Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THROMBOGEN,20,000U,SPRAY

Facility

$1,112.00

Hospital Charge Code	60635420
Hospital Revenue Code	250
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$556.00
Rate for Payer: Aetna Commercial	$422.56
Rate for Payer: Aetna Medicare Advantage	$333.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$283.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$283.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$283.56
Rate for Payer: Cigna Commercial	$556.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.60
Rate for Payer: Oxford Commercial	$222.40
Rate for Payer: Qualcare PPO/HMO/WC	$166.80
Rate for Payer: UnitedHealthcare Commercial	$222.40
Rate for Payer: UnitedHealthcare Community & State	$26.80
Rate for Payer: Wellpoint Medicaid Managed Care	$29.47

THROMBOGEN,20,000U,SPRAY

Facility

$1,112.00

Hospital Charge Code	60635420
Hospital Revenue Code	250
Min. Negotiated Rate	$166.80
Max. Negotiated Rate	$166.80
Rate for Payer: Qualcare PPO/HMO/WC	$166.80

THROMBOLYSIS

Facility

$2,765.00

Hospital Charge Code	2692180
Hospital Revenue Code	320
Min. Negotiated Rate	$414.75
Max. Negotiated Rate	$414.75
Rate for Payer: Qualcare PPO/HMO/WC	$414.75

THROMBOLYSIS

Facility

$2,765.00

Hospital Charge Code	2692180
Hospital Revenue Code	320
Min. Negotiated Rate	$66.64
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,050.70
Rate for Payer: Aetna Medicare Advantage	$829.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$705.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$705.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$705.08
Rate for Payer: Cigna Commercial	$1,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$414.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$66.64
Rate for Payer: Wellpoint Medicaid Managed Care	$73.27

THROMBOLYTIC ART THEARPY

Facility

$4,631.03

Service Code	HCPCS 37211
Hospital Charge Code	7411502
Hospital Revenue Code	361
Min. Negotiated Rate	$111.61
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,389.31
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$694.65
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$111.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$122.72

THROMBOLYTIC ART THEARPY

Facility

$4,631.03

Service Code	HCPCS 37211
Hospital Charge Code	7411502
Hospital Revenue Code	361
Min. Negotiated Rate	$694.65
Max. Negotiated Rate	$694.65
Rate for Payer: Qualcare PPO/HMO/WC	$694.65

THROMBOLYTIC ART THERAPY

Facility

$25,628.45

Service Code	HCPCS 37211
Hospital Charge Code	5600229
Hospital Revenue Code	361
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,688.53
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$617.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$679.15

THROMBOLYTIC ART THERAPY

Facility

$25,628.45

Service Code	HCPCS 37211
Hospital Charge Code	5600229
Hospital Revenue Code	361
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

THROMBOLYTIC ART THERAPY

Facility

$21,323.35

Service Code	HCPCS 37211
Hospital Charge Code	366837211
Hospital Revenue Code	361
Min. Negotiated Rate	$513.89
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,397.01
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$513.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$565.07

THROMBOLYTIC ART THERAPY

Facility

$21,323.35

Service Code	HCPCS 37211
Hospital Charge Code	411037211
Hospital Revenue Code	361
Min. Negotiated Rate	$513.89
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,397.01
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$513.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$565.07

THROMBOLYTIC ART THERAPY

Facility

$21,323.35

Service Code	HCPCS 37211
Hospital Charge Code	411037211
Hospital Revenue Code	361
Min. Negotiated Rate	$3,198.50
Max. Negotiated Rate	$3,198.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50

THROMBOLYTIC ART THERAPY

Facility

$25,628.45

Service Code	HCPCS 37211
Hospital Charge Code	321037211
Hospital Revenue Code	361
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,688.53
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$617.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$679.15

THROMBOLYTIC ART THERAPY

Facility

$22,361.41

Service Code	HCPCS 37211
Hospital Charge Code	2692242
Hospital Revenue Code	361
Min. Negotiated Rate	$538.91
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,708.42
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,354.21
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$538.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$592.58

THROMBOLYTIC ART THERAPY

Facility

$22,361.41

Service Code	HCPCS 37211
Hospital Charge Code	2692242
Hospital Revenue Code	361
Min. Negotiated Rate	$3,354.21
Max. Negotiated Rate	$3,354.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,354.21

THROMBOLYTIC ART THERAPY

Facility

$21,323.35

Service Code	HCPCS 37211
Hospital Charge Code	366837211
Hospital Revenue Code	361
Min. Negotiated Rate	$3,198.50
Max. Negotiated Rate	$3,198.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,198.50

THROMBOLYTIC ART THERAPY

Facility

$25,628.45

Service Code	HCPCS 37211
Hospital Charge Code	321037211
Hospital Revenue Code	361
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

THROMBOLYTIC ART/VEN THEARPY

Facility

$10,333.93

Service Code	HCPCS 37213
Hospital Charge Code	5600231
Hospital Revenue Code	361
Min. Negotiated Rate	$249.05
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,100.18
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.09
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$249.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$273.85

THROMBOLYTIC ART/VEN THEARPY

Facility

$10,333.93

Service Code	HCPCS 37213
Hospital Charge Code	5600231
Hospital Revenue Code	361
Min. Negotiated Rate	$1,550.09
Max. Negotiated Rate	$1,550.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.09

THROMBOLYTIC ART/VEN THERAPY

Facility

$6,404.20

Service Code	HCPCS 37213
Hospital Charge Code	321037213
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

THROMBOLYTIC ART/VEN THERAPY

Facility

$6,404.20

Service Code	HCPCS 37213
Hospital Charge Code	321037213
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.26
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$169.71

THROMBOLYTIC ART/VEN THERAPY

Facility

$13,241.04

Service Code	HCPCS 37213
Hospital Charge Code	2692244
Hospital Revenue Code	361
Min. Negotiated Rate	$319.11
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,972.31
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,986.16
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$319.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$350.89

THROMBOLYTIC ART/VEN THERAPY

Facility

$10,333.93

Service Code	HCPCS 37213
Hospital Charge Code	7411506
Hospital Revenue Code	361
Min. Negotiated Rate	$249.05
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,100.18
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.09
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$249.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$273.85

THROMBOLYTIC ART/VEN THERAPY

Facility

$10,333.93

Service Code	HCPCS 37213
Hospital Charge Code	7411506
Hospital Revenue Code	361
Min. Negotiated Rate	$1,550.09
Max. Negotiated Rate	$1,550.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.09

THROMBOLYTIC ART/VEN THERAPY

Facility

$13,241.04

Service Code	HCPCS 37213
Hospital Charge Code	2692244
Hospital Revenue Code	361
Min. Negotiated Rate	$1,986.16
Max. Negotiated Rate	$1,986.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,986.16

THROMBOLYTIC DEVICE ROTATOR

Facility

$781.30

Hospital Charge Code	270664875
Hospital Revenue Code	270
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$390.65
Rate for Payer: Aetna Commercial	$296.89
Rate for Payer: Aetna Medicare Advantage	$234.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.23
Rate for Payer: Cigna Commercial	$390.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.39
Rate for Payer: Oxford Commercial	$156.26
Rate for Payer: Qualcare PPO/HMO/WC	$117.19
Rate for Payer: UnitedHealthcare Commercial	$156.26
Rate for Payer: UnitedHealthcare Community & State	$18.83
Rate for Payer: Wellpoint Medicaid Managed Care	$20.70

Know your out-of-pocket cost for care.

All Charges