Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TBA PERIPH DIALYSIS SEGMENT

Facility

$24,115.80

Service Code	HCPCS 36902
Hospital Charge Code	2709023
Hospital Revenue Code	361
Min. Negotiated Rate	$684.89
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,270.11
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$762.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$684.89

TBA PERIPH DIALYSIS SEGMENT

Facility

$24,115.80

Service Code	HCPCS 36902
Hospital Charge Code	2709023
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA PERIPH DIALYSIS SEGMENT

Facility

$24,115.80

Service Code	HCPCS 36902
Hospital Charge Code	7412057
Hospital Revenue Code	361
Min. Negotiated Rate	$684.89
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,270.11
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$762.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$684.89

TBA PERIPH DIALYSIS SEGMENT

Facility

$24,115.80

Service Code	HCPCS 36902
Hospital Charge Code	366836902
Hospital Revenue Code	361
Min. Negotiated Rate	$684.89
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,270.11
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$762.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$684.89

TBA PERIPH DIALYSIS SEGMENT

Facility

$24,115.80

Service Code	HCPCS 36902
Hospital Charge Code	366836902
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA PERIPH DIALYSIS SEGMENT

Facility

$27,397.00

Service Code	HCPCS 36902
Hospital Charge Code	2692128
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

TBA PERIPH DIALYSIS SEGMENT

Facility

$24,115.80

Service Code	HCPCS 36902
Hospital Charge Code	7412057
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA PERIPH DIALYSIS SEGMENT

Facility

$27,397.00

Service Code	HCPCS 36902
Hospital Charge Code	321036902
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

TBA PERIPH DIALYSIS SEGMENT

Facility

$27,397.00

Service Code	HCPCS 36902
Hospital Charge Code	321036902
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

TBG

Facility

$390.00

Service Code	HCPCS 84442
Hospital Charge Code	39900140
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.20
Rate for Payer: Aetna Medicare Advantage	$47.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.61
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.78
Rate for Payer: Clover Medicare Advantage	$14.04
Rate for Payer: EmblemHealth Commercial	$44.34
Rate for Payer: Humana Medicare Advantage	$15.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.78
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	$11.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.78
Rate for Payer: Wellcare Medicare Advantage	$14.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TBG

Facility

$390.00

Service Code	HCPCS 84442
Hospital Charge Code	39900140
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TBII

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900097
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.75
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
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	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TBII

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900097
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TBI N6 TRIATH TS PL X3 N6 9MM

Facility

$5,821.00

Service Code	HCPCS C1776
Hospital Charge Code	270694173
Hospital Revenue Code	278
Min. Negotiated Rate	$873.15
Max. Negotiated Rate	$1,408.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,164.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,408.68
Rate for Payer: Qualcare PPO/HMO/WC	$873.15

TBI N6 TRIATH TS PL X3 N6 9MM

Facility

$5,821.00

Service Code	HCPCS C1776
Hospital Charge Code	270694173
Hospital Revenue Code	278
Min. Negotiated Rate	$165.32
Max. Negotiated Rate	$2,910.50
Rate for Payer: Aetna Commercial	$2,211.98
Rate for Payer: Aetna Medicare Advantage	$1,746.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,484.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,484.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,164.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,484.36
Rate for Payer: Cigna Commercial	$2,910.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,408.68
Rate for Payer: Qualcare PPO/HMO/WC	$873.15
Rate for Payer: UnitedHealthcare Community & State	$183.94
Rate for Payer: Wellpoint Medicaid Managed Care	$165.32

TBI PS SZ3 10MM

Facility

$5,212.45

Service Code	HCPCS C1776
Hospital Charge Code	270699195
Hospital Revenue Code	278
Min. Negotiated Rate	$781.87
Max. Negotiated Rate	$1,261.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.41
Rate for Payer: Qualcare PPO/HMO/WC	$781.87

TBI PS SZ3 10MM

Facility

$5,212.45

Service Code	HCPCS C1776
Hospital Charge Code	270699195
Hospital Revenue Code	278
Min. Negotiated Rate	$148.03
Max. Negotiated Rate	$2,606.22
Rate for Payer: Aetna Commercial	$1,980.73
Rate for Payer: Aetna Medicare Advantage	$1,563.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,329.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,329.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,329.17
Rate for Payer: Cigna Commercial	$2,606.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.41
Rate for Payer: Qualcare PPO/HMO/WC	$781.87
Rate for Payer: UnitedHealthcare Community & State	$164.71
Rate for Payer: Wellpoint Medicaid Managed Care	$148.03

TBI TRIATHLON CS SZ 5 10MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697224
Hospital Revenue Code	278
Min. Negotiated Rate	$141.58
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,894.41
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$157.54
Rate for Payer: Wellpoint Medicaid Managed Care	$141.58

TBI TRIATHLON CS SZ 5 10MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697224
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TBI TRIATHLON CS SZ 8

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695714
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON CS SZ 8

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695714
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TBI TRIATHLON SZ4 CS 14MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270698940
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON SZ4 CS 14MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270698940
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TBI TRIATHLON X3 SZ 2 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695587
Hospital Revenue Code	278
Min. Negotiated Rate	$144.34
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$160.60
Rate for Payer: Wellpoint Medicaid Managed Care	$144.34

TBI TRIATHLON X3 SZ 2 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695587
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

Know your out-of-pocket cost for care.

All Charges