Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

REV PRESSFIT STEM NSLT 10 X 10

Facility

$11,322.50

Service Code	HCPCS C1776
Hospital Charge Code	270686903
Hospital Revenue Code	278
Min. Negotiated Rate	$1,698.38
Max. Negotiated Rate	$2,740.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,264.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,740.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,490.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,698.38

REV /REM IMPL SPNL NS PG/REC

Facility

$27,115.93

Service Code	HCPCS 63688
Hospital Charge Code	1600000878
Hospital Revenue Code	360
Min. Negotiated Rate	$653.49
Max. Negotiated Rate	$14,992.78
Rate for Payer: Aetna Commercial	$11,297.44
Rate for Payer: Aetna Medicare Advantage	$13,457.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,992.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,992.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,153.47
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	$14,992.78
Rate for Payer: Cigna Commercial	$8,325.61
Rate for Payer: Cigna Medicare Advantage	$4,153.47
Rate for Payer: Clover Medicare Advantage	$3,945.80
Rate for Payer: EmblemHealth Commercial	$12,460.41
Rate for Payer: Humana Medicare Advantage	$4,278.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,153.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,134.78
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,067.39
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$653.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,153.47
Rate for Payer: Wellcare Medicare Advantage	$4,153.47
Rate for Payer: Wellpoint Medicaid Managed Care	$718.57

REV /REM IMPL SPNL NS PG/REC

Facility

$27,115.93

Service Code	HCPCS 63688
Hospital Charge Code	1600000878
Hospital Revenue Code	360
Min. Negotiated Rate	$4,067.39
Max. Negotiated Rate	$4,067.39
Rate for Payer: Qualcare PPO/HMO/WC	$4,067.39

REVSC EVASC FPVT ANGIO SF 1

Facility

$25,423.30

Service Code	HCPCS 37263
Hospital Charge Code	404637263
Hospital Revenue Code	481
Min. Negotiated Rate	$612.70
Max. Negotiated Rate	$24,407.82
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,407.82
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,626.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49
Rate for Payer: UnitedHealthcare Community & State	$612.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$673.72

REVSC EVASC FPVT ANGIO SF 1

Facility

$25,423.30

Service Code	HCPCS 37263
Hospital Charge Code	404637263
Hospital Revenue Code	481
Min. Negotiated Rate	$3,813.49
Max. Negotiated Rate	$3,813.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49

REVSC EVASC FPVT ANGIO SF 1

Facility

$25,423.30

Service Code	HCPCS 37263
Hospital Charge Code	403437263
Hospital Revenue Code	481
Min. Negotiated Rate	$612.70
Max. Negotiated Rate	$24,407.82
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,407.82
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,626.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49
Rate for Payer: UnitedHealthcare Community & State	$612.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$673.72

REVSC EVASC FPVT ANGIO SF 1

Facility

$25,423.30

Service Code	HCPCS 37263
Hospital Charge Code	403437263
Hospital Revenue Code	481
Min. Negotiated Rate	$3,813.49
Max. Negotiated Rate	$3,813.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49

REVSC EVASC FPVT ST CPLX 1ST

Facility

$68,574.00

Service Code	HCPCS 37269
Hospital Charge Code	404637269
Hospital Revenue Code	481
Min. Negotiated Rate	$10,286.10
Max. Negotiated Rate	$10,286.10
Rate for Payer: Qualcare PPO/HMO/WC	$10,286.10

REVSC EVASC FPVT ST CPLX 1ST

Facility

$68,574.00

Service Code	HCPCS 37269
Hospital Charge Code	404637269
Hospital Revenue Code	481
Min. Negotiated Rate	$1,652.63
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,572.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$10,286.10
Rate for Payer: UnitedHealthcare Community & State	$1,652.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,817.21

REVSC EVASC IVT ANGIO CPLX 1

Facility

$27,397.00

Service Code	HCPCS 37256
Hospital Charge Code	403437256
Hospital Revenue Code	481
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

REVSC EVASC IVT ANGIO CPLX 1

Facility

$27,397.00

Service Code	HCPCS 37256
Hospital Charge Code	404637256
Hospital Revenue Code	481
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

REVSC EVASC IVT ANGIO CPLX 1

Facility

$27,397.00

Service Code	HCPCS 37256
Hospital Charge Code	403437256
Hospital Revenue Code	481
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$24,407.82
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,407.82
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

REVSC EVASC IVT ANGIO CPLX 1

Facility

$27,397.00

Service Code	HCPCS 37256
Hospital Charge Code	404637256
Hospital Revenue Code	481
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$24,407.82
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,407.82
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

REVSC EVASC IVT ANGIO SF 1ST

Facility

$27,397.00

Service Code	HCPCS 37254
Hospital Charge Code	403437254
Hospital Revenue Code	481
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

REVSC EVASC IVT ANGIO SF 1ST

Facility

$27,397.00

Service Code	HCPCS 37254
Hospital Charge Code	403437254
Hospital Revenue Code	481
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$24,407.82
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,407.82
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

REVSC EVASC IVT ANGIO SF 1ST

Facility

$27,397.00

Service Code	HCPCS 37254
Hospital Charge Code	404637254
Hospital Revenue Code	481
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$24,407.82
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,407.82
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

REVSC EVASC IVT ANGIO SF 1ST

Facility

$27,397.00

Service Code	HCPCS 37254
Hospital Charge Code	404637254
Hospital Revenue Code	481
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

REVSC EVASC IVT ST CPLX 1ST

Facility

$61,616.39

Service Code	HCPCS 37260
Hospital Charge Code	403437260
Hospital Revenue Code	481
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

REVSC EVASC IVT ST CPLX 1ST

Facility

$61,616.39

Service Code	HCPCS 37260
Hospital Charge Code	403437260
Hospital Revenue Code	481
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

REVSC EVASC IVT ST CPLX 1ST

Facility

$61,616.39

Service Code	HCPCS 37260
Hospital Charge Code	404637260
Hospital Revenue Code	481
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

REVSC EVASC IVT ST CPLX 1ST

Facility

$61,616.39

Service Code	HCPCS 37260
Hospital Charge Code	404637260
Hospital Revenue Code	481
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

REVSC EVASC IVT ST CPLX EA

Facility

$15,877.00

Service Code	HCPCS 37261
Hospital Charge Code	403437261
Hospital Revenue Code	481
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,763.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$382.64
Rate for Payer: Wellpoint Medicaid Managed Care	$420.74

REVSC EVASC IVT ST CPLX EA

Facility

$15,877.00

Service Code	HCPCS 37261
Hospital Charge Code	404637261
Hospital Revenue Code	481
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

REVSC EVASC IVT ST CPLX EA

Facility

$15,877.00

Service Code	HCPCS 37261
Hospital Charge Code	404637261
Hospital Revenue Code	481
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,763.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$382.64
Rate for Payer: Wellpoint Medicaid Managed Care	$420.74

REVSC EVASC IVT ST CPLX EA

Facility

$15,877.00

Service Code	HCPCS 37261
Hospital Charge Code	403437261
Hospital Revenue Code	481
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

Know your out-of-pocket cost for care.

All Charges