Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ELOCON 0.1%/45GM

Facility

$127.00

Hospital Charge Code	60632932
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$63.50
Rate for Payer: Aetna Commercial	$48.26
Rate for Payer: Aetna Medicare Advantage	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.38
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.10
Rate for Payer: Oxford Commercial	$25.40
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$25.40
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

ELOCON 0.1%/45GM

Facility

$127.00

Hospital Charge Code	60632932
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

ELOCON 0.1%/45GM

Facility

$127.00

Hospital Charge Code	60632934
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

ELOCON 0.1%/45GM

Facility

$127.00

Hospital Charge Code	60632934
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$63.50
Rate for Payer: Aetna Commercial	$48.26
Rate for Payer: Aetna Medicare Advantage	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.38
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.10
Rate for Payer: Oxford Commercial	$25.40
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$25.40
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

ELSPAR 10,000 UNITS

Facility

$489.70

Service Code	HCPCS J9020
Hospital Charge Code	60635703
Hospital Revenue Code	636
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$244.85
Rate for Payer: Aetna Commercial	$186.09
Rate for Payer: Aetna Medicare Advantage	$146.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.87
Rate for Payer: Cigna Commercial	$244.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.51
Rate for Payer: Qualcare PPO/HMO/WC	$73.45
Rate for Payer: UnitedHealthcare Community & State	$11.80
Rate for Payer: Wellpoint Medicaid Managed Care	$12.98

ELSPAR 10,000 UNITS

Facility

$489.70

Service Code	HCPCS J9020
Hospital Charge Code	60635703
Hospital Revenue Code	636
Min. Negotiated Rate	$73.45
Max. Negotiated Rate	$118.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.51
Rate for Payer: Qualcare PPO/HMO/WC	$73.45

EMBOLECTOMY CATH 2FR 60CM

Facility

$489.00

Hospital Charge Code	270331051
Hospital Revenue Code	278
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$244.50
Rate for Payer: Aetna Commercial	$185.82
Rate for Payer: Aetna Medicare Advantage	$146.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.69
Rate for Payer: Cigna Commercial	$244.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$107.58
Rate for Payer: Qualcare PPO/HMO/WC	$73.35
Rate for Payer: UnitedHealthcare Community & State	$11.78
Rate for Payer: Wellpoint Medicaid Managed Care	$12.96

EMBOLECTOMY CATH 2FR 60CM

Facility

$489.00

Hospital Charge Code	270331051
Hospital Revenue Code	278
Min. Negotiated Rate	$73.35
Max. Negotiated Rate	$118.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$107.58
Rate for Payer: Qualcare PPO/HMO/WC	$73.35

EMBOLECTOMY CATH.5FR. 80CM

Facility

$264.00

Hospital Charge Code	270331052
Hospital Revenue Code	278
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$132.00
Rate for Payer: Aetna Commercial	$100.32
Rate for Payer: Aetna Medicare Advantage	$79.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.32
Rate for Payer: Cigna Commercial	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.08
Rate for Payer: Qualcare PPO/HMO/WC	$39.60
Rate for Payer: UnitedHealthcare Community & State	$6.36
Rate for Payer: Wellpoint Medicaid Managed Care	$7.00

EMBOLECTOMY CATH.5FR. 80CM

Facility

$264.00

Hospital Charge Code	270331052
Hospital Revenue Code	278
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.08
Rate for Payer: Qualcare PPO/HMO/WC	$39.60

EMBOLECTOMY CATH 6FR 80CM

Facility

$314.00

Hospital Charge Code	270331053
Hospital Revenue Code	278
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$75.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

EMBOLECTOMY CATH 6FR 80CM

Facility

$314.00

Hospital Charge Code	270331053
Hospital Revenue Code	278
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$157.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

EMBOLIZATION COILS 035 2 6 4x3

Facility

$480.00

Hospital Charge Code	270658346
Hospital Revenue Code	272
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.00
Rate for Payer: Oxford Commercial	$96.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Commercial	$96.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

EMBOLIZATION COILS 035 2 6 4x3

Facility

$480.00

Hospital Charge Code	270658346
Hospital Revenue Code	272
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

EMBOLIZATION COILS .035 4.1CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658347
Hospital Revenue Code	278
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

EMBOLIZATION COILS .035 4.1CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658347N
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

EMBOLIZATION COILS .035 4.1CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658347N
Hospital Revenue Code	278
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

EMBOLIZATION COILS .035 4.1CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658347
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

EMBOLIZATION COILS .035 8.2CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658350N
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

EMBOLIZATION COILS .035 8.2CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658350
Hospital Revenue Code	278
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

EMBOLIZATION COILS .035 8.2CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658350
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

EMBOLIZATION COILS .035 8.2CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658350N
Hospital Revenue Code	278
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

EMBOLIZATION DIALYS CIRC ADDON

Facility

$979.50

Service Code	HCPCS 36909
Hospital Charge Code	366836909
Hospital Revenue Code	361
Min. Negotiated Rate	$146.93
Max. Negotiated Rate	$146.93
Rate for Payer: Qualcare PPO/HMO/WC	$146.93

EMBOLIZATION DIALYS CIRC ADDON

Facility

$979.50

Service Code	HCPCS 36909
Hospital Charge Code	7412064
Hospital Revenue Code	361
Min. Negotiated Rate	$146.93
Max. Negotiated Rate	$146.93
Rate for Payer: Qualcare PPO/HMO/WC	$146.93

EMBOLIZATION DIALYS CIRC ADDON

Facility

$979.50

Service Code	HCPCS 36909
Hospital Charge Code	5100843
Hospital Revenue Code	361
Min. Negotiated Rate	$23.61
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$372.21
Rate for Payer: Aetna Medicare Advantage	$293.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.77
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	$249.77
Rate for Payer: Cigna Commercial	$489.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.85
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.93
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.61
Rate for Payer: Wellpoint Medicaid Managed Care	$25.96

Know your out-of-pocket cost for care.

All Charges