Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	321053899R
Hospital Revenue Code	361
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$514.96
Rate for Payer: Aetna Medicare Advantage	$406.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.56
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	$345.56
Rate for Payer: Cigna Commercial	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.55
Rate for Payer: Qualcare PPO/HMO/WC	$203.27
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	321053899R
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	2691715
Hospital Revenue Code	361
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$514.96
Rate for Payer: Aetna Medicare Advantage	$406.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.56
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	$345.56
Rate for Payer: Cigna Commercial	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.55
Rate for Payer: Qualcare PPO/HMO/WC	$203.27
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	411053899
Hospital Revenue Code	361
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$514.96
Rate for Payer: Aetna Medicare Advantage	$406.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.56
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	$345.56
Rate for Payer: Cigna Commercial	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.55
Rate for Payer: Qualcare PPO/HMO/WC	$203.27
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

IR-DIL OF URETER-RT

Facility

$327.00

Service Code	HCPCS 53899RT
Hospital Charge Code	7411983
Hospital Revenue Code	361
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$49.05
Rate for Payer: Qualcare PPO/HMO/WC	$49.05

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	366853899R
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$327.00

Service Code	HCPCS 53899RT
Hospital Charge Code	7411983
Hospital Revenue Code	361
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$124.26
Rate for Payer: Aetna Medicare Advantage	$98.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.39
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	$83.39
Rate for Payer: Cigna Commercial	$163.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.10
Rate for Payer: Qualcare PPO/HMO/WC	$49.05
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: Wellpoint Medicaid Managed Care	$8.67

IR DIR-ARTERGRM CAROT CERE UNI

Facility

$12,400.74

Service Code	HCPCS 75665
Hospital Charge Code	2680325
Hospital Revenue Code	323
Min. Negotiated Rate	$298.86
Max. Negotiated Rate	$6,200.37
Rate for Payer: Aetna Commercial	$4,712.28
Rate for Payer: Aetna Medicare Advantage	$3,720.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,162.19
Rate for Payer: Cigna Commercial	$6,200.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,720.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$298.86
Rate for Payer: Wellpoint Medicaid Managed Care	$328.62

IR DIR-ARTERGRM CAROT CERE UNI

Facility

$12,400.74

Service Code	HCPCS 75665
Hospital Charge Code	2680325
Hospital Revenue Code	323
Min. Negotiated Rate	$1,860.11
Max. Negotiated Rate	$1,860.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11

IR DIR-ARTERGRM CAROTID,EXT,UN

Facility

$20,648.21

Service Code	HCPCS 75660
Hospital Charge Code	2680320
Hospital Revenue Code	323
Min. Negotiated Rate	$3,097.23
Max. Negotiated Rate	$3,097.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,097.23

IR DIR-ARTERGRM CAROTID,EXT,UN

Facility

$20,648.21

Service Code	HCPCS 75660
Hospital Charge Code	2680320
Hospital Revenue Code	323
Min. Negotiated Rate	$497.62
Max. Negotiated Rate	$10,324.10
Rate for Payer: Aetna Commercial	$7,846.32
Rate for Payer: Aetna Medicare Advantage	$6,194.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,265.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,265.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,265.29
Rate for Payer: Cigna Commercial	$10,324.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,194.46
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,097.23
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$497.62
Rate for Payer: Wellpoint Medicaid Managed Care	$547.18

IR DIR-ARTERIGRAM VERT CERV UN

Facility

$12,400.74

Service Code	HCPCS 75685
Hospital Charge Code	2670070
Hospital Revenue Code	323
Min. Negotiated Rate	$298.86
Max. Negotiated Rate	$6,200.37
Rate for Payer: Aetna Commercial	$4,712.28
Rate for Payer: Aetna Medicare Advantage	$3,720.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,162.19
Rate for Payer: Cigna Commercial	$6,200.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,720.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$298.86
Rate for Payer: Wellpoint Medicaid Managed Care	$328.62

IR DIR-ARTERIGRAM VERT CERV UN

Facility

$12,400.74

Service Code	HCPCS 75685
Hospital Charge Code	2670070
Hospital Revenue Code	323
Min. Negotiated Rate	$1,860.11
Max. Negotiated Rate	$1,860.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11

