Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EXCISE OLECRANON BURSA LT

Facility

$21,422.50

Service Code	HCPCS 24105
Hospital Charge Code	16000376
Hospital Revenue Code	360
Min. Negotiated Rate	$3,213.38
Max. Negotiated Rate	$3,213.38
Rate for Payer: Qualcare PPO/HMO/WC	$3,213.38

EXCISE OLECRANON BURSA LT

Facility

$21,422.50

Service Code	HCPCS 24105
Hospital Charge Code	16000376
Hospital Revenue Code	360
Min. Negotiated Rate	$608.40
Max. Negotiated Rate	$14,100.89
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	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
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	$5,569.85
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,213.38
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$676.95
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	$608.40

EXCISION DIAM 0.5CM OR LESS

Facility

$7,903.25

Service Code	HCPCS 11420
Hospital Charge Code	412311420
Hospital Revenue Code	361
Min. Negotiated Rate	$1,185.49
Max. Negotiated Rate	$1,185.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.49

EXCISION DIAM 0.5CM OR LESS

Facility

$7,903.25

Service Code	HCPCS 11420
Hospital Charge Code	412311420
Hospital Revenue Code	361
Min. Negotiated Rate	$224.45
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	$3,536.00
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	$2,054.84
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.49
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$249.74
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	$224.45

EXCISION DIAM 0.6 - 1.0 CM

Facility

$3,358.50

Service Code	HCPCS 11421
Hospital Charge Code	412311421
Hospital Revenue Code	361
Min. Negotiated Rate	$503.77
Max. Negotiated Rate	$503.77
Rate for Payer: Qualcare PPO/HMO/WC	$503.77

EXCISION DIAM 0.6 - 1.0 CM

Facility

$3,358.50

Service Code	HCPCS 11421
Hospital Charge Code	412311421
Hospital Revenue Code	361
Min. Negotiated Rate	$95.38
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	$873.21
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$503.77
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$106.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$95.38

EXCISION DIAM 1.1 - 2.0 CM

Facility

$7,903.25

Service Code	HCPCS 11422
Hospital Charge Code	412311422
Hospital Revenue Code	361
Min. Negotiated Rate	$224.45
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	$3,536.00
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	$2,054.84
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.49
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$249.74
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	$224.45

EXCISION DIAM 1.1 - 2.0 CM

Facility

$7,903.25

Service Code	HCPCS 11422
Hospital Charge Code	412311422
Hospital Revenue Code	361
Min. Negotiated Rate	$1,185.49
Max. Negotiated Rate	$1,185.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.49

EXCISION DIAM 2.1 - 3.0 CM

Facility

$7,903.25

Service Code	HCPCS 11423
Hospital Charge Code	412311423
Hospital Revenue Code	361
Min. Negotiated Rate	$1,185.49
Max. Negotiated Rate	$1,185.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.49

EXCISION DIAM 2.1 - 3.0 CM

Facility

$7,903.25

Service Code	HCPCS 11423
Hospital Charge Code	412311423
Hospital Revenue Code	361
Min. Negotiated Rate	$224.45
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	$3,536.00
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	$2,054.84
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.49
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$249.74
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	$224.45

EXCISION DIAM 6-1.0 CM

Facility

$917.00

Service Code	HCPCS 11401
Hospital Charge Code	93950015
Hospital Revenue Code	761
Min. Negotiated Rate	$137.55
Max. Negotiated Rate	$137.55
Rate for Payer: Qualcare PPO/HMO/WC	$137.55

EXCISION DIAM 6-1.0 CM

Facility

$917.00

Service Code	HCPCS 11401
Hospital Charge Code	93950015
Hospital Revenue Code	761
Min. Negotiated Rate	$26.04
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	$238.42
Rate for Payer: Oxford Commercial	$183.40
Rate for Payer: Qualcare PPO/HMO/WC	$137.55
Rate for Payer: UnitedHealthcare Commercial	$183.40
Rate for Payer: UnitedHealthcare Community & State	$28.98
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	$26.04

