Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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	2691235
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	321036216R
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	321036216R
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 3RD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621750
Hospital Charge Code	2690465
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART 3RD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621750
Hospital Charge Code	2690465
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	411036217L
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	321036217L
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	321036217L
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	366836217L
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	366836217L
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	2691240
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	2691240
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	411036217L
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	366836217R
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	366836217R
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	411036217R
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	321036217R
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	411036217R
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	321036217R
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	2691245
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	2691245
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART AD A/P-BI

Facility

$484.00

Service Code	HCPCS 3624850
Hospital Charge Code	7411797
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

IR-PL CATH ART AD A/P-BI

Facility

$484.00

Service Code	HCPCS 3624850
Hospital Charge Code	2690480
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-PL CATH ART AD A/P-BI

Facility

$484.00

Service Code	HCPCS 3624850
Hospital Charge Code	2690480
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

Know your out-of-pocket cost for care.

All Charges