Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INSERTION BILIARY DRAIN

Facility

$331.55

Service Code	HCPCS 47510
Hospital Charge Code	5100505
Hospital Revenue Code	361
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

INSERTION BILIARY DR TUBE S&I

Facility

$2,149.80

Service Code	HCPCS 75982
Hospital Charge Code	5100506
Hospital Revenue Code	320
Min. Negotiated Rate	$51.81
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$816.92
Rate for Payer: Aetna Medicare Advantage	$644.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$548.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$548.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$548.20
Rate for Payer: Cigna Commercial	$1,074.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$644.94
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$322.47
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$51.81
Rate for Payer: Wellpoint Medicaid Managed Care	$56.97

INSERTION BILIARY DR TUBE S&I

Facility

$2,149.80

Service Code	HCPCS 75982
Hospital Charge Code	5100506
Hospital Revenue Code	320
Min. Negotiated Rate	$322.47
Max. Negotiated Rate	$322.47
Rate for Payer: Qualcare PPO/HMO/WC	$322.47

INSERTION BILIARY STENT S&I

Facility

$1,670.40

Service Code	HCPCS 74363
Hospital Charge Code	5100507
Hospital Revenue Code	278
Min. Negotiated Rate	$250.56
Max. Negotiated Rate	$404.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$367.49
Rate for Payer: Qualcare PPO/HMO/WC	$250.56

INSERTION BILIARY STENT S&I

Facility

$1,670.40

Service Code	HCPCS 74363
Hospital Charge Code	5100507
Hospital Revenue Code	278
Min. Negotiated Rate	$40.26
Max. Negotiated Rate	$835.20
Rate for Payer: Aetna Commercial	$634.75
Rate for Payer: Aetna Medicare Advantage	$501.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$425.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$425.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$425.95
Rate for Payer: Cigna Commercial	$835.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$367.49
Rate for Payer: Qualcare PPO/HMO/WC	$250.56
Rate for Payer: UnitedHealthcare Community & State	$40.26
Rate for Payer: Wellpoint Medicaid Managed Care	$44.27

INSERTION CATHETER ARTERY

Facility

$959.80

Service Code	HCPCS 36620
Hospital Charge Code	1600000759
Hospital Revenue Code	360
Min. Negotiated Rate	$143.97
Max. Negotiated Rate	$143.97
Rate for Payer: Qualcare PPO/HMO/WC	$143.97

INSERTION CATHETER ARTERY

Facility

$959.80

Service Code	HCPCS 36620
Hospital Charge Code	1600000759
Hospital Revenue Code	360
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$364.72
Rate for Payer: Aetna Medicare Advantage	$287.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.75
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	$244.75
Rate for Payer: Cigna Commercial	$479.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.94
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$143.97
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.13

INSERTION CERVICAL DILATOR

Facility

$169.00

Service Code	HCPCS 59200
Hospital Charge Code	1800155
Hospital Revenue Code	361
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
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	$1,306.82
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$4.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$4.48

INSERTION CERVICAL DILATOR

Facility

$169.00

Service Code	HCPCS 59200
Hospital Charge Code	1800155
Hospital Revenue Code	361
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

INSERTION CHEST TUBE PNEUMOTHO

Facility

$2,289.68

Service Code	HCPCS 32422
Hospital Charge Code	5780175
Hospital Revenue Code	450
Min. Negotiated Rate	$343.45
Max. Negotiated Rate	$343.45
Rate for Payer: Qualcare PPO/HMO/WC	$343.45

INSERTION CHEST TUBE PNEUMOTHO

Facility

$2,289.68

Service Code	HCPCS 32422
Hospital Charge Code	5780175
Hospital Revenue Code	450
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$1,144.84
Rate for Payer: Aetna Commercial	$870.08
Rate for Payer: Aetna Medicare Advantage	$686.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$583.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$583.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$583.87
Rate for Payer: Cigna Commercial	$1,144.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$686.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$343.45
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$60.68

Insertion Guide

Facility

$6,852.35

Hospital Charge Code	270681577
Hospital Revenue Code	272
Min. Negotiated Rate	$1,027.85
Max. Negotiated Rate	$1,027.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.85

