Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INJ PARAVERT F JNT L/S 2 LEV

Facility

$511.97

Service Code	HCPCS 64494
Hospital Charge Code	1600000737
Hospital Revenue Code	360
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$76.80
Rate for Payer: Qualcare PPO/HMO/WC	$76.80

INJ PARAVERT F JNT L/S 2 LEV

Facility

$511.97

Service Code	HCPCS 64494
Hospital Charge Code	1600000737
Hospital Revenue Code	360
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$194.55
Rate for Payer: Aetna Medicare Advantage	$153.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.55
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	$130.55
Rate for Payer: Cigna Commercial	$255.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.59
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.80
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$12.34

INJ PARAVERT F JNT L/S 2 LEV

Facility

$5,111.97

Service Code	HCPCS 64494
Hospital Charge Code	321564494
Hospital Revenue Code	361
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$2,555.99
Rate for Payer: Aetna Commercial	$1,942.55
Rate for Payer: Aetna Medicare Advantage	$1,533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.55
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	$1,303.55
Rate for Payer: Cigna Commercial	$2,555.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,533.59
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$123.20

INJ PARAVERT F JNT L/S 2 LEV

Facility

$6,666.60

Service Code	HCPCS 64494
Hospital Charge Code	441064494
Hospital Revenue Code	361
Min. Negotiated Rate	$160.67
Max. Negotiated Rate	$3,333.30
Rate for Payer: Aetna Commercial	$2,533.31
Rate for Payer: Aetna Medicare Advantage	$1,999.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.98
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	$1,699.98
Rate for Payer: Cigna Commercial	$3,333.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,999.98
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$999.99
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$160.67

INJ PARAVERT F JNT L/S 2 LEV

Facility

$6,666.60

Service Code	HCPCS 64494
Hospital Charge Code	441064494
Hospital Revenue Code	361
Min. Negotiated Rate	$999.99
Max. Negotiated Rate	$999.99
Rate for Payer: Qualcare PPO/HMO/WC	$999.99

INJ PARAVERT F JNT L/S 2-LEV

Facility

$6,666.60

Service Code	HCPCS 64494
Hospital Charge Code	1600000430
Hospital Revenue Code	360
Min. Negotiated Rate	$160.67
Max. Negotiated Rate	$3,333.30
Rate for Payer: Aetna Commercial	$2,533.31
Rate for Payer: Aetna Medicare Advantage	$1,999.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.98
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	$1,699.98
Rate for Payer: Cigna Commercial	$3,333.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,999.98
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$999.99
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$160.67

INJ PARAVERT F JNT L/S 2-LEV

Facility

$6,666.60

Service Code	HCPCS 64494
Hospital Charge Code	1600000430
Hospital Revenue Code	360
Min. Negotiated Rate	$999.99
Max. Negotiated Rate	$999.99
Rate for Payer: Qualcare PPO/HMO/WC	$999.99

INJ PARAVERT F JNT L/S 3 LEV

Facility

$5,111.97

Service Code	HCPCS 64495
Hospital Charge Code	321564495
Hospital Revenue Code	361
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$2,555.99
Rate for Payer: Aetna Commercial	$1,942.55
Rate for Payer: Aetna Medicare Advantage	$1,533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.55
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	$1,303.55
Rate for Payer: Cigna Commercial	$2,555.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,533.59
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$123.20

INJ PARAVERT F JNT L/S 3 LEV

Facility

$5,111.97

Service Code	HCPCS 64495
Hospital Charge Code	321564495
Hospital Revenue Code	361
Min. Negotiated Rate	$766.80
Max. Negotiated Rate	$766.80
Rate for Payer: Qualcare PPO/HMO/WC	$766.80

INJ PARAVERT F JNT L/S 3-LEV

Facility

$6,666.60

Service Code	HCPCS 64495
Hospital Charge Code	1600000431
Hospital Revenue Code	360
Min. Negotiated Rate	$999.99
Max. Negotiated Rate	$999.99
Rate for Payer: Qualcare PPO/HMO/WC	$999.99

INJ PARAVERT F JNT L/S 3-LEV

Facility

$6,666.60

Service Code	HCPCS 64495
Hospital Charge Code	411064495
Hospital Revenue Code	361
Min. Negotiated Rate	$999.99
Max. Negotiated Rate	$999.99
Rate for Payer: Qualcare PPO/HMO/WC	$999.99

