Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IN.PACT Admiral 5x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684955N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 5x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684955N
Hospital Revenue Code	278
Min. Negotiated Rate	$258.47
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$258.47
Rate for Payer: Wellpoint Medicaid Managed Care	$284.21

IN.PACT Admiral 5x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684956N
Hospital Revenue Code	278
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$284.38
Rate for Payer: Wellpoint Medicaid Managed Care	$312.70

IN.PACT Admiral 5x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684956
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 5x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684956
Hospital Revenue Code	278
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$284.38
Rate for Payer: Wellpoint Medicaid Managed Care	$312.70

IN.PACT Admiral 5x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684956N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 6x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957N
Hospital Revenue Code	278
Min. Negotiated Rate	$258.47
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$258.47
Rate for Payer: Wellpoint Medicaid Managed Care	$284.21

IN.PACT Admiral 6x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 6x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957
Hospital Revenue Code	278
Min. Negotiated Rate	$258.47
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$258.47
Rate for Payer: Wellpoint Medicaid Managed Care	$284.21

IN.PACT Admiral 6x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT ADMIRAL 6X200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT ADMIRAL 6X200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957S
Hospital Revenue Code	278
Min. Negotiated Rate	$258.47
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$258.47
Rate for Payer: Wellpoint Medicaid Managed Care	$284.21

IN.PACT Admiral 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958N
Hospital Revenue Code	278
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$284.38
Rate for Payer: Wellpoint Medicaid Managed Care	$312.70

IN.PACT Admiral 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958
Hospital Revenue Code	278
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$284.38
Rate for Payer: Wellpoint Medicaid Managed Care	$312.70

IN.PACT ADMIRAL 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958S
Hospital Revenue Code	278
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$284.38
Rate for Payer: Wellpoint Medicaid Managed Care	$312.70

IN.PACT ADMIRAL 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,596.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral DCB 40mm

Facility

$7,050.00

Service Code	HCPCS C2623
Hospital Charge Code	270686203
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

IN.PACT Admiral DCB 40mm

Facility

$7,050.00

Service Code	HCPCS C2623
Hospital Charge Code	270686203
Hospital Revenue Code	278
Min. Negotiated Rate	$169.91
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$169.91
Rate for Payer: Wellpoint Medicaid Managed Care	$186.82

INR STRIP

Facility

$390.00

Service Code	HCPCS 85610
Hospital Charge Code	87502750
Hospital Revenue Code	305
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.67
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.29
Rate for Payer: Clover Medicare Advantage	$4.08
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Humana Medicare Advantage	$4.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.29
Rate for Payer: Wellcare Medicare Advantage	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

INR STRIP

Facility

$390.00

Service Code	HCPCS 85610
Hospital Charge Code	87502750
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INS CATH ABD/L-EXT ART 1ST

Facility

$364.00

Service Code	HCPCS 36245
Hospital Charge Code	366836245
Hospital Revenue Code	361
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

INS CATH ABD/L-EXT ART 1ST

Facility

$364.00

Service Code	HCPCS 36245
Hospital Charge Code	366836245
Hospital Revenue Code	361
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$138.32
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
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	$92.82
Rate for Payer: Cigna Commercial	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$8.77
Rate for Payer: Wellpoint Medicaid Managed Care	$9.65

INS CATH ABD/L-EXT ART 1ST

Facility

$3,632.92

Service Code	HCPCS 36245
Hospital Charge Code	16000580
Hospital Revenue Code	360
Min. Negotiated Rate	$544.94
Max. Negotiated Rate	$544.94
Rate for Payer: Qualcare PPO/HMO/WC	$544.94

Know your out-of-pocket cost for care.

All Charges