Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INSERTION PICC LINE

Facility

$4,284.00

Service Code	HCPCS 36489
Hospital Charge Code	5100531
Hospital Revenue Code	361
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$642.60
Rate for Payer: Qualcare PPO/HMO/WC	$642.60

INSERTION PICC LINE

Facility

$4,284.00

Service Code	HCPCS 36489
Hospital Charge Code	5100531
Hospital Revenue Code	361
Min. Negotiated Rate	$103.24
Max. Negotiated Rate	$2,142.00
Rate for Payer: Aetna Commercial	$1,627.92
Rate for Payer: Aetna Medicare Advantage	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.42
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	$1,092.42
Rate for Payer: Cigna Commercial	$2,142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,285.20
Rate for Payer: Qualcare PPO/HMO/WC	$642.60
Rate for Payer: UnitedHealthcare Community & State	$103.24
Rate for Payer: Wellpoint Medicaid Managed Care	$113.53

INSERTION PICC LINE S&I

Facility

$852.00

Service Code	HCPCS 77002
Hospital Charge Code	5100530
Hospital Revenue Code	320
Min. Negotiated Rate	$20.53
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$323.76
Rate for Payer: Aetna Medicare Advantage	$255.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.26
Rate for Payer: Cigna Commercial	$426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$20.53
Rate for Payer: Wellpoint Medicaid Managed Care	$22.58

INSERTION PICC LINE S&I

Facility

$852.00

Service Code	HCPCS 77002
Hospital Charge Code	5100530
Hospital Revenue Code	320
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$127.80
Rate for Payer: Qualcare PPO/HMO/WC	$127.80

INSERTION REVEAL LINQ RECORDER

Facility

$13,388.13

Service Code	HCPCS 33282
Hospital Charge Code	5100535
Hospital Revenue Code	361
Min. Negotiated Rate	$2,008.22
Max. Negotiated Rate	$2,008.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.22

INSERTION REVEAL LINQ RECORDER

Facility

$13,388.13

Service Code	HCPCS 33282
Hospital Charge Code	5100535
Hospital Revenue Code	361
Min. Negotiated Rate	$322.65
Max. Negotiated Rate	$6,694.06
Rate for Payer: Aetna Commercial	$5,087.49
Rate for Payer: Aetna Medicare Advantage	$4,016.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,413.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,413.97
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	$3,413.97
Rate for Payer: Cigna Commercial	$6,694.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,016.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.22
Rate for Payer: UnitedHealthcare Community & State	$322.65
Rate for Payer: Wellpoint Medicaid Managed Care	$354.79

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$20,575.46

Service Code	APR-DRG 1761
Min. Negotiated Rate	$20,172.02
Max. Negotiated Rate	$20,575.46
Rate for Payer: UnitedHealthcare Community & State	$20,172.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,575.46
Rate for Payer: Wellpoint Medicaid Managed Care	$20,172.02

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$61,382.91

Service Code	APR-DRG 1764
Min. Negotiated Rate	$60,179.32
Max. Negotiated Rate	$61,382.91
Rate for Payer: UnitedHealthcare Community & State	$60,179.32
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$61,382.91
Rate for Payer: Wellpoint Medicaid Managed Care	$60,179.32

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$24,637.94

Service Code	APR-DRG 1762
Min. Negotiated Rate	$24,154.84
Max. Negotiated Rate	$24,637.94
Rate for Payer: UnitedHealthcare Community & State	$24,154.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,637.94
Rate for Payer: Wellpoint Medicaid Managed Care	$24,154.84

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$36,593.02

Service Code	APR-DRG 1763
Min. Negotiated Rate	$35,875.51
Max. Negotiated Rate	$36,593.02
Rate for Payer: UnitedHealthcare Community & State	$35,875.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$36,593.02
Rate for Payer: Wellpoint Medicaid Managed Care	$35,875.51

INSERTION STENT BILLIARY

Facility

$3,503.40

Service Code	HCPCS 47555
Hospital Charge Code	5100504
Hospital Revenue Code	361
Min. Negotiated Rate	$525.51
Max. Negotiated Rate	$525.51
Rate for Payer: Qualcare PPO/HMO/WC	$525.51

INSERTION STENT BILLIARY

Facility

$3,503.40

Service Code	HCPCS 47555
Hospital Charge Code	5100504
Hospital Revenue Code	361
Min. Negotiated Rate	$84.43
Max. Negotiated Rate	$27,762.46
Rate for Payer: Aetna Commercial	$20,919.71
Rate for Payer: Aetna Medicare Advantage	$24,919.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,762.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,762.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,691.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,762.46
Rate for Payer: Cigna Commercial	$15,416.72
Rate for Payer: Cigna Medicare Advantage	$7,691.07
Rate for Payer: Clover Medicare Advantage	$7,306.52
Rate for Payer: EmblemHealth Commercial	$23,073.21
Rate for Payer: Humana Medicare Advantage	$7,921.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,691.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,051.02
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.51
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$84.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,691.07
Rate for Payer: Wellcare Medicare Advantage	$7,691.07
Rate for Payer: Wellpoint Medicaid Managed Care	$92.84

