Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MYCOPHENOLATE CAP 250MG

Facility

$57.42

Service Code	HCPCS J7517
Hospital Charge Code	60628535
Hospital Revenue Code	636
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$28.71
Rate for Payer: Aetna Commercial	$21.82
Rate for Payer: Aetna Medicare Advantage	$17.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.64
Rate for Payer: Cigna Commercial	$28.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.61
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

MYCOPHENOLATE SODIUM TAB 180MG

Facility

$30.62

Service Code	HCPCS J7518
Hospital Charge Code	606390560
Hospital Revenue Code	636
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$7.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

MYCOPHENOLATE SODIUM TAB 180MG

Facility

$30.62

Service Code	HCPCS J7518
Hospital Charge Code	606390560
Hospital Revenue Code	636
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$15.31
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$9.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.81
Rate for Payer: Cigna Commercial	$15.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

MYCOPHENOLIC ACID

Facility

$208.00

Service Code	HCPCS 83789
Hospital Charge Code	38472300
Hospital Revenue Code	301
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.46
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.08
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.91

MYCOPHENOLIC ACID

Facility

$208.00

Service Code	HCPCS 83789
Hospital Charge Code	38472300
Hospital Revenue Code	301
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

MYCOPHENOLIC ACID

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900317
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOPHENOLIC ACID

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900317
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
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	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MYCOPHENOLIC ACID 360MG

Facility

$67.00

Service Code	NDC 68084091825
Hospital Charge Code	606390190
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.42
Rate for Payer: Oxford Commercial	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$13.40
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.90

MYCOPHENOLIC ACID 360MG

Facility

$67.00

Service Code	NDC 68084091825
Hospital Charge Code	606390190
Hospital Revenue Code	250
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

MYCOSTATIN/500KU/TAB

Facility

$9.51

Service Code	NDC 93098301
Hospital Charge Code	60633476
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$3.61
Rate for Payer: Aetna Medicare Advantage	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.43
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$1.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$1.90
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

MYCOSTATIN/500KU/TAB

Facility

$9.51

Service Code	NDC 93098301
Hospital Charge Code	60633476
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

MYELIN BASIC PROTEIN

Facility

$390.00

Service Code	HCPCS 83873
Hospital Charge Code	39900109
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.78
Rate for Payer: Aetna Medicare Advantage	$55.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.20
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	$62.39
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.20
Rate for Payer: Clover Medicare Advantage	$16.34
Rate for Payer: EmblemHealth Commercial	$51.60
Rate for Payer: Humana Medicare Advantage	$17.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.20
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	$13.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.20
Rate for Payer: Wellcare Medicare Advantage	$17.20
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MYELIN BASIC PROTEIN

Facility

$390.00

Service Code	HCPCS 83873
Hospital Charge Code	39900109
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYELIN BASIC PROTEIN,CSF

Facility

$291.00

Service Code	HCPCS 83873
Hospital Charge Code	38472749
Hospital Revenue Code	301
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$46.78
Rate for Payer: Aetna Medicare Advantage	$55.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.20
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	$62.39
Rate for Payer: Cigna Commercial	$145.50
Rate for Payer: Cigna Medicare Advantage	$17.20
Rate for Payer: Clover Medicare Advantage	$16.34
Rate for Payer: EmblemHealth Commercial	$51.60
Rate for Payer: Humana Medicare Advantage	$17.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.20
Rate for Payer: Wellcare Medicare Advantage	$17.20
Rate for Payer: Wellpoint Medicaid Managed Care	$8.26

MYELIN BASIC PROTEIN,CSF

Facility

$291.00

Service Code	HCPCS 83873
Hospital Charge Code	38472749
Hospital Revenue Code	301
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$43.65
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

MYELOGRAM INJ; SPINAL NOT C1-C

Facility

$2,994.91

Service Code	HCPCS 62284
Hospital Charge Code	16001016
Hospital Revenue Code	360
Min. Negotiated Rate	$94.64
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,138.07
Rate for Payer: Aetna Medicare Advantage	$898.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$763.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$763.70
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	$763.70
Rate for Payer: Cigna Commercial	$1,497.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.68
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$449.24
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$94.64

MYELOGRAM INJ; SPINAL NOT C1-C

Facility

$2,994.91

Service Code	HCPCS 62284
Hospital Charge Code	16001016
Hospital Revenue Code	360
Min. Negotiated Rate	$449.24
Max. Negotiated Rate	$449.24
Rate for Payer: Qualcare PPO/HMO/WC	$449.24

MYELOPEROXIDASE AB

Facility

$390.00

Service Code	HCPCS 86021
Hospital Charge Code	39900188
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
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	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MYELOPEROXIDASE AB

