Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OPN TX GRTER HMRL TUBER FRAC

Facility

$63,943.60

Service Code	HCPCS 23630
Hospital Charge Code	16000679
Hospital Revenue Code	360
Min. Negotiated Rate	$1,816.00
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,625.34
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$2,020.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,816.00

OPN TX GRTER HMRL TUBER FRAC

Facility

$63,943.60

Service Code	HCPCS 23630
Hospital Charge Code	16000679
Hospital Revenue Code	360
Min. Negotiated Rate	$9,591.54
Max. Negotiated Rate	$9,591.54
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54

OPN TXGTR TROCHANTEC FRACT RT

Facility

$8,380.30

Service Code	HCPCS 27248
Hospital Charge Code	1600000598
Hospital Revenue Code	360
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.88
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,257.05
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$264.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$238.00

OPN TXGTR TROCHANTEC FRACT RT

Facility

$8,380.30

Service Code	HCPCS 27248
Hospital Charge Code	1600000598
Hospital Revenue Code	360
Min. Negotiated Rate	$1,257.05
Max. Negotiated Rate	$1,257.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,257.05

OPN TX RADIAL HEAD/NCK FRCT RT

Facility

$48,992.10

Service Code	HCPCS 24665
Hospital Charge Code	16000685
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

OPN TX RADIAL HEAD/NCK FRCT RT

Facility

$48,992.10

Service Code	HCPCS 24665
Hospital Charge Code	16000685
Hospital Revenue Code	360
Min. Negotiated Rate	$1,391.38
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,737.95
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,548.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,391.38

OPN TX RDCPL/INTCRPL DISLC1+BN

Facility

$23,899.60

Service Code	HCPCS 25670
Hospital Charge Code	16000695
Hospital Revenue Code	360
Min. Negotiated Rate	$3,584.94
Max. Negotiated Rate	$3,584.94
Rate for Payer: Qualcare PPO/HMO/WC	$3,584.94

OPN TX RDCPL/INTCRPL DISLC1+BN

Facility

$23,899.60

Service Code	HCPCS 25670
Hospital Charge Code	16000695
Hospital Revenue Code	360
Min. Negotiated Rate	$678.75
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,213.90
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,584.94
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$755.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$678.75

OPN TX TIBIAL FX PROXIM,BICOND

Facility

$13,433.90

Service Code	HCPCS 27536
Hospital Charge Code	1600000685
Hospital Revenue Code	360
Min. Negotiated Rate	$381.52
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,492.81
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,015.09
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$424.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$381.52

OPN TX TIBIAL FX PROXIM,BICOND

Facility

$13,433.90

Service Code	HCPCS 27536
Hospital Charge Code	1600000685
Hospital Revenue Code	360
Min. Negotiated Rate	$2,015.09
Max. Negotiated Rate	$2,015.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,015.09

OPN TX TIBL FRACT PRX UNICND

Facility

$14,933.10

Service Code	HCPCS 27535
Hospital Charge Code	16000623
Hospital Revenue Code	360
Min. Negotiated Rate	$2,239.97
Max. Negotiated Rate	$2,239.97
Rate for Payer: Qualcare PPO/HMO/WC	$2,239.97

OPN TX TIBL FRACT PRX UNICND

Facility

$14,933.10

Service Code	HCPCS 27535
Hospital Charge Code	16000623
Hospital Revenue Code	360
Min. Negotiated Rate	$424.10
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,882.61
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,239.97
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$471.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$424.10

OPN TX ULNAR FRAC PROXIMAL END

Facility

$48,992.10

Service Code	HCPCS 24685
Hospital Charge Code	16000377
Hospital Revenue Code	360
Min. Negotiated Rate	$1,391.38
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,737.95
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,548.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,391.38

OPN TX ULNAR FRAC PROXIMAL END

Facility

$48,992.10

Service Code	HCPCS 24685
Hospital Charge Code	16000377
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

OP/PERC TX TIB SHAFT FX BY IM

Facility

$84,627.62

Service Code	HCPCS 27759
Hospital Charge Code	1600000541
Hospital Revenue Code	360
Min. Negotiated Rate	$12,694.14
Max. Negotiated Rate	$12,694.14
Rate for Payer: Qualcare PPO/HMO/WC	$12,694.14

OP/PERC TX TIB SHAFT FX BY IM

Facility

$84,627.62

Service Code	HCPCS 27759
Hospital Charge Code	1600000541
Hospital Revenue Code	360
Min. Negotiated Rate	$2,403.42
Max. Negotiated Rate	$55,329.13
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,329.13
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,003.18
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,694.14
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$2,674.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2,403.42

OPRELVEKIN 5 MG INJ

Facility

$1,968.19

Service Code	HCPCS J2355
Hospital Charge Code	60629001
Hospital Revenue Code	636
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$984.10
Rate for Payer: Aetna Commercial	$747.91
Rate for Payer: Aetna Medicare Advantage	$590.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.89
Rate for Payer: Cigna Commercial	$984.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.30
Rate for Payer: Qualcare PPO/HMO/WC	$295.23
Rate for Payer: UnitedHealthcare Community & State	$62.19
Rate for Payer: Wellpoint Medicaid Managed Care	$55.90

OPRELVEKIN 5 MG INJ

Facility

$1,968.19

Service Code	HCPCS J2355
Hospital Charge Code	60629001
Hospital Revenue Code	636
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$476.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.30
Rate for Payer: Qualcare PPO/HMO/WC	$295.23

OPTEFIL 1CC SYRINGE

Facility

$624.00

Hospital Charge Code	270332652
Hospital Revenue Code	278
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$151.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: Qualcare PPO/HMO/WC	$93.60

OPTEFIL 1CC SYRINGE

Facility

$624.00

Hospital Charge Code	270332652
Hospital Revenue Code	278
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$237.12
Rate for Payer: Aetna Medicare Advantage	$187.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.12
Rate for Payer: Cigna Commercial	$312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: Qualcare PPO/HMO/WC	$93.60
Rate for Payer: UnitedHealthcare Community & State	$19.72
Rate for Payer: Wellpoint Medicaid Managed Care	$17.72

OPTEFIL 5CC SYRINGE

Facility

$2,703.00

Hospital Charge Code	270332653
Hospital Revenue Code	278
Min. Negotiated Rate	$76.77
Max. Negotiated Rate	$1,351.50
Rate for Payer: Aetna Commercial	$1,027.14
Rate for Payer: Aetna Medicare Advantage	$810.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$689.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$689.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$689.26
Rate for Payer: Cigna Commercial	$1,351.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.13
Rate for Payer: Qualcare PPO/HMO/WC	$405.45
Rate for Payer: UnitedHealthcare Community & State	$85.41
Rate for Payer: Wellpoint Medicaid Managed Care	$76.77

OPTEFIL 5CC SYRINGE

Facility

$2,703.00

Hospital Charge Code	270332653
Hospital Revenue Code	278
Min. Negotiated Rate	$405.45
Max. Negotiated Rate	$654.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.13
Rate for Payer: Qualcare PPO/HMO/WC	$405.45

OPTEFORM ALLOGRAFT 3x20MM

Facility

$1,650.00

Service Code	HCPCS C1762
Hospital Charge Code	270674250
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

OPTEFORM ALLOGRAFT 3x20MM

Facility

$1,650.00

Service Code	HCPCS C1762
Hospital Charge Code	270674250
Hospital Revenue Code	278
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$52.14
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

OPTEFORM ALLOGRAFT 3x20MM

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270681387
Hospital Revenue Code	278
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$52.14
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

Know your out-of-pocket cost for care.

All Charges