Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-BX SOFT TISSUE-SUPR-BI

Facility

$1,916.00

Service Code	HCPCS 2704050
Hospital Charge Code	7411776
Hospital Revenue Code	361
Min. Negotiated Rate	$287.40
Max. Negotiated Rate	$287.40
Rate for Payer: Qualcare PPO/HMO/WC	$287.40

IR-BX SOFT TISSUE-SUPR-LT

Facility

$1,916.00

Service Code	HCPCS 27040LT
Hospital Charge Code	7411871
Hospital Revenue Code	361
Min. Negotiated Rate	$46.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$728.08
Rate for Payer: Aetna Medicare Advantage	$574.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.58
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	$488.58
Rate for Payer: Cigna Commercial	$958.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.80
Rate for Payer: Qualcare PPO/HMO/WC	$287.40
Rate for Payer: UnitedHealthcare Community & State	$46.18
Rate for Payer: Wellpoint Medicaid Managed Care	$50.77

IR-BX SOFT TISSUE-SUPR-LT

Facility

$1,916.00

Service Code	HCPCS 27040LT
Hospital Charge Code	7411871
Hospital Revenue Code	361
Min. Negotiated Rate	$287.40
Max. Negotiated Rate	$287.40
Rate for Payer: Qualcare PPO/HMO/WC	$287.40

IR-BX SOFT TISSUE-SUPR-LT

Facility

$1,916.00

Service Code	HCPCS 27040LT
Hospital Charge Code	2690960
Hospital Revenue Code	361
Min. Negotiated Rate	$287.40
Max. Negotiated Rate	$287.40
Rate for Payer: Qualcare PPO/HMO/WC	$287.40

IR-BX SOFT TISSUE-SUPR-LT

Facility

$1,916.00

Service Code	HCPCS 27040LT
Hospital Charge Code	2690960
Hospital Revenue Code	361
Min. Negotiated Rate	$46.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$728.08
Rate for Payer: Aetna Medicare Advantage	$574.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.58
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	$488.58
Rate for Payer: Cigna Commercial	$958.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.80
Rate for Payer: Qualcare PPO/HMO/WC	$287.40
Rate for Payer: UnitedHealthcare Community & State	$46.18
Rate for Payer: Wellpoint Medicaid Managed Care	$50.77

IR-BX SOFT TISSUE-SUPR-RT

Facility

$1,916.00

Service Code	HCPCS 27040RT
Hospital Charge Code	2690965
Hospital Revenue Code	361
Min. Negotiated Rate	$287.40
Max. Negotiated Rate	$287.40
Rate for Payer: Qualcare PPO/HMO/WC	$287.40

IR-BX SOFT TISSUE-SUPR-RT

Facility

$1,916.00

Service Code	HCPCS 27040RT
Hospital Charge Code	2690965
Hospital Revenue Code	361
Min. Negotiated Rate	$46.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$728.08
Rate for Payer: Aetna Medicare Advantage	$574.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.58
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	$488.58
Rate for Payer: Cigna Commercial	$958.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.80
Rate for Payer: Qualcare PPO/HMO/WC	$287.40
Rate for Payer: UnitedHealthcare Community & State	$46.18
Rate for Payer: Wellpoint Medicaid Managed Care	$50.77

IR-BX SOFT TISSUE-SUPR-RT

Facility

$1,916.00

Service Code	HCPCS 27040RT
Hospital Charge Code	7411872
Hospital Revenue Code	361
Min. Negotiated Rate	$287.40
Max. Negotiated Rate	$287.40
Rate for Payer: Qualcare PPO/HMO/WC	$287.40

IR-BX SOFT TISSUE-SUPR-RT

Facility

$1,916.00

Service Code	HCPCS 27040RT
Hospital Charge Code	7411872
Hospital Revenue Code	361
Min. Negotiated Rate	$46.18
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$728.08
Rate for Payer: Aetna Medicare Advantage	$574.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.58
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	$488.58
Rate for Payer: Cigna Commercial	$958.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.80
Rate for Payer: Qualcare PPO/HMO/WC	$287.40
Rate for Payer: UnitedHealthcare Community & State	$46.18
Rate for Payer: Wellpoint Medicaid Managed Care	$50.77

IR BX SPINAL CORD,PERCUTNS NEE

Facility

$4,021.35

Service Code	HCPCS 62269
Hospital Charge Code	2670120
Hospital Revenue Code	361
Min. Negotiated Rate	$96.91
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$603.20
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$96.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$106.57

IR BX SPINAL CORD,PERCUTNS NEE

Facility

$4,021.35

Service Code	HCPCS 62269
Hospital Charge Code	2670120
Hospital Revenue Code	361
Min. Negotiated Rate	$603.20
Max. Negotiated Rate	$603.20
Rate for Payer: Qualcare PPO/HMO/WC	$603.20

IR BX SPINAL CORD,PERCUTNS NEE

Facility

$4,021.35

Service Code	HCPCS 62269
Hospital Charge Code	7411649
Hospital Revenue Code	361
Min. Negotiated Rate	$96.91
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$603.20
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$96.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$106.57

IR BX SPINAL CORD,PERCUTNS NEE

Facility

$4,021.35

Service Code	HCPCS 62269
Hospital Charge Code	7411649
Hospital Revenue Code	361
Min. Negotiated Rate	$603.20
Max. Negotiated Rate	$603.20
Rate for Payer: Qualcare PPO/HMO/WC	$603.20

IR CATH IN ART INIT 2ND BILAT

Facility

$8,697.00

Service Code	HCPCS 3624650
Hospital Charge Code	321036246B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND BILAT

Facility

$8,697.00

Service Code	HCPCS 3624650
Hospital Charge Code	2101167
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND BILAT

Facility

$17,394.00

Service Code	HCPCS 3624650
Hospital Charge Code	7411796
Hospital Revenue Code	361
Min. Negotiated Rate	$419.20
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$6,609.72
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,218.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10
Rate for Payer: UnitedHealthcare Community & State	$419.20
Rate for Payer: Wellpoint Medicaid Managed Care	$460.94

IR CATH IN ART INIT 2ND BILAT

Facility

$8,697.00

Service Code	HCPCS 3624650
Hospital Charge Code	321036246B
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND BILAT

Facility

$8,697.00

Service Code	HCPCS 3624650
Hospital Charge Code	2101167
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND BILAT

Facility

$17,394.00

Service Code	HCPCS 3624650
Hospital Charge Code	7411796
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	366836246L
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	411036246L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	321036246L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	321036246L
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	411036246L
Hospital Revenue Code	361
Min. Negotiated Rate	$209.60
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$209.60
Rate for Payer: Wellpoint Medicaid Managed Care	$230.47

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	366836246L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

Know your out-of-pocket cost for care.

All Charges