Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ENDO UNIVERSAL 65 DEG 4.0MM***

Facility

$952.00

Hospital Charge Code	1605898
Hospital Revenue Code	272
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$476.00
Rate for Payer: Aetna Commercial	$361.76
Rate for Payer: Aetna Medicare Advantage	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.76
Rate for Payer: Cigna Commercial	$476.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.60
Rate for Payer: Oxford Commercial	$190.40
Rate for Payer: Qualcare PPO/HMO/WC	$142.80
Rate for Payer: UnitedHealthcare Commercial	$190.40
Rate for Payer: UnitedHealthcare Community & State	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$25.23

ENDO UNIVERSAL 65 DEG 4.0MM***

Facility

$952.00

Hospital Charge Code	1605898
Hospital Revenue Code	272
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$142.80
Rate for Payer: Qualcare PPO/HMO/WC	$142.80

ENDO UNIVERSAL 65 DEG 4.8MM***

Facility

$952.00

Hospital Charge Code	1605906
Hospital Revenue Code	272
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$476.00
Rate for Payer: Aetna Commercial	$361.76
Rate for Payer: Aetna Medicare Advantage	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.76
Rate for Payer: Cigna Commercial	$476.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.60
Rate for Payer: Oxford Commercial	$190.40
Rate for Payer: Qualcare PPO/HMO/WC	$142.80
Rate for Payer: UnitedHealthcare Commercial	$190.40
Rate for Payer: UnitedHealthcare Community & State	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$25.23

ENDO UNIVERSAL 65 DEG 4.8MM***

Facility

$952.00

Hospital Charge Code	1605906
Hospital Revenue Code	272
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$142.80
Rate for Payer: Qualcare PPO/HMO/WC	$142.80

ENDOVASC IC PR ADM 1ST TERR

Facility

$4,582.00

Service Code	HCPCS 61650
Hospital Charge Code	5792273
Hospital Revenue Code	450
Min. Negotiated Rate	$121.42
Max. Negotiated Rate	$2,291.00
Rate for Payer: Aetna Commercial	$1,741.16
Rate for Payer: Aetna Medicare Advantage	$1,374.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,168.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,168.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,168.41
Rate for Payer: Cigna Commercial	$2,291.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$687.30
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$121.42

ENDOVASC IC PR ADM 1ST TERR

Facility

$7,825.00

Service Code	HCPCS 61650
Hospital Charge Code	7411645
Hospital Revenue Code	361
Min. Negotiated Rate	$1,173.75
Max. Negotiated Rate	$1,173.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,173.75

ENDOVASC IC PR ADM 1ST TERR

Facility

$7,825.00

Service Code	HCPCS 61650
Hospital Charge Code	7411645
Hospital Revenue Code	361
Min. Negotiated Rate	$188.58
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,973.50
Rate for Payer: Aetna Medicare Advantage	$2,347.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,995.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,995.38
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	$1,995.38
Rate for Payer: Cigna Commercial	$3,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,173.75
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$188.58
Rate for Payer: Wellpoint Medicaid Managed Care	$207.36

ENDOVASC IC PR ADM 1ST TERR

Facility

$7,825.00

Service Code	HCPCS 61650
Hospital Charge Code	2600241
Hospital Revenue Code	361
Min. Negotiated Rate	$1,173.75
Max. Negotiated Rate	$1,173.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,173.75

ENDOVASC IC PR ADM 1ST TERR

Facility

$7,825.00

Service Code	HCPCS 61650
Hospital Charge Code	2600241
Hospital Revenue Code	361
Min. Negotiated Rate	$188.58
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,973.50
Rate for Payer: Aetna Medicare Advantage	$2,347.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,995.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,995.38
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	$1,995.38
Rate for Payer: Cigna Commercial	$3,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,173.75
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$188.58
Rate for Payer: Wellpoint Medicaid Managed Care	$207.36

ENDOVASC IC PR ADM 1ST TERR

Facility

$4,582.00

Service Code	HCPCS 61650
Hospital Charge Code	5792273
Hospital Revenue Code	450
Min. Negotiated Rate	$687.30
Max. Negotiated Rate	$687.30
Rate for Payer: Qualcare PPO/HMO/WC	$687.30

ENDOVASC IC PR ADM EA ADD TERR

Facility

$7,825.00

Service Code	HCPCS 61651
Hospital Charge Code	2600242
Hospital Revenue Code	361
Min. Negotiated Rate	$188.58
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,973.50
Rate for Payer: Aetna Medicare Advantage	$2,347.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,995.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,995.38
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	$1,995.38
Rate for Payer: Cigna Commercial	$3,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,173.75
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$188.58
Rate for Payer: Wellpoint Medicaid Managed Care	$207.36

ENDOVASC IC PR ADM EA ADD TERR

Facility

$7,825.00

Service Code	HCPCS 61651
Hospital Charge Code	7411646
Hospital Revenue Code	361
Min. Negotiated Rate	$188.58
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,973.50
Rate for Payer: Aetna Medicare Advantage	$2,347.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,995.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,995.38
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	$1,995.38
Rate for Payer: Cigna Commercial	$3,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,173.75
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$188.58
Rate for Payer: Wellpoint Medicaid Managed Care	$207.36

ENDOVASC IC PR ADM EA ADD TERR

Facility

$7,825.00

Service Code	HCPCS 61651
Hospital Charge Code	2600242
Hospital Revenue Code	361
Min. Negotiated Rate	$1,173.75
Max. Negotiated Rate	$1,173.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,173.75

ENDOVASC IC PR ADM EA ADD TERR

Facility

$4,582.00

Service Code	HCPCS 61651
Hospital Charge Code	5792274
Hospital Revenue Code	450
Min. Negotiated Rate	$687.30
Max. Negotiated Rate	$687.30
Rate for Payer: Qualcare PPO/HMO/WC	$687.30

ENDOVASC IC PR ADM EA ADD TERR

Facility

$4,582.00

Service Code	HCPCS 61651
Hospital Charge Code	5792274
Hospital Revenue Code	450
Min. Negotiated Rate	$121.42
Max. Negotiated Rate	$2,291.00
Rate for Payer: Aetna Commercial	$1,741.16
Rate for Payer: Aetna Medicare Advantage	$1,374.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,168.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,168.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$233.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,168.41
Rate for Payer: Cigna Commercial	$2,291.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$687.30
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$121.42

ENDOVASC IC PR ADM EA ADD TERR

Facility

$7,825.00

Service Code	HCPCS 61651
Hospital Charge Code	7411646
Hospital Revenue Code	361
Min. Negotiated Rate	$1,173.75
Max. Negotiated Rate	$1,173.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,173.75

ENDOVASC TAA REPR W/O SUBCL

Facility

$9,572.95

Service Code	HCPCS 33881
Hospital Charge Code	5701112
Hospital Revenue Code	361
Min. Negotiated Rate	$1,435.94
Max. Negotiated Rate	$1,435.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,435.94

ENDOVASC TAA REPR W/O SUBCL

Facility

$9,572.95

Service Code	HCPCS 33881
Hospital Charge Code	5701112
Hospital Revenue Code	361
Min. Negotiated Rate	$230.71
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$3,637.72
Rate for Payer: Aetna Medicare Advantage	$2,871.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,441.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,441.10
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	$2,441.10
Rate for Payer: Cigna Commercial	$4,786.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,871.89
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,435.94
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$230.71
Rate for Payer: Wellpoint Medicaid Managed Care	$253.68

ENDOVASC TAA REPR W/O SUBCL

Facility

$9,572.95

Service Code	HCPCS 33881
Hospital Charge Code	7411390
Hospital Revenue Code	361
Min. Negotiated Rate	$1,435.94
Max. Negotiated Rate	$1,435.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,435.94

ENDOVASC TAA REPR W/O SUBCL

Facility

$9,572.95

Service Code	HCPCS 33881
Hospital Charge Code	7411390
Hospital Revenue Code	361
Min. Negotiated Rate	$230.71
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$3,637.72
Rate for Payer: Aetna Medicare Advantage	$2,871.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,441.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,441.10
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	$2,441.10
Rate for Payer: Cigna Commercial	$4,786.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,871.89
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,435.94
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$230.71
Rate for Payer: Wellpoint Medicaid Managed Care	$253.68

ENDOVASC TAA REPR W/O SUBCL

Facility

$9,572.95

Service Code	HCPCS 33881
Hospital Charge Code	321033881
Hospital Revenue Code	361
Min. Negotiated Rate	$230.71
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$3,637.72
Rate for Payer: Aetna Medicare Advantage	$2,871.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,441.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,441.10
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	$2,441.10
Rate for Payer: Cigna Commercial	$4,786.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,871.89
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,435.94
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$230.71
Rate for Payer: Wellpoint Medicaid Managed Care	$253.68

ENDOVASC TAA REPR W/O SUBCL

Facility

$9,572.95

Service Code	HCPCS 33881
Hospital Charge Code	321033881
Hospital Revenue Code	361
Min. Negotiated Rate	$1,435.94
Max. Negotiated Rate	$1,435.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,435.94

ENDOVASC TEMPORY VESSEL OCCL

Facility

$61,620.70

Service Code	HCPCS 61623
Hospital Charge Code	411061623
Hospital Revenue Code	361
Min. Negotiated Rate	$1,485.06
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	$18,486.21
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,243.10
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,485.06
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	$1,632.95

ENDOVASC TEMPORY VESSEL OCCL

Facility

$61,620.70

Service Code	HCPCS 61623
Hospital Charge Code	411061623
Hospital Revenue Code	361
Min. Negotiated Rate	$9,243.10
Max. Negotiated Rate	$9,243.10
Rate for Payer: Qualcare PPO/HMO/WC	$9,243.10

ENDOVASC TEMPORY VESSEL OCCL

Facility

$61,620.70

Service Code	HCPCS 61623
Hospital Charge Code	366861623
Hospital Revenue Code	361
Min. Negotiated Rate	$9,243.10
Max. Negotiated Rate	$9,243.10
Rate for Payer: Qualcare PPO/HMO/WC	$9,243.10

Know your out-of-pocket cost for care.

All Charges