Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR ENDOVASC REPAIR ABD AORTA

Facility

$4,000.00

Service Code	HCPCS 75952
Hospital Charge Code	2011287
Hospital Revenue Code	329
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

IR ENDOVASC REPAIR ABD AORTA

Facility

$4,000.00

Service Code	HCPCS 75952
Hospital Charge Code	2011287
Hospital Revenue Code	329
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ENDOVASC REPAIR ABD AORTA

Facility

$4,000.00

Service Code	HCPCS 75952
Hospital Charge Code	7411732
Hospital Revenue Code	329
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

IR ENDOVAS EXTEND PROSTH ADD'L

Facility

$4,000.00

Service Code	HCPCS 34826
Hospital Charge Code	7411401
Hospital Revenue Code	361
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ENDOVAS EXTEND PROSTH ADD'L

Facility

$4,000.00

Service Code	HCPCS 34826
Hospital Charge Code	2011294
Hospital Revenue Code	361
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
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	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

IR ENDOVAS EXTEND PROSTH ADD'L

Facility

$4,000.00

Service Code	HCPCS 34826
Hospital Charge Code	2011294
Hospital Revenue Code	361
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ENDOVAS EXTEND PROSTH ADD'L

Facility

$4,000.00

Service Code	HCPCS 34826
Hospital Charge Code	7411401
Hospital Revenue Code	361
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
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	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

IR ENDOVAS EXTEND PROSTH INIT

Facility

$4,000.00

Service Code	HCPCS 34825
Hospital Charge Code	2011296
Hospital Revenue Code	361
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
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	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

IR ENDOVAS EXTEND PROSTH INIT

Facility

$4,000.00

Service Code	HCPCS 34825
Hospital Charge Code	7411400
Hospital Revenue Code	361
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ENDOVAS EXTEND PROSTH INIT

Facility

$4,000.00

Service Code	HCPCS 34825
Hospital Charge Code	2011296
Hospital Revenue Code	361
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ENDOVAS EXTEND PROSTH INIT

Facility

$4,000.00

Service Code	HCPCS 34825
Hospital Charge Code	7411400
Hospital Revenue Code	361
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
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	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

IR ENTEROCLYSIS TUBE PLACEMENT

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	2600079
Hospital Revenue Code	320
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$94.12
Rate for Payer: Qualcare PPO/HMO/WC	$94.12

IR ENTEROCLYSIS TUBE PLACEMENT

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	7411673
Hospital Revenue Code	320
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$94.12
Rate for Payer: Qualcare PPO/HMO/WC	$94.12

IR ENTEROCLYSIS TUBE PLACEMENT

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	7411673
Hospital Revenue Code	320
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$238.45
Rate for Payer: Aetna Medicare Advantage	$188.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.01
Rate for Payer: Cigna Commercial	$313.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.12
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$15.12
Rate for Payer: Wellpoint Medicaid Managed Care	$16.63

IR ENTEROCLYSIS TUBE PLACEMENT

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	2600079
Hospital Revenue Code	320
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$238.45
Rate for Payer: Aetna Medicare Advantage	$188.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.01
Rate for Payer: Cigna Commercial	$313.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.12
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$15.12
Rate for Payer: Wellpoint Medicaid Managed Care	$16.63

IR EPIDIDYMOGRAPHY

Facility

$906.25

Service Code	HCPCS 74440
Hospital Charge Code	2600080
Hospital Revenue Code	320
Min. Negotiated Rate	$135.94
Max. Negotiated Rate	$135.94
Rate for Payer: Qualcare PPO/HMO/WC	$135.94

IR EPIDIDYMOGRAPHY

Facility

$906.25

Service Code	HCPCS 74440
Hospital Charge Code	2600080
Hospital Revenue Code	320
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.94
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$21.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$24.02

IR EPIDUROGRAPHY

Facility

$395.00

Service Code	HCPCS 72275
Hospital Charge Code	2680250
Hospital Revenue Code	320
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$150.10
Rate for Payer: Aetna Medicare Advantage	$118.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.72
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$9.52
Rate for Payer: Wellpoint Medicaid Managed Care	$10.47

IR EPIDUROGRAPHY

Facility

$395.00

Service Code	HCPCS 72275
Hospital Charge Code	7411661
Hospital Revenue Code	320
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$150.10
Rate for Payer: Aetna Medicare Advantage	$118.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.72
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$9.52
Rate for Payer: Wellpoint Medicaid Managed Care	$10.47

IR EPIDUROGRAPHY

Facility

$395.00

Service Code	HCPCS 72275
Hospital Charge Code	7411661
Hospital Revenue Code	320
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$59.25
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

IR EPIDUROGRAPHY

Facility

$395.00

Service Code	HCPCS 72275
Hospital Charge Code	2680250
Hospital Revenue Code	320
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$59.25
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

IR ESOPHAGEAL FOREGN BODY RMVL

Facility

$804.30

Service Code	HCPCS 74235
Hospital Charge Code	2600085
Hospital Revenue Code	320
Min. Negotiated Rate	$120.64
Max. Negotiated Rate	$120.64
Rate for Payer: Qualcare PPO/HMO/WC	$120.64

IR ESOPHAGEAL FOREGN BODY RMVL

Facility

$804.30

Service Code	HCPCS 74235
Hospital Charge Code	2600085
Hospital Revenue Code	320
Min. Negotiated Rate	$19.38
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$305.63
Rate for Payer: Aetna Medicare Advantage	$241.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.10
Rate for Payer: Cigna Commercial	$402.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.64
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$19.38
Rate for Payer: Wellpoint Medicaid Managed Care	$21.31

IRESSA 250MG TAB

Facility

$75.00

Hospital Charge Code	60635886
Hospital Revenue Code	636
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

IRESSA 250MG TAB

Facility

$75.00

Hospital Charge Code	60635886
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

Know your out-of-pocket cost for care.

All Charges