INSERT IUD

Facility

$6,866.80

Service Code	HCPCS 58300
Hospital Charge Code	16001006
Hospital Revenue Code	360
Min. Negotiated Rate	$165.49
Max. Negotiated Rate	$3,433.40
Rate for Payer: Aetna Commercial	$2,609.38
Rate for Payer: Aetna Medicare Advantage	$2,060.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.03
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	$1,751.03
Rate for Payer: Cigna Commercial	$3,433.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,060.04
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,030.02
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$165.49
Rate for Payer: Wellpoint Medicaid Managed Care	$181.97

INSERT IUD

Facility

$6,866.80

Service Code	HCPCS 58300
Hospital Charge Code	16001006
Hospital Revenue Code	360
Min. Negotiated Rate	$1,030.02
Max. Negotiated Rate	$1,030.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,030.02

INSERT IVC FILTER

Facility

$13,353.00

Service Code	HCPCS 37191
Hospital Charge Code	7411127
Hospital Revenue Code	361
Min. Negotiated Rate	$321.81
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,005.90
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,002.95
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$321.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$353.85

INSERT IVC FILTER

Facility

$13,353.00

Service Code	HCPCS 37191
Hospital Charge Code	366837191
Hospital Revenue Code	361
Min. Negotiated Rate	$2,002.95
Max. Negotiated Rate	$2,002.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,002.95

INSERT IVC FILTER

Facility

$13,353.00

Service Code	HCPCS 37191
Hospital Charge Code	366837191
Hospital Revenue Code	361
Min. Negotiated Rate	$321.81
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,005.90
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,002.95
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$321.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$353.85

INSERT IVC FILTER

Facility

$13,353.00

Service Code	HCPCS 37191
Hospital Charge Code	7411127
Hospital Revenue Code	361
Min. Negotiated Rate	$2,002.95
Max. Negotiated Rate	$2,002.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,002.95

INSERT KNEE 3D SIZE 8 10MM

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692262
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

INSERT KNEE 3D SIZE 8 10MM

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692262
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

INSERT LOCKING

Facility

$550.00

Hospital Charge Code	270640258
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

INSERT LOCKING

Facility

$550.00

Hospital Charge Code	270640258
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

INSERT MESH/PELVIC FLR ADDON

Facility

$7,795.00

Service Code	HCPCS 57267
Hospital Charge Code	1600000434
Hospital Revenue Code	360
Min. Negotiated Rate	$187.86
Max. Negotiated Rate	$3,897.50
Rate for Payer: Aetna Commercial	$2,962.10
Rate for Payer: Aetna Medicare Advantage	$2,338.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,987.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,987.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,987.72
Rate for Payer: Cigna Commercial	$3,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,338.50
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,169.25
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$187.86
Rate for Payer: Wellpoint Medicaid Managed Care	$206.57

INSERT MESH/PELVIC FLR ADDON

Facility

$7,795.00

Service Code	HCPCS 57267
Hospital Charge Code	1600000434
Hospital Revenue Code	360
Min. Negotiated Rate	$1,169.25
Max. Negotiated Rate	$1,169.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,169.25

INSERT MULTI-COMP PENIS PROS

Facility

$94,816.00

Service Code	HCPCS 54405
Hospital Charge Code	16000168
Hospital Revenue Code	360
Min. Negotiated Rate	$1,355.00
Max. Negotiated Rate	$88,882.29
Rate for Payer: Aetna Commercial	$66,975.05
Rate for Payer: Aetna Medicare Advantage	$79,779.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88,882.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88,882.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,623.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88,882.29
Rate for Payer: Cigna Commercial	$49,357.08
Rate for Payer: Cigna Medicare Advantage	$24,623.18
Rate for Payer: Clover Medicare Advantage	$23,392.02
Rate for Payer: EmblemHealth Commercial	$73,869.54
Rate for Payer: Humana Medicare Advantage	$25,361.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,623.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,444.80
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,222.40
Rate for Payer: UnitedHealthcare Commercial	$17,313.00
Rate for Payer: UnitedHealthcare Community & State	$2,285.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,623.18
Rate for Payer: Wellcare Medicare Advantage	$24,623.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2,512.62

Know your out-of-pocket cost for care.

All Charges