Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	321024220R
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	321024220R
Hospital Revenue Code	361
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
Rate for Payer: UnitedHealthcare Community & State	$15.57
Rate for Payer: Wellpoint Medicaid Managed Care	$17.12

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	2690945
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	2690945
Hospital Revenue Code	361
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
Rate for Payer: UnitedHealthcare Community & State	$15.57
Rate for Payer: Wellpoint Medicaid Managed Care	$17.12

IR-INJ/EVAL PERITONEAL SHUNT

Facility

$266.00

Service Code	HCPCS 49427
Hospital Charge Code	7411592
Hospital Revenue Code	361
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.05

IR-INJ/EVAL PERITONEAL SHUNT

Facility

$266.00

Service Code	HCPCS 49427
Hospital Charge Code	2670145
Hospital Revenue Code	361
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

IR-INJ/EVAL PERITONEAL SHUNT

Facility

$266.00

Service Code	HCPCS 49427
Hospital Charge Code	2670145
Hospital Revenue Code	361
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.05

IR-INJ/EVAL PERITONEAL SHUNT

Facility

$266.00

Service Code	HCPCS 49427
Hospital Charge Code	7411592
Hospital Revenue Code	361
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

IR-INJ FOR SIALOGRAPH-BIL

Facility

$793.00

Service Code	HCPCS 4255050
Hospital Charge Code	7411816
Hospital Revenue Code	761
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$396.50
Rate for Payer: Aetna Commercial	$301.34
Rate for Payer: Aetna Medicare Advantage	$237.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.22
Rate for Payer: Cigna Commercial	$396.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.90
Rate for Payer: Oxford Commercial	$158.60
Rate for Payer: Qualcare PPO/HMO/WC	$118.95
Rate for Payer: UnitedHealthcare Commercial	$158.60
Rate for Payer: UnitedHealthcare Community & State	$19.11
Rate for Payer: Wellpoint Medicaid Managed Care	$21.01

IR-INJ FOR SIALOGRAPH-BIL

Facility

$793.00

Service Code	HCPCS 4255050
Hospital Charge Code	2690590
Hospital Revenue Code	761
Min. Negotiated Rate	$118.95
Max. Negotiated Rate	$118.95
Rate for Payer: Qualcare PPO/HMO/WC	$118.95

IR-INJ FOR SIALOGRAPH-BIL

Facility

$793.00

Service Code	HCPCS 4255050
Hospital Charge Code	2690590
Hospital Revenue Code	761
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$396.50
Rate for Payer: Aetna Commercial	$301.34
Rate for Payer: Aetna Medicare Advantage	$237.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.22
Rate for Payer: Cigna Commercial	$396.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.90
Rate for Payer: Oxford Commercial	$158.60
Rate for Payer: Qualcare PPO/HMO/WC	$118.95
Rate for Payer: UnitedHealthcare Commercial	$158.60
Rate for Payer: UnitedHealthcare Community & State	$19.11
Rate for Payer: Wellpoint Medicaid Managed Care	$21.01

IR-INJ FOR SIALOGRAPH-BIL

Facility

$793.00

Service Code	HCPCS 4255050
Hospital Charge Code	7411816
Hospital Revenue Code	761
Min. Negotiated Rate	$118.95
Max. Negotiated Rate	$118.95
Rate for Payer: Qualcare PPO/HMO/WC	$118.95

IR-INJ FOR SIALOGRAPHY-LT

Facility

$793.00

Service Code	HCPCS 42550LT
Hospital Charge Code	7411952
Hospital Revenue Code	761
Min. Negotiated Rate	$118.95
Max. Negotiated Rate	$118.95
Rate for Payer: Qualcare PPO/HMO/WC	$118.95

IR-INJ FOR SIALOGRAPHY-LT

Facility

$793.00

Service Code	HCPCS 42550LT
Hospital Charge Code	7411952
Hospital Revenue Code	761
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$396.50
Rate for Payer: Aetna Commercial	$301.34
Rate for Payer: Aetna Medicare Advantage	$237.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.22
Rate for Payer: Cigna Commercial	$396.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.90
Rate for Payer: Oxford Commercial	$158.60
Rate for Payer: Qualcare PPO/HMO/WC	$118.95
Rate for Payer: UnitedHealthcare Commercial	$158.60
Rate for Payer: UnitedHealthcare Community & State	$19.11
Rate for Payer: Wellpoint Medicaid Managed Care	$21.01

IR-INJ FOR SIALOGRAPHY-LT

Facility

$793.00

Service Code	HCPCS 42550LT
Hospital Charge Code	2691510
Hospital Revenue Code	761
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$396.50
Rate for Payer: Aetna Commercial	$301.34
Rate for Payer: Aetna Medicare Advantage	$237.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.22
Rate for Payer: Cigna Commercial	$396.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.90
Rate for Payer: Oxford Commercial	$158.60
Rate for Payer: Qualcare PPO/HMO/WC	$118.95
Rate for Payer: UnitedHealthcare Commercial	$158.60
Rate for Payer: UnitedHealthcare Community & State	$19.11
Rate for Payer: Wellpoint Medicaid Managed Care	$21.01

