Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR INSERT OF IMPLANT VEN DEV

Facility

$5,224.75

Service Code	HCPCS 36557
Hospital Charge Code	2101150
Hospital Revenue Code	361
Min. Negotiated Rate	$125.92
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,567.42
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$783.71
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$125.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$138.46

IR INSERT OF IMPLANT VEN DEV

Facility

$5,224.75

Service Code	HCPCS 36557
Hospital Charge Code	2101150
Hospital Revenue Code	361
Min. Negotiated Rate	$783.71
Max. Negotiated Rate	$783.71
Rate for Payer: Qualcare PPO/HMO/WC	$783.71

IR INSERT OF TUBE THORACOSTOMY

Facility

$2,422.65

Service Code	HCPCS 32551
Hospital Charge Code	5600185
Hospital Revenue Code	361
Min. Negotiated Rate	$363.40
Max. Negotiated Rate	$363.40
Rate for Payer: Qualcare PPO/HMO/WC	$363.40

IR INSERT OF TUBE THORACOSTOMY

Facility

$2,422.65

Service Code	HCPCS 32551
Hospital Charge Code	5600185
Hospital Revenue Code	361
Min. Negotiated Rate	$58.39
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.79
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$363.40
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$58.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,475.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2,426.75

IR INSERT TIPS W/ IMAGE GUIDE

Facility

$18,561.00

Service Code	HCPCS 37182
Hospital Charge Code	411037182
Hospital Revenue Code	361
Min. Negotiated Rate	$447.32
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,568.30
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,784.15
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$447.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$491.87

IR INSERT TIPS W/ IMAGE GUIDE

Facility

$18,561.00

Service Code	HCPCS 37182
Hospital Charge Code	411037182
Hospital Revenue Code	361
Min. Negotiated Rate	$2,784.15
Max. Negotiated Rate	$2,784.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,784.15

IR INSERT TIPS W/ IMAGE GUIDE

Facility

$18,561.00

Service Code	HCPCS 37182
Hospital Charge Code	366837182
Hospital Revenue Code	361
Min. Negotiated Rate	$447.32
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,568.30
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,784.15
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$447.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$491.87

IR INSERT TIPS W/ IMAGE GUIDE

Facility

$1,600.00

Service Code	HCPCS 37182
Hospital Charge Code	7411492
Hospital Revenue Code	361
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.00
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$38.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$42.40

IR INSERT TIPS W/ IMAGE GUIDE

Facility

$18,561.00

Service Code	HCPCS 37182
Hospital Charge Code	366837182
Hospital Revenue Code	361
Min. Negotiated Rate	$2,784.15
Max. Negotiated Rate	$2,784.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,784.15

IR INSERT TIPS W/ IMAGE GUIDE

Facility

$1,600.00

Service Code	HCPCS 37182
Hospital Charge Code	2011099
Hospital Revenue Code	361
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

IR INSERT TIPS W/ IMAGE GUIDE

Facility

$1,600.00

Service Code	HCPCS 37182
Hospital Charge Code	2011099
Hospital Revenue Code	361
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.00
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$38.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$42.40

IR INSERT TIPS W/ IMAGE GUIDE

Facility

$1,600.00

Service Code	HCPCS 37182
Hospital Charge Code	7411492
Hospital Revenue Code	361
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

IR INS NON-TUNNEL CV CATH >5

Facility

$6,402.70

Service Code	HCPCS 36556
Hospital Charge Code	2011275
Hospital Revenue Code	361
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,920.81
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.40
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$154.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$169.67

IR INS NON-TUNNEL CV CATH >5

Facility

$6,107.50

Service Code	HCPCS 36556
Hospital Charge Code	7411448
Hospital Revenue Code	361
Min. Negotiated Rate	$916.12
Max. Negotiated Rate	$916.12
Rate for Payer: Qualcare PPO/HMO/WC	$916.12