Facility

$390.00

Service Code	HCPCS 86021
Hospital Charge Code	39900188
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYELOPEROXIDASE (MPO)

Facility

$239.00

Service Code	HCPCS 83876
Hospital Charge Code	38477190
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$184.49
Rate for Payer: Aetna Commercial	$138.34
Rate for Payer: Aetna Medicare Advantage	$164.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$50.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.49
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$50.86
Rate for Payer: Clover Medicare Advantage	$48.32
Rate for Payer: EmblemHealth Commercial	$152.58
Rate for Payer: Humana Medicare Advantage	$52.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$50.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$40.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.86
Rate for Payer: Wellcare Medicare Advantage	$50.86
Rate for Payer: Wellpoint Medicaid Managed Care	$6.79

MYELOPEROXIDASE (MPO)

Facility

$239.00

Service Code	HCPCS 83876
Hospital Charge Code	38477190
Hospital Revenue Code	301
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$92,483.70

Service Code	MSDRG 827
Min. Negotiated Rate	$28,160.10
Max. Negotiated Rate	$92,483.70
Rate for Payer: Aetna Commercial	$67,726.46
Rate for Payer: Aetna Medicare Advantage	$92,483.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64,275.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64,275.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29,642.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64,275.60
Rate for Payer: Cigna Commercial	$51,523.58
Rate for Payer: Cigna Medicare Advantage	$29,642.21
Rate for Payer: Clover Medicare Advantage	$28,160.10
Rate for Payer: EmblemHealth Commercial	$88,926.63
Rate for Payer: Humana Medicare Advantage	$30,531.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29,642.21
Rate for Payer: Oxford Commercial	$40,723.34
Rate for Payer: UnitedHealthcare Commercial	$54,509.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$29,642.21
Rate for Payer: Wellcare Medicare Advantage	$29,642.21

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$167,253.03

Service Code	MSDRG 826
Min. Negotiated Rate	$50,926.40
Max. Negotiated Rate	$167,253.03
Rate for Payer: Aetna Commercial	$120,978.04
Rate for Payer: Aetna Medicare Advantage	$167,253.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128,274.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128,274.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$53,606.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128,274.15
Rate for Payer: Cigna Commercial	$104,282.20
Rate for Payer: Cigna Medicare Advantage	$53,606.74
Rate for Payer: Clover Medicare Advantage	$50,926.40
Rate for Payer: EmblemHealth Commercial	$160,820.22
Rate for Payer: Humana Medicare Advantage	$55,214.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$53,606.74
Rate for Payer: Oxford Commercial	$82,422.84
Rate for Payer: UnitedHealthcare Commercial	$110,325.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$53,606.74
Rate for Payer: Wellcare Medicare Advantage	$53,606.74

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$73,293.76

Service Code	MSDRG 828
Min. Negotiated Rate	$22,317.01
Max. Negotiated Rate	$73,293.76
Rate for Payer: Aetna Commercial	$54,059.17
Rate for Payer: Aetna Medicare Advantage	$73,293.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,436.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,436.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,491.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,436.20
Rate for Payer: Cigna Commercial	$37,982.81
Rate for Payer: Cigna Medicare Advantage	$23,491.59
Rate for Payer: Clover Medicare Advantage	$22,317.01
Rate for Payer: EmblemHealth Commercial	$70,474.77
Rate for Payer: Humana Medicare Advantage	$24,196.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,491.59
Rate for Payer: Oxford Commercial	$30,020.96
Rate for Payer: UnitedHealthcare Commercial	$40,184.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,491.59
Rate for Payer: Wellcare Medicare Advantage	$23,491.59

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$119,300.25

Service Code	MSDRG 829
Min. Negotiated Rate	$36,325.40
Max. Negotiated Rate	$119,300.25
Rate for Payer: Aetna Commercial	$86,825.52
Rate for Payer: Aetna Medicare Advantage	$119,300.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87,270.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87,270.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38,237.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87,270.75
Rate for Payer: Cigna Commercial	$70,445.88
Rate for Payer: Cigna Medicare Advantage	$38,237.26
Rate for Payer: Clover Medicare Advantage	$36,325.40
Rate for Payer: EmblemHealth Commercial	$114,711.78
Rate for Payer: Humana Medicare Advantage	$39,384.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38,237.26
Rate for Payer: Oxford Commercial	$55,679.20
Rate for Payer: UnitedHealthcare Commercial	$74,528.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$38,237.26
Rate for Payer: Wellcare Medicare Advantage	$38,237.26

Know your out-of-pocket cost for care.

All Charges