EXCISION GRAFT EXTREMITY

Facility

$18,553.40

Service Code	HCPCS 35903
Hospital Charge Code	1600000724
Hospital Revenue Code	360
Min. Negotiated Rate	$2,783.01
Max. Negotiated Rate	$2,783.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,783.01

EXCISION GRAFT EXTREMITY

Facility

$18,553.40

Service Code	HCPCS 35903
Hospital Charge Code	1600000724
Hospital Revenue Code	360
Min. Negotiated Rate	$526.92
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,823.88
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,783.01
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$586.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$526.92

EXCISION OF 1 OR MORE LESIONS OF SMALL OR LARGE INTESTINE NOT REQUIRING ANASTOMOSIS, EXTERIORIZATION, OR FISTULIZATION; MULTIPLE ENTEROTOMIES

Facility

$10,269.00

Service Code	CPT 44111
Hospital Revenue Code	360
Min. Negotiated Rate	$3,536.00
Max. Negotiated Rate	$10,269.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: UnitedHealthcare Commercial	$10,269.00

EXCISION OF MESENTERY LESION

Facility

$10,347.00

Service Code	HCPCS 44820
Hospital Charge Code	1600000666
Hospital Revenue Code	360
Min. Negotiated Rate	$1,552.05
Max. Negotiated Rate	$1,552.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.05

EXCISION OF MESENTERY LESION

Facility

$10,347.00

Service Code	HCPCS 44820
Hospital Charge Code	1600000666
Hospital Revenue Code	360
Min. Negotiated Rate	$293.85
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,931.86
Rate for Payer: Aetna Medicare Advantage	$3,104.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,638.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,638.49
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	$2,638.49
Rate for Payer: Cigna Commercial	$5,173.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,690.22
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.05
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$326.97
Rate for Payer: Wellpoint Medicaid Managed Care	$293.85

EXCISION OF PENIS LESION(S)

Facility

$8,945.09

Service Code	HCPCS 54060
Hospital Charge Code	412354060
Hospital Revenue Code	361
Min. Negotiated Rate	$1,341.76
Max. Negotiated Rate	$1,341.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.76

EXCISION OF PENIS LESION(S)

Facility

$8,945.09

Service Code	HCPCS 54060
Hospital Charge Code	412354060
Hospital Revenue Code	361
Min. Negotiated Rate	$254.04
Max. Negotiated Rate	$8,891.84
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	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,891.84
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	$2,325.72
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.76
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$282.66
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	$254.04

EXCISION OF PENIS LESIONS

Facility

$10,771.05

Service Code	HCPCS 54060
Hospital Charge Code	1600000655
Hospital Revenue Code	360
Min. Negotiated Rate	$305.90
Max. Negotiated Rate	$8,891.84
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	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,891.84
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	$2,800.47
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$340.37
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	$305.90

EXCISION OF PENIS LESIONS

Facility

$10,771.05

Service Code	HCPCS 54060
Hospital Charge Code	1600000655
Hospital Revenue Code	360
Min. Negotiated Rate	$1,615.66
Max. Negotiated Rate	$1,615.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66

EXCISION PREPATELLAR BURSA

Facility

$19,467.90

Service Code	HCPCS 27340
Hospital Charge Code	16000560
Hospital Revenue Code	360
Min. Negotiated Rate	$552.89
Max. Negotiated Rate	$14,100.89
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	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
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	$5,061.65
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$615.19
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	$552.89

EXCISION PREPATELLAR BURSA

Facility

$19,467.90

Service Code	HCPCS 27340
Hospital Charge Code	16000560
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

EXCISOR FISCHER LARGE

Facility

$117.03

Hospital Charge Code	270654601
Hospital Revenue Code	272
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

EXCISOR FISCHER LARGE

Facility

$117.03

Hospital Charge Code	270654601
Hospital Revenue Code	272
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$58.52
Rate for Payer: Aetna Commercial	$44.47
Rate for Payer: Aetna Medicare Advantage	$35.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.43
Rate for Payer: Oxford Commercial	$23.41
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$23.41
Rate for Payer: UnitedHealthcare Community & State	$3.70
Rate for Payer: Wellpoint Medicaid Managed Care	$3.32

Know your out-of-pocket cost for care.

All Charges