Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EXC BENIGN LES DIAM 1.1-2.0 CM

Facility

$3,473.00

Service Code	HCPCS 11422
Hospital Charge Code	75190060
Hospital Revenue Code	761
Min. Negotiated Rate	$520.95
Max. Negotiated Rate	$520.95
Rate for Payer: Qualcare PPO/HMO/WC	$520.95

EXC BENIGN LES DIAM 1.1-2.0 CM

Facility

$3,473.00

Service Code	HCPCS 11422
Hospital Charge Code	75190060
Hospital Revenue Code	761
Min. Negotiated Rate	$98.63
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$902.98
Rate for Payer: Oxford Commercial	$694.60
Rate for Payer: Qualcare PPO/HMO/WC	$520.95
Rate for Payer: UnitedHealthcare Commercial	$694.60
Rate for Payer: UnitedHealthcare Community & State	$109.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$98.63

EXC BENIGN LES DIAM 2.1-3.0 CM

Facility

$7,392.00

Service Code	HCPCS 11423
Hospital Charge Code	75190065
Hospital Revenue Code	761
Min. Negotiated Rate	$1,108.80
Max. Negotiated Rate	$1,108.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80

EXC BENIGN LES DIAM 2.1-3.0 CM

Facility

$7,392.00

Service Code	HCPCS 11423
Hospital Charge Code	75190065
Hospital Revenue Code	761
Min. Negotiated Rate	$124.43
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.92
Rate for Payer: Oxford Commercial	$1,478.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80
Rate for Payer: UnitedHealthcare Commercial	$1,478.40
Rate for Payer: UnitedHealthcare Community & State	$233.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$209.93

EXC BENIGN LES DIAM 2.1-3.0 CM

Facility

$3,472.00

Service Code	HCPCS 11443
Hospital Charge Code	75190090
Hospital Revenue Code	761
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$902.72
Rate for Payer: Oxford Commercial	$694.40
Rate for Payer: Qualcare PPO/HMO/WC	$520.80
Rate for Payer: UnitedHealthcare Commercial	$694.40
Rate for Payer: UnitedHealthcare Community & State	$109.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$98.60

EXC BENIGN LES DIAM 2.1-3.0 CM

Facility

$3,472.00

Service Code	HCPCS 11443
Hospital Charge Code	75190090
Hospital Revenue Code	761
Min. Negotiated Rate	$520.80
Max. Negotiated Rate	$520.80
Rate for Payer: Qualcare PPO/HMO/WC	$520.80

EXC BENIGN LES DIAM 2.1-3.0CM

Facility

$1,049.00

Service Code	HCPCS 11403
Hospital Charge Code	75190045
Hospital Revenue Code	761
Min. Negotiated Rate	$29.79
Max. Negotiated Rate	$3,051.74
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.74
Rate for Payer: Oxford Commercial	$209.80
Rate for Payer: Qualcare PPO/HMO/WC	$157.35
Rate for Payer: UnitedHealthcare Commercial	$209.80
Rate for Payer: UnitedHealthcare Community & State	$33.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$29.79

EXC BENIGN LES DIAM 2.1-3.0CM

Facility

$1,049.00

Service Code	HCPCS 11403
Hospital Charge Code	75190045
Hospital Revenue Code	761
Min. Negotiated Rate	$157.35
Max. Negotiated Rate	$157.35
Rate for Payer: Qualcare PPO/HMO/WC	$157.35

EXC BENIGN LES DIAM 3.1-4.0 CM

Facility

$7,392.00

Service Code	HCPCS 11424
Hospital Charge Code	75190070
Hospital Revenue Code	761
Min. Negotiated Rate	$1,108.80
Max. Negotiated Rate	$1,108.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80

EXC BENIGN LES DIAM 3.1-4.0 CM

Facility

$1,192.00

Service Code	HCPCS 11404
Hospital Charge Code	75190050
Hospital Revenue Code	761
Min. Negotiated Rate	$178.80
Max. Negotiated Rate	$178.80
Rate for Payer: Qualcare PPO/HMO/WC	$178.80

EXC BENIGN LES DIAM 3.1-4.0 CM

Facility

$1,192.00

Service Code	HCPCS 11404
Hospital Charge Code	75190050
Hospital Revenue Code	761
Min. Negotiated Rate	$33.85
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.92
Rate for Payer: Oxford Commercial	$238.40
Rate for Payer: Qualcare PPO/HMO/WC	$178.80
Rate for Payer: UnitedHealthcare Commercial	$238.40
Rate for Payer: UnitedHealthcare Community & State	$37.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$33.85

EXC BENIGN LES DIAM 3.1-4.0 CM

Facility

$7,392.00

Service Code	HCPCS 11424
Hospital Charge Code	75190070
Hospital Revenue Code	761
Min. Negotiated Rate	$142.86
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.92
Rate for Payer: Oxford Commercial	$1,478.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80
Rate for Payer: UnitedHealthcare Commercial	$1,478.40
Rate for Payer: UnitedHealthcare Community & State	$233.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$209.93