Insertion Guide

Facility

$6,852.35

Hospital Charge Code	270681577
Hospital Revenue Code	272
Min. Negotiated Rate	$165.14
Max. Negotiated Rate	$3,426.18
Rate for Payer: Aetna Commercial	$2,603.89
Rate for Payer: Aetna Medicare Advantage	$2,055.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,747.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,747.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,747.35
Rate for Payer: Cigna Commercial	$3,426.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,055.70
Rate for Payer: Oxford Commercial	$1,370.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.85
Rate for Payer: UnitedHealthcare Commercial	$1,370.47
Rate for Payer: UnitedHealthcare Community & State	$165.14
Rate for Payer: Wellpoint Medicaid Managed Care	$181.59

INSERTION INT EXT BILIARY DRG

Facility

$331.55

Service Code	HCPCS 47511
Hospital Charge Code	5100503
Hospital Revenue Code	361
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

INSERTION INT EXT BILIARY DRG

Facility

$331.55

Service Code	HCPCS 47511
Hospital Charge Code	5100503
Hospital Revenue Code	361
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$1,626.00
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	$1,626.00
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

INSERTION INTRA AORTIC BALLOON

Facility

$22,823.38

Service Code	HCPCS 33967
Hospital Charge Code	83120001
Hospital Revenue Code	361
Min. Negotiated Rate	$3,423.51
Max. Negotiated Rate	$3,423.51
Rate for Payer: Qualcare PPO/HMO/WC	$3,423.51

INSERTION INTRA AORTIC BALLOON

Facility

$22,823.38

Service Code	HCPCS 33967
Hospital Charge Code	83120001
Hospital Revenue Code	361
Min. Negotiated Rate	$550.04
Max. Negotiated Rate	$20,074.00
Rate for Payer: Aetna Commercial	$8,672.88
Rate for Payer: Aetna Medicare Advantage	$6,847.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,819.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,819.96
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	$5,819.96
Rate for Payer: Cigna Commercial	$11,411.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,847.01
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,423.51
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$550.04
Rate for Payer: Wellpoint Medicaid Managed Care	$604.82

INSERTION OF CATHETER VEIN

Facility

$907.20

Service Code	HCPCS 36500
Hospital Charge Code	366836500
Hospital Revenue Code	361
Min. Negotiated Rate	$136.08
Max. Negotiated Rate	$136.08
Rate for Payer: Qualcare PPO/HMO/WC	$136.08

INSERTION OF CATHETER VEIN

Facility

$907.20

Service Code	HCPCS 36500
Hospital Charge Code	411036500
Hospital Revenue Code	361
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$344.74
Rate for Payer: Aetna Medicare Advantage	$272.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.34
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	$231.34
Rate for Payer: Cigna Commercial	$453.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.16
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.08
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$21.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.04

INSERTION OF CATHETER VEIN

Facility

$907.20

Service Code	HCPCS 36500
Hospital Charge Code	411036500
Hospital Revenue Code	361
Min. Negotiated Rate	$136.08
Max. Negotiated Rate	$136.08
Rate for Payer: Qualcare PPO/HMO/WC	$136.08

INSERTION OF CATHETER VEIN

Facility

$907.20

Service Code	HCPCS 36500
Hospital Charge Code	366836500
Hospital Revenue Code	361
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$344.74
Rate for Payer: Aetna Medicare Advantage	$272.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.34
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	$231.34
Rate for Payer: Cigna Commercial	$453.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.16
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.08
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$21.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.04

INSERTION OF CERVICAL DILATOR

Facility

$1,124.96

Service Code	HCPCS 59200
Hospital Charge Code	73190141
Hospital Revenue Code	720
Min. Negotiated Rate	$168.74
Max. Negotiated Rate	$168.74
Rate for Payer: Qualcare PPO/HMO/WC	$168.74

INSERTION OF CERVICAL DILATOR

Facility

$1,124.96

Service Code	HCPCS 59200
Hospital Charge Code	73190141
Hospital Revenue Code	720
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.82
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.49
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.74
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

INSERTION OF CHEST TUBE

Facility

$11,525.10

Service Code	HCPCS 32551
Hospital Charge Code	1600000369
Hospital Revenue Code	360
Min. Negotiated Rate	$277.75
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,457.53
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,728.77
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$277.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,475.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2,426.75

INSERTION OF CHEST TUBE

Facility

$11,525.10

Service Code	HCPCS 32551
Hospital Charge Code	1600000369
Hospital Revenue Code	360
Min. Negotiated Rate	$1,728.77
Max. Negotiated Rate	$1,728.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,728.77

Know your out-of-pocket cost for care.

All Charges