Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-TRANS ARTHERE RENAL-BI

Facility

$86,028.15

Service Code	HCPCS 3722550
Hospital Charge Code	2690525
Hospital Revenue Code	361
Min. Negotiated Rate	$12,904.22
Max. Negotiated Rate	$12,904.22
Rate for Payer: Qualcare PPO/HMO/WC	$12,904.22

IR-TRANS ARTHERE RENAL-BI

Facility

$75,737.34

Service Code	HCPCS 3722550
Hospital Charge Code	7411515
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

IR-TRANS ARTHERE RENAL-BI

Facility

$75,737.34

Service Code	HCPCS 3722550
Hospital Charge Code	7411515
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
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	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,721.20
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$1,825.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.04

IR-TRANS ARTHERE RENAL-BI

Facility

$86,028.15

Service Code	HCPCS 3722550
Hospital Charge Code	2690525
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$43,014.07
Rate for Payer: Aetna Commercial	$32,690.70
Rate for Payer: Aetna Medicare Advantage	$25,808.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,937.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,937.18
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	$21,937.18
Rate for Payer: Cigna Commercial	$43,014.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,808.44
Rate for Payer: Qualcare PPO/HMO/WC	$12,904.22
Rate for Payer: UnitedHealthcare Community & State	$2,073.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2,279.75

IR-TRANS ARTHERE RENAL-BI

Facility

$8,231.00

Service Code	HCPCS 3722550
Hospital Charge Code	7411804
Hospital Revenue Code	361
Min. Negotiated Rate	$198.37
Max. Negotiated Rate	$4,115.50
Rate for Payer: Aetna Commercial	$3,127.78
Rate for Payer: Aetna Medicare Advantage	$2,469.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.91
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	$2,098.91
Rate for Payer: Cigna Commercial	$4,115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,469.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65
Rate for Payer: UnitedHealthcare Community & State	$198.37
Rate for Payer: Wellpoint Medicaid Managed Care	$218.12

IR-TRANS ARTHERE RENAL-BI

Facility

$8,231.00

Service Code	HCPCS 3722550
Hospital Charge Code	7411804
Hospital Revenue Code	361
Min. Negotiated Rate	$1,234.65
Max. Negotiated Rate	$1,234.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65

IR-TRANS ARTHERE RENAL-LT

Facility

$47,711.75

Service Code	HCPCS 37225LT
Hospital Charge Code	7412043
Hospital Revenue Code	361
Min. Negotiated Rate	$7,156.76
Max. Negotiated Rate	$7,156.76
Rate for Payer: Qualcare PPO/HMO/WC	$7,156.76

IR-TRANS ARTHERE RENAL-LT

Facility

$8,231.00

Service Code	HCPCS 37225LT
Hospital Charge Code	7411927
Hospital Revenue Code	361
Min. Negotiated Rate	$1,234.65
Max. Negotiated Rate	$1,234.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65

IR-TRANS ARTHERE RENAL-LT

Facility

$47,711.75

Service Code	HCPCS 37225LT
Hospital Charge Code	7412043
Hospital Revenue Code	361
Min. Negotiated Rate	$1,149.85
Max. Negotiated Rate	$23,855.88
Rate for Payer: Aetna Commercial	$18,130.47
Rate for Payer: Aetna Medicare Advantage	$14,313.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,166.50
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	$12,166.50
Rate for Payer: Cigna Commercial	$23,855.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,313.52
Rate for Payer: Qualcare PPO/HMO/WC	$7,156.76
Rate for Payer: UnitedHealthcare Community & State	$1,149.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1,264.36

IR-TRANS ARTHERE RENAL-LT

Facility

$8,231.00

Service Code	HCPCS 37225LT
Hospital Charge Code	7411927
Hospital Revenue Code	361
Min. Negotiated Rate	$198.37
Max. Negotiated Rate	$4,115.50
Rate for Payer: Aetna Commercial	$3,127.78
Rate for Payer: Aetna Medicare Advantage	$2,469.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.91
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	$2,098.91
Rate for Payer: Cigna Commercial	$4,115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,469.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65
Rate for Payer: UnitedHealthcare Community & State	$198.37
Rate for Payer: Wellpoint Medicaid Managed Care	$218.12

IR-TRANS ARTHERE RENAL-LT

Facility

$47,711.75

Service Code	HCPCS 37225LT
Hospital Charge Code	2691375
Hospital Revenue Code	361
Min. Negotiated Rate	$1,149.85
Max. Negotiated Rate	$23,855.88
Rate for Payer: Aetna Commercial	$18,130.47
Rate for Payer: Aetna Medicare Advantage	$14,313.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,166.50
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	$12,166.50
Rate for Payer: Cigna Commercial	$23,855.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,313.52
Rate for Payer: Qualcare PPO/HMO/WC	$7,156.76
Rate for Payer: UnitedHealthcare Community & State	$1,149.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1,264.36

IR-TRANS ARTHERE RENAL-LT

Facility

$47,711.75

Service Code	HCPCS 37225LT
Hospital Charge Code	2691375
Hospital Revenue Code	361
Min. Negotiated Rate	$7,156.76
Max. Negotiated Rate	$7,156.76
Rate for Payer: Qualcare PPO/HMO/WC	$7,156.76

IR-TRANS ARTHERE RENAL-RT

Facility

$47,711.75

Service Code	HCPCS 37225RT
Hospital Charge Code	2691385
Hospital Revenue Code	361
Min. Negotiated Rate	$7,156.76
Max. Negotiated Rate	$7,156.76
Rate for Payer: Qualcare PPO/HMO/WC	$7,156.76

