Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

UNLSTD LAPAROSCOPY HERNIA PROC

Facility

$17,954.72

Service Code	HCPCS 49659
Hospital Charge Code	16000166
Hospital Revenue Code	360
Min. Negotiated Rate	$509.91
Max. Negotiated Rate	$26,053.61
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,053.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,053.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$26,053.61
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,668.23
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,693.21
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$567.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$509.91

UNLSTD LAPAROSCOPY HERNIA PROC

Facility

$17,954.72

Service Code	HCPCS 49659
Hospital Charge Code	16000166
Hospital Revenue Code	360
Min. Negotiated Rate	$2,693.21
Max. Negotiated Rate	$2,693.21
Rate for Payer: Qualcare PPO/HMO/WC	$2,693.21

UNLSTD MUSCULOSKELTL SYSTEM OP

Facility

$11,149.60

Service Code	HCPCS 20999
Hospital Charge Code	16000322
Hospital Revenue Code	360
Min. Negotiated Rate	$278.40
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,063.04
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,898.90
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,672.44
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$352.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$316.65

UNLSTD MUSCULOSKELTL SYSTEM OP

Facility

$11,149.60

Service Code	HCPCS 20999
Hospital Charge Code	16000322
Hospital Revenue Code	360
Min. Negotiated Rate	$1,672.44
Max. Negotiated Rate	$1,672.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,672.44

UNLSTD PROC DENTOALVEOLAR STRT

Facility

$8,124.18

Service Code	HCPCS 41899
Hospital Charge Code	16000741
Hospital Revenue Code	360
Min. Negotiated Rate	$1,218.63
Max. Negotiated Rate	$1,218.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.63

UNLSTD PROC DENTOALVEOLAR STRT

Facility

$8,124.18

Service Code	HCPCS 41899
Hospital Charge Code	16000741
Hospital Revenue Code	360
Min. Negotiated Rate	$230.73
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
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	$1,020.71
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,112.29
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.63
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$256.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$230.73

UNLSTD PROCD PHARYNX ADENOIDS

Facility

$1,129.88

Service Code	HCPCS 42999
Hospital Charge Code	16000585
Hospital Revenue Code	360
Min. Negotiated Rate	$169.48
Max. Negotiated Rate	$169.48
Rate for Payer: Qualcare PPO/HMO/WC	$169.48

UNLSTD PROCD PHARYNX ADENOIDS

Facility

$1,129.88

Service Code	HCPCS 42999
Hospital Charge Code	16000585
Hospital Revenue Code	360
Min. Negotiated Rate	$32.09
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
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	$1,020.71
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.77
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$169.48
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$35.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$32.09

UNLSTD PROCEDRE PELVIS/HIP JNT

Facility

$19,503.55

Service Code	HCPCS 27299
Hospital Charge Code	16000876
Hospital Revenue Code	360
Min. Negotiated Rate	$278.40
Max. Negotiated Rate	$5,070.92
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,063.04
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,070.92
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.53
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$616.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$553.90

UNLSTD PROCEDRE PELVIS/HIP JNT

Facility

$19,503.55

Service Code	HCPCS 27299
Hospital Charge Code	16000876
Hospital Revenue Code	360
Min. Negotiated Rate	$2,925.53
Max. Negotiated Rate	$2,925.53
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.53

UNLSTD PROCEDURE FOREARM /WST

Facility

$859.60

Service Code	HCPCS 25999
Hospital Charge Code	16000698
Hospital Revenue Code	360
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,063.04
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.50
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.94
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$27.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$24.41

UNLSTD PROCEDURE FOREARM /WST

Facility

$859.60

Service Code	HCPCS 25999
Hospital Charge Code	16000698
Hospital Revenue Code	360
Min. Negotiated Rate	$128.94
Max. Negotiated Rate	$128.94
Rate for Payer: Qualcare PPO/HMO/WC	$128.94

UNLSTD PROCEDURE HANDS /FINGER

Facility

$1,007.96

Service Code	HCPCS 26989
Hospital Charge Code	16000363
Hospital Revenue Code	360
Min. Negotiated Rate	$28.63
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,063.04
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.07
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$151.19
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$31.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$28.63