IR-INJ FOR SIALOGRAPHY-LT

Facility

$793.00

Service Code	HCPCS 42550LT
Hospital Charge Code	2691510
Hospital Revenue Code	761
Min. Negotiated Rate	$118.95
Max. Negotiated Rate	$118.95
Rate for Payer: Qualcare PPO/HMO/WC	$118.95

IR-INJ FOR SIALOGRAPHY-RT

Facility

$793.00

Service Code	HCPCS 42550RT
Hospital Charge Code	7411953
Hospital Revenue Code	761
Min. Negotiated Rate	$118.95
Max. Negotiated Rate	$118.95
Rate for Payer: Qualcare PPO/HMO/WC	$118.95

IR-INJ FOR SIALOGRAPHY-RT

Facility

$793.00

Service Code	HCPCS 42550RT
Hospital Charge Code	7411953
Hospital Revenue Code	761
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$396.50
Rate for Payer: Aetna Commercial	$301.34
Rate for Payer: Aetna Medicare Advantage	$237.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.22
Rate for Payer: Cigna Commercial	$396.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.90
Rate for Payer: Oxford Commercial	$158.60
Rate for Payer: Qualcare PPO/HMO/WC	$118.95
Rate for Payer: UnitedHealthcare Commercial	$158.60
Rate for Payer: UnitedHealthcare Community & State	$19.11
Rate for Payer: Wellpoint Medicaid Managed Care	$21.01

IR-INJ FOR SIALOGRAPHY-RT

Facility

$793.00

Service Code	HCPCS 42550RT
Hospital Charge Code	2691515
Hospital Revenue Code	761
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$396.50
Rate for Payer: Aetna Commercial	$301.34
Rate for Payer: Aetna Medicare Advantage	$237.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.22
Rate for Payer: Cigna Commercial	$396.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.90
Rate for Payer: Oxford Commercial	$158.60
Rate for Payer: Qualcare PPO/HMO/WC	$118.95
Rate for Payer: UnitedHealthcare Commercial	$158.60
Rate for Payer: UnitedHealthcare Community & State	$19.11
Rate for Payer: Wellpoint Medicaid Managed Care	$21.01

IR-INJ FOR SIALOGRAPHY-RT

Facility

$793.00

Service Code	HCPCS 42550RT
Hospital Charge Code	2691515
Hospital Revenue Code	761
Min. Negotiated Rate	$118.95
Max. Negotiated Rate	$118.95
Rate for Payer: Qualcare PPO/HMO/WC	$118.95

IR-INJ FOR URETOPYELOG-LT

Facility

$942.00

Service Code	HCPCS 50690LT
Hospital Charge Code	2691700
Hospital Revenue Code	761
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

IR-INJ FOR URETOPYELOG-LT

Facility

$942.00

Service Code	HCPCS 50690LT
Hospital Charge Code	7411980
Hospital Revenue Code	761
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

IR-INJ FOR URETOPYELOG-LT

Facility

$942.00

Service Code	HCPCS 50690LT
Hospital Charge Code	2691700
Hospital Revenue Code	761
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$471.00
Rate for Payer: Aetna Commercial	$357.96
Rate for Payer: Aetna Medicare Advantage	$282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.21
Rate for Payer: Cigna Commercial	$471.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$282.60
Rate for Payer: Oxford Commercial	$188.40
Rate for Payer: Qualcare PPO/HMO/WC	$141.30
Rate for Payer: UnitedHealthcare Commercial	$188.40
Rate for Payer: UnitedHealthcare Community & State	$22.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.96

IR-INJ FOR URETOPYELOG-LT

Facility

$942.00

Service Code	HCPCS 50690LT
Hospital Charge Code	7411980
Hospital Revenue Code	761
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$471.00
Rate for Payer: Aetna Commercial	$357.96
Rate for Payer: Aetna Medicare Advantage	$282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.21
Rate for Payer: Cigna Commercial	$471.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$282.60
Rate for Payer: Oxford Commercial	$188.40
Rate for Payer: Qualcare PPO/HMO/WC	$141.30
Rate for Payer: UnitedHealthcare Commercial	$188.40
Rate for Payer: UnitedHealthcare Community & State	$22.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.96

IR-INJ FOR URETOPYELOG-RT

Facility

$942.00

Service Code	HCPCS 50690RT
Hospital Charge Code	7411981
Hospital Revenue Code	761
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

Know your out-of-pocket cost for care.

All Charges