Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-EST ACCE CAR/VET AR-BI

Facility

$239.00

Service Code	HCPCS 3610050
Hospital Charge Code	7411794
Hospital Revenue Code	361
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-BI

Facility

$239.00

Service Code	HCPCS 3610050
Hospital Charge Code	2690445
Hospital Revenue Code	361
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-BI

Facility

$239.00

Service Code	HCPCS 3610050
Hospital Charge Code	2690445
Hospital Revenue Code	361
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$90.82
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
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	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

IR-EST ACCE CAR/VET AR-BI

Facility

$239.00

Service Code	HCPCS 3610050
Hospital Charge Code	7411794
Hospital Revenue Code	361
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$90.82
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
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	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

IR-EST ACCE CAR/VET AR-LT

Facility

$239.00

Service Code	HCPCS 36100LT
Hospital Charge Code	2691190
Hospital Revenue Code	761
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-LT

Facility

$239.00

Service Code	HCPCS 36100LT
Hospital Charge Code	2691190
Hospital Revenue Code	761
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$119.50
Rate for Payer: Aetna Commercial	$90.82
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Oxford Commercial	$47.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$47.80
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

IR-EST ACCE CAR/VET AR-LT

Facility

$239.00

Service Code	HCPCS 36100LT
Hospital Charge Code	7411906
Hospital Revenue Code	761
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-LT

Facility

$239.00

Service Code	HCPCS 36100LT
Hospital Charge Code	7411906
Hospital Revenue Code	761
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$119.50
Rate for Payer: Aetna Commercial	$90.82
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Oxford Commercial	$47.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$47.80
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

IR-EST ACCE CAR/VET AR-RT

Facility

$239.00

Service Code	HCPCS 36100RT
Hospital Charge Code	7411907
Hospital Revenue Code	761
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-RT

Facility

$239.00

Service Code	HCPCS 36100RT
Hospital Charge Code	7411907
Hospital Revenue Code	761
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$119.50
Rate for Payer: Aetna Commercial	$90.82
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Oxford Commercial	$47.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$47.80
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

IR-EST ACCE CAR/VET AR-RT

Facility

$239.00

Service Code	HCPCS 36100RT
Hospital Charge Code	2691195
Hospital Revenue Code	361
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

IR-EST ACCE CAR/VET AR-RT

Facility

$239.00

Service Code	HCPCS 36100RT
Hospital Charge Code	2691195
Hospital Revenue Code	361
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$90.82
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
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	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

IR-EST ACCES BRACH ART-BI

Facility

$154.00

Service Code	HCPCS 3612050
Hospital Charge Code	2690450
Hospital Revenue Code	361
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

IR-EST ACCES BRACH ART-BI

Facility

$154.00

Service Code	HCPCS 3612050
Hospital Charge Code	2690450
Hospital Revenue Code	361
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
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	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

IR-EST ACCES BRACH ART-LT

Facility

$154.00

Service Code	HCPCS 36140LT
Hospital Charge Code	2691200
Hospital Revenue Code	761
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$77.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Oxford Commercial	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$30.80
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

IR-EST ACCES BRACH ART-LT

Facility

$154.00

Service Code	HCPCS 36140LT
Hospital Charge Code	2691200
Hospital Revenue Code	761
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

IR-EST ACCES BRACH ART-RT

Facility

$154.00

Service Code	HCPCS 36140RT
Hospital Charge Code	2691205
Hospital Revenue Code	361
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
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	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

IR-EST ACCES BRACH ART-RT

Facility

$154.00

Service Code	HCPCS 36140RT
Hospital Charge Code	2691205
Hospital Revenue Code	361
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

IR-EST ACCES EXTRE ART-LT

Facility

$154.00

Service Code	HCPCS 36140LT
Hospital Charge Code	411036140L
Hospital Revenue Code	361
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
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	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

IR-EST ACCES EXTRE ART-LT

Facility

$154.00

Service Code	HCPCS 36140LT
Hospital Charge Code	321036140L
Hospital Revenue Code	361
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

IR-EST ACCES EXTRE ART-LT

Facility

$154.00

Service Code	HCPCS 36140LT
Hospital Charge Code	411036140L
Hospital Revenue Code	361
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

IR-EST ACCES EXTRE ART-LT

Facility

$154.00

Service Code	HCPCS 36140LT
Hospital Charge Code	366836140L
Hospital Revenue Code	361
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

IR-EST ACCES EXTRE ART-LT

Facility

$154.00

Service Code	HCPCS 36140LT
Hospital Charge Code	2691210
Hospital Revenue Code	361
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

IR-EST ACCES EXTRE ART-LT

Facility

$154.00

Service Code	HCPCS 36140LT
Hospital Charge Code	321036140L
Hospital Revenue Code	361
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
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	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

IR-EST ACCES EXTRE ART-LT

Facility

$154.00

Service Code	HCPCS 36140LT
Hospital Charge Code	2691210
Hospital Revenue Code	361
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
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	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

Know your out-of-pocket cost for care.

All Charges