

Facility

$722.50

Hospital Charge Code	270642215
Hospital Revenue Code	278
Min. Negotiated Rate	$108.38
Max. Negotiated Rate	$174.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.95
Rate for Payer: Qualcare PPO/HMO/WC	$108.38

SHTH PINNCLE 2 INTROD 6FRx10

Facility

$159.50

Service Code	HCPCS C1766
Hospital Charge Code	270654371
Hospital Revenue Code	278
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$79.75
Rate for Payer: Aetna Commercial	$60.61
Rate for Payer: Aetna Medicare Advantage	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.67
Rate for Payer: Cigna Commercial	$79.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.09
Rate for Payer: Qualcare PPO/HMO/WC	$23.93
Rate for Payer: UnitedHealthcare Community & State	$3.84
Rate for Payer: Wellpoint Medicaid Managed Care	$4.23

SHTH PINNCLE 2 INTROD 6FRx10

Facility

$159.50

Service Code	HCPCS C1766
Hospital Charge Code	270654371S
Hospital Revenue Code	278
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$79.75
Rate for Payer: Aetna Commercial	$60.61
Rate for Payer: Aetna Medicare Advantage	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.67
Rate for Payer: Cigna Commercial	$79.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.09
Rate for Payer: Qualcare PPO/HMO/WC	$23.93
Rate for Payer: UnitedHealthcare Community & State	$3.84
Rate for Payer: Wellpoint Medicaid Managed Care	$4.23

SHTH PINNCLE 2 INTROD 6FRx10

Facility

$159.50

Service Code	HCPCS C1766
Hospital Charge Code	270654371
Hospital Revenue Code	278
Min. Negotiated Rate	$23.93
Max. Negotiated Rate	$38.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.09
Rate for Payer: Qualcare PPO/HMO/WC	$23.93

SHTH PINNCLE 2 INTROD 6FRx10

Facility

$159.50

Service Code	HCPCS C1766
Hospital Charge Code	270654371S
Hospital Revenue Code	278
Min. Negotiated Rate	$23.93
Max. Negotiated Rate	$38.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.09
Rate for Payer: Qualcare PPO/HMO/WC	$23.93

Know your out-of-pocket cost for care.

All Charges