Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EMBOLIZATION DIALYS CIRC ADDON

Facility

$979.50

Service Code	HCPCS 36909
Hospital Charge Code	5100843
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	2709030
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

EMBOLIZATION DIALYS CIRC ADDON

Facility

$979.50

Service Code	HCPCS 36909
Hospital Charge Code	321036909
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

EMBOLIZATION DIALYS CIRC ADDON

Facility

$979.50

Service Code	HCPCS 36909
Hospital Charge Code	2709030
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	321036909
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	2692149
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

EMBOLIZATION DIALYS CIRC ADDON

Facility

$979.50

Service Code	HCPCS 36909
Hospital Charge Code	2692149
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	366836909
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

EMBOLIZATION DIALYS CIRC ADDON

Facility

$979.50

Service Code	HCPCS 36909
Hospital Charge Code	7412064
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

EMBOLIZATION MICROCOILS .018

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658339
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 MICROCOILS .018

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658339
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 MICROCOILS .018

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658339N
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 MICROCOILS .018

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270658339N
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

EMBOSHD N6 SML 5.0x190 2243719

Facility

$8,475.00

Hospital Charge Code	270643273V
Hospital Revenue Code	278
Min. Negotiated Rate	$204.25
Max. Negotiated Rate	$4,237.50
Rate for Payer: Aetna Commercial	$3,220.50
Rate for Payer: Aetna Medicare Advantage	$2,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,161.12
Rate for Payer: Cigna Commercial	$4,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25
Rate for Payer: UnitedHealthcare Community & State	$204.25
Rate for Payer: Wellpoint Medicaid Managed Care	$224.59

EMBOSHD N6 SML 5.0x190 2243719

Facility

$8,475.00

Hospital Charge Code	270643273V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$2,050.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

EMBOSHD NAV LG 7.2X190 2243819

Facility

$8,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270643420N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$2,050.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

EMBOSHD NAV LG 7.2X190 2243819

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643420C
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

EMBOSHD NAV LG 7.2X190 2243819

Facility

$8,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270643420N
Hospital Revenue Code	278
Min. Negotiated Rate	$204.25
Max. Negotiated Rate	$4,237.50
Rate for Payer: Aetna Commercial	$3,220.50
Rate for Payer: Aetna Medicare Advantage	$2,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,161.12
Rate for Payer: Cigna Commercial	$4,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25
Rate for Payer: UnitedHealthcare Community & State	$204.25
Rate for Payer: Wellpoint Medicaid Managed Care	$224.59

EMBOSHD NAV LG 7.2X190 2243819

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643420C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

EMBOSHIELD NAV 2.5-4.8mm SMAL

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273S
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

EMBOSHIELD NAV 2.5-4.8mm SMAL

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

EMBOSHIELD NAV 2.5-4.8mm SMAL

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

EMBOSHIELD NAV 2.5-4.8mm SMAL

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

EMBOSHIELD NAV 2.5-.8MM SMALL

Facility

$9,975.00

Hospital Charge Code	2709005680
Hospital Revenue Code	272
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$1,496.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

EMBOSHIELD NAV 2.5-.8MM SMALL

Facility

$9,975.00

Hospital Charge Code	2709005680
Hospital Revenue Code	272
Min. Negotiated Rate	$240.40
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,992.50
Rate for Payer: Oxford Commercial	$1,995.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Commercial	$1,995.00
Rate for Payer: UnitedHealthcare Community & State	$240.40
Rate for Payer: Wellpoint Medicaid Managed Care	$264.34

Know your out-of-pocket cost for care.

All Charges