Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-PL CATH ART 1ST A/P-RT

Facility

$364.00

Service Code	HCPCS 36245RT
Hospital Charge Code	321036245R
Hospital Revenue Code	361
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$138.32
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
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	$92.82
Rate for Payer: Cigna Commercial	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.20
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Community & State	$8.77
Rate for Payer: Wellpoint Medicaid Managed Care	$9.65

IR-PL CATH ART 1ST A/P-RT

Facility

$364.00

Service Code	HCPCS 36245RT
Hospital Charge Code	321036245R
Hospital Revenue Code	361
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

IR-PL CATH ART 1ST A/P-RT

Facility

$364.00

Service Code	HCPCS 36245RT
Hospital Charge Code	2691265
Hospital Revenue Code	361
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

IR-PL CATH ART 1ST T/B-BI

Facility

$359.00

Service Code	HCPCS 3621550
Hospital Charge Code	2690455
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

IR-PL CATH ART 1ST T/B-BI

Facility

$359.00

Service Code	HCPCS 3621550
Hospital Charge Code	2690455
Hospital Revenue Code	361
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$136.42
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.85
Rate for Payer: UnitedHealthcare Community & State	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$9.51

IR-PL CATH ART 1ST T/B-LT

Facility

$359.00

Service Code	HCPCS 36215LT
Hospital Charge Code	366836215L
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

IR-PL CATH ART 1ST T/B-LT

Facility

$359.00

Service Code	HCPCS 36215LT
Hospital Charge Code	366836215L
Hospital Revenue Code	361
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$136.42
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.85
Rate for Payer: UnitedHealthcare Community & State	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$9.51

IR-PL CATH ART 1ST T/B-LT

Facility

$359.00

Service Code	HCPCS 36215LT
Hospital Charge Code	2691220
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

IR-PL CATH ART 1ST T/B-LT

Facility

$359.00

Service Code	HCPCS 36215LT
Hospital Charge Code	2691220
Hospital Revenue Code	361
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$136.42
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.85
Rate for Payer: UnitedHealthcare Community & State	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$9.51

IR-PL CATH ART 1ST T/B-LT

Facility

$359.00

Service Code	HCPCS 36215LT
Hospital Charge Code	321036215L
Hospital Revenue Code	361
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$136.42
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.85
Rate for Payer: UnitedHealthcare Community & State	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$9.51

IR-PL CATH ART 1ST T/B-LT

Facility

$359.00

Service Code	HCPCS 36215LT
Hospital Charge Code	411036215
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

IR-PL CATH ART 1ST T/B-LT

Facility

$359.00

Service Code	HCPCS 36215LT
Hospital Charge Code	321036215L
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

IR-PL CATH ART 1ST T/B-LT

Facility

$359.00

Service Code	HCPCS 36215LT
Hospital Charge Code	411036215
Hospital Revenue Code	361
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$136.42
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.85
Rate for Payer: UnitedHealthcare Community & State	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$9.51

IR-PL CATH ART 1ST T/B-RT

Facility

$359.00

Service Code	HCPCS 36215RT
Hospital Charge Code	2691225
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

IR-PL CATH ART 1ST T/B-RT

Facility

$359.00

Service Code	HCPCS 36215RT
Hospital Charge Code	2691225
Hospital Revenue Code	361
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$136.42
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.85
Rate for Payer: UnitedHealthcare Community & State	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$9.51

IR-PL CATH ART 2ND T/B-BI

Facility

$403.00

Service Code	HCPCS 3621650
Hospital Charge Code	2690460
Hospital Revenue Code	361
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$153.14
Rate for Payer: Aetna Medicare Advantage	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.77
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	$102.77
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Community & State	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

IR-PL CATH ART 2ND T/B-BI

Facility

$403.00

Service Code	HCPCS 3621650
Hospital Charge Code	2690460
Hospital Revenue Code	361
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

IR-PL CATH ART 2ND T/B-LT

Facility

$403.00

Service Code	HCPCS 36216LT
Hospital Charge Code	321036216L
Hospital Revenue Code	361
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$153.14
Rate for Payer: Aetna Medicare Advantage	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.77
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	$102.77
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Community & State	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

IR-PL CATH ART 2ND T/B-LT

Facility

$403.00

Service Code	HCPCS 36216LT
Hospital Charge Code	2691230
Hospital Revenue Code	361
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

IR-PL CATH ART 2ND T/B-LT

Facility

$403.00

Service Code	HCPCS 36216LT
Hospital Charge Code	321036216L
Hospital Revenue Code	361
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

IR-PL CATH ART 2ND T/B-LT

Facility

$403.00

Service Code	HCPCS 36216LT
Hospital Charge Code	2691230
Hospital Revenue Code	361
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$153.14
Rate for Payer: Aetna Medicare Advantage	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.77
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	$102.77
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Community & State	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

IR-PL CATH ART 2ND T/B-RT

Facility

$403.00

Service Code	HCPCS 36216RT
Hospital Charge Code	2691235
Hospital Revenue Code	361
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

IR-PL CATH ART 2ND T/B-RT

Facility

$403.00

Service Code	HCPCS 36216RT
Hospital Charge Code	366836216R
Hospital Revenue Code	361
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$153.14
Rate for Payer: Aetna Medicare Advantage	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.77
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	$102.77
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Community & State	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

IR-PL CATH ART 2ND T/B-RT

Facility

$403.00

Service Code	HCPCS 36216RT
Hospital Charge Code	411036216
Hospital Revenue Code	361
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

IR-PL CATH ART 2ND T/B-RT

Facility

$403.00

Service Code	HCPCS 36216RT
Hospital Charge Code	411036216
Hospital Revenue Code	361
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$153.14
Rate for Payer: Aetna Medicare Advantage	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.77
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	$102.77
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Community & State	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

Know your out-of-pocket cost for care.

All Charges