Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INSERT PLEUAL CATH-LT

Facility

$17,259.20

Service Code	HCPCS 32550LT
Hospital Charge Code	2691060
Hospital Revenue Code	361
Min. Negotiated Rate	$2,588.88
Max. Negotiated Rate	$2,588.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88

INSERT PLEUAL CATH-LT

Facility

$17,259.20

Service Code	HCPCS 32550LT
Hospital Charge Code	321032550L
Hospital Revenue Code	361
Min. Negotiated Rate	$415.95
Max. Negotiated Rate	$8,629.60
Rate for Payer: Aetna Commercial	$6,558.50
Rate for Payer: Aetna Medicare Advantage	$5,177.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,401.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,401.10
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	$4,401.10
Rate for Payer: Cigna Commercial	$8,629.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,177.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88
Rate for Payer: UnitedHealthcare Community & State	$415.95
Rate for Payer: Wellpoint Medicaid Managed Care	$457.37

INSERT PLEUAL CATH-LT

Facility

$17,259.20

Service Code	HCPCS 32550LT
Hospital Charge Code	321032550L
Hospital Revenue Code	361
Min. Negotiated Rate	$2,588.88
Max. Negotiated Rate	$2,588.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88

INSERT PLEUAL CATH-LT

Facility

$9,055.00

Service Code	HCPCS 32550LT
Hospital Charge Code	7411883
Hospital Revenue Code	361
Min. Negotiated Rate	$218.23
Max. Negotiated Rate	$4,527.50
Rate for Payer: Aetna Commercial	$3,440.90
Rate for Payer: Aetna Medicare Advantage	$2,716.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,309.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,309.03
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	$2,309.03
Rate for Payer: Cigna Commercial	$4,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,716.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.25
Rate for Payer: UnitedHealthcare Community & State	$218.23
Rate for Payer: Wellpoint Medicaid Managed Care	$239.96

INSERT PLEUAL CATH-LT

Facility

$9,055.00

Service Code	HCPCS 32550LT
Hospital Charge Code	7411883
Hospital Revenue Code	361
Min. Negotiated Rate	$1,358.25
Max. Negotiated Rate	$1,358.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.25

INSERT PLEUAL CATH-LT

Facility

$17,259.20

Service Code	HCPCS 32550LT
Hospital Charge Code	2691060
Hospital Revenue Code	361
Min. Negotiated Rate	$415.95
Max. Negotiated Rate	$8,629.60
Rate for Payer: Aetna Commercial	$6,558.50
Rate for Payer: Aetna Medicare Advantage	$5,177.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,401.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,401.10
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	$4,401.10
Rate for Payer: Cigna Commercial	$8,629.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,177.76
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88
Rate for Payer: UnitedHealthcare Community & State	$415.95
Rate for Payer: Wellpoint Medicaid Managed Care	$457.37

INSERT PLEURAL CATH

Facility

$9,976.00

Service Code	HCPCS 32550
Hospital Charge Code	1600000689
Hospital Revenue Code	360
Min. Negotiated Rate	$240.42
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	$2,992.80
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.40
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$240.42
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	$264.36

INSERT PLEURAL CATH

Facility

$9,976.00

Service Code	HCPCS 32550
Hospital Charge Code	1600000689
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.40
Max. Negotiated Rate	$1,496.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.40

INSERT POLYETHYLENE 10 DEGR 36

Facility

$4,836.25

Service Code	HCPCS C1776
Hospital Charge Code	270676582
Hospital Revenue Code	278
Min. Negotiated Rate	$725.44
Max. Negotiated Rate	$1,170.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,063.97
Rate for Payer: Qualcare PPO/HMO/WC	$725.44

INSERT POLYETHYLENE 10 DEGR 36

Facility

$4,836.25

Service Code	HCPCS C1776
Hospital Charge Code	270676582
Hospital Revenue Code	278
Min. Negotiated Rate	$116.55
Max. Negotiated Rate	$2,418.12
Rate for Payer: Aetna Commercial	$1,837.78
Rate for Payer: Aetna Medicare Advantage	$1,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,233.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,233.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,233.24
Rate for Payer: Cigna Commercial	$2,418.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,063.97
Rate for Payer: Qualcare PPO/HMO/WC	$725.44
Rate for Payer: UnitedHealthcare Community & State	$116.55
Rate for Payer: Wellpoint Medicaid Managed Care	$128.16