EXC BENIGN LES DIAM > 4.0 CM

Facility

$1,683.00

Service Code	HCPCS 11406
Hospital Charge Code	75190055
Hospital Revenue Code	761
Min. Negotiated Rate	$252.45
Max. Negotiated Rate	$252.45
Rate for Payer: Qualcare PPO/HMO/WC	$252.45

EXC BENIGN LES DIAM > 4.0 CM

Facility

$1,683.00

Service Code	HCPCS 11406
Hospital Charge Code	75190055
Hospital Revenue Code	761
Min. Negotiated Rate	$47.80
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.58
Rate for Payer: Oxford Commercial	$336.60
Rate for Payer: Qualcare PPO/HMO/WC	$252.45
Rate for Payer: UnitedHealthcare Commercial	$336.60
Rate for Payer: UnitedHealthcare Community & State	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$47.80

EXC BENIGN LES DIAM > 4.0CM

Facility

$9,771.00

Service Code	HCPCS 11426
Hospital Charge Code	75190075
Hospital Revenue Code	761
Min. Negotiated Rate	$1,465.65
Max. Negotiated Rate	$1,465.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,465.65

EXC BENIGN LES DIAM > 4.0CM

Facility

$9,771.00

Service Code	HCPCS 11426
Hospital Charge Code	75190075
Hospital Revenue Code	761
Min. Negotiated Rate	$201.73
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,540.46
Rate for Payer: Oxford Commercial	$1,954.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,465.65
Rate for Payer: UnitedHealthcare Commercial	$1,954.20
Rate for Payer: UnitedHealthcare Community & State	$308.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$277.50

EXC BEN LES TAL 0.6-1.0 CM

Facility

$2,403.20

Service Code	HCPCS 11401
Hospital Charge Code	5792277
Hospital Revenue Code	450
Min. Negotiated Rate	$360.48
Max. Negotiated Rate	$360.48
Rate for Payer: Qualcare PPO/HMO/WC	$360.48

EXC BEN LES TAL 0.6-1.0 CM

Facility

$2,403.20

Service Code	HCPCS 11401
Hospital Charge Code	5792277
Hospital Revenue Code	450
Min. Negotiated Rate	$49.03
Max. Negotiated Rate	$1,751.90
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$49.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$624.83
Rate for Payer: Qualcare PPO/HMO/WC	$360.48
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$68.25

EXC BEN LES T/A/L,0.6-1.0CM

Facility

$3,972.54

Service Code	HCPCS 11401
Hospital Charge Code	16000255
Hospital Revenue Code	360
Min. Negotiated Rate	$595.88
Max. Negotiated Rate	$595.88
Rate for Payer: Qualcare PPO/HMO/WC	$595.88

EXC BEN LES T/A/L,0.6-1.0CM

Facility

$3,972.54

Service Code	HCPCS 11401
Hospital Charge Code	16000255
Hospital Revenue Code	360
Min. Negotiated Rate	$125.53
Max. Negotiated Rate	$3,536.00
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$1,032.86
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$595.88
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$125.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

EXC BEN LES T/A/L 1.1-2.0CM

Facility

$4,151.00

Service Code	HCPCS 11402
Hospital Charge Code	1600000386
Hospital Revenue Code	360
Min. Negotiated Rate	$622.65
Max. Negotiated Rate	$622.65
Rate for Payer: Qualcare PPO/HMO/WC	$622.65

EXC BEN LES T/A/L 1.1-2.0CM

Facility

$4,744.00

Service Code	HCPCS 11042
Hospital Charge Code	160000240
Hospital Revenue Code	360
Min. Negotiated Rate	$711.60
Max. Negotiated Rate	$711.60
Rate for Payer: Qualcare PPO/HMO/WC	$711.60

EXC BEN LES T/A/L 1.1-2.0CM

Facility

$4,151.00

Service Code	HCPCS 11402
Hospital Charge Code	1600000386
Hospital Revenue Code	360
Min. Negotiated Rate	$117.89
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.26
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$622.65
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$131.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$117.89

EXC BEN LES T/A/L 1.1-2.0CM

Facility

$4,744.00

Service Code	HCPCS 11042
Hospital Charge Code	160000240
Hospital Revenue Code	360
Min. Negotiated Rate	$149.91
Max. Negotiated Rate	$3,536.00
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$1,233.44
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$711.60
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$149.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

EXC BEN LES T/A/L,2.1-3.0CM

Facility

$7,918.25

Service Code	HCPCS 11403
Hospital Charge Code	16000189
Hospital Revenue Code	360
Min. Negotiated Rate	$224.88
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,058.74
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.74
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$250.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$224.88

Know your out-of-pocket cost for care.

All Charges