Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SKIN TE PRODUCT 256SQCM

Facility

$92,500.00

Service Code	HCPCS Q4200
Hospital Charge Code	270690189
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$22,385.00
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,385.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,875.00
Rate for Payer: UnitedHealthcare Community & State	$2,229.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2,451.25

SKIN TE PRODUCT 256SQCM

Facility

$92,500.00

Service Code	HCPCS Q4200
Hospital Charge Code	270690189
Hospital Revenue Code	278
Min. Negotiated Rate	$13,875.00
Max. Negotiated Rate	$22,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,385.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,875.00

SKIN TEST TB TINE

Facility

$36.45

Service Code	HCPCS 86580
Hospital Charge Code	2500396
Hospital Revenue Code	302
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.47

SKIN TEST TB TINE

Facility

$36.45

Service Code	HCPCS 86580
Hospital Charge Code	2500396
Hospital Revenue Code	302
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$124.03
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.47
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

SKIN TISSUE REARRANGEMENT

Facility

$16,286.20

Service Code	HCPCS 14000
Hospital Charge Code	16000190
Hospital Revenue Code	360
Min. Negotiated Rate	$2,442.93
Max. Negotiated Rate	$2,442.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93

SKIN TISSUE REARRANGEMENT

Facility

$16,286.20

Service Code	HCPCS 14000
Hospital Charge Code	16000190
Hospital Revenue Code	360
Min. Negotiated Rate	$64.50
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	$1,016.00
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	$4,885.86
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$392.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$65.79
Rate for Payer: Wellpoint Medicaid Managed Care	$64.50

SKIN ULCERS

Facility

$21,609.56

Service Code	APR-DRG 3804
Min. Negotiated Rate	$21,185.84
Max. Negotiated Rate	$21,609.56
Rate for Payer: UnitedHealthcare Community & State	$21,185.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,609.56
Rate for Payer: Wellpoint Medicaid Managed Care	$21,185.84

SKIN ULCERS

Facility

$12,419.86

Service Code	APR-DRG 3803
Min. Negotiated Rate	$12,176.33
Max. Negotiated Rate	$12,419.86
Rate for Payer: UnitedHealthcare Community & State	$12,176.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,419.86
Rate for Payer: Wellpoint Medicaid Managed Care	$12,176.33

SKIN ULCERS

Facility

$8,497.80

Service Code	APR-DRG 3802
Min. Negotiated Rate	$8,331.18
Max. Negotiated Rate	$8,497.80
Rate for Payer: UnitedHealthcare Community & State	$8,331.18
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,497.80
Rate for Payer: Wellpoint Medicaid Managed Care	$8,331.18

SKIN ULCERS

Facility

$6,596.78

Service Code	APR-DRG 3801
Min. Negotiated Rate	$6,467.43
Max. Negotiated Rate	$6,596.78
Rate for Payer: UnitedHealthcare Community & State	$6,467.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,596.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6,467.43

SKIN ULCERS WITH CC

Facility

$40,477.29

Service Code	MSDRG 593
Min. Negotiated Rate	$12,324.82
Max. Negotiated Rate	$40,477.29
Rate for Payer: Aetna Commercial	$28,069.83
Rate for Payer: Aetna Medicare Advantage	$40,477.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,145.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,145.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,973.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,145.81
Rate for Payer: Cigna Commercial	$22,200.42
Rate for Payer: Cigna Medicare Advantage	$12,973.49
Rate for Payer: Clover Medicare Advantage	$12,324.82
Rate for Payer: EmblemHealth Commercial	$38,920.47
Rate for Payer: Humana Medicare Advantage	$13,362.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,973.49
Rate for Payer: Oxford Commercial	$15,955.74
Rate for Payer: UnitedHealthcare Commercial	$27,978.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,973.49
Rate for Payer: Wellcare Medicare Advantage	$12,973.49

SKIN ULCERS WITH MCC

Facility

$64,686.21

Service Code	MSDRG 592
Min. Negotiated Rate	$19,696.12
Max. Negotiated Rate	$64,686.21
Rate for Payer: Aetna Commercial	$44,704.12
Rate for Payer: Aetna Medicare Advantage	$64,686.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48,615.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48,615.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,732.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48,615.49
Rate for Payer: Cigna Commercial	$36,217.20
Rate for Payer: Cigna Medicare Advantage	$20,732.76
Rate for Payer: Clover Medicare Advantage	$19,696.12
Rate for Payer: EmblemHealth Commercial	$62,198.28
Rate for Payer: Humana Medicare Advantage	$21,354.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,732.76
Rate for Payer: Oxford Commercial	$26,029.78
Rate for Payer: UnitedHealthcare Commercial	$45,644.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,732.76
Rate for Payer: Wellcare Medicare Advantage	$20,732.76