INSERT POLYETHYLENE 28MM SZ C

Facility

$5,694.75

Hospital Charge Code	270676687
Hospital Revenue Code	278
Min. Negotiated Rate	$137.24
Max. Negotiated Rate	$2,847.38
Rate for Payer: Aetna Commercial	$2,164.01
Rate for Payer: Aetna Medicare Advantage	$1,708.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,138.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.16
Rate for Payer: Cigna Commercial	$2,847.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,252.85
Rate for Payer: Qualcare PPO/HMO/WC	$854.21
Rate for Payer: UnitedHealthcare Community & State	$137.24
Rate for Payer: Wellpoint Medicaid Managed Care	$150.91

INSERT POLYETHYLENE 28MM SZ C

Facility

$5,694.75

Hospital Charge Code	270676687
Hospital Revenue Code	278
Min. Negotiated Rate	$854.21
Max. Negotiated Rate	$1,378.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,138.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,252.85
Rate for Payer: Qualcare PPO/HMO/WC	$854.21

INSERT POLYETHYLENE 32MM D

Facility

$8,225.75

Service Code	HCPCS C1776
Hospital Charge Code	270680444
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.86
Max. Negotiated Rate	$1,990.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,809.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.86

INSERT POLYETHYLENE 32MM D

Facility

$8,225.75

Service Code	HCPCS C1776
Hospital Charge Code	270680444
Hospital Revenue Code	278
Min. Negotiated Rate	$198.24
Max. Negotiated Rate	$4,112.88
Rate for Payer: Aetna Commercial	$3,125.78
Rate for Payer: Aetna Medicare Advantage	$2,467.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,097.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,097.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,097.57
Rate for Payer: Cigna Commercial	$4,112.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,809.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.86
Rate for Payer: UnitedHealthcare Community & State	$198.24
Rate for Payer: Wellpoint Medicaid Managed Care	$217.98

INSERT POLYETHYLENE 36MM E

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679971
Hospital Revenue Code	278
Min. Negotiated Rate	$223.07
Max. Negotiated Rate	$4,628.00
Rate for Payer: Aetna Commercial	$3,517.28
Rate for Payer: Aetna Medicare Advantage	$2,776.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,360.28
Rate for Payer: Cigna Commercial	$4,628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,036.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40
Rate for Payer: UnitedHealthcare Community & State	$223.07
Rate for Payer: Wellpoint Medicaid Managed Care	$245.28

INSERT POLYETHYLENE 36MM E

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679971
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.40
Max. Negotiated Rate	$2,239.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,036.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40

INSERT POLYETHYLENE 36MM F

Facility

$4,279.80

Service Code	HCPCS C1776
Hospital Charge Code	270677485
Hospital Revenue Code	278
Min. Negotiated Rate	$103.14
Max. Negotiated Rate	$2,139.90
Rate for Payer: Aetna Commercial	$1,626.32
Rate for Payer: Aetna Medicare Advantage	$1,283.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,091.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,091.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,091.35
Rate for Payer: Cigna Commercial	$2,139.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$941.56
Rate for Payer: Qualcare PPO/HMO/WC	$641.97
Rate for Payer: UnitedHealthcare Community & State	$103.14
Rate for Payer: Wellpoint Medicaid Managed Care	$113.41

INSERT POLYETHYLENE 36MM F

Facility

$4,279.80

Service Code	HCPCS C1776
Hospital Charge Code	270677485
Hospital Revenue Code	278
Min. Negotiated Rate	$641.97
Max. Negotiated Rate	$1,035.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$941.56
Rate for Payer: Qualcare PPO/HMO/WC	$641.97

INSERT POLYETHYLENE 36MM G

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679922
Hospital Revenue Code	278
Min. Negotiated Rate	$223.07
Max. Negotiated Rate	$4,628.00
Rate for Payer: Aetna Commercial	$3,517.28
Rate for Payer: Aetna Medicare Advantage	$2,776.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,360.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,360.28
Rate for Payer: Cigna Commercial	$4,628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,036.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40
Rate for Payer: UnitedHealthcare Community & State	$223.07
Rate for Payer: Wellpoint Medicaid Managed Care	$245.28

INSERT POLYETHYLENE 36MM G

Facility

$9,256.00

Service Code	HCPCS C1776
Hospital Charge Code	270679922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.40
Max. Negotiated Rate	$2,239.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,851.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,239.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,036.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,388.40

INSERT PROLONG TIBIAL SZ2 +0

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677294
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

INSERT PROLONG TIBIAL SZ2 +0

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

INSERT P.S 17MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681470
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT P.S 17MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681470
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

INSERT P.S. 20MM S3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679716
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

Know your out-of-pocket cost for care.

All Charges