Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

THRMBC/NFS DIALYSIS CIRCUIT

Facility

IP

$20,340.00

Service Code	HCPCS 36904
Hospital Charge Code	16000951
Hospital Revenue Code	360
Min. Negotiated Rate	$3,051.00
Max. Negotiated Rate	$3,051.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00

THROAT & NOSE CULTURE

Facility

IP

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475068
Hospital Revenue Code	306
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

THROAT & NOSE CULTURE

Facility

OP

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475068
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$174.50
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
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	$31.27
Rate for Payer: Cigna Commercial	$174.50
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.91

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

IP

$24,115.80

Service Code	HCPCS 36904
Hospital Charge Code	5100838
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

IP

$24,115.80

Service Code	HCPCS 36904
Hospital Charge Code	366836904
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

OP

$24,115.80

Service Code	HCPCS 36904
Hospital Charge Code	366836904
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

OP

$24,115.80

Service Code	HCPCS 36904
Hospital Charge Code	5100838
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

IP

$27,397.00

Service Code	HCPCS 36904
Hospital Charge Code	321036904
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

IP

$24,115.80

Service Code	HCPCS 36904
Hospital Charge Code	2709025
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

OP

$24,115.80

Service Code	HCPCS 36904
Hospital Charge Code	2709025
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

IP

$27,397.00

Service Code	HCPCS 36904
Hospital Charge Code	2692148
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

IP

$24,115.80

Service Code	HCPCS 36904
Hospital Charge Code	7412059
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

OP

$27,397.00

Service Code	HCPCS 36904
Hospital Charge Code	2692148
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

OP

$27,397.00

Service Code	HCPCS 36904
Hospital Charge Code	321036904
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

THROMBECTOMY/LYSIS DIALYS CIRC

Facility

OP

$24,115.80

Service Code	HCPCS 36904
Hospital Charge Code	7412059
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

THROMBECTOMY SET 4FR SOLENT

Facility

OP

$10,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270650590S
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

THROMBECTOMY SET 4FR SOLENT

Facility

IP

$10,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270650590S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

THROMBECTOMY SET 4FR SOLENT

Facility

OP

$2,240.00

Service Code	HCPCS C1757
Hospital Charge Code	270650590N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.62
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$851.20
Rate for Payer: Aetna Medicare Advantage	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$571.20
Rate for Payer: Cigna Commercial	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: Qualcare PPO/HMO/WC	$336.00
Rate for Payer: UnitedHealthcare Community & State	$70.78
Rate for Payer: Wellpoint Medicaid Managed Care	$63.62

THROMBECTOMY SET 4FR SOLENT

Facility

IP

$2,240.00

Service Code	HCPCS C1757
Hospital Charge Code	270650590N
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$542.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: Qualcare PPO/HMO/WC	$336.00

THROMBECTOMY SET 4FR SOLENT

Facility

OP

$10,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270650590
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

THROMBECTOMY SET 4FR SOLENT

Facility

IP

$10,000.00

Service Code	HCPCS C1757
Hospital Charge Code	270650590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

THROMBECTOMY SET SOLENT OMNI U

Facility

OP

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590
Hospital Revenue Code	278
Min. Negotiated Rate	$239.98
Max. Negotiated Rate	$4,225.00
Rate for Payer: Aetna Commercial	$3,211.00
Rate for Payer: Aetna Medicare Advantage	$2,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,154.75
Rate for Payer: Cigna Commercial	$4,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50
Rate for Payer: UnitedHealthcare Community & State	$267.02
Rate for Payer: Wellpoint Medicaid Managed Care	$239.98

THROMBECTOMY SET SOLENT OMNI U

Facility

OP

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590S
Hospital Revenue Code	278
Min. Negotiated Rate	$239.98
Max. Negotiated Rate	$4,225.00
Rate for Payer: Aetna Commercial	$3,211.00
Rate for Payer: Aetna Medicare Advantage	$2,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,154.75
Rate for Payer: Cigna Commercial	$4,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50
Rate for Payer: UnitedHealthcare Community & State	$267.02
Rate for Payer: Wellpoint Medicaid Managed Care	$239.98

THROMBECTOMY SET SOLENT OMNI U

Facility

IP

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,267.50
Max. Negotiated Rate	$2,044.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50

THROMBECTOMY SET SOLENT OMNI U

Facility

OP

$9,600.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590N
Hospital Revenue Code	278
Min. Negotiated Rate	$272.64
Max. Negotiated Rate	$4,800.00
Rate for Payer: Aetna Commercial	$3,648.00
Rate for Payer: Aetna Medicare Advantage	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,920.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,448.00
Rate for Payer: Cigna Commercial	$4,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,323.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,440.00
Rate for Payer: UnitedHealthcare Community & State	$303.36
Rate for Payer: Wellpoint Medicaid Managed Care	$272.64