Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FACTOR V

Facility

$384.00

Service Code	HCPCS 85220
Hospital Charge Code	38478035
Hospital Revenue Code	305
Min. Negotiated Rate	$10.91
Max. Negotiated Rate	$192.00
Rate for Payer: Aetna Commercial	$48.01
Rate for Payer: Aetna Medicare Advantage	$57.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.03
Rate for Payer: Cigna Commercial	$192.00
Rate for Payer: Cigna Medicare Advantage	$17.65
Rate for Payer: Clover Medicare Advantage	$16.77
Rate for Payer: EmblemHealth Commercial	$52.95
Rate for Payer: Humana Medicare Advantage	$18.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.84
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.65
Rate for Payer: Wellcare Medicare Advantage	$17.65
Rate for Payer: Wellpoint Medicaid Managed Care	$10.91

FACTOR V

Facility

$384.00

Service Code	HCPCS 85220
Hospital Charge Code	38478035
Hospital Revenue Code	305
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

FACTOR V ACTIVITY

Facility

$390.00

Service Code	HCPCS 85220
Hospital Charge Code	39900345
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR V ACTIVITY

Facility

$390.00

Service Code	HCPCS 85220
Hospital Charge Code	39900345
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.01
Rate for Payer: Aetna Medicare Advantage	$57.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.03
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.65
Rate for Payer: Clover Medicare Advantage	$16.77
Rate for Payer: EmblemHealth Commercial	$52.95
Rate for Payer: Humana Medicare Advantage	$18.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.65
Rate for Payer: Wellcare Medicare Advantage	$17.65
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR V,FUNCTIONAL

Facility

$121.30

Service Code	HCPCS 85220
Hospital Charge Code	39900156
Hospital Revenue Code	305
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$18.20
Rate for Payer: Qualcare PPO/HMO/WC	$18.20

FACTOR V,FUNCTIONAL

Facility

$121.30

Service Code	HCPCS 85220
Hospital Charge Code	39900156
Hospital Revenue Code	305
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.01
Rate for Payer: Aetna Medicare Advantage	$57.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.03
Rate for Payer: Cigna Commercial	$60.65
Rate for Payer: Cigna Medicare Advantage	$17.65
Rate for Payer: Clover Medicare Advantage	$16.77
Rate for Payer: EmblemHealth Commercial	$52.95
Rate for Payer: Humana Medicare Advantage	$18.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.65
Rate for Payer: Wellcare Medicare Advantage	$17.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

FACTOR VII ACTIVITY

Facility

$390.00

Service Code	HCPCS 85230
Hospital Charge Code	39900346
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR VII ACTIVITY

Facility

$390.00

Service Code	HCPCS 85230
Hospital Charge Code	39900346
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR VII-CLOTTING

Facility

$299.00

Service Code	HCPCS 85230
Hospital Charge Code	38478038
Hospital Revenue Code	305
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

FACTOR VII-CLOTTING

Facility

$299.00

Service Code	HCPCS 85230
Hospital Charge Code	38478038
Hospital Revenue Code	305
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

FACTOR VII,FUNCTIONAL

Facility

$123.05

Service Code	HCPCS 85230
Hospital Charge Code	39900157
Hospital Revenue Code	305
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$18.46
Rate for Payer: Qualcare PPO/HMO/WC	$18.46

FACTOR VII,FUNCTIONAL

Facility

$123.05

Service Code	HCPCS 85230
Hospital Charge Code	39900157
Hospital Revenue Code	305
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$61.52
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.99
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

FACTOR VIII ANTIGEN

Facility

$390.00

Service Code	HCPCS 85244
Hospital Charge Code	397073169
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$55.54
Rate for Payer: Aetna Medicare Advantage	$66.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.07
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.42
Rate for Payer: Clover Medicare Advantage	$19.40
Rate for Payer: EmblemHealth Commercial	$61.26
Rate for Payer: Humana Medicare Advantage	$21.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.42
Rate for Payer: Wellcare Medicare Advantage	$20.42
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR VIII ANTIGEN

Facility

$390.00

Service Code	HCPCS 85244
Hospital Charge Code	397073169
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR VIII,FUNCTIONAL

Facility

$123.05

Service Code	HCPCS 85240
Hospital Charge Code	39900158
Hospital Revenue Code	305
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$61.52
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.99
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

FACTOR VIII,FUNCTIONAL

Facility

$123.05

Service Code	HCPCS 85240
Hospital Charge Code	39900158
Hospital Revenue Code	305
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$18.46
Rate for Payer: Qualcare PPO/HMO/WC	$18.46

FACTOR VIII,ONE STAGE

Facility

$305.00

Service Code	HCPCS 85240
Hospital Charge Code	38479462
Hospital Revenue Code	305
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$152.50
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$8.66

FACTOR VIII,ONE STAGE

Facility

$305.00

Service Code	HCPCS 85240
Hospital Charge Code	38479462
Hospital Revenue Code	305
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$45.75
Rate for Payer: Qualcare PPO/HMO/WC	$45.75

FACTOR VIII,ONE STAGE

Facility

$252.00

Service Code	HCPCS 85240
Hospital Charge Code	38478059
Hospital Revenue Code	305
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$37.80

FACTOR VIII,ONE STAGE

Facility

$252.00

Service Code	HCPCS 85240
Hospital Charge Code	38478059
Hospital Revenue Code	305
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$126.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.16

FACTOR V (LEIDEN) MUTATIO

Facility

$390.00

Service Code	HCPCS 81241
Hospital Charge Code	39900017
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR V (LEIDEN) MUTATIO

Facility

$390.00

Service Code	HCPCS 81241
Hospital Charge Code	39900017
Hospital Revenue Code	310
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$266.15
Rate for Payer: Aetna Commercial	$199.57
Rate for Payer: Aetna Medicare Advantage	$237.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$73.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.15
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$73.37
Rate for Payer: Clover Medicare Advantage	$69.70
Rate for Payer: EmblemHealth Commercial	$220.11
Rate for Payer: Humana Medicare Advantage	$75.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$73.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$58.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$73.37
Rate for Payer: Wellcare Medicare Advantage	$73.37
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR X

Facility

$303.00

Service Code	HCPCS 85260
Hospital Charge Code	38478044
Hospital Revenue Code	305
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

FACTOR X

Facility

$303.00

Service Code	HCPCS 85260
Hospital Charge Code	38478044
Hospital Revenue Code	305
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

FACTOR X ACTIVITY

Facility

$390.00

Service Code	HCPCS 85260
Hospital Charge Code	39900349
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges