Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR UROGRAPHY W/NEPHROTOMOGRPHY

Facility

$906.25

Service Code	HCPCS 74415
Hospital Charge Code	2011414
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

XR UROGRAPHY W/NEPHROTOMOGRPHY

Facility

$906.25

Service Code	HCPCS 74415
Hospital Charge Code	2011414
Hospital Revenue Code	320
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$21.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$24.02

XR UROGRPHY W/INFSN W/O TMGRPY

Facility

$906.25

Service Code	HCPCS 74410
Hospital Charge Code	2011413
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

XR UROGRPHY W/INFSN W/O TMGRPY

Facility

$906.25

Service Code	HCPCS 74410
Hospital Charge Code	2011413
Hospital Revenue Code	320
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$21.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$24.02

XR US GUIDE TISSUE ABLATION

Facility

$1,521.25

Service Code	HCPCS 76940
Hospital Charge Code	5600180
Hospital Revenue Code	361
Min. Negotiated Rate	$228.19
Max. Negotiated Rate	$228.19
Rate for Payer: Qualcare PPO/HMO/WC	$228.19

XR US GUIDE TISSUE ABLATION

Facility

$1,521.25

Service Code	HCPCS 76940
Hospital Charge Code	5600180
Hospital Revenue Code	361
Min. Negotiated Rate	$36.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$578.08
Rate for Payer: Aetna Medicare Advantage	$456.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$387.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$387.92
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	$387.92
Rate for Payer: Cigna Commercial	$760.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.38
Rate for Payer: Qualcare PPO/HMO/WC	$228.19
Rate for Payer: UnitedHealthcare Community & State	$36.66
Rate for Payer: Wellpoint Medicaid Managed Care	$40.31

XR VEIN CUTDOWN <1 YR

Facility

$68.75

Service Code	HCPCS 36420
Hospital Charge Code	5600030
Hospital Revenue Code	361
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$10.31
Rate for Payer: Qualcare PPO/HMO/WC	$10.31

XR VEIN CUTDOWN <1 YR

Facility

$68.75

Service Code	HCPCS 36420
Hospital Charge Code	5600030
Hospital Revenue Code	361
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.62
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.31
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

XR VEIN CUTDOWN <1 YR

Facility

$68.75

Service Code	HCPCS 36420
Hospital Charge Code	7411439
Hospital Revenue Code	361
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$10.31
Rate for Payer: Qualcare PPO/HMO/WC	$10.31

XR VEIN CUTDOWN <1 YR

Facility

$68.75

Service Code	HCPCS 36420
Hospital Charge Code	7411439
Hospital Revenue Code	361
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.62
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.31
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

XR VEN MECH THROMBECTOMY W/MF

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	7411495
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR VEN MECH THROMBECTOMY W/MF

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	7411495
Hospital Revenue Code	361
Min. Negotiated Rate	$441.22
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	$1,626.00
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	$5,492.34
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$441.22
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	$485.16

XR VEN MECH THROMBECTOMY W/MF

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	5600143MF
Hospital Revenue Code	361
Min. Negotiated Rate	$441.22
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	$1,626.00
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	$5,492.34
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$441.22
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	$485.16

XR VEN MECH THROMBECTOMY W/MF

Facility

$18,307.80

Service Code	HCPCS 37187
Hospital Charge Code	5600143MF
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR VENOGRAM LOWER XTRMITY LEFT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011416
Hospital Revenue Code	320
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$53.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$59.30

XR VENOGRAM LOWER XTRMITY LEFT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011416
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM LOWER XTRMITY RGHT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011417
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM LOWER XTRMITY RGHT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011417
Hospital Revenue Code	320
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$53.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$59.30

XR VENOGRAM LWR XTRMTY BILATRL

Facility

$2,237.55

Service Code	HCPCS 75822
Hospital Charge Code	2011415
Hospital Revenue Code	320
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$53.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$59.30

XR VENOGRAM LWR XTRMTY BILATRL

Facility

$2,237.55

Service Code	HCPCS 75822
Hospital Charge Code	2011415
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM UPPER XTRMTY LEFT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011419
Hospital Revenue Code	320
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$53.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$59.30

XR VENOGRAM UPPER XTRMTY LEFT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011419
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM UPPER XTRMTY RIGHT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011420
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

XR VENOGRAM UPPER XTRMTY RIGHT

Facility

$2,237.55

Service Code	HCPCS 75820
Hospital Charge Code	2011420
Hospital Revenue Code	320
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.63
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$53.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$59.30

XR VENOGRAM UPPR XTRMTY BILTRL

Facility

$2,237.55

Service Code	HCPCS 75822
Hospital Charge Code	2011418
Hospital Revenue Code	320
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$335.63
Rate for Payer: Qualcare PPO/HMO/WC	$335.63

Know your out-of-pocket cost for care.

All Charges