INJ PARAVERT F JNT L/S 3-LEV

Facility

$6,666.60

Service Code	HCPCS 64495
Hospital Charge Code	1600000431
Hospital Revenue Code	360
Min. Negotiated Rate	$160.67
Max. Negotiated Rate	$3,333.30
Rate for Payer: Aetna Commercial	$2,533.31
Rate for Payer: Aetna Medicare Advantage	$1,999.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.98
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	$1,699.98
Rate for Payer: Cigna Commercial	$3,333.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,999.98
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$999.99
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$160.67

INJ PARAVERT F JNT L/S 3-LEV

Facility

$6,666.60

Service Code	HCPCS 64495
Hospital Charge Code	411064495
Hospital Revenue Code	361
Min. Negotiated Rate	$160.67
Max. Negotiated Rate	$3,333.30
Rate for Payer: Aetna Commercial	$2,533.31
Rate for Payer: Aetna Medicare Advantage	$1,999.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.98
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	$1,699.98
Rate for Payer: Cigna Commercial	$3,333.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,999.98
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$999.99
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$160.67

INJ PROC AORTOGRAPHY

Facility

$408.00

Service Code	HCPCS 93567
Hospital Charge Code	7411247
Hospital Revenue Code	481
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$61.20
Rate for Payer: Qualcare PPO/HMO/WC	$61.20

INJ PROC AORTOGRAPHY

Facility

$408.00

Service Code	HCPCS 93567
Hospital Charge Code	7411247
Hospital Revenue Code	481
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$155.04
Rate for Payer: Aetna Medicare Advantage	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.04
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	$104.04
Rate for Payer: Cigna Commercial	$204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.40
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	$61.20
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$10.81

INJ PROC AORTOGRAPHY

Facility

$408.00

Service Code	HCPCS 93567
Hospital Charge Code	366893567
Hospital Revenue Code	481
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$155.04
Rate for Payer: Aetna Medicare Advantage	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.04
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	$104.04
Rate for Payer: Cigna Commercial	$204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.40
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	$61.20
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$10.81

INJ PROC AORTOGRAPHY

Facility

$408.00

Service Code	HCPCS 93567
Hospital Charge Code	366893567
Hospital Revenue Code	481
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$61.20
Rate for Payer: Qualcare PPO/HMO/WC	$61.20

INJ PSEUDOANEURYSM

Facility

$1,133.35

Service Code	HCPCS 36002
Hospital Charge Code	5100826
Hospital Revenue Code	361
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$170.00

INJ PSEUDOANEURYSM

Facility

$1,133.35

Service Code	HCPCS 36002
Hospital Charge Code	5100826
Hospital Revenue Code	361
Min. Negotiated Rate	$27.31
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.00
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$170.00
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$27.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$30.03

INJ PX CHOLANG EXISTING ACCESS

Facility

$2,072.24

Service Code	HCPCS 47531
Hospital Charge Code	2011599
Hospital Revenue Code	361
Min. Negotiated Rate	$49.94
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.67
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.84
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$49.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$54.91

INJ PX CHOLANG EXISTING ACCESS

Facility

$2,072.24

Service Code	HCPCS 47531
Hospital Charge Code	7411560
Hospital Revenue Code	361
Min. Negotiated Rate	$49.94
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.67
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.84
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$49.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$54.91

INJ PX CHOLANG EXISTING ACCESS

Facility

$14,313.70

Service Code	HCPCS 47531
Hospital Charge Code	2600222
Hospital Revenue Code	361
Min. Negotiated Rate	$2,147.05
Max. Negotiated Rate	$2,147.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.05

INJ PX CHOLANG EXISTING ACCESS

Facility

$14,313.70

Service Code	HCPCS 47531
Hospital Charge Code	2600222
Hospital Revenue Code	361
Min. Negotiated Rate	$344.96
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,294.11
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.05
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$344.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$379.31

INJ PX CHOLANG EXISTING ACCESS

Facility

$2,072.24

Service Code	HCPCS 47531
Hospital Charge Code	2011599
Hospital Revenue Code	361
Min. Negotiated Rate	$310.84
Max. Negotiated Rate	$310.84
Rate for Payer: Qualcare PPO/HMO/WC	$310.84

INJ PX CHOLANG EXISTING ACCESS

Facility

$2,072.24

Service Code	HCPCS 47531
Hospital Charge Code	7411560
Hospital Revenue Code	361
Min. Negotiated Rate	$310.84
Max. Negotiated Rate	$310.84
Rate for Payer: Qualcare PPO/HMO/WC	$310.84

Know your out-of-pocket cost for care.

All Charges