Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$690.45

Service Code	HCPCS 36907
Hospital Charge Code	5100841
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	366836907
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	7412062
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	7412062
Hospital Revenue Code	361
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$103.57
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	2709032
Hospital Revenue Code	361
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$370.46
Rate for Payer: Aetna Medicare Advantage	$292.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.60
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	$248.60
Rate for Payer: Cigna Commercial	$487.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.24
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.83

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	5100845
Hospital Revenue Code	361
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$370.46
Rate for Payer: Aetna Medicare Advantage	$292.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.60
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	$248.60
Rate for Payer: Cigna Commercial	$487.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.24
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.83

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	2709032
Hospital Revenue Code	361
Min. Negotiated Rate	$146.24
Max. Negotiated Rate	$146.24
Rate for Payer: Qualcare PPO/HMO/WC	$146.24

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	321037247
Hospital Revenue Code	361
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$370.46
Rate for Payer: Aetna Medicare Advantage	$292.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.60
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	$248.60
Rate for Payer: Cigna Commercial	$487.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.24
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.83

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	321037247
Hospital Revenue Code	361
Min. Negotiated Rate	$146.24
Max. Negotiated Rate	$146.24
Rate for Payer: Qualcare PPO/HMO/WC	$146.24

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	366837247
Hospital Revenue Code	361
Min. Negotiated Rate	$146.24
Max. Negotiated Rate	$146.24
Rate for Payer: Qualcare PPO/HMO/WC	$146.24

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	2692137
Hospital Revenue Code	361
Min. Negotiated Rate	$146.24
Max. Negotiated Rate	$146.24
Rate for Payer: Qualcare PPO/HMO/WC	$146.24

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	2692137
Hospital Revenue Code	361
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$370.46
Rate for Payer: Aetna Medicare Advantage	$292.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.60
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	$248.60
Rate for Payer: Cigna Commercial	$487.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.24
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.83

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	7412066
Hospital Revenue Code	361
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$370.46
Rate for Payer: Aetna Medicare Advantage	$292.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.60
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	$248.60
Rate for Payer: Cigna Commercial	$487.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.24
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.83

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	5100845
Hospital Revenue Code	361
Min. Negotiated Rate	$146.24
Max. Negotiated Rate	$146.24
Rate for Payer: Qualcare PPO/HMO/WC	$146.24

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	7412066
Hospital Revenue Code	361
Min. Negotiated Rate	$146.24
Max. Negotiated Rate	$146.24
Rate for Payer: Qualcare PPO/HMO/WC	$146.24

TBA EA ADD ARTERY (NOT LE)

Facility

$974.90

Service Code	HCPCS 37247
Hospital Charge Code	366837247
Hospital Revenue Code	361
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$370.46
Rate for Payer: Aetna Medicare Advantage	$292.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.60
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	$248.60
Rate for Payer: Cigna Commercial	$487.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.47
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.24
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.83

TBA EA ADD ART (NOT DIALYSIS)

Facility

$829.85

Service Code	HCPCS 37249
Hospital Charge Code	5100847
Hospital Revenue Code	361
Min. Negotiated Rate	$124.48
Max. Negotiated Rate	$124.48
Rate for Payer: Qualcare PPO/HMO/WC	$124.48

TBA EA ADD ART (NOT DIALYSIS)

Facility

$829.85

Service Code	HCPCS 37249
Hospital Charge Code	5100847
Hospital Revenue Code	361
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$315.34
Rate for Payer: Aetna Medicare Advantage	$248.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.61
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	$211.61
Rate for Payer: Cigna Commercial	$414.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.96
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.48
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$21.99

TBA EA ADD ART (NOT DIALYSIS)

Facility

$829.85

Service Code	HCPCS 37249
Hospital Charge Code	321037249
Hospital Revenue Code	361
Min. Negotiated Rate	$124.48
Max. Negotiated Rate	$124.48
Rate for Payer: Qualcare PPO/HMO/WC	$124.48

TBA EA ADD ART (NOT DIALYSIS)

Facility

$829.85

Service Code	HCPCS 37249
Hospital Charge Code	321037249
Hospital Revenue Code	361
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$315.34
Rate for Payer: Aetna Medicare Advantage	$248.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.61
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	$211.61
Rate for Payer: Cigna Commercial	$414.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.96
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.48
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$21.99

TBA EA ADD ART (NOT DIALYSIS)

Facility

$829.85

Service Code	HCPCS 37249
Hospital Charge Code	2709034
Hospital Revenue Code	361
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$315.34
Rate for Payer: Aetna Medicare Advantage	$248.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.61
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	$211.61
Rate for Payer: Cigna Commercial	$414.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.96
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.48
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$21.99

TBA EA ADD ART (NOT DIALYSIS)

Facility

$829.85

Service Code	HCPCS 37249
Hospital Charge Code	2692139
Hospital Revenue Code	361
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$315.34
Rate for Payer: Aetna Medicare Advantage	$248.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.61
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	$211.61
Rate for Payer: Cigna Commercial	$414.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.96
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.48
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$21.99

TBA EA ADD ART (NOT DIALYSIS)

Facility

$829.85

Service Code	HCPCS 37249
Hospital Charge Code	2709034
Hospital Revenue Code	361
Min. Negotiated Rate	$124.48
Max. Negotiated Rate	$124.48
Rate for Payer: Qualcare PPO/HMO/WC	$124.48

TBA EA ADD ART (NOT DIALYSIS)

Facility

$829.85

Service Code	HCPCS 37249
Hospital Charge Code	2692139
Hospital Revenue Code	361
Min. Negotiated Rate	$124.48
Max. Negotiated Rate	$124.48
Rate for Payer: Qualcare PPO/HMO/WC	$124.48

TBA EA ADD ART (NOT DIALYSIS)

Facility

$829.85

Service Code	HCPCS 37249
Hospital Charge Code	366837249
Hospital Revenue Code	361
Min. Negotiated Rate	$124.48
Max. Negotiated Rate	$124.48
Rate for Payer: Qualcare PPO/HMO/WC	$124.48

Know your out-of-pocket cost for care.

All Charges