Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-INJ ANKLE ARTHRO-BIL

Facility

$578.00

Service Code	HCPCS 2764850
Hospital Charge Code	2690355
Hospital Revenue Code	361
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

IR-INJ ANKLE ARTHRO-BIL

Facility

$578.00

Service Code	HCPCS 2764850
Hospital Charge Code	2690355
Hospital Revenue Code	361
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
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	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

IR-INJ ANKLE ARTHRO-BIL

Facility

$578.00

Service Code	HCPCS 2764850
Hospital Charge Code	7411779
Hospital Revenue Code	361
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

IR-INJ ANKLE ARTHRO-BIL

Facility

$578.00

Service Code	HCPCS 2764850
Hospital Charge Code	7411779
Hospital Revenue Code	361
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
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	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

IR-INJ ANKLE ARTHRO-LT

Facility

$578.00

Service Code	HCPCS 27648LT
Hospital Charge Code	2690990
Hospital Revenue Code	361
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
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	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

IR-INJ ANKLE ARTHRO-LT

Facility

$578.00

Service Code	HCPCS 27648LT
Hospital Charge Code	2690990
Hospital Revenue Code	361
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

IR-INJ ANKLE ARTHRO-LT

Facility

$578.00

Service Code	HCPCS 27648LT
Hospital Charge Code	7411877
Hospital Revenue Code	361
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

IR-INJ ANKLE ARTHRO-LT

Facility

$578.00

Service Code	HCPCS 27648LT
Hospital Charge Code	7411877
Hospital Revenue Code	361
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
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	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

IR-INJ ANKLE ARTHRO-RT

Facility

$578.00

Service Code	HCPCS 27648RT
Hospital Charge Code	7411878
Hospital Revenue Code	361
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

IR-INJ ANKLE ARTHRO-RT

Facility

$578.00

Service Code	HCPCS 27648RT
Hospital Charge Code	2690995
Hospital Revenue Code	361
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
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	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

IR-INJ ANKLE ARTHRO-RT

Facility

$578.00

Service Code	HCPCS 27648RT
Hospital Charge Code	7411878
Hospital Revenue Code	361
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
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	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

IR-INJ ANKLE ARTHRO-RT

Facility

$578.00

Service Code	HCPCS 27648RT
Hospital Charge Code	2690995
Hospital Revenue Code	361
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

IR INJ CHOL THROUGH EXIST CATH

Facility

$414.45

Hospital Charge Code	2004741
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

IR INJ CHOL THROUGH EXIST CATH

Facility

$414.45

Hospital Charge Code	2004741
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR-INJECT KNEE ARTHRO-BIL

Facility

$719.00

Service Code	HCPCS 2737050
Hospital Charge Code	2690350
Hospital Revenue Code	761
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$359.50
Rate for Payer: Aetna Commercial	$273.22
Rate for Payer: Aetna Medicare Advantage	$215.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.34
Rate for Payer: Cigna Commercial	$359.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.70
Rate for Payer: Oxford Commercial	$143.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.85
Rate for Payer: UnitedHealthcare Commercial	$143.80
Rate for Payer: UnitedHealthcare Community & State	$17.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.05

IR-INJECT KNEE ARTHRO-BIL

Facility

$719.00

Service Code	HCPCS 2737050
Hospital Charge Code	7411778
Hospital Revenue Code	761
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$359.50
Rate for Payer: Aetna Commercial	$273.22
Rate for Payer: Aetna Medicare Advantage	$215.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.34
Rate for Payer: Cigna Commercial	$359.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.70
Rate for Payer: Oxford Commercial	$143.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.85
Rate for Payer: UnitedHealthcare Commercial	$143.80
Rate for Payer: UnitedHealthcare Community & State	$17.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.05

IR-INJECT KNEE ARTHRO-BIL

Facility

$719.00

Service Code	HCPCS 2737050
Hospital Charge Code	7411778
Hospital Revenue Code	761
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$107.85
Rate for Payer: Qualcare PPO/HMO/WC	$107.85

IR-INJECT KNEE ARTHRO-BIL

Facility

$719.00

Service Code	HCPCS 2737050
Hospital Charge Code	2690350
Hospital Revenue Code	761
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$107.85
Rate for Payer: Qualcare PPO/HMO/WC	$107.85

IR-INJECT KNEE ARTHRO-LT

Facility

$719.00

Service Code	HCPCS 27370LT
Hospital Charge Code	2690980
Hospital Revenue Code	761
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$107.85
Rate for Payer: Qualcare PPO/HMO/WC	$107.85

IR-INJECT KNEE ARTHRO-LT

Facility

$719.00

Service Code	HCPCS 27370LT
Hospital Charge Code	2690980
Hospital Revenue Code	761
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$359.50
Rate for Payer: Aetna Commercial	$273.22
Rate for Payer: Aetna Medicare Advantage	$215.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.34
Rate for Payer: Cigna Commercial	$359.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.70
Rate for Payer: Oxford Commercial	$143.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.85
Rate for Payer: UnitedHealthcare Commercial	$143.80
Rate for Payer: UnitedHealthcare Community & State	$17.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.05

IR-INJECT KNEE ARTHRO-LT

Facility

$719.00

Service Code	HCPCS 27370LT
Hospital Charge Code	7411875
Hospital Revenue Code	761
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$359.50
Rate for Payer: Aetna Commercial	$273.22
Rate for Payer: Aetna Medicare Advantage	$215.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.34
Rate for Payer: Cigna Commercial	$359.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.70
Rate for Payer: Oxford Commercial	$143.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.85
Rate for Payer: UnitedHealthcare Commercial	$143.80
Rate for Payer: UnitedHealthcare Community & State	$17.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.05

IR-INJECT KNEE ARTHRO-LT

Facility

$719.00

Service Code	HCPCS 27370LT
Hospital Charge Code	7411875
Hospital Revenue Code	761
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$107.85
Rate for Payer: Qualcare PPO/HMO/WC	$107.85

IR-INJECT KNEE ARTHRO-RT

Facility

$719.00

Service Code	HCPCS 27370RT
Hospital Charge Code	7411876
Hospital Revenue Code	761
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$359.50
Rate for Payer: Aetna Commercial	$273.22
Rate for Payer: Aetna Medicare Advantage	$215.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.34
Rate for Payer: Cigna Commercial	$359.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.70
Rate for Payer: Oxford Commercial	$143.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.85
Rate for Payer: UnitedHealthcare Commercial	$143.80
Rate for Payer: UnitedHealthcare Community & State	$17.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.05

IR-INJECT KNEE ARTHRO-RT

Facility

$719.00

Service Code	HCPCS 27370RT
Hospital Charge Code	7411876
Hospital Revenue Code	761
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$107.85
Rate for Payer: Qualcare PPO/HMO/WC	$107.85

IR-INJECT KNEE ARTHRO-RT

Facility

$719.00

Service Code	HCPCS 27370RT
Hospital Charge Code	2690985
Hospital Revenue Code	761
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$107.85
Rate for Payer: Qualcare PPO/HMO/WC	$107.85

Know your out-of-pocket cost for care.

All Charges