Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX-PERC DRAIN OR STENT-BI

Facility

$919.00

Hospital Charge Code	2009160
Hospital Revenue Code	320
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$349.22
Rate for Payer: Aetna Medicare Advantage	$275.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.34
Rate for Payer: Cigna Commercial	$459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$137.85
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$22.15
Rate for Payer: Wellpoint Medicaid Managed Care	$24.35

DX-PERC DRAIN OR STENT-LT

Facility

$1,895.00

Hospital Charge Code	2009320
Hospital Revenue Code	320
Min. Negotiated Rate	$45.67
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$720.10
Rate for Payer: Aetna Medicare Advantage	$568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.23
Rate for Payer: Cigna Commercial	$947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$45.67
Rate for Payer: Wellpoint Medicaid Managed Care	$50.22

DX-PERC DRAIN OR STENT-LT

Facility

$1,895.00

Hospital Charge Code	2009320
Hospital Revenue Code	320
Min. Negotiated Rate	$284.25
Max. Negotiated Rate	$284.25
Rate for Payer: Qualcare PPO/HMO/WC	$284.25

DX-PERC NEPH DRN/INJ REN PL LT

Facility

$7,271.12

Hospital Charge Code	2008065
Hospital Revenue Code	320
Min. Negotiated Rate	$175.23
Max. Negotiated Rate	$3,635.56
Rate for Payer: Aetna Commercial	$2,763.03
Rate for Payer: Aetna Medicare Advantage	$2,181.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,854.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,854.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,854.14
Rate for Payer: Cigna Commercial	$3,635.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,181.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,090.67
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$175.23
Rate for Payer: Wellpoint Medicaid Managed Care	$192.68

DX-PERC NEPH DRN/INJ REN PL LT

Facility

$7,271.12

Hospital Charge Code	2008065
Hospital Revenue Code	320
Min. Negotiated Rate	$1,090.67
Max. Negotiated Rate	$1,090.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,090.67

DX-PERC NEPH DRN/INJ RN PEL B

Facility

$7,271.12

Hospital Charge Code	2008055
Hospital Revenue Code	320
Min. Negotiated Rate	$175.23
Max. Negotiated Rate	$3,635.56
Rate for Payer: Aetna Commercial	$2,763.03
Rate for Payer: Aetna Medicare Advantage	$2,181.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,854.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,854.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,854.14
Rate for Payer: Cigna Commercial	$3,635.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,181.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,090.67
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$175.23
Rate for Payer: Wellpoint Medicaid Managed Care	$192.68

DX-PERC NEPH DRN/INJ RN PEL B

Facility

$7,271.12

Hospital Charge Code	2008055
Hospital Revenue Code	320
Min. Negotiated Rate	$1,090.67
Max. Negotiated Rate	$1,090.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,090.67

DX-PERC NEPH DRN/INJ RN PEL RT

Facility

$7,271.12

Hospital Charge Code	2008060
Hospital Revenue Code	320
Min. Negotiated Rate	$1,090.67
Max. Negotiated Rate	$1,090.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,090.67

DX-PERC NEPH DRN/INJ RN PEL RT

Facility

$7,271.12

Hospital Charge Code	2008060
Hospital Revenue Code	320
Min. Negotiated Rate	$175.23
Max. Negotiated Rate	$3,635.56
Rate for Payer: Aetna Commercial	$2,763.03
Rate for Payer: Aetna Medicare Advantage	$2,181.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,854.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,854.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,854.14
Rate for Payer: Cigna Commercial	$3,635.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,181.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,090.67
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$175.23
Rate for Payer: Wellpoint Medicaid Managed Care	$192.68

DX-PERC TRANSHEP TRCT

Facility

$4,824.00

Hospital Charge Code	2009095
Hospital Revenue Code	320
Min. Negotiated Rate	$723.60
Max. Negotiated Rate	$723.60
Rate for Payer: Qualcare PPO/HMO/WC	$723.60

DX-PERC TRANSHEP TRCT

Facility

$4,824.00

Hospital Charge Code	2009095
Hospital Revenue Code	320
Min. Negotiated Rate	$116.26
Max. Negotiated Rate	$2,412.00
Rate for Payer: Aetna Commercial	$1,833.12
Rate for Payer: Aetna Medicare Advantage	$1,447.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,230.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,230.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,230.12
Rate for Payer: Cigna Commercial	$2,412.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$723.60
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$116.26
Rate for Payer: Wellpoint Medicaid Managed Care	$127.84

DX-PTA BRACHIOCEPHALIC

Facility

$7,281.00

Hospital Charge Code	2009125
Hospital Revenue Code	320
Min. Negotiated Rate	$1,092.15
Max. Negotiated Rate	$1,092.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.15

