Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR DISKOGRAPHY LUMBAR

Facility

$9,928.00

Service Code	HCPCS 72295
Hospital Charge Code	366872295
Hospital Revenue Code	320
Min. Negotiated Rate	$1,489.20
Max. Negotiated Rate	$1,489.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,489.20

IR DISKOGRAPHY LUMBAR

Facility

$9,928.00

Service Code	HCPCS 72295
Hospital Charge Code	321072295
Hospital Revenue Code	320
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$1,623.92
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,978.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,489.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$239.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$556.68
Rate for Payer: Wellpoint Medicaid Managed Care	$263.09

IR DISKOGRAPHY LUMBAR

Facility

$9,928.00

Service Code	HCPCS 72295
Hospital Charge Code	321072295
Hospital Revenue Code	320
Min. Negotiated Rate	$1,489.20
Max. Negotiated Rate	$1,489.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,489.20

IR DISKOGRAPHY LUMBAR

Facility

$9,928.00

Service Code	HCPCS 72295
Hospital Charge Code	7411663
Hospital Revenue Code	320
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$1,623.92
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,978.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,489.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$239.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$556.68
Rate for Payer: Wellpoint Medicaid Managed Care	$263.09

IR DISKOGRAPHY LUMBAR

Facility

$9,928.00

Service Code	HCPCS 72295
Hospital Charge Code	2680260
Hospital Revenue Code	320
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$1,623.92
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,978.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,489.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$239.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$556.68
Rate for Payer: Wellpoint Medicaid Managed Care	$263.09

IR DRAINAGE LIVER

Facility

$3,410.10

Hospital Charge Code	2600061
Hospital Revenue Code	361
Min. Negotiated Rate	$511.51
Max. Negotiated Rate	$511.51
Rate for Payer: Qualcare PPO/HMO/WC	$511.51

IR DRAINAGE LIVER

Facility

$3,410.10

Hospital Charge Code	2600061
Hospital Revenue Code	361
Min. Negotiated Rate	$82.18
Max. Negotiated Rate	$1,705.05
Rate for Payer: Aetna Commercial	$1,295.84
Rate for Payer: Aetna Medicare Advantage	$1,023.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$869.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$869.58
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	$869.58
Rate for Payer: Cigna Commercial	$1,705.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,023.03
Rate for Payer: Qualcare PPO/HMO/WC	$511.51
Rate for Payer: UnitedHealthcare Community & State	$82.18
Rate for Payer: Wellpoint Medicaid Managed Care	$90.37

IR DRAINAGE LUNG BILATERAL

Facility

$1,139.65

Hospital Charge Code	2600062
Hospital Revenue Code	361
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$433.07
Rate for Payer: Aetna Medicare Advantage	$341.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.61
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	$290.61
Rate for Payer: Cigna Commercial	$569.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$341.89
Rate for Payer: Qualcare PPO/HMO/WC	$170.95
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.20

IR DRAINAGE LUNG BILATERAL

Facility

$1,139.65

Hospital Charge Code	2600062
Hospital Revenue Code	361
Min. Negotiated Rate	$170.95
Max. Negotiated Rate	$170.95
Rate for Payer: Qualcare PPO/HMO/WC	$170.95

IR DRAINAGE LUNG LEFT

Facility

$1,139.65

Hospital Charge Code	2600063
Hospital Revenue Code	361
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$433.07
Rate for Payer: Aetna Medicare Advantage	$341.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.61
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	$290.61
Rate for Payer: Cigna Commercial	$569.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$341.89
Rate for Payer: Qualcare PPO/HMO/WC	$170.95
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.20

IR DRAINAGE LUNG LEFT

Facility

$1,139.65

Hospital Charge Code	2600063
Hospital Revenue Code	361
Min. Negotiated Rate	$170.95
Max. Negotiated Rate	$170.95
Rate for Payer: Qualcare PPO/HMO/WC	$170.95

IR DRAINAGE LUNG RIGHT

Facility

$1,139.65

Hospital Charge Code	2600064
Hospital Revenue Code	361
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$433.07
Rate for Payer: Aetna Medicare Advantage	$341.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.61
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	$290.61
Rate for Payer: Cigna Commercial	$569.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$341.89
Rate for Payer: Qualcare PPO/HMO/WC	$170.95
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.20

IR DRAINAGE LUNG RIGHT

Facility

$1,139.65

Hospital Charge Code	2600064
Hospital Revenue Code	361
Min. Negotiated Rate	$170.95
Max. Negotiated Rate	$170.95
Rate for Payer: Qualcare PPO/HMO/WC	$170.95

IR-DRAINAGE OF NOSE LESIO

Facility

$573.00

Service Code	HCPCS 30000
Hospital Charge Code	2690035
Hospital Revenue Code	761
Min. Negotiated Rate	$85.95
Max. Negotiated Rate	$85.95
Rate for Payer: Qualcare PPO/HMO/WC	$85.95

