Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CLSD TX RADIAL HEAD/NECK W/MAN

Facility

$7,112.55

Service Code	HCPCS 24655
Hospital Charge Code	5780050
Hospital Revenue Code	450
Min. Negotiated Rate	$1,066.88
Max. Negotiated Rate	$1,066.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,066.88

CLSD TX RADIAL HEAD/NECK W/MAN

Facility

$7,112.55

Service Code	HCPCS 24655
Hospital Charge Code	5780050
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,849.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,066.88
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$202.00

CLSD TX TARSAL BONE W/MANIP

Facility

$645.00

Service Code	HCPCS 28455
Hospital Charge Code	5780100
Hospital Revenue Code	450
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.70
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$18.32

CLSD TX TARSAL BONE W/MANIP

Facility

$645.00

Service Code	HCPCS 28455
Hospital Charge Code	5780100
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CLSD TX ULNR FRAC PRXM END WO

Facility

$6,152.64

Service Code	HCPCS 24675
Hospital Charge Code	16000686
Hospital Revenue Code	360
Min. Negotiated Rate	$174.73
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,599.69
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$922.90
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$194.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$174.73

CLSD TX ULNR FRAC PRXM END WO

Facility

$6,152.64

Service Code	HCPCS 24675
Hospital Charge Code	16000686
Hospital Revenue Code	360
Min. Negotiated Rate	$922.90
Max. Negotiated Rate	$922.90
Rate for Payer: Qualcare PPO/HMO/WC	$922.90

CLS ENTEROSTOMY LG/SM INTESTIN

Facility

$9,689.00

Service Code	HCPCS 44620
Hospital Charge Code	16000977
Hospital Revenue Code	360
Min. Negotiated Rate	$1,453.35
Max. Negotiated Rate	$1,453.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.35

CLS ENTEROSTOMY LG/SM INTESTIN

Facility

$9,689.00

Service Code	HCPCS 44620
Hospital Charge Code	16000977
Hospital Revenue Code	360
Min. Negotiated Rate	$275.17
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,681.82
Rate for Payer: Aetna Medicare Advantage	$2,906.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,470.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,470.70
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	$2,470.70
Rate for Payer: Cigna Commercial	$4,844.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,519.14
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.35
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$306.17
Rate for Payer: Wellpoint Medicaid Managed Care	$275.17

CLS ENTERSTMY,W RESECT&ANASTOM

Facility

$11,385.30

Service Code	HCPCS 44625
Hospital Charge Code	16000978
Hospital Revenue Code	360
Min. Negotiated Rate	$323.34
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$4,326.41
Rate for Payer: Aetna Medicare Advantage	$3,415.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,903.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,903.25
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	$2,903.25
Rate for Payer: Cigna Commercial	$5,692.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,960.18
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,707.80
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$359.78
Rate for Payer: Wellpoint Medicaid Managed Care	$323.34

CLS ENTERSTMY,W RESECT&ANASTOM

Facility

$11,385.30

Service Code	HCPCS 44625
Hospital Charge Code	16000978
Hospital Revenue Code	360
Min. Negotiated Rate	$1,707.80
Max. Negotiated Rate	$1,707.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,707.80

CL TX ARTCLR FX W/O MANIPUL

Facility

$645.00

Service Code	HCPCS 26740
Hospital Charge Code	5780075
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

CL TX ARTCLR FX W/O MANIPUL

Facility

$645.00

Service Code	HCPCS 26740
Hospital Charge Code	5780075
Hospital Revenue Code	450
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$1,063.04
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	$66.99
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	$167.70
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$18.32

CL TX ARTFX MCP/IP JNT; W MANI

Facility

$6,353.84

Service Code	HCPCS 26742
Hospital Charge Code	16000702
Hospital Revenue Code	360
Min. Negotiated Rate	$953.08
Max. Negotiated Rate	$953.08
Rate for Payer: Qualcare PPO/HMO/WC	$953.08