UNLSTD PROCEDURE HANDS /FINGER

Facility

$1,007.96

Service Code	HCPCS 26989
Hospital Charge Code	16000363
Hospital Revenue Code	360
Min. Negotiated Rate	$151.19
Max. Negotiated Rate	$151.19
Rate for Payer: Qualcare PPO/HMO/WC	$151.19

UNLSTD PROCEDURE LEG OR ANKLE

Facility

$859.60

Service Code	HCPCS 27899
Hospital Charge Code	16000415
Hospital Revenue Code	360
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,063.04
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.50
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.94
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$27.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$24.41

UNLSTD PROCEDURE LEG OR ANKLE

Facility

$859.60

Service Code	HCPCS 27899
Hospital Charge Code	16000415
Hospital Revenue Code	360
Min. Negotiated Rate	$128.94
Max. Negotiated Rate	$128.94
Rate for Payer: Qualcare PPO/HMO/WC	$128.94

UNLSTD PROCEDURE LUNGS&PLEURA

Facility

$2,450.28

Service Code	HCPCS 32999
Hospital Charge Code	1600000513
Hospital Revenue Code	360
Min. Negotiated Rate	$367.54
Max. Negotiated Rate	$367.54
Rate for Payer: Qualcare PPO/HMO/WC	$367.54

UNLSTD PROCEDURE LUNGS&PLEURA

Facility

$2,450.28

Service Code	HCPCS 32999
Hospital Charge Code	1600000513
Hospital Revenue Code	360
Min. Negotiated Rate	$69.59
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,703.39
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$637.07
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.54
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$77.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$69.59

UNLSTD PROCEDURE,NERVOUS-SYSTM

Facility

$5,954.30

Service Code	HCPCS 64999
Hospital Charge Code	160000243
Hospital Revenue Code	360
Min. Negotiated Rate	$169.10
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.12
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$893.14
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$188.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$169.10

UNLSTD PROCEDURE,NERVOUS-SYSTM

Facility

$5,954.30

Service Code	HCPCS 64999
Hospital Charge Code	160000243
Hospital Revenue Code	360
Min. Negotiated Rate	$893.14
Max. Negotiated Rate	$893.14
Rate for Payer: Qualcare PPO/HMO/WC	$893.14

UNLSTD PROCEDURE UNARY SYSTEM

Facility

$918.12

Service Code	HCPCS 53899
Hospital Charge Code	16000460
Hospital Revenue Code	360
Min. Negotiated Rate	$137.72
Max. Negotiated Rate	$137.72
Rate for Payer: Qualcare PPO/HMO/WC	$137.72

UNLSTD PROCEDURE UNARY SYSTEM

Facility

$918.12

Service Code	HCPCS 53899
Hospital Charge Code	16000460
Hospital Revenue Code	360
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
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	$1,076.75
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.71
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$137.72
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$29.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$26.07

UNLSTD PROC FEMALE GENITAL SYS

Facility

$642.80

Service Code	HCPCS 58999
Hospital Charge Code	16001011
Hospital Revenue Code	360
Min. Negotiated Rate	$18.26
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
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	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.13
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.42
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$20.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$18.26

UNLSTD PROC FEMALE GENITAL SYS

Facility

$642.80

Service Code	HCPCS 58999
Hospital Charge Code	16001011
Hospital Revenue Code	360
Min. Negotiated Rate	$96.42
Max. Negotiated Rate	$96.42
Rate for Payer: Qualcare PPO/HMO/WC	$96.42

UNLSTD PROC SKIN MM & SQ TISS

Facility

$5,068.40

Service Code	HCPCS 17999
Hospital Charge Code	16000262
Hospital Revenue Code	360
Min. Negotiated Rate	$760.26
Max. Negotiated Rate	$760.26
Rate for Payer: Qualcare PPO/HMO/WC	$760.26

Know your out-of-pocket cost for care.

All Charges