Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR INJ PROC VENOGRAPHY

Facility

$414.45

Service Code	HCPCS 36005
Hospital Charge Code	2004679
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
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: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99

IR INJ PROC WRIST ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 25246
Hospital Charge Code	7411364
Hospital Revenue Code	361
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.98

IR INJ PROC WRIST ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 25246
Hospital Charge Code	2680075
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC WRIST ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 25246
Hospital Charge Code	7411364
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC WRIST ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 25246
Hospital Charge Code	2680075
Hospital Revenue Code	361
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.98

IR INJ PROD SPLENOPORTOGRAM

Facility

$414.45

Service Code	HCPCS 38200
Hospital Charge Code	7411542
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ PROD SPLENOPORTOGRAM

Facility

$414.45

Service Code	HCPCS 38200
Hospital Charge Code	7411542
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
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: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99

IR INJ PROD SPLENOPORTOGRAM

Facility

$414.45

Service Code	HCPCS 38200
Hospital Charge Code	2004661
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
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: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99

IR INJ PROD SPLENOPORTOGRAM

Facility

$414.45

Service Code	HCPCS 38200
Hospital Charge Code	2004661
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	2670230
Hospital Revenue Code	361
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$71.85
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	7411625
Hospital Revenue Code	361
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$71.85
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	2670230
Hospital Revenue Code	361
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$182.02
Rate for Payer: Aetna Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.14
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	$122.14
Rate for Payer: Cigna Commercial	$239.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.70
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$11.54
Rate for Payer: Wellpoint Medicaid Managed Care	$12.69

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	7411625
Hospital Revenue Code	361
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$182.02
Rate for Payer: Aetna Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.14
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	$122.14
Rate for Payer: Cigna Commercial	$239.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.70
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$11.54
Rate for Payer: Wellpoint Medicaid Managed Care	$12.69

IR INJ SCLEROSING SOL SNG VEIN

Facility

$375.00

Service Code	HCPCS 36470
Hospital Charge Code	7411440
Hospital Revenue Code	361
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IR INJ SCLEROSING SOL SNG VEIN

Facility

$375.00

Service Code	HCPCS 36470
Hospital Charge Code	5600220
Hospital Revenue Code	361
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
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	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

IR INJ SCLEROSING SOL SNG VEIN

Facility

$375.00

Service Code	HCPCS 36470
Hospital Charge Code	5600220
Hospital Revenue Code	361
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IR INJ SCLEROSING SOL SNG VEIN

Facility

$375.00

Service Code	HCPCS 36470
Hospital Charge Code	7411440
Hospital Revenue Code	361
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
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	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

IR-INJ SHOULDER ARTHR-BIL

Facility

$271.00

Service Code	HCPCS 2335050
Hospital Charge Code	2690325
Hospital Revenue Code	361
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$102.98
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
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	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.30
Rate for Payer: Qualcare PPO/HMO/WC	$40.65
Rate for Payer: UnitedHealthcare Community & State	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.18

IR-INJ SHOULDER ARTHR-BIL

Facility

$271.00

Service Code	HCPCS 2335050
Hospital Charge Code	2690325
Hospital Revenue Code	361
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR-INJ SHOULDER ARTHR-BIL

Facility

$271.00

Service Code	HCPCS 2335050
Hospital Charge Code	7411773
Hospital Revenue Code	361
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$102.98
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
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	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.30
Rate for Payer: Qualcare PPO/HMO/WC	$40.65
Rate for Payer: UnitedHealthcare Community & State	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.18

IR-INJ SHOULDER ARTHR-BIL

Facility

$271.00

Service Code	HCPCS 2335050
Hospital Charge Code	7411773
Hospital Revenue Code	361
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

IR INJ,SHOULDER ARTHROGRPHYCT/

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	7411360
Hospital Revenue Code	361
Min. Negotiated Rate	$42.56
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$671.08
Rate for Payer: Aetna Medicare Advantage	$529.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.33
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	$450.33
Rate for Payer: Cigna Commercial	$883.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.90
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$42.56
Rate for Payer: Wellpoint Medicaid Managed Care	$46.80

IR INJ,SHOULDER ARTHROGRPHYCT/

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	7411360
Hospital Revenue Code	361
Min. Negotiated Rate	$264.90
Max. Negotiated Rate	$264.90
Rate for Payer: Qualcare PPO/HMO/WC	$264.90

IR INJ,SHOULDER ARTHROGRPHYCT/

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	2680055
Hospital Revenue Code	361
Min. Negotiated Rate	$264.90
Max. Negotiated Rate	$264.90
Rate for Payer: Qualcare PPO/HMO/WC	$264.90

IR INJ,SHOULDER ARTHROGRPHYCT/

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	2680055
Hospital Revenue Code	361
Min. Negotiated Rate	$42.56
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$671.08
Rate for Payer: Aetna Medicare Advantage	$529.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.33
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	$450.33
Rate for Payer: Cigna Commercial	$883.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.80
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.90
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$42.56
Rate for Payer: Wellpoint Medicaid Managed Care	$46.80

Know your out-of-pocket cost for care.

All Charges