Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX-VENOGRAPH EXTREMITY-RT

Facility

$5,100.00

Service Code	HCPCS 75820RT
Hospital Charge Code	2691930
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

DX-VENOGRAPH EXTREMITY-RT

Facility

$5,100.00

Service Code	HCPCS 75820RT
Hospital Charge Code	2691930
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VERTEBRAL CERVICAL-RT

Facility

$3,431.00

Hospital Charge Code	2009275
Hospital Revenue Code	323
Min. Negotiated Rate	$514.65
Max. Negotiated Rate	$514.65
Rate for Payer: Qualcare PPO/HMO/WC	$514.65

DX-VERTEBRAL CERVICAL-RT

Facility

$3,431.00

Hospital Charge Code	2009275
Hospital Revenue Code	323
Min. Negotiated Rate	$82.69
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,303.78
Rate for Payer: Aetna Medicare Advantage	$1,029.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$874.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$874.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$874.90
Rate for Payer: Cigna Commercial	$1,715.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$514.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$82.69
Rate for Payer: Wellpoint Medicaid Managed Care	$90.92

DX-VERTEBRAL CERVICA-LT

Facility

$5,226.00

Hospital Charge Code	2009270
Hospital Revenue Code	323
Min. Negotiated Rate	$125.95
Max. Negotiated Rate	$2,613.00
Rate for Payer: Aetna Commercial	$1,985.88
Rate for Payer: Aetna Medicare Advantage	$1,567.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,332.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,332.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,332.63
Rate for Payer: Cigna Commercial	$2,613.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,567.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$783.90
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$125.95
Rate for Payer: Wellpoint Medicaid Managed Care	$138.49

DX-VERTEBRAL CERVICA-LT

Facility

$5,226.00

Hospital Charge Code	2009270
Hospital Revenue Code	323
Min. Negotiated Rate	$783.90
Max. Negotiated Rate	$783.90
Rate for Payer: Qualcare PPO/HMO/WC	$783.90

DX-VISCERAL ATHERECTOM-BI

Facility

$37,914.35

Service Code	HCPCS 0235T50
Hospital Charge Code	2690810
Hospital Revenue Code	361
Min. Negotiated Rate	$913.74
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,374.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$913.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,004.73

DX-VISCERAL ATHERECTOM-BI

Facility

$37,914.35

Service Code	HCPCS 0235T50
Hospital Charge Code	2690810
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

DX-VISCERAL ATHERECTOM-BI

Facility

$37,614.35

Service Code	HCPCS 0235T50
Hospital Charge Code	7411852
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

DX-VISCERAL ATHERECTOM-BI

Facility

$37,614.35

Service Code	HCPCS 0235T50
Hospital Charge Code	7411852
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	32100235TL
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	2690815
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

DX-VISCERAL ATHERECTOM-LT

Facility

$37,614.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	41100235T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	32100235TL
Hospital Revenue Code	361
Min. Negotiated Rate	$913.74
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,374.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$913.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,004.73

DX-VISCERAL ATHERECTOM-LT

Facility

$37,614.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	41100235T
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	36680235T
Hospital Revenue Code	361
Min. Negotiated Rate	$913.74
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,374.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$913.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,004.73

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	36680235T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	2690815
Hospital Revenue Code	361
Min. Negotiated Rate	$913.74
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,374.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$913.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,004.73

DX-VISCERAL ATHERECTOM-LT

Facility

$37,614.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	7411853
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

DX-VISCERAL ATHERECTOM-LT

Facility

$37,614.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	7411853
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

DX-VISCERAL ATHERECTOM-RT

Facility

$37,914.35

Service Code	HCPCS 0235TRT
Hospital Charge Code	2690820
Hospital Revenue Code	361
Min. Negotiated Rate	$913.74
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,374.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$913.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,004.73

DX-VISCERAL ATHERECTOM-RT

Facility

$37,614.35

Service Code	HCPCS 0235TRT
Hospital Charge Code	7411854
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

DX-VISCERAL ATHERECTOM-RT

Facility

$37,614.35

Service Code	HCPCS 0235TRT
Hospital Charge Code	7411854
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

DX-VISCERAL ATHERECTOM-RT

Facility

$37,914.35

Service Code	HCPCS 0235TRT
Hospital Charge Code	2690820
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

DX-VISCERAL SEL EA ADD-LT

Facility

$5,100.00

Service Code	HCPCS 75774LT
Hospital Charge Code	2691915
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

Know your out-of-pocket cost for care.

All Charges