Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INSERT FOR ADM MDM 28/48MM 42E

Facility

$4,081.30

Service Code	HCPCS C1776
Hospital Charge Code	270646337
Hospital Revenue Code	278
Min. Negotiated Rate	$612.20
Max. Negotiated Rate	$987.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$897.89
Rate for Payer: Qualcare PPO/HMO/WC	$612.20

INSERT FOR ADM MDM 28/48MM 42E

Facility

$4,081.30

Service Code	HCPCS C1776
Hospital Charge Code	270646337
Hospital Revenue Code	278
Min. Negotiated Rate	$98.36
Max. Negotiated Rate	$2,040.65
Rate for Payer: Aetna Commercial	$1,550.89
Rate for Payer: Aetna Medicare Advantage	$1,224.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,040.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,040.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,040.73
Rate for Payer: Cigna Commercial	$2,040.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$897.89
Rate for Payer: Qualcare PPO/HMO/WC	$612.20
Rate for Payer: UnitedHealthcare Community & State	$98.36
Rate for Payer: Wellpoint Medicaid Managed Care	$108.15

INSERT FOR ADM/MDM 28/52MM 48f

Facility

$8,250.00

Hospital Charge Code	270684945
Hospital Revenue Code	272
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INSERT FOR ADM/MDM 28/52MM 48f

Facility

$8,250.00

Hospital Charge Code	270684945
Hospital Revenue Code	272
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,475.00
Rate for Payer: Oxford Commercial	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Commercial	$1,650.00
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

INSERT FOR ADM/MDM 28/54MM 48G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INSERT FOR ADM/MDM 28/54MM 48G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671849
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

INSERT FOR MDM LINER 22.2MM 36

Facility

$4,465.10

Service Code	HCPCS C1776
Hospital Charge Code	270682914
Hospital Revenue Code	278
Min. Negotiated Rate	$669.76
Max. Negotiated Rate	$1,080.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$893.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,080.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$982.32
Rate for Payer: Qualcare PPO/HMO/WC	$669.76

INSERT FOR MDM LINER 22.2MM 36

Facility

$4,465.10

Service Code	HCPCS C1776
Hospital Charge Code	270682914
Hospital Revenue Code	278
Min. Negotiated Rate	$107.61
Max. Negotiated Rate	$2,232.55
Rate for Payer: Aetna Commercial	$1,696.74
Rate for Payer: Aetna Medicare Advantage	$1,339.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$893.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,138.60
Rate for Payer: Cigna Commercial	$2,232.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,080.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$982.32
Rate for Payer: Qualcare PPO/HMO/WC	$669.76
Rate for Payer: UnitedHealthcare Community & State	$107.61
Rate for Payer: Wellpoint Medicaid Managed Care	$118.33

INSERT FOR MDM LINER 22.2MM 38

Facility

$4,055.65

Service Code	HCPCS C1776
Hospital Charge Code	270681379
Hospital Revenue Code	278
Min. Negotiated Rate	$97.74
Max. Negotiated Rate	$2,027.83
Rate for Payer: Aetna Commercial	$1,541.15
Rate for Payer: Aetna Medicare Advantage	$1,216.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,034.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,034.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$811.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,034.19
Rate for Payer: Cigna Commercial	$2,027.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$981.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$892.24
Rate for Payer: Qualcare PPO/HMO/WC	$608.35
Rate for Payer: UnitedHealthcare Community & State	$97.74
Rate for Payer: Wellpoint Medicaid Managed Care	$107.47

INSERT FOR MDM LINER 22.2MM 38

Facility

$4,055.65

Service Code	HCPCS C1776
Hospital Charge Code	270681379
Hospital Revenue Code	278
Min. Negotiated Rate	$608.35
Max. Negotiated Rate	$981.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$811.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$981.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$892.24
Rate for Payer: Qualcare PPO/HMO/WC	$608.35

INSERT HEPATIC SHUNT (TIPS)

Facility

$48,530.72

Service Code	HCPCS 37182
Hospital Charge Code	16000430
Hospital Revenue Code	360
Min. Negotiated Rate	$1,169.59
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,559.22
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,279.61
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,169.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1,286.06

INSERT HEPATIC SHUNT (TIPS)

Facility

$48,530.72

Service Code	HCPCS 37182
Hospital Charge Code	16000430
Hospital Revenue Code	360
Min. Negotiated Rate	$7,279.61
Max. Negotiated Rate	$7,279.61
Rate for Payer: Qualcare PPO/HMO/WC	$7,279.61