IR-DRAINAGE OF NOSE LESIO

Facility

$573.00

Service Code	HCPCS 30000
Hospital Charge Code	7411373
Hospital Revenue Code	761
Min. Negotiated Rate	$13.81
Max. Negotiated Rate	$1,015.70
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,015.70
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.90
Rate for Payer: Oxford Commercial	$114.60
Rate for Payer: Qualcare PPO/HMO/WC	$85.95
Rate for Payer: UnitedHealthcare Commercial	$114.60
Rate for Payer: UnitedHealthcare Community & State	$13.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.18

IR-DRAINAGE OF NOSE LESIO

Facility

$573.00

Service Code	HCPCS 30000
Hospital Charge Code	2690035
Hospital Revenue Code	761
Min. Negotiated Rate	$13.81
Max. Negotiated Rate	$1,015.70
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,015.70
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.90
Rate for Payer: Oxford Commercial	$114.60
Rate for Payer: Qualcare PPO/HMO/WC	$85.95
Rate for Payer: UnitedHealthcare Commercial	$114.60
Rate for Payer: UnitedHealthcare Community & State	$13.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.18

IR-DRAINAGE OF NOSE LESIO

Facility

$573.00

Service Code	HCPCS 30000
Hospital Charge Code	7411373
Hospital Revenue Code	761
Min. Negotiated Rate	$85.95
Max. Negotiated Rate	$85.95
Rate for Payer: Qualcare PPO/HMO/WC	$85.95

IR DRAINAGE PANCREAS

Facility

$3,407.60

Hospital Charge Code	2600065
Hospital Revenue Code	361
Min. Negotiated Rate	$82.12
Max. Negotiated Rate	$1,703.80
Rate for Payer: Aetna Commercial	$1,294.89
Rate for Payer: Aetna Medicare Advantage	$1,022.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$868.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$868.94
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	$868.94
Rate for Payer: Cigna Commercial	$1,703.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,022.28
Rate for Payer: Qualcare PPO/HMO/WC	$511.14
Rate for Payer: UnitedHealthcare Community & State	$82.12
Rate for Payer: Wellpoint Medicaid Managed Care	$90.30

IR DRAINAGE PANCREAS

Facility

$3,407.60

Hospital Charge Code	2600065
Hospital Revenue Code	361
Min. Negotiated Rate	$511.14
Max. Negotiated Rate	$511.14
Rate for Payer: Qualcare PPO/HMO/WC	$511.14

IR DRAINAGE PERITONEAL

Facility

$6,139.10

Hospital Charge Code	2600066
Hospital Revenue Code	361
Min. Negotiated Rate	$920.87
Max. Negotiated Rate	$920.87
Rate for Payer: Qualcare PPO/HMO/WC	$920.87

IR DRAINAGE PERITONEAL

Facility

$6,139.10

Hospital Charge Code	2600066
Hospital Revenue Code	361
Min. Negotiated Rate	$147.95
Max. Negotiated Rate	$3,069.55
Rate for Payer: Aetna Commercial	$2,332.86
Rate for Payer: Aetna Medicare Advantage	$1,841.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.47
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	$1,565.47
Rate for Payer: Cigna Commercial	$3,069.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,841.73
Rate for Payer: Qualcare PPO/HMO/WC	$920.87
Rate for Payer: UnitedHealthcare Community & State	$147.95
Rate for Payer: Wellpoint Medicaid Managed Care	$162.69

IR DRAINAGE RENAL BILATERAL

Facility

$4,350.20

Service Code	HCPCS 50200
Hospital Charge Code	2600067
Hospital Revenue Code	361
Min. Negotiated Rate	$652.53
Max. Negotiated Rate	$652.53
Rate for Payer: Qualcare PPO/HMO/WC	$652.53

IR DRAINAGE RENAL BILATERAL

Facility

$4,350.20

Service Code	HCPCS 50200
Hospital Charge Code	2600067
Hospital Revenue Code	361
Min. Negotiated Rate	$104.84
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	$1,305.06
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$652.53
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$104.84
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	$115.28

IR DRAINAGE RENAL LEFT

Facility

$4,350.20

Service Code	HCPCS 50200
Hospital Charge Code	2600068
Hospital Revenue Code	361
Min. Negotiated Rate	$104.84
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	$1,305.06
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$652.53
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$104.84
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	$115.28

IR DRAINAGE RENAL LEFT

Facility

$4,350.20

Service Code	HCPCS 50200
Hospital Charge Code	2600068
Hospital Revenue Code	361
Min. Negotiated Rate	$652.53
Max. Negotiated Rate	$652.53
Rate for Payer: Qualcare PPO/HMO/WC	$652.53

Know your out-of-pocket cost for care.

All Charges