Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-PL CATH ART AD A/P-BI

Facility

$484.00

Service Code	HCPCS 3624850
Hospital Charge Code	321036248B
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	321036248B
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	411036248
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	411036248
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	3668362485
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	3668362485
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	7411797
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-LT

Facility

$484.00

Service Code	HCPCS 36248LT
Hospital Charge Code	2691270
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-LT

Facility

$484.00

Service Code	HCPCS 36248LT
Hospital Charge Code	321036248L
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-LT

Facility

$484.00

Service Code	HCPCS 36248LT
Hospital Charge Code	321036248L
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-LT

Facility

$484.00

Service Code	HCPCS 36248LT
Hospital Charge Code	7411910
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-LT

Facility

$484.00

Service Code	HCPCS 36248LT
Hospital Charge Code	7411910
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-LT

Facility

$484.00

Service Code	HCPCS 36248LT
Hospital Charge Code	2691270
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-RT

Facility

$484.00

Service Code	HCPCS 36248RT
Hospital Charge Code	2691275
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-RT

Facility

$484.00

Service Code	HCPCS 36248RT
Hospital Charge Code	7411911
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-RT

Facility

$484.00

Service Code	HCPCS 36248RT
Hospital Charge Code	7411911
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-RT

Facility

$484.00

Service Code	HCPCS 36248RT
Hospital Charge Code	321036248R
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-RT

Facility

$484.00

Service Code	HCPCS 36248RT
Hospital Charge Code	2691275
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-RT

Facility

$484.00

Service Code	HCPCS 36248RT
Hospital Charge Code	321036248R
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 T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	7411795
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 AD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	321036218B
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 T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	3668362185
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 T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	3668362185
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 AD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	7411795
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 T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	321036218B
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

Know your out-of-pocket cost for care.

All Charges