INSERT HUMERAL FLEX SYS 36MM

Facility

$6,787.50

Service Code	HCPCS C1776
Hospital Charge Code	270698765
Hospital Revenue Code	278
Min. Negotiated Rate	$1,018.12
Max. Negotiated Rate	$1,642.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,642.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,493.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,018.12

INSERT HUMERAL FLEX SYS 36MM

Facility

$6,787.50

Service Code	HCPCS C1776
Hospital Charge Code	270698765
Hospital Revenue Code	278
Min. Negotiated Rate	$163.58
Max. Negotiated Rate	$3,393.75
Rate for Payer: Aetna Commercial	$2,579.25
Rate for Payer: Aetna Medicare Advantage	$2,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,730.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,730.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,730.81
Rate for Payer: Cigna Commercial	$3,393.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,642.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,493.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,018.12
Rate for Payer: UnitedHealthcare Community & State	$163.58
Rate for Payer: Wellpoint Medicaid Managed Care	$179.87

INSERT HUNT BIPOLAR LONG *****

Facility

$224.00

Hospital Charge Code	1605658
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$85.12
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: Oxford Commercial	$44.80
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$44.80
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

INSERT HUNT BIPOLAR LONG *****

Facility

$224.00

Hospital Charge Code	1605658
Hospital Revenue Code	272
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

INSERT HUNT MACRO BIPOLAR ****

Facility

$224.00

Hospital Charge Code	1605633
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$85.12
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: Oxford Commercial	$44.80
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$44.80
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

INSERT HUNT MACRO BIPOLAR ****

Facility

$224.00

Hospital Charge Code	1605633
Hospital Revenue Code	272
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

INSERT INTRA AORTIC BALLN PERC

Facility

$6,070.00

Service Code	HCPCS 33967
Hospital Charge Code	5100313
Hospital Revenue Code	480
Min. Negotiated Rate	$146.29
Max. Negotiated Rate	$3,035.00
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	$240.06
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: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$146.29
Rate for Payer: Wellpoint Medicaid Managed Care	$160.85

INSERT INTRA AORTIC BALLN PERC

Facility

$6,070.00

Service Code	HCPCS 33967
Hospital Charge Code	5100313
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

INSERT INTRA AORTIC BALLN PERC

Facility

$3,932.20

Service Code	HCPCS 33967
Hospital Charge Code	74110037
Hospital Revenue Code	480
Min. Negotiated Rate	$589.83
Max. Negotiated Rate	$589.83
Rate for Payer: Qualcare PPO/HMO/WC	$589.83

INSERT INTRA AORTIC BALLN PERC

Facility

$3,932.20

Service Code	HCPCS 33967
Hospital Charge Code	74110037
Hospital Revenue Code	480
Min. Negotiated Rate	$94.77
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,494.24
Rate for Payer: Aetna Medicare Advantage	$1,179.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,002.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,002.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,002.71
Rate for Payer: Cigna Commercial	$1,966.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.66
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$589.83
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$94.77
Rate for Payer: Wellpoint Medicaid Managed Care	$104.20

INSERT INTRACRANIAL PRESSURE M

Facility

$9,489.90

Service Code	HCPCS 61107
Hospital Charge Code	83120005
Hospital Revenue Code	361
Min. Negotiated Rate	$228.71
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$3,606.16
Rate for Payer: Aetna Medicare Advantage	$2,846.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,419.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,419.92
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	$2,419.92
Rate for Payer: Cigna Commercial	$4,744.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,846.97
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$228.71
Rate for Payer: Wellpoint Medicaid Managed Care	$251.48

INSERT INTRACRANIAL PRESSURE M

Facility

$9,489.90

Service Code	HCPCS 61107
Hospital Charge Code	83120005
Hospital Revenue Code	361
Min. Negotiated Rate	$1,423.48
Max. Negotiated Rate	$1,423.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48

INSERTION BILIARY DRAIN

Facility

$331.55

Service Code	HCPCS 47510
Hospital Charge Code	5100505
Hospital Revenue Code	361
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$1,016.00
Rate for Payer: Aetna Commercial	$125.99
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.55
Rate for Payer: Cigna Commercial	$165.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.47
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

Know your out-of-pocket cost for care.

All Charges