Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CYSTO W FULG OF MINOR LESIONS

Facility

$24,567.50

Service Code	HCPCS 52224
Hospital Charge Code	16000999
Hospital Revenue Code	360
Min. Negotiated Rate	$697.72
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,387.55
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,685.12
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$776.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$697.72

CYSTO W FULG OF MINOR LESIONS

Facility

$24,567.50

Service Code	HCPCS 52224
Hospital Charge Code	16000999
Hospital Revenue Code	360
Min. Negotiated Rate	$3,685.12
Max. Negotiated Rate	$3,685.12
Rate for Payer: Qualcare PPO/HMO/WC	$3,685.12

CYSTO W INT URETHROTOMY,MALE

Facility

$23,841.70

Service Code	HCPCS 52275
Hospital Charge Code	160000234
Hospital Revenue Code	360
Min. Negotiated Rate	$3,576.26
Max. Negotiated Rate	$3,576.26
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26

CYSTO W INT URETHROTOMY,MALE

Facility

$23,841.70

Service Code	HCPCS 52275
Hospital Charge Code	160000234
Hospital Revenue Code	360
Min. Negotiated Rate	$677.10
Max. Negotiated Rate	$9,008.64
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
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	$9,008.64
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,198.84
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$753.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$677.10

CYSTO W LITHOSCOPY

Facility

$34,504.00

Service Code	HCPCS 52353
Hospital Charge Code	1600000437
Hospital Revenue Code	360
Min. Negotiated Rate	$979.91
Max. Negotiated Rate	$23,107.03
Rate for Payer: Aetna Commercial	$17,326.29
Rate for Payer: Aetna Medicare Advantage	$20,638.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,107.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,107.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,369.96
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	$23,107.03
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: Cigna Medicare Advantage	$6,369.96
Rate for Payer: Clover Medicare Advantage	$6,051.46
Rate for Payer: EmblemHealth Commercial	$19,109.88
Rate for Payer: Humana Medicare Advantage	$6,561.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,369.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,971.04
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,175.60
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$1,090.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,369.96
Rate for Payer: Wellcare Medicare Advantage	$6,369.96
Rate for Payer: Wellpoint Medicaid Managed Care	$979.91

CYSTO W LITHOSCOPY

Facility

$34,504.00

Service Code	HCPCS 52353
Hospital Charge Code	1600000437
Hospital Revenue Code	360
Min. Negotiated Rate	$5,175.60
Max. Negotiated Rate	$5,175.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,175.60

CYSTO W MANIP WO REM OF CALCUL

Facility

$23,847.70

Service Code	HCPCS 52330
Hospital Charge Code	1600000731
Hospital Revenue Code	360
Min. Negotiated Rate	$677.27
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,200.40
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,577.16
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$753.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$677.27

CYSTO W MANIP WO REM OF CALCUL

Facility

$23,847.70

Service Code	HCPCS 52330
Hospital Charge Code	1600000731
Hospital Revenue Code	360
Min. Negotiated Rate	$3,577.16
Max. Negotiated Rate	$3,577.16
Rate for Payer: Qualcare PPO/HMO/WC	$3,577.16

CYSTO W MULTI OBSTR CLOT REM

Facility

$14,309.90

Service Code	HCPCS 52001
Hospital Charge Code	1600000309
Hospital Revenue Code	360
Min. Negotiated Rate	$2,146.49
Max. Negotiated Rate	$2,146.49
Rate for Payer: Qualcare PPO/HMO/WC	$2,146.49

CYSTO W MULTI OBSTR CLOT REM

Facility

$14,309.90

Service Code	HCPCS 52001
Hospital Charge Code	1600000309
Hospital Revenue Code	360
Min. Negotiated Rate	$406.40
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,720.57
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,146.49
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$452.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$406.40

CYSTO W REM FB/STNT URET/BDR,S

Facility

$18,994.25

Service Code	HCPCS 52310
Hospital Charge Code	160000200
Hospital Revenue Code	360
Min. Negotiated Rate	$539.44
Max. Negotiated Rate	$9,008.64
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
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	$9,008.64
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,938.51
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,849.14
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$600.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$539.44

