Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CT ABSCESS PERITONEAL PERC

Facility

$9,500.00

Service Code	HCPCS 49406
Hospital Charge Code	2200483
Hospital Revenue Code	361
Min. Negotiated Rate	$228.95
Max. Negotiated Rate	$7,082.74
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	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
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	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
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	$2,850.00
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
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	$251.75

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 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	$3,354.00
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	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
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	$358.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
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	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CTA LOW EXT WO/W CONT BILAT

Facility

$3,541.80

Service Code	HCPCS 7370650
Hospital Charge Code	2205314
Hospital Revenue Code	352
Min. Negotiated Rate	$531.27
Max. Negotiated Rate	$531.27
Rate for Payer: Qualcare PPO/HMO/WC	$531.27

CTA LOW EXT WO/W CONT BILAT

Facility

$3,541.80

Service Code	HCPCS 7370650
Hospital Charge Code	2205314
Hospital Revenue Code	352
Min. Negotiated Rate	$85.36
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,345.88
Rate for Payer: Aetna Medicare Advantage	$1,062.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$903.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$903.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$903.16
Rate for Payer: Cigna Commercial	$1,770.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,062.54
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$531.27
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$85.36
Rate for Payer: Wellpoint Medicaid Managed Care	$93.86

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	$3,354.00
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	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
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	$358.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
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	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT ANGIO ABD AORTA&ILIOFEMORAL

Facility

$1,770.90

Service Code	HCPCS 75635
Hospital Charge Code	2205449
Hospital Revenue Code	352
Min. Negotiated Rate	$265.63
Max. Negotiated Rate	$265.63
Rate for Payer: Qualcare PPO/HMO/WC	$265.63

CT ANGIO ABD AORTA&ILIOFEMORAL

Facility

$1,770.90

Service Code	HCPCS 75635
Hospital Charge Code	2205449
Hospital Revenue Code	352
Min. Negotiated Rate	$42.68
Max. Negotiated Rate	$3,354.00
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	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
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	$356.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
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	$531.27
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$265.63
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$42.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$46.93

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 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	$3,354.00
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	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
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	$356.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
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	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

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	$3,354.00
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	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
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	$329.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
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	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

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	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT ANGIO ABD W/ CONTRAST

Facility

$9,500.00

Service Code	HCPCS 74175
Hospital Charge Code	2250407
Hospital Revenue Code	352
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,354.00
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	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
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	$329.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
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	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT ANGIO ABD W/ CONTRAST

Facility

$9,500.00

Service Code	HCPCS 74175
Hospital Charge Code	2250407
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 ANGIOGRAPH PELV W/WO DYE

Facility

$9,500.00

Service Code	HCPCS 72191
Hospital Charge Code	2200150
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 ANGIOGRAPH PELV W/WO DYE

Facility

$9,500.00

Service Code	HCPCS 72191
Hospital Charge Code	2200150
Hospital Revenue Code	352
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,354.00
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	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
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	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
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	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT ANGIOGRAPHY, CHEST

Facility

$9,500.00

Service Code	HCPCS 71275
Hospital Charge Code	2200003
Hospital Revenue Code	352
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,354.00
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	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
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	$338.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
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	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT ANGIOGRAPHY, CHEST

Facility

$9,500.00

Service Code	HCPCS 71275
Hospital Charge Code	2200003
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 ANGIOGRAPHY HEAD (DUAL SIN)

Facility

$1,770.90

Service Code	HCPCS 70496
Hospital Charge Code	2205476
Hospital Revenue Code	351
Min. Negotiated Rate	$265.63
Max. Negotiated Rate	$265.63
Rate for Payer: Qualcare PPO/HMO/WC	$265.63

CT ANGIOGRAPHY HEAD (DUAL SIN)

Facility

$1,770.90

Service Code	HCPCS 70496
Hospital Charge Code	2205476
Hospital Revenue Code	351
Min. Negotiated Rate	$42.68
Max. Negotiated Rate	$3,354.00
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	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
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	$358.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
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	$531.27
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$265.63
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$42.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$46.93

CT ANGIO LOWER EXT LT W/WO DYE

Facility

$1,770.90

Service Code	HCPCS 73706LT
Hospital Charge Code	2205309
Hospital Revenue Code	352
Min. Negotiated Rate	$265.63
Max. Negotiated Rate	$265.63
Rate for Payer: Qualcare PPO/HMO/WC	$265.63

CT ANGIO LOWER EXT LT W/WO DYE

Facility

$1,770.90

Service Code	HCPCS 73706LT
Hospital Charge Code	2205309
Hospital Revenue Code	352
Min. Negotiated Rate	$42.68
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$672.94
Rate for Payer: Aetna Medicare Advantage	$531.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.58
Rate for Payer: Cigna Commercial	$885.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$531.27
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$265.63
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$42.68
Rate for Payer: Wellpoint Medicaid Managed Care	$46.93

CT ANGIO LOWER EXT RT W/WO DYE

Facility

$1,770.90

Service Code	HCPCS 73706RT
Hospital Charge Code	2205311
Hospital Revenue Code	352
Min. Negotiated Rate	$265.63
Max. Negotiated Rate	$265.63
Rate for Payer: Qualcare PPO/HMO/WC	$265.63

CT ANGIO LOWER EXT RT W/WO DYE

Facility

$1,770.90

Service Code	HCPCS 73706RT
Hospital Charge Code	2205311
Hospital Revenue Code	352
Min. Negotiated Rate	$42.68
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$672.94
Rate for Payer: Aetna Medicare Advantage	$531.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.58
Rate for Payer: Cigna Commercial	$885.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$531.27
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$265.63
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$42.68
Rate for Payer: Wellpoint Medicaid Managed Care	$46.93

Know your out-of-pocket cost for care.

All Charges