Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	2101171
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	2101171
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	2101172
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	2101172
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	321036246R
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	366836246R
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	321036246R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	366836246R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	411036246R
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	411036246R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	411036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	3668362475
Hospital Revenue Code	361
Min. Negotiated Rate	$419.20
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$6,609.72
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,218.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10
Rate for Payer: UnitedHealthcare Community & State	$419.20
Rate for Payer: Wellpoint Medicaid Managed Care	$460.94

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	3668362475
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	411036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$419.20
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$6,609.72
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,218.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10
Rate for Payer: UnitedHealthcare Community & State	$419.20
Rate for Payer: Wellpoint Medicaid Managed Care	$460.94

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	321036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	321036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$419.20
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$6,609.72
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,218.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10
Rate for Payer: UnitedHealthcare Community & State	$419.20
Rate for Payer: Wellpoint Medicaid Managed Care	$460.94

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	2101168
Hospital Revenue Code	361
Min. Negotiated Rate	$419.20
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$6,609.72
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,218.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10
Rate for Payer: UnitedHealthcare Community & State	$419.20
Rate for Payer: Wellpoint Medicaid Managed Care	$460.94

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	2101168
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD LEFT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	2101174
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD LEFT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	2101174
Hospital Revenue Code	361
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

IR CATH IN ART INIT 3RD LEFT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	321036247L
Hospital Revenue Code	361
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

IR CATH IN ART INIT 3RD LEFT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	321036247L
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD RIGHT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	2101173
Hospital Revenue Code	361
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

IR CATH IN ART INIT 3RD RIGHT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	321036247R
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR CATH IN ART INIT 3RD RIGHT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	321036247R
Hospital Revenue Code	361
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

Know your out-of-pocket cost for care.

All Charges