Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-INJ SHOULDER ARTHRO-LT

Facility

$271.00

Service Code	HCPCS 23350LT
Hospital Charge Code	2690930
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 ARTHRO-LT

Facility

$271.00

Service Code	HCPCS 23350LT
Hospital Charge Code	7411865
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 ARTHRO-LT

Facility

$271.00

Service Code	HCPCS 23350LT
Hospital Charge Code	2690930
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 ARTHRO-LT

Facility

$271.00

Service Code	HCPCS 23350LT
Hospital Charge Code	7411865
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 ARTHRO-RT

Facility

$271.00

Service Code	HCPCS 23350RT
Hospital Charge Code	7411866
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 ARTHRO-RT

Facility

$271.00

Service Code	HCPCS 23350RT
Hospital Charge Code	2690935
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 ARTHRO-RT

Facility

$271.00

Service Code	HCPCS 23350RT
Hospital Charge Code	2690935
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 ARTHRO-RT

Facility

$271.00

Service Code	HCPCS 23350RT
Hospital Charge Code	7411866
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 TMJ JOINT ARTHROGRAPHY

Facility

$150.00

Service Code	HCPCS 21116
Hospital Charge Code	7411349
Hospital Revenue Code	361
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

IR INJ TMJ JOINT ARTHROGRAPHY

Facility

$150.00

Service Code	HCPCS 21116
Hospital Charge Code	7411349
Hospital Revenue Code	361
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
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	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$3.62

IR INJ TMJ JOINT ARTHROGRAPHY

Facility

$150.00

Service Code	HCPCS 21116
Hospital Charge Code	2680040
Hospital Revenue Code	361
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
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	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$3.62

IR INJ TMJ JOINT ARTHROGRAPHY

Facility

$150.00

Service Code	HCPCS 21116
Hospital Charge Code	2680040
Hospital Revenue Code	361
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

IR-INJ URETOPYELOG-BILAT

Facility

$942.00

Service Code	HCPCS 5069050
Hospital Charge Code	7411829
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 URETOPYELOG-BILAT

Facility

$942.00

Service Code	HCPCS 5069050
Hospital Charge Code	7411829
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 URETOPYELOG-BILAT

Facility

$942.00

Service Code	HCPCS 5069050
Hospital Charge Code	2690680
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 URETOPYELOG-BILAT

Facility

$942.00

Service Code	HCPCS 5069050
Hospital Charge Code	2690680
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

IRINOTECAN 20 MG/ML INJ

Facility

$4,625.35

Service Code	HCPCS J9206
Hospital Charge Code	6017073
Hospital Revenue Code	636
Min. Negotiated Rate	$693.80
Max. Negotiated Rate	$1,119.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.33
Rate for Payer: Qualcare PPO/HMO/WC	$693.80

IRINOTECAN 20 MG/ML INJ

Facility

$4,625.35

Service Code	HCPCS J9206
Hospital Charge Code	6017073
Hospital Revenue Code	636
Min. Negotiated Rate	$111.47
Max. Negotiated Rate	$2,312.68
Rate for Payer: Aetna Commercial	$1,757.63
Rate for Payer: Aetna Medicare Advantage	$1,387.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,179.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,179.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,179.46
Rate for Payer: Cigna Commercial	$2,312.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.33
Rate for Payer: Qualcare PPO/HMO/WC	$693.80
Rate for Payer: UnitedHealthcare Community & State	$111.47
Rate for Payer: Wellpoint Medicaid Managed Care	$122.57

IR INS CATH RENAL ART 1ST UNI

Facility

$15,468.50

Service Code	HCPCS 36251
Hospital Charge Code	321036251
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR INS CATH RENAL ART 1ST UNI

Facility

$15,468.50

Service Code	HCPCS 36251
Hospital Charge Code	321036251
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

IR INS CATH RENAL ART 1ST UNI

Facility

$15,468.50

Service Code	HCPCS 36251
Hospital Charge Code	5700253
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

IR INS CATH RENAL ART 1ST UNI

Facility

$15,468.50

Service Code	HCPCS 36251
Hospital Charge Code	5700253
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR INS CATH REN ART 1st BILAT

Facility

$15,468.50

Service Code	HCPCS 36252
Hospital Charge Code	321036252
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR INS CATH REN ART 1st BILAT

Facility

$15,468.50

Service Code	HCPCS 36252
Hospital Charge Code	5700264
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

IR INS CATH REN ART 1st BILAT

Facility

$15,468.50

Service Code	HCPCS 36252
Hospital Charge Code	5700264
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

Know your out-of-pocket cost for care.

All Charges