Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INJECTOR INLINE *******

Facility

$43.00

Hospital Charge Code	8003188
Hospital Revenue Code	279
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

INJECTOR RESTRICTOR MIL

Facility

$218.45

Hospital Charge Code	270600230
Hospital Revenue Code	272
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$109.22
Rate for Payer: Aetna Commercial	$83.01
Rate for Payer: Aetna Medicare Advantage	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.70
Rate for Payer: Cigna Commercial	$109.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.53
Rate for Payer: Oxford Commercial	$43.69
Rate for Payer: Qualcare PPO/HMO/WC	$32.77
Rate for Payer: UnitedHealthcare Commercial	$43.69
Rate for Payer: UnitedHealthcare Community & State	$5.26
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

INJECTOR RESTRICTOR MIL

Facility

$218.45

Hospital Charge Code	270600230
Hospital Revenue Code	272
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Qualcare PPO/HMO/WC	$32.77

INJECTOR SYRINGE FASTLOAD MR

Facility

$66.00

Hospital Charge Code	270690351
Hospital Revenue Code	272
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

INJECTOR SYRINGE FASTLOAD MR

Facility

$66.00

Hospital Charge Code	270690351
Hospital Revenue Code	272
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

INJECT R VENTR/ATRIAL ANGIO

Facility

$6,070.00

Service Code	HCPCS 93566
Hospital Charge Code	411093566
Hospital Revenue Code	481
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

INJECT R VENTR/ATRIAL ANGIO

Facility

$6,070.00

Service Code	HCPCS 93566
Hospital Charge Code	411093566
Hospital Revenue Code	481
Min. Negotiated Rate	$146.29
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,821.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$146.29
Rate for Payer: Wellpoint Medicaid Managed Care	$160.85

INJECT SACROILIAC JOINT

Facility

$3,087.00

Service Code	HCPCS G0259
Hospital Charge Code	3215G0259
Hospital Revenue Code	361
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,173.06
Rate for Payer: Aetna Medicare Advantage	$926.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.18
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	$787.18
Rate for Payer: Cigna Commercial	$1,543.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.10
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$463.05
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$74.40
Rate for Payer: Wellpoint Medicaid Managed Care	$81.81

INJECT SACROILIAC JOINT

Facility

$12,825.00

Service Code	HCPCS 27096
Hospital Charge Code	16000706
Hospital Revenue Code	360
Min. Negotiated Rate	$1,923.75
Max. Negotiated Rate	$1,923.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,923.75

INJECT SACROILIAC JOINT

Facility

$12,825.00

Service Code	HCPCS 27096
Hospital Charge Code	16000706
Hospital Revenue Code	360
Min. Negotiated Rate	$309.08
Max. Negotiated Rate	$6,412.50
Rate for Payer: Aetna Commercial	$4,873.50
Rate for Payer: Aetna Medicare Advantage	$3,847.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,270.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,270.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,270.38
Rate for Payer: Cigna Commercial	$6,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,847.50
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,923.75
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$309.08
Rate for Payer: Wellpoint Medicaid Managed Care	$339.86

INJECT SACROILIAC JOINT

Facility

$3,087.00

Service Code	HCPCS G0259
Hospital Charge Code	3215G0259
Hospital Revenue Code	361
Min. Negotiated Rate	$463.05
Max. Negotiated Rate	$463.05
Rate for Payer: Qualcare PPO/HMO/WC	$463.05

INJECT SKIN LESIONS </= 7

Facility

$1,033.25

Service Code	HCPCS 11900
Hospital Charge Code	412311900
Hospital Revenue Code	361
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.98
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$154.99
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$24.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$27.38

INJECT SKIN LESIONS </= 7

Facility

$1,033.25

Service Code	HCPCS 11900
Hospital Charge Code	412311900
Hospital Revenue Code	361
Min. Negotiated Rate	$154.99
Max. Negotiated Rate	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$154.99

INJECT SKIN LESIONS >7

Facility

$1,033.25

Service Code	HCPCS 11901
Hospital Charge Code	412311901
Hospital Revenue Code	361
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.98
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$154.99
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$24.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$27.38

INJECT SKIN LESIONS >7

Facility

$1,033.25

Service Code	HCPCS 11901
Hospital Charge Code	412311901
Hospital Revenue Code	361
Min. Negotiated Rate	$154.99
Max. Negotiated Rate	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$154.99

INJECT SPINE C/T

Facility

$3,466.32

Service Code	HCPCS 62320
Hospital Charge Code	16000767
Hospital Revenue Code	360
Min. Negotiated Rate	$519.95
Max. Negotiated Rate	$519.95
Rate for Payer: Qualcare PPO/HMO/WC	$519.95

INJECT SPINE C/T

Facility

$3,466.32

Service Code	HCPCS 62320
Hospital Charge Code	16000767
Hospital Revenue Code	360
Min. Negotiated Rate	$83.54
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,039.90
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$519.95
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$83.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61

INJECT SPINE DISK X-RAY LUMBAR

Facility

$6,095.00

Service Code	HCPCS 62290
Hospital Charge Code	16000523
Hospital Revenue Code	360
Min. Negotiated Rate	$146.89
Max. Negotiated Rate	$3,047.50
Rate for Payer: Aetna Commercial	$2,316.10
Rate for Payer: Aetna Medicare Advantage	$1,828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,554.22
Rate for Payer: Cigna Commercial	$3,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,828.50
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$914.25
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$146.89
Rate for Payer: Wellpoint Medicaid Managed Care	$161.52

INJECT SPINE DISK X-RAY LUMBAR

Facility

$6,095.00

Service Code	HCPCS 62290
Hospital Charge Code	16000523
Hospital Revenue Code	360
Min. Negotiated Rate	$914.25
Max. Negotiated Rate	$914.25
Rate for Payer: Qualcare PPO/HMO/WC	$914.25

INJECT TGGER POINTS =/>3

Facility

$4,088.04

Service Code	HCPCS 20553
Hospital Charge Code	1600000442
Hospital Revenue Code	360
Min. Negotiated Rate	$613.21
Max. Negotiated Rate	$613.21
Rate for Payer: Qualcare PPO/HMO/WC	$613.21

INJECT TGGER POINTS =/>3

Facility

$4,088.04

Service Code	HCPCS 20553
Hospital Charge Code	1600000442
Hospital Revenue Code	360
Min. Negotiated Rate	$98.52
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,226.41
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$613.21
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$98.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$108.33

INJ ERCP

Facility

$10,268.63

Hospital Charge Code	2011500
Hospital Revenue Code	361
Min. Negotiated Rate	$247.47
Max. Negotiated Rate	$5,134.31
Rate for Payer: Aetna Commercial	$3,902.08
Rate for Payer: Aetna Medicare Advantage	$3,080.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,618.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,618.50
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	$2,618.50
Rate for Payer: Cigna Commercial	$5,134.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,080.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.29
Rate for Payer: UnitedHealthcare Community & State	$247.47
Rate for Payer: Wellpoint Medicaid Managed Care	$272.12

INJ ERCP

Facility

$10,268.63

Hospital Charge Code	2011500
Hospital Revenue Code	361
Min. Negotiated Rate	$1,540.29
Max. Negotiated Rate	$1,540.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.29

INJ ERGONOVINE MALEATE 0.2ML

Facility

$34.60

Hospital Charge Code	6012512
Hospital Revenue Code	636
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$8.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

INJ ERGONOVINE MALEATE 0.2ML

Facility

$34.60

Hospital Charge Code	6012512
Hospital Revenue Code	636
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

Know your out-of-pocket cost for care.

All Charges