IR-TRANS ARTHERE RENAL-RT

Facility

$47,711.75

Service Code	HCPCS 37225RT
Hospital Charge Code	2691385
Hospital Revenue Code	361
Min. Negotiated Rate	$1,149.85
Max. Negotiated Rate	$23,855.88
Rate for Payer: Aetna Commercial	$18,130.47
Rate for Payer: Aetna Medicare Advantage	$14,313.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,166.50
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	$12,166.50
Rate for Payer: Cigna Commercial	$23,855.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,313.52
Rate for Payer: Qualcare PPO/HMO/WC	$7,156.76
Rate for Payer: UnitedHealthcare Community & State	$1,149.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1,264.36

IR-TRANS ARTHERE RENAL-RT

Facility

$8,231.00

Service Code	HCPCS 37225RT
Hospital Charge Code	7411929
Hospital Revenue Code	361
Min. Negotiated Rate	$198.37
Max. Negotiated Rate	$4,115.50
Rate for Payer: Aetna Commercial	$3,127.78
Rate for Payer: Aetna Medicare Advantage	$2,469.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.91
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	$2,098.91
Rate for Payer: Cigna Commercial	$4,115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,469.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65
Rate for Payer: UnitedHealthcare Community & State	$198.37
Rate for Payer: Wellpoint Medicaid Managed Care	$218.12

IR-TRANS ARTHERE RENAL-RT

Facility

$47,711.75

Service Code	HCPCS 37225RT
Hospital Charge Code	7412045
Hospital Revenue Code	361
Min. Negotiated Rate	$1,149.85
Max. Negotiated Rate	$23,855.88
Rate for Payer: Aetna Commercial	$18,130.47
Rate for Payer: Aetna Medicare Advantage	$14,313.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,166.50
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	$12,166.50
Rate for Payer: Cigna Commercial	$23,855.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,313.52
Rate for Payer: Qualcare PPO/HMO/WC	$7,156.76
Rate for Payer: UnitedHealthcare Community & State	$1,149.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1,264.36

IR-TRANS ARTHERE RENAL-RT

Facility

$8,231.00

Service Code	HCPCS 37225RT
Hospital Charge Code	7411929
Hospital Revenue Code	361
Min. Negotiated Rate	$1,234.65
Max. Negotiated Rate	$1,234.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65

IR-TRANS ARTHERE RENAL-RT

Facility

$47,711.75

Service Code	HCPCS 37225RT
Hospital Charge Code	7412045
Hospital Revenue Code	361
Min. Negotiated Rate	$7,156.76
Max. Negotiated Rate	$7,156.76
Rate for Payer: Qualcare PPO/HMO/WC	$7,156.76

IR-TRANS BALLN ANG BRA-BI

Facility

$8,231.00

Service Code	HCPCS 3547550
Hospital Charge Code	2690410
Hospital Revenue Code	361
Min. Negotiated Rate	$1,234.65
Max. Negotiated Rate	$1,234.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65

IR-TRANS BALLN ANG BRA-BI

Facility

$8,231.00

Service Code	HCPCS 3547550
Hospital Charge Code	2690410
Hospital Revenue Code	361
Min. Negotiated Rate	$198.37
Max. Negotiated Rate	$4,115.50
Rate for Payer: Aetna Commercial	$3,127.78
Rate for Payer: Aetna Medicare Advantage	$2,469.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.91
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	$2,098.91
Rate for Payer: Cigna Commercial	$4,115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,469.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65
Rate for Payer: UnitedHealthcare Community & State	$198.37
Rate for Payer: Wellpoint Medicaid Managed Care	$218.12

IR-TRANS BALLN ANG BRA-LT

Facility

$8,231.00

Service Code	HCPCS 35475LT
Hospital Charge Code	2691115
Hospital Revenue Code	361
Min. Negotiated Rate	$198.37
Max. Negotiated Rate	$4,115.50
Rate for Payer: Aetna Commercial	$3,127.78
Rate for Payer: Aetna Medicare Advantage	$2,469.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.91
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	$2,098.91
Rate for Payer: Cigna Commercial	$4,115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,469.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65
Rate for Payer: UnitedHealthcare Community & State	$198.37
Rate for Payer: Wellpoint Medicaid Managed Care	$218.12

IR-TRANS BALLN ANG BRA-LT

Facility

$8,231.00

Service Code	HCPCS 35475LT
Hospital Charge Code	2691115
Hospital Revenue Code	361
Min. Negotiated Rate	$1,234.65
Max. Negotiated Rate	$1,234.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65

IR-TRANS BALLN ANG BRA-RT

Facility

$8,231.00

Service Code	HCPCS 35475RT
Hospital Charge Code	2691120
Hospital Revenue Code	361
Min. Negotiated Rate	$1,234.65
Max. Negotiated Rate	$1,234.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65

IR-TRANS BALLN ANG BRA-RT

Facility

$8,231.00

Service Code	HCPCS 35475RT
Hospital Charge Code	2691120
Hospital Revenue Code	361
Min. Negotiated Rate	$198.37
Max. Negotiated Rate	$4,115.50
Rate for Payer: Aetna Commercial	$3,127.78
Rate for Payer: Aetna Medicare Advantage	$2,469.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.91
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	$2,098.91
Rate for Payer: Cigna Commercial	$4,115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,469.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65
Rate for Payer: UnitedHealthcare Community & State	$198.37
Rate for Payer: Wellpoint Medicaid Managed Care	$218.12

IR-TRANS BALLN ANG F/P-BI

Facility

$44,000.00

Service Code	HCPCS 3722450
Hospital Charge Code	7411802
Hospital Revenue Code	361
Min. Negotiated Rate	$6,600.00
Max. Negotiated Rate	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,600.00

Know your out-of-pocket cost for care.

All Charges