Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$27,397.00

Service Code	HCPCS 37248
Hospital Charge Code	321037248
Hospital Revenue Code	361
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	$1,626.00
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: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
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

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	2692138
Hospital Revenue Code	361
Min. Negotiated Rate	$581.19
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	$1,626.00
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	$7,234.74
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$581.19
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	$639.07

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	2709033
Hospital Revenue Code	361
Min. Negotiated Rate	$581.19
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	$1,626.00
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	$7,234.74
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$581.19
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	$639.07

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	7412067
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$24,115.80

Service Code	HCPCS 37248
Hospital Charge Code	7412067
Hospital Revenue Code	361
Min. Negotiated Rate	$581.19
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	$1,626.00
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	$7,234.74
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$581.19
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	$639.07

TBA 1ST ARTERY (NOT LE)

Facility

$24,115.80

Service Code	HCPCS 37246
Hospital Charge Code	5100844
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT LE)

Facility

$24,115.80

Service Code	HCPCS 37246
Hospital Charge Code	5100844
Hospital Revenue Code	361
Min. Negotiated Rate	$581.19
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	$1,626.00
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	$7,234.74
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$581.19
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	$639.07

TBA 1ST ARTERY (NOT LE)

Facility

$27,397.00

Service Code	HCPCS 37246
Hospital Charge Code	321037246
Hospital Revenue Code	361
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	$1,626.00
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: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
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

TBA 1ST ARTERY (NOT LE)

Facility

$27,397.00

Service Code	HCPCS 37246
Hospital Charge Code	321037246
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

TBA 1ST ARTERY (NOT LE)

Facility

$27,397.00

Service Code	HCPCS 37246
Hospital Charge Code	2692136
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

TBA 1ST ARTERY (NOT LE)

Facility

$27,397.00

Service Code	HCPCS 37246
Hospital Charge Code	2692136
Hospital Revenue Code	361
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	$1,626.00
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: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
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

TBA 1ST ARTERY (NOT LE)

Facility

$24,115.80

Service Code	HCPCS 37246
Hospital Charge Code	7412065
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT LE)

Facility

$24,115.80

Service Code	HCPCS 37246
Hospital Charge Code	366837246
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT LE)

Facility

$24,115.80

Service Code	HCPCS 37246
Hospital Charge Code	7412065
Hospital Revenue Code	361
Min. Negotiated Rate	$581.19
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	$1,626.00
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	$7,234.74
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$581.19
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	$639.07

TBA 1ST ARTERY (NOT LE)

Facility

$24,115.80

Service Code	HCPCS 37246
Hospital Charge Code	2709031
Hospital Revenue Code	361
Min. Negotiated Rate	$3,617.37
Max. Negotiated Rate	$3,617.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37

TBA 1ST ARTERY (NOT LE)

Facility

$24,115.80

Service Code	HCPCS 37246
Hospital Charge Code	2709031
Hospital Revenue Code	361
Min. Negotiated Rate	$581.19
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	$1,626.00
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	$7,234.74
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$581.19
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	$639.07

TBA 1ST ARTERY (NOT LE)

Facility

$24,115.80

Service Code	HCPCS 37246
Hospital Charge Code	366837246
Hospital Revenue Code	361
Min. Negotiated Rate	$581.19
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	$1,626.00
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	$7,234.74
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.37
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$581.19
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	$639.07

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$690.45

Service Code	HCPCS 36907
Hospital Charge Code	2692133
Hospital Revenue Code	361
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$103.57
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$690.45

Service Code	HCPCS 36907
Hospital Charge Code	2709028
Hospital Revenue Code	361
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
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	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.13
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$690.45

Service Code	HCPCS 36907
Hospital Charge Code	2709028
Hospital Revenue Code	361
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$103.57
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$690.45

Service Code	HCPCS 36907
Hospital Charge Code	2692133
Hospital Revenue Code	361
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
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	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.13
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$690.45

Service Code	HCPCS 36907
Hospital Charge Code	321036907
Hospital Revenue Code	361
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$103.57
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$690.45

Service Code	HCPCS 36907
Hospital Charge Code	366836907
Hospital Revenue Code	361
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
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	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.13
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$690.45

Service Code	HCPCS 36907
Hospital Charge Code	321036907
Hospital Revenue Code	361
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
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	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.13
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$690.45

Service Code	HCPCS 36907
Hospital Charge Code	5100841
Hospital Revenue Code	361
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$103.57
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

Know your out-of-pocket cost for care.

All Charges