Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-ID SENTINEL NODE-LT

Facility

$374.00

Service Code	HCPCS 38792LT
Hospital Charge Code	7411948
Hospital Revenue Code	361
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$56.10
Rate for Payer: Qualcare PPO/HMO/WC	$56.10

IR-ID SENTINEL NODE-LT

Facility

$374.00

Service Code	HCPCS 38792LT
Hospital Charge Code	2691490
Hospital Revenue Code	361
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$56.10
Rate for Payer: Qualcare PPO/HMO/WC	$56.10

IR-ID SENTINEL NODE-LT

Facility

$374.00

Service Code	HCPCS 38792LT
Hospital Charge Code	2691490
Hospital Revenue Code	361
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$142.12
Rate for Payer: Aetna Medicare Advantage	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.37
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	$95.37
Rate for Payer: Cigna Commercial	$187.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.20
Rate for Payer: Qualcare PPO/HMO/WC	$56.10
Rate for Payer: UnitedHealthcare Community & State	$9.01
Rate for Payer: Wellpoint Medicaid Managed Care	$9.91

IR-ID SENTINEL NODE-RT

Facility

$374.00

Service Code	HCPCS 38792RT
Hospital Charge Code	2691495
Hospital Revenue Code	361
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$56.10
Rate for Payer: Qualcare PPO/HMO/WC	$56.10

IR-ID SENTINEL NODE-RT

Facility

$374.00

Service Code	HCPCS 38792RT
Hospital Charge Code	7411949
Hospital Revenue Code	361
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$56.10
Rate for Payer: Qualcare PPO/HMO/WC	$56.10

IR-ID SENTINEL NODE-RT

Facility

$374.00

Service Code	HCPCS 38792RT
Hospital Charge Code	7411949
Hospital Revenue Code	361
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$142.12
Rate for Payer: Aetna Medicare Advantage	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.37
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	$95.37
Rate for Payer: Cigna Commercial	$187.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.20
Rate for Payer: Qualcare PPO/HMO/WC	$56.10
Rate for Payer: UnitedHealthcare Community & State	$9.01
Rate for Payer: Wellpoint Medicaid Managed Care	$9.91

IR-ID SENTINEL NODE-RT

Facility

$374.00

Service Code	HCPCS 38792RT
Hospital Charge Code	2691495
Hospital Revenue Code	361
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$142.12
Rate for Payer: Aetna Medicare Advantage	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.37
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	$95.37
Rate for Payer: Cigna Commercial	$187.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.20
Rate for Payer: Qualcare PPO/HMO/WC	$56.10
Rate for Payer: UnitedHealthcare Community & State	$9.01
Rate for Payer: Wellpoint Medicaid Managed Care	$9.91

IR ILIAC ANEURISM ENDOVAS RPR

Facility

$4,000.00

Service Code	HCPCS 75954
Hospital Charge Code	7411734
Hospital Revenue Code	320
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 ILIAC ANEURISM ENDOVAS RPR

Facility

$4,000.00

Service Code	HCPCS 75954
Hospital Charge Code	2011300
Hospital Revenue Code	320
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ILIAC ANEURISM ENDOVAS RPR

Facility

$4,000.00

Service Code	HCPCS 75954
Hospital Charge Code	2011300
Hospital Revenue Code	320
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 ILIAC ANEURISM ENDOVAS RPR

Facility

$4,000.00

Service Code	HCPCS 75954
Hospital Charge Code	7411734
Hospital Revenue Code	320
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

IR ILIAC ANGIO W/CARD CATH

Facility

$6,837.15

Hospital Charge Code	2101166
Hospital Revenue Code	320
Min. Negotiated Rate	$164.78
Max. Negotiated Rate	$3,418.57
Rate for Payer: Aetna Commercial	$2,598.12
Rate for Payer: Aetna Medicare Advantage	$2,051.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.47
Rate for Payer: Cigna Commercial	$3,418.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,051.14
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.57
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$164.78
Rate for Payer: Wellpoint Medicaid Managed Care	$181.18

IR ILIAC ANGIO W/CARD CATH

Facility

$6,837.15

Hospital Charge Code	2101166
Hospital Revenue Code	320
Min. Negotiated Rate	$1,025.57
Max. Negotiated Rate	$1,025.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.57

IR ILIAC REVASC

Facility

$25,423.30

Service Code	HCPCS 37254
Hospital Charge Code	411037220
Hospital Revenue Code	361
Min. Negotiated Rate	$612.70
Max. Negotiated Rate	$24,407.82
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,407.82
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,626.99
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49
Rate for Payer: UnitedHealthcare Community & State	$612.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$673.72

IR ILIAC REVASC

Facility

$27,397.00

Service Code	HCPCS 37220
Hospital Charge Code	5600201
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR ILIAC REVASC

Facility

$25,423.30

Service Code	HCPCS 37220
Hospital Charge Code	366837220
Hospital Revenue Code	361
Min. Negotiated Rate	$612.70
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$9,660.85
Rate for Payer: Aetna Medicare Advantage	$7,626.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,482.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,482.94
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	$6,482.94
Rate for Payer: Cigna Commercial	$12,711.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,626.99
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$612.70
Rate for Payer: Wellpoint Medicaid Managed Care	$673.72

IR ILIAC REVASC

Facility

$25,423.30

Service Code	HCPCS 37254
Hospital Charge Code	411037220
Hospital Revenue Code	361
Min. Negotiated Rate	$3,813.49
Max. Negotiated Rate	$3,813.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49

IR ILIAC REVASC

Facility

$22,441.40

Service Code	HCPCS 37220
Hospital Charge Code	5700301
Hospital Revenue Code	360
Min. Negotiated Rate	$540.84
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,732.42
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$540.84
Rate for Payer: Wellpoint Medicaid Managed Care	$594.70

IR ILIAC REVASC

Facility

$27,397.00

Service Code	HCPCS 37220
Hospital Charge Code	321037220
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
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	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR ILIAC REVASC

Facility

$25,423.30

Service Code	HCPCS 37220
Hospital Charge Code	366837220
Hospital Revenue Code	361
Min. Negotiated Rate	$3,813.49
Max. Negotiated Rate	$3,813.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,813.49

IR ILIAC REVASC

Facility

$22,441.40

Service Code	HCPCS 37220
Hospital Charge Code	7411510
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

IR ILIAC REVASC

Facility

$22,441.40

Service Code	HCPCS 37220
Hospital Charge Code	7411510
Hospital Revenue Code	361
Min. Negotiated Rate	$540.84
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,732.42
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$540.84
Rate for Payer: Wellpoint Medicaid Managed Care	$594.70

IR ILIAC REVASC

Facility

$22,441.40

Service Code	HCPCS 37220
Hospital Charge Code	5700301
Hospital Revenue Code	360
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

IR ILIAC REVASC

Facility

$27,397.00

Service Code	HCPCS 37220
Hospital Charge Code	321037220
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR ILIAC REVASC

Facility

$27,397.00

Service Code	HCPCS 37220
Hospital Charge Code	5600201
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
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	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

Know your out-of-pocket cost for care.

All Charges