CL TX ARTFX MCP/IP JNT; W MANI

Facility

$6,353.84

Service Code	HCPCS 26742
Hospital Charge Code	16000702
Hospital Revenue Code	360
Min. Negotiated Rate	$180.45
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,652.00
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$953.08
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$200.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$180.45

CLTX BIMALLEOLAR ANKLE FRACT W

Facility

$6,728.28

Service Code	HCPCS 27810
Hospital Charge Code	16000629
Hospital Revenue Code	360
Min. Negotiated Rate	$1,009.24
Max. Negotiated Rate	$1,009.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.24

CLTX BIMALLEOLAR ANKLE FRACT W

Facility

$6,728.28

Service Code	HCPCS 27810
Hospital Charge Code	16000629
Hospital Revenue Code	360
Min. Negotiated Rate	$191.08
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,749.35
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.24
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$212.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$191.08

CLTX BOMALLEOLAR ANKL FX WO M

Facility

$2,285.27

Service Code	HCPCS 27808
Hospital Charge Code	1600000542
Hospital Revenue Code	360
Min. Negotiated Rate	$342.79
Max. Negotiated Rate	$342.79
Rate for Payer: Qualcare PPO/HMO/WC	$342.79

CLTX BOMALLEOLAR ANKL FX WO M

Facility

$2,285.27

Service Code	HCPCS 27808
Hospital Charge Code	1600000542
Hospital Revenue Code	360
Min. Negotiated Rate	$72.21
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	$594.17
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$342.79
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$72.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02
Rate for Payer: Wellpoint Medicaid Managed Care	$708.84

CL TX CALCANEAL FX,W MANIP BL

Facility

$5,332.00

Service Code	HCPCS 28405
Hospital Charge Code	16000912
Hospital Revenue Code	360
Min. Negotiated Rate	$799.80
Max. Negotiated Rate	$799.80
Rate for Payer: Qualcare PPO/HMO/WC	$799.80

CL TX CALCANEAL FX,W MANIP BL

Facility

$5,332.00

Service Code	HCPCS 28405
Hospital Charge Code	16000912
Hospital Revenue Code	360
Min. Negotiated Rate	$151.43
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	$1,386.32
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$799.80
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$168.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$151.43

CL TX CARPL SCAPHOID FX W MANI

Facility

$12,932.20

Service Code	HCPCS 25624
Hospital Charge Code	16000693
Hospital Revenue Code	360
Min. Negotiated Rate	$367.27
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,362.37
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.83
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$408.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$367.27

CL TX CARPL SCAPHOID FX W MANI

Facility

$12,932.20

Service Code	HCPCS 25624
Hospital Charge Code	16000693
Hospital Revenue Code	360
Min. Negotiated Rate	$1,939.83
Max. Negotiated Rate	$1,939.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.83

CL TX DSTL RADLNR DISLC W MANP

Facility

$2,060.30

Service Code	HCPCS 25675
Hospital Charge Code	16000696
Hospital Revenue Code	360
Min. Negotiated Rate	$309.05
Max. Negotiated Rate	$309.05
Rate for Payer: Qualcare PPO/HMO/WC	$309.05

CL TX DSTL RADLNR DISLC W MANP

Facility

$2,060.30

Service Code	HCPCS 25675
Hospital Charge Code	16000696
Hospital Revenue Code	360
Min. Negotiated Rate	$58.51
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	$535.68
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.05
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$65.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$58.51

CLTX DSTL RDL FX/EPIPHYSL SEP

Facility

$5,332.00

Service Code	HCPCS 25605
Hospital Charge Code	1600000561
Hospital Revenue Code	360
Min. Negotiated Rate	$799.80
Max. Negotiated Rate	$799.80
Rate for Payer: Qualcare PPO/HMO/WC	$799.80

Know your out-of-pocket cost for care.

All Charges