Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CSPINE TRUSS INBOD 16X19 7DEG

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704072
Hospital Revenue Code	278
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$632.00
Rate for Payer: Wellpoint Medicaid Managed Care	$568.00

CSPINE TRUSS INBOD 16X19 7DEG

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704072
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CSPINE TRUSYS INBOD 12X15 7DEG

Facility

$20,000.00

Hospital Charge Code	270703180
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CSPINE TRUSYS INBOD 12X15 7DEG

Facility

$20,000.00

Hospital Charge Code	270703180
Hospital Revenue Code	278
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$632.00
Rate for Payer: Wellpoint Medicaid Managed Care	$568.00

CT 3D RENDERING-IMAGE RPRCS WS

Facility

$781.00

Service Code	HCPCS 76377
Hospital Charge Code	2207010
Hospital Revenue Code	350
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$117.15
Rate for Payer: Qualcare PPO/HMO/WC	$117.15

CT 3D RENDERING-IMAGE RPRCS WS

Facility

$781.00

Service Code	HCPCS 76377
Hospital Charge Code	2207010
Hospital Revenue Code	350
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$296.78
Rate for Payer: Aetna Medicare Advantage	$234.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.16
Rate for Payer: Cigna Commercial	$390.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.06
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.15
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$24.68
Rate for Payer: Wellpoint Medicaid Managed Care	$22.18

CT 3D RENDRING W INTPR/RPRT CT

Facility

$781.00

Service Code	HCPCS 76376
Hospital Charge Code	2208015
Hospital Revenue Code	350
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$117.15
Rate for Payer: Qualcare PPO/HMO/WC	$117.15

CT 3D RENDRING W INTPR/RPRT CT

Facility

$781.00

Service Code	HCPCS 76376
Hospital Charge Code	2208015
Hospital Revenue Code	350
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$296.78
Rate for Payer: Aetna Medicare Advantage	$234.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.16
Rate for Payer: Cigna Commercial	$390.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.06
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.15
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$24.68
Rate for Payer: Wellpoint Medicaid Managed Care	$22.18

CTA ABD&PELVIS W/CONT

Facility

$9,500.00

Service Code	HCPCS 74174
Hospital Charge Code	2207015
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,503.49
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CTA ABD&PELVIS W/CONT

Facility

$9,500.00

Service Code	HCPCS 74174
Hospital Charge Code	2207015
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ABDOMEN,PELVIS W/WO CONT

Facility

$9,500.00

Service Code	HCPCS 74178
Hospital Charge Code	2200062
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,503.49
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,543.21
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT ABDOMEN,PELVIS W/WO CONT

Facility

$9,500.00

Service Code	HCPCS 74178
Hospital Charge Code	2200062
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT-ABDOMINAL AORTA W/O CONT

Facility

$2,089.00

Service Code	HCPCS 76380
Hospital Charge Code	2208020
Hospital Revenue Code	352
Min. Negotiated Rate	$59.33
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.14
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$313.35
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$66.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$59.33

CT-ABDOMINAL AORTA W/O CONT

Facility

$2,089.00

Service Code	HCPCS 76380
Hospital Charge Code	2208020
Hospital Revenue Code	352
Min. Negotiated Rate	$313.35
Max. Negotiated Rate	$313.35
Rate for Payer: Qualcare PPO/HMO/WC	$313.35

CT ABLATION LIVER PERC/RE

Facility

$26,912.85

Service Code	HCPCS 47382
Hospital Charge Code	2200245
Hospital Revenue Code	361
Min. Negotiated Rate	$4,036.93
Max. Negotiated Rate	$4,036.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93

CT ABLATION LIVER PERC/RE

Facility

$26,912.85

Service Code	HCPCS 47382
Hospital Charge Code	2200245
Hospital Revenue Code	361
Min. Negotiated Rate	$764.32
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	$6,997.34
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,036.93
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$850.45
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	$764.32

CT ABSCESS PERITONEAL PERC

Facility

$9,500.00

Service Code	HCPCS 49406
Hospital Charge Code	2200483
Hospital Revenue Code	361
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ABSCESS PERITONEAL PERC

Facility

$9,500.00

Service Code	HCPCS 49406
Hospital Charge Code	2200483
Hospital Revenue Code	361
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CTA HEAD W & W/O CONT

Facility

$9,500.00

Service Code	HCPCS 70496
Hospital Charge Code	2200001
Hospital Revenue Code	351
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CTA HEAD W & W/O CONT

Facility

$9,500.00

Service Code	HCPCS 70496
Hospital Charge Code	2200001
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CTA NECK W & W/O CONT

Facility

$9,500.00

Service Code	HCPCS 70498
Hospital Charge Code	2200002
Hospital Revenue Code	351
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CTA NECK W & W/O CONT

Facility

$9,500.00

Service Code	HCPCS 70498
Hospital Charge Code	2200002
Hospital Revenue Code	351
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT ANGIO ABDMNL AORTA&BIL IFLE

Facility

$9,500.00

Service Code	HCPCS 75635
Hospital Charge Code	2207001
Hospital Revenue Code	352
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$303.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT ANGIO ABDMNL AORTA&BIL IFLE

Facility

$9,500.00

Service Code	HCPCS 75635
Hospital Charge Code	2207001
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ANGIO ABDOM W/WO DYE

Facility

$9,500.00

Service Code	HCPCS 74175
Hospital Charge Code	2200065
Hospital Revenue Code	352
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

Know your out-of-pocket cost for care.

All Charges