IR DIR-ARTGRM CAROT CEREB-BILA

Facility

$20,648.21

Service Code	HCPCS 75671
Hospital Charge Code	2670080
Hospital Revenue Code	323
Min. Negotiated Rate	$3,097.23
Max. Negotiated Rate	$3,097.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,097.23

IR DIR-ARTGRM CAROT CEREB-BILA

Facility

$20,648.21

Service Code	HCPCS 75671
Hospital Charge Code	2670080
Hospital Revenue Code	323
Min. Negotiated Rate	$497.62
Max. Negotiated Rate	$10,324.10
Rate for Payer: Aetna Commercial	$7,846.32
Rate for Payer: Aetna Medicare Advantage	$6,194.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,265.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,265.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,265.29
Rate for Payer: Cigna Commercial	$10,324.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,194.46
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,097.23
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$497.62
Rate for Payer: Wellpoint Medicaid Managed Care	$547.18

IR DIR-ARTGRM CAROT CERV BILAT

Facility

$12,400.74

Service Code	HCPCS 75680
Hospital Charge Code	2670075
Hospital Revenue Code	323
Min. Negotiated Rate	$298.86
Max. Negotiated Rate	$6,200.37
Rate for Payer: Aetna Commercial	$4,712.28
Rate for Payer: Aetna Medicare Advantage	$3,720.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,162.19
Rate for Payer: Cigna Commercial	$6,200.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,720.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$298.86
Rate for Payer: Wellpoint Medicaid Managed Care	$328.62

IR DIR-ARTGRM CAROT CERV BILAT

Facility

$12,400.74

Service Code	HCPCS 75680
Hospital Charge Code	2670075
Hospital Revenue Code	323
Min. Negotiated Rate	$1,860.11
Max. Negotiated Rate	$1,860.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11

IR DIR-ARTGRM CERV-CERE ARCH

Facility

$20,648.21

Service Code	HCPCS 75650
Hospital Charge Code	2670090
Hospital Revenue Code	323
Min. Negotiated Rate	$3,097.23
Max. Negotiated Rate	$3,097.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,097.23

IR DIR-ARTGRM CERV-CERE ARCH

Facility

$20,648.21

Service Code	HCPCS 75650
Hospital Charge Code	2670090
Hospital Revenue Code	323
Min. Negotiated Rate	$497.62
Max. Negotiated Rate	$10,324.10
Rate for Payer: Aetna Commercial	$7,846.32
Rate for Payer: Aetna Medicare Advantage	$6,194.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,265.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,265.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,265.29
Rate for Payer: Cigna Commercial	$10,324.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,194.46
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,097.23
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$497.62
Rate for Payer: Wellpoint Medicaid Managed Care	$547.18

IR DIR-ARTRGRM CAROT EXTERN-BI

Facility

$20,648.21

Service Code	HCPCS 75662
Hospital Charge Code	2670085
Hospital Revenue Code	323
Min. Negotiated Rate	$497.62
Max. Negotiated Rate	$10,324.10
Rate for Payer: Aetna Commercial	$7,846.32
Rate for Payer: Aetna Medicare Advantage	$6,194.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,265.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,265.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,265.29
Rate for Payer: Cigna Commercial	$10,324.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,194.46
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,097.23
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$497.62
Rate for Payer: Wellpoint Medicaid Managed Care	$547.18

IR DIR-ARTRGRM CAROT EXTERN-BI

Facility

$20,648.21

Service Code	HCPCS 75662
Hospital Charge Code	2670085
Hospital Revenue Code	323
Min. Negotiated Rate	$3,097.23
Max. Negotiated Rate	$3,097.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,097.23

IR DIR FLOUR GUIDANCE,SPINE/IN

Facility

$5,100.00

Service Code	HCPCS 77003
Hospital Charge Code	366877003
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

IR DIR FLOUR GUIDANCE,SPINE/IN

Facility

$5,100.00

Service Code	HCPCS 77003
Hospital Charge Code	321077003
Hospital Revenue Code	320
Min. Negotiated Rate	$39.15
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

IR DIR FLOUR GUIDANCE,SPINE/IN

Facility

$5,100.00

Service Code	HCPCS 77003
Hospital Charge Code	2670015
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

IR DIR FLOUR GUIDANCE,SPINE/IN

Facility

$5,100.00

Service Code	HCPCS 77003
Hospital Charge Code	2670015
Hospital Revenue Code	320
Min. Negotiated Rate	$39.15
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

Know your out-of-pocket cost for care.

All Charges