IR INS NON-TUNNEL CV CATH >5

Facility

$6,402.70

Service Code	HCPCS 36556
Hospital Charge Code	2011275
Hospital Revenue Code	361
Min. Negotiated Rate	$960.40
Max. Negotiated Rate	$960.40
Rate for Payer: Qualcare PPO/HMO/WC	$960.40

IR INS NON-TUNNEL CV CATH >5

Facility

$6,402.70

Service Code	HCPCS 36556
Hospital Charge Code	321036556
Hospital Revenue Code	361
Min. Negotiated Rate	$960.40
Max. Negotiated Rate	$960.40
Rate for Payer: Qualcare PPO/HMO/WC	$960.40

IR INS NON-TUNNEL CV CATH >5

Facility

$6,402.70

Service Code	HCPCS 36556
Hospital Charge Code	321036556
Hospital Revenue Code	361
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,920.81
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.40
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$154.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$169.67

IR INS NON-TUNNEL CV CATH >5

Facility

$6,107.50

Service Code	HCPCS 36556
Hospital Charge Code	411036556
Hospital Revenue Code	361
Min. Negotiated Rate	$147.19
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,832.25
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$916.12
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$147.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$161.85

IR INS NON-TUNNEL CV CATH >5

Facility

$6,107.50

Service Code	HCPCS 36556
Hospital Charge Code	411036556
Hospital Revenue Code	361
Min. Negotiated Rate	$916.12
Max. Negotiated Rate	$916.12
Rate for Payer: Qualcare PPO/HMO/WC	$916.12

IR INS NON-TUNNEL CV CATH >5

Facility

$6,107.50

Service Code	HCPCS 36556
Hospital Charge Code	366836556
Hospital Revenue Code	361
Min. Negotiated Rate	$147.19
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,832.25
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$916.12
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$147.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$161.85

IR INS NON-TUNNEL CV CATH >5

Facility

$6,107.50

Service Code	HCPCS 36556
Hospital Charge Code	366836556
Hospital Revenue Code	361
Min. Negotiated Rate	$916.12
Max. Negotiated Rate	$916.12
Rate for Payer: Qualcare PPO/HMO/WC	$916.12

IR INS NON-TUNNEL CV CATH >5

Facility

$6,107.50

Service Code	HCPCS 36556
Hospital Charge Code	7411448
Hospital Revenue Code	361
Min. Negotiated Rate	$147.19
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,832.25
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$916.12
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$147.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$161.85

IR INS PEG TUBE

Facility

$8,686.35

Service Code	HCPCS 49441
Hospital Charge Code	321049441
Hospital Revenue Code	361
Min. Negotiated Rate	$1,302.95
Max. Negotiated Rate	$1,302.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,302.95

IR INS PEG TUBE

Facility

$8,686.35

Service Code	HCPCS 49441
Hospital Charge Code	321049441
Hospital Revenue Code	361
Min. Negotiated Rate	$209.34
Max. Negotiated Rate	$8,229.07
Rate for Payer: Aetna Commercial	$6,200.81
Rate for Payer: Aetna Medicare Advantage	$7,386.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,279.71
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	$8,229.07
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Cigna Medicare Advantage	$2,279.71
Rate for Payer: Clover Medicare Advantage	$2,165.72
Rate for Payer: EmblemHealth Commercial	$6,839.13
Rate for Payer: Humana Medicare Advantage	$2,348.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,279.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,605.91
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,302.95
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$209.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,279.71
Rate for Payer: Wellcare Medicare Advantage	$2,279.71
Rate for Payer: Wellpoint Medicaid Managed Care	$230.19

IR INS PEG TUBE

Facility

$8,368.50

Service Code	HCPCS 49441
Hospital Charge Code	366849441
Hospital Revenue Code	361
Min. Negotiated Rate	$1,255.28
Max. Negotiated Rate	$1,255.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,255.28

Know your out-of-pocket cost for care.

All Charges