DX-PTA BRACHIOCEPHALIC

Facility

$7,281.00

Hospital Charge Code	2009125
Hospital Revenue Code	320
Min. Negotiated Rate	$175.47
Max. Negotiated Rate	$3,640.50
Rate for Payer: Aetna Commercial	$2,766.78
Rate for Payer: Aetna Medicare Advantage	$2,184.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,856.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,856.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,856.65
Rate for Payer: Cigna Commercial	$3,640.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$175.47
Rate for Payer: Wellpoint Medicaid Managed Care	$192.95

DX-PTA ILIAC

Facility

$7,281.00

Hospital Charge Code	2009115
Hospital Revenue Code	320
Min. Negotiated Rate	$175.47
Max. Negotiated Rate	$3,640.50
Rate for Payer: Aetna Commercial	$2,766.78
Rate for Payer: Aetna Medicare Advantage	$2,184.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,856.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,856.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,856.65
Rate for Payer: Cigna Commercial	$3,640.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$175.47
Rate for Payer: Wellpoint Medicaid Managed Care	$192.95

DX-PTA ILIAC

Facility

$7,281.00

Hospital Charge Code	2009115
Hospital Revenue Code	320
Min. Negotiated Rate	$1,092.15
Max. Negotiated Rate	$1,092.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.15

DX-PTA PERIPH ARTERY

Facility

$7,281.00

Hospital Charge Code	2009120
Hospital Revenue Code	320
Min. Negotiated Rate	$175.47
Max. Negotiated Rate	$3,640.50
Rate for Payer: Aetna Commercial	$2,766.78
Rate for Payer: Aetna Medicare Advantage	$2,184.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,856.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,856.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,856.65
Rate for Payer: Cigna Commercial	$3,640.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$175.47
Rate for Payer: Wellpoint Medicaid Managed Care	$192.95

DX-PTA PERIPH ARTERY

Facility

$7,281.00

Hospital Charge Code	2009120
Hospital Revenue Code	320
Min. Negotiated Rate	$1,092.15
Max. Negotiated Rate	$1,092.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.15

DX-PTA VENOUS

Facility

$7,281.00

Hospital Charge Code	2009130
Hospital Revenue Code	320
Min. Negotiated Rate	$1,092.15
Max. Negotiated Rate	$1,092.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.15

DX-PTA VENOUS

Facility

$7,281.00

Hospital Charge Code	2009130
Hospital Revenue Code	320
Min. Negotiated Rate	$175.47
Max. Negotiated Rate	$3,640.50
Rate for Payer: Aetna Commercial	$2,766.78
Rate for Payer: Aetna Medicare Advantage	$2,184.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,856.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,856.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,856.65
Rate for Payer: Cigna Commercial	$3,640.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$175.47
Rate for Payer: Wellpoint Medicaid Managed Care	$192.95

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	321075741L
Hospital Revenue Code	320
Min. Negotiated Rate	$820.61
Max. Negotiated Rate	$17,025.00
Rate for Payer: Aetna Commercial	$12,939.00
Rate for Payer: Aetna Medicare Advantage	$10,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,682.75
Rate for Payer: Cigna Commercial	$17,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,215.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$820.61
Rate for Payer: Wellpoint Medicaid Managed Care	$902.33

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	7412008
Hospital Revenue Code	320
Min. Negotiated Rate	$820.61
Max. Negotiated Rate	$17,025.00
Rate for Payer: Aetna Commercial	$12,939.00
Rate for Payer: Aetna Medicare Advantage	$10,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,682.75
Rate for Payer: Cigna Commercial	$17,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,215.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$820.61
Rate for Payer: Wellpoint Medicaid Managed Care	$902.33

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	7412008
Hospital Revenue Code	320
Min. Negotiated Rate	$5,107.50
Max. Negotiated Rate	$5,107.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	2691895
Hospital Revenue Code	320
Min. Negotiated Rate	$5,107.50
Max. Negotiated Rate	$5,107.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	321075741L
Hospital Revenue Code	320
Min. Negotiated Rate	$5,107.50
Max. Negotiated Rate	$5,107.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	2691895
Hospital Revenue Code	320
Min. Negotiated Rate	$820.61
Max. Negotiated Rate	$17,025.00
Rate for Payer: Aetna Commercial	$12,939.00
Rate for Payer: Aetna Medicare Advantage	$10,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,682.75
Rate for Payer: Cigna Commercial	$17,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,215.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$820.61
Rate for Payer: Wellpoint Medicaid Managed Care	$902.33

Know your out-of-pocket cost for care.

All Charges