CYSTO W REM FB/STNT URET/BDR,S

Facility

$18,994.25

Service Code	HCPCS 52310
Hospital Charge Code	160000200
Hospital Revenue Code	360
Min. Negotiated Rate	$2,849.14
Max. Negotiated Rate	$2,849.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,849.14

CYSTO W REMOVAL OF CALCULUS

Facility

$23,841.70

Service Code	HCPCS 52320
Hospital Charge Code	16000160
Hospital Revenue Code	360
Min. Negotiated Rate	$677.10
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,198.84
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$753.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$677.10

CYSTO W REMOVAL OF CALCULUS

Facility

$23,841.70

Service Code	HCPCS 52320
Hospital Charge Code	16000160
Hospital Revenue Code	360
Min. Negotiated Rate	$3,576.26
Max. Negotiated Rate	$3,576.26
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26

CYSTO W STONE MANIP OR REM LT

Facility

$24,549.90

Service Code	HCPCS 52352
Hospital Charge Code	160000174
Hospital Revenue Code	360
Min. Negotiated Rate	$697.22
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,382.97
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.49
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$775.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$697.22

CYSTO W STONE MANIP OR REM LT

Facility

$24,549.90

Service Code	HCPCS 52352
Hospital Charge Code	160000174
Hospital Revenue Code	360
Min. Negotiated Rate	$3,682.49
Max. Negotiated Rate	$3,682.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.49

CYSTO W URETER STRICTURE TX

Facility

$8,149.84

Service Code	HCPCS 52341
Hospital Charge Code	160000196
Hospital Revenue Code	360
Min. Negotiated Rate	$231.46
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,118.96
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,222.48
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$257.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$231.46

CYSTO W URETER STRICTURE TX

Facility

$8,149.84

Service Code	HCPCS 52341
Hospital Charge Code	160000196
Hospital Revenue Code	360
Min. Negotiated Rate	$1,222.48
Max. Negotiated Rate	$1,222.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,222.48

CYST W INS INDWELLING URTR ST

Facility

$32,050.10

Service Code	HCPCS 52332
Hospital Charge Code	16000757
Hospital Revenue Code	360
Min. Negotiated Rate	$4,807.52
Max. Negotiated Rate	$4,807.52
Rate for Payer: Qualcare PPO/HMO/WC	$4,807.52

CYST W INS INDWELLING URTR ST

Facility

$32,050.10

Service Code	HCPCS 52332
Hospital Charge Code	16000757
Hospital Revenue Code	360
Min. Negotiated Rate	$910.22
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,333.03
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,807.52
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$1,012.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$910.22

CYST W REMFB/STNT UR/BLD, CML

Facility

$23,841.70

Service Code	HCPCS 52315
Hospital Charge Code	1600000323
Hospital Revenue Code	360
Min. Negotiated Rate	$677.10
Max. Negotiated Rate	$9,008.64
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
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	$9,008.64
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,198.84
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$753.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$677.10

CYST W REMFB/STNT UR/BLD, CML

Facility

$23,841.70

Service Code	HCPCS 52315
Hospital Charge Code	1600000323
Hospital Revenue Code	360
Min. Negotiated Rate	$3,576.26
Max. Negotiated Rate	$3,576.26
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26

CYTAL ACEL WND MATRIX 7X10CM

Facility

$14,241.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696524
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,446.32
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,446.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,136.15
Rate for Payer: UnitedHealthcare Community & State	$450.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$404.44

CYTAL ACEL WND MATRIX 7X10CM

Facility

$14,241.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696524
Hospital Revenue Code	278
Min. Negotiated Rate	$2,136.15
Max. Negotiated Rate	$3,446.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,848.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,446.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,136.15

CYTOCENT 2

Facility

$390.00

Service Code	HCPCS 88108
Hospital Charge Code	3005360
Hospital Revenue Code	311
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
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	$55.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges