Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMPLATZER VASCUL PLUG II 12MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679202C
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

AMPLATZER VASCUL PLUG II 12MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679202C
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

AMPLATZ SUPER STIFF GUIDE WIRE

Facility

$107.50

Hospital Charge Code	270653645
Hospital Revenue Code	278
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare Advantage	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.41
Rate for Payer: Cigna Commercial	$53.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.12
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.85

AMPLATZ SUPER STIFF GUIDE WIRE

Facility

$107.50

Hospital Charge Code	270653645
Hospital Revenue Code	278
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.12

AMPLATZ SUPER STIFF GUIDE WIRE

Facility

$107.50

Hospital Charge Code	270653643
Hospital Revenue Code	278
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.12

AMPLATZ SUPER STIFF GUIDE WIRE

Facility

$107.50

Hospital Charge Code	270653643
Hospital Revenue Code	278
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare Advantage	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.41
Rate for Payer: Cigna Commercial	$53.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.12
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.85

AMPLIFICATION FST 2 SEQUENCES

Facility

$237.39

Service Code	HCPCS 83900
Hospital Charge Code	38478081
Hospital Revenue Code	301
Min. Negotiated Rate	$35.61
Max. Negotiated Rate	$35.61
Rate for Payer: Qualcare PPO/HMO/WC	$35.61

AMPLIFICATION FST 2 SEQUENCES

Facility

$237.39

Service Code	HCPCS 83900
Hospital Charge Code	38478081
Hospital Revenue Code	301
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$90.21
Rate for Payer: Aetna Medicare Advantage	$71.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.53
Rate for Payer: Cigna Commercial	$118.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.61
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.72
Rate for Payer: Wellpoint Medicaid Managed Care	$6.29

AMPLIFICATION OF NUCLEIC ACID

Facility

$128.00

Hospital Charge Code	3032738B
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

AMPLIFICATION OF NUCLEIC ACID

Facility

$128.00

Hospital Charge Code	3004168F
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

AMPLIFICATION OF NUCLEIC ACID

Facility

$128.00

Hospital Charge Code	3032738B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

AMPLIFICATION OF NUCLEIC ACID

Facility

$128.00

Hospital Charge Code	3004168G
Hospital Revenue Code	301
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

AMPLIFICATION OF NUCLEIC ACID

Facility

$128.00

Hospital Charge Code	3004168F
Hospital Revenue Code	301
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

AMPLIFICATION OF NUCLEIC ACID

Facility

$128.00

Hospital Charge Code	3004168G
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

AMPLIFICATION OF NUCLEIC ACID

Facility

$128.00

Hospital Charge Code	3009069E
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

AMPLIFICATION OF NUCLEIC ACID

Facility

$128.00

Hospital Charge Code	3009069E
Hospital Revenue Code	301
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

AMPLIFICATION OF PT NUCLE ACID

Facility

$121.00

Hospital Charge Code	3009345B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.98
Rate for Payer: Aetna Medicare Advantage	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.86
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

AMPLIFICATION OF PT NUCLE ACID

Facility

$121.00

Hospital Charge Code	3009345B
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

AMPLIFICATION PAT NUCLEIC

Facility

$237.39

Service Code	HCPCS 83900
Hospital Charge Code	38472940
Hospital Revenue Code	301
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$90.21
Rate for Payer: Aetna Medicare Advantage	$71.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.53
Rate for Payer: Cigna Commercial	$118.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.61
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.72
Rate for Payer: Wellpoint Medicaid Managed Care	$6.29

AMPLIFICATION PAT NUCLEIC

Facility

$237.39

Service Code	HCPCS 83900
Hospital Charge Code	38472940
Hospital Revenue Code	301
Min. Negotiated Rate	$35.61
Max. Negotiated Rate	$35.61
Rate for Payer: Qualcare PPO/HMO/WC	$35.61

AMPLIFICATION PAT NUCLEIC ACID

Facility

$237.39

Service Code	HCPCS 83900
Hospital Charge Code	38472803
Hospital Revenue Code	301
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$90.21
Rate for Payer: Aetna Medicare Advantage	$71.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.53
Rate for Payer: Cigna Commercial	$118.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.61
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.72
Rate for Payer: Wellpoint Medicaid Managed Care	$6.29

AMPLIFICATION PAT NUCLEIC ACID

Facility

$237.39

Service Code	HCPCS 83900
Hospital Charge Code	38472803
Hospital Revenue Code	301
Min. Negotiated Rate	$35.61
Max. Negotiated Rate	$35.61
Rate for Payer: Qualcare PPO/HMO/WC	$35.61

AMPLIFICTION PAT NUC ACID

Facility

$237.39

Service Code	HCPCS 83900
Hospital Charge Code	38479423
Hospital Revenue Code	301
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$90.21
Rate for Payer: Aetna Medicare Advantage	$71.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.53
Rate for Payer: Cigna Commercial	$118.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.22
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.61
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.72
Rate for Payer: Wellpoint Medicaid Managed Care	$6.29

AMPLIFICTION PAT NUC ACID

Facility

$237.39

Service Code	HCPCS 83900
Hospital Charge Code	38479423
Hospital Revenue Code	301
Min. Negotiated Rate	$35.61
Max. Negotiated Rate	$35.61
Rate for Payer: Qualcare PPO/HMO/WC	$35.61

AMP NUCLEID ACID,EACH ADDITNL

Facility

$118.69

Service Code	HCPCS 8390191
Hospital Charge Code	38472805
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

Know your out-of-pocket cost for care.

All Charges