Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ILIAC EXT SYSTEM 12mm-12mm45cm

Facility

$21,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270679992
Hospital Revenue Code	278
Min. Negotiated Rate	$3,224.25
Max. Negotiated Rate	$5,201.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,201.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,728.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,224.25

ILIAC EXT SYSTEM 12mm-12mm45cm

Facility

$21,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270679992
Hospital Revenue Code	278
Min. Negotiated Rate	$518.03
Max. Negotiated Rate	$10,747.50
Rate for Payer: Aetna Commercial	$8,168.10
Rate for Payer: Aetna Medicare Advantage	$6,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,481.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,481.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,481.23
Rate for Payer: Cigna Commercial	$10,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,201.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,728.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,224.25
Rate for Payer: UnitedHealthcare Community & State	$518.03
Rate for Payer: Wellpoint Medicaid Managed Care	$569.62

ILIAC/FEMORAL ARTRY ANGIO

Facility

$221.00

Service Code	HCPCS G0278
Hospital Charge Code	7411269
Hospital Revenue Code	323
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.15

ILIAC/FEMORAL ARTRY ANGIO

Facility

$221.00

Service Code	HCPCS G0278
Hospital Charge Code	7411269
Hospital Revenue Code	323
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$83.98
Rate for Payer: Aetna Medicare Advantage	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.35
Rate for Payer: Cigna Commercial	$110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.86

ILIAC LEG GRAFT

Facility

$18,825.00

Service Code	HCPCS C1768
Hospital Charge Code	270686468
Hospital Revenue Code	278
Min. Negotiated Rate	$453.68
Max. Negotiated Rate	$9,412.50
Rate for Payer: Aetna Commercial	$7,153.50
Rate for Payer: Aetna Medicare Advantage	$5,647.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,800.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,800.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,800.38
Rate for Payer: Cigna Commercial	$9,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,555.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,141.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,823.75
Rate for Payer: UnitedHealthcare Community & State	$453.68
Rate for Payer: Wellpoint Medicaid Managed Care	$498.86

ILIAC LEG GRAFT

Facility

$18,825.00

Service Code	HCPCS C1768
Hospital Charge Code	270686468
Hospital Revenue Code	278
Min. Negotiated Rate	$2,823.75
Max. Negotiated Rate	$4,555.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,555.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,141.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,823.75

ILIAC LIMB

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270683900
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB

Facility

$225.00

Service Code	HCPCS C1768
Hospital Charge Code	270679253
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

ILIAC LIMB

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270679762
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,498.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

ILIAC LIMB

Facility

$225.00

Service Code	HCPCS C1768
Hospital Charge Code	270679253
Hospital Revenue Code	278
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

ILIAC LIMB

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270683900
Hospital Revenue Code	278
Min. Negotiated Rate	$566.23
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$566.23
Rate for Payer: Wellpoint Medicaid Managed Care	$622.62

ILIAC LIMB

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270679762
Hospital Revenue Code	278
Min. Negotiated Rate	$602.38
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$9,498.10
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,498.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25
Rate for Payer: UnitedHealthcare Community & State	$602.38
Rate for Payer: Wellpoint Medicaid Managed Care	$662.37

ILIAC LIMB 10X 120MM

Facility

$23,495.00

Hospital Charge Code	270683415
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB 10X 120MM

Facility

$23,495.00

Hospital Charge Code	270683415
Hospital Revenue Code	278
Min. Negotiated Rate	$566.23
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$566.23
Rate for Payer: Wellpoint Medicaid Managed Care	$622.62

ILIAC LIMB 22 X 120MM MM

Facility

$23,495.00

Hospital Charge Code	270683417
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB 22 X 120MM MM

Facility

$23,495.00

Hospital Charge Code	270683417
Hospital Revenue Code	278
Min. Negotiated Rate	$566.23
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$566.23
Rate for Payer: Wellpoint Medicaid Managed Care	$622.62

ILIAC LIMB EXTENSION

Facility

$21,145.00

Service Code	HCPCS C1768
Hospital Charge Code	270679763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,171.75
Max. Negotiated Rate	$5,117.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,117.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,651.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,171.75

ILIAC LIMB EXTENSION

Facility

$21,145.00

Service Code	HCPCS C1768
Hospital Charge Code	270679763
Hospital Revenue Code	278
Min. Negotiated Rate	$509.59
Max. Negotiated Rate	$10,572.50
Rate for Payer: Aetna Commercial	$8,035.10
Rate for Payer: Aetna Medicare Advantage	$6,343.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,391.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,391.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,391.98
Rate for Payer: Cigna Commercial	$10,572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,117.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,651.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,171.75
Rate for Payer: UnitedHealthcare Community & State	$509.59
Rate for Payer: Wellpoint Medicaid Managed Care	$560.34

ILIAC PTA ADD EA-BI

Facility

$15,877.00

Service Code	HCPCS 3722250
Hospital Charge Code	2690505
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-BI

Facility

$15,877.00

Service Code	HCPCS 3722250
Hospital Charge Code	7411800
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC PTA ADD EA-BI

Facility

$15,877.00

Service Code	HCPCS 3722250
Hospital Charge Code	7411800
Hospital Revenue Code	361
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$382.64
Rate for Payer: Wellpoint Medicaid Managed Care	$420.74

ILIAC PTA ADD EA-BI

Facility

$15,877.00

Service Code	HCPCS 3722250
Hospital Charge Code	2690505
Hospital Revenue Code	361
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$382.64
Rate for Payer: Wellpoint Medicaid Managed Care	$420.74

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	41037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$540.84
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,732.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Community & State	$540.84
Rate for Payer: Wellpoint Medicaid Managed Care	$594.70

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	366837222
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37222LT
Hospital Charge Code	7411920
Hospital Revenue Code	361
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,763.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$382.64
Rate for Payer: Wellpoint Medicaid Managed Care	$420.74

Know your out-of-pocket cost for care.

All Charges