SKIN ULCERS WITHOUT CC/MCC

Facility

$30,150.46

Service Code	MSDRG 594
Min. Negotiated Rate	$9,180.43
Max. Negotiated Rate	$30,150.46
Rate for Payer: Aetna Commercial	$20,974.14
Rate for Payer: Aetna Medicare Advantage	$30,150.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,376.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,376.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,663.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,376.19
Rate for Payer: Cigna Commercial	$16,221.30
Rate for Payer: Cigna Medicare Advantage	$9,663.61
Rate for Payer: Clover Medicare Advantage	$9,180.43
Rate for Payer: EmblemHealth Commercial	$28,990.83
Rate for Payer: Humana Medicare Advantage	$9,953.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,663.61
Rate for Payer: Oxford Commercial	$11,658.46
Rate for Payer: UnitedHealthcare Commercial	$20,443.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,663.61
Rate for Payer: Wellcare Medicare Advantage	$9,663.61

SKN FL GRFT FCE/GNT/HF=<20SQCM

Facility

$17,100.51

Service Code	HCPCS 15240
Hospital Charge Code	1600000799
Hospital Revenue Code	360
Min. Negotiated Rate	$412.12
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	$1,355.00
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	$5,130.15
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,565.08
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$412.12
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	$453.16

SKN FL GRFT FCE/GNT/HF=<20SQCM

Facility

$17,100.51

Service Code	HCPCS 15240
Hospital Charge Code	1600000799
Hospital Revenue Code	360
Min. Negotiated Rate	$2,565.08
Max. Negotiated Rate	$2,565.08
Rate for Payer: Qualcare PPO/HMO/WC	$2,565.08

SKN SP AGRF F/N/H/G100SQ CM/1B

Facility

$26,848.40

Service Code	HCPCS 15120
Hospital Charge Code	1600000474
Hospital Revenue Code	360
Min. Negotiated Rate	$4,027.26
Max. Negotiated Rate	$4,027.26
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26

SKN SP AGRF F/N/H/G100SQ CM/1B

Facility

$26,848.40

Service Code	HCPCS 15120
Hospital Charge Code	1600000474
Hospital Revenue Code	360
Min. Negotiated Rate	$647.05
Max. Negotiated Rate	$15,196.98
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,196.98
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,054.52
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$647.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$711.48

SKN SPLT A-GRFT F/N/HF/G ADD

Facility

$7,580.00

Service Code	HCPCS 15121
Hospital Charge Code	1600000378
Hospital Revenue Code	360
Min. Negotiated Rate	$182.68
Max. Negotiated Rate	$3,790.00
Rate for Payer: Aetna Commercial	$2,880.40
Rate for Payer: Aetna Medicare Advantage	$2,274.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,932.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,932.90
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	$1,932.90
Rate for Payer: Cigna Commercial	$3,790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,137.00
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$182.68

SKN SPLT A-GRFT F/N/HF/G ADD

Facility

$7,580.00

Service Code	HCPCS 15121
Hospital Charge Code	1600000378
Hospital Revenue Code	360
Min. Negotiated Rate	$1,137.00
Max. Negotiated Rate	$1,137.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,137.00

SKULL COMPLETE

Facility

$5,100.00

Service Code	HCPCS 70260
Hospital Charge Code	94061015
Hospital Revenue Code	320
Min. Negotiated Rate	$53.24
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

SKULL COMPLETE

Facility

$5,100.00

Service Code	HCPCS 70260
Hospital Charge Code	94061015
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SKULL LESS THAN 4 VWS

Facility

$5,100.00

Service Code	HCPCS 70250
Hospital Charge Code	94061013
Hospital Revenue Code	320
Min. Negotiated Rate	$36.45
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

SKULL LESS THAN 4 VWS

Facility

$5,100.00

Service Code	HCPCS 70250
Hospital Charge Code	94061013
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SKWAVE LITHO W/ANGIO&ATHERECT

Facility

$50,061.70

Service Code	HCPCS C9766
Hospital Charge Code	4046C9766
Hospital Revenue Code	481
Min. Negotiated Rate	$1,206.49
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	$15,018.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,509.26
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,206.49
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	$1,326.64

SKWAVE LITHO W/ANGIO&ATHERECT

Facility

$50,061.70

Service Code	HCPCS C9766
Hospital Charge Code	4046C9766
Hospital Revenue Code	481
Min. Negotiated Rate	$7,509.26
Max. Negotiated Rate	$7,509.26
Rate for Payer: Qualcare PPO/HMO/WC	$7,509.26

Know your out-of-pocket cost for care.

All Charges