Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-INTERSTIT PLACE NDL/CA

Facility

$10,856.00

Service Code	HCPCS 55875
Hospital Charge Code	2690210
Hospital Revenue Code	761
Min. Negotiated Rate	$1,628.40
Max. Negotiated Rate	$1,628.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,628.40

IR-INTERSTIT PLACE NDL/CA

Facility

$10,856.00

Service Code	HCPCS 55875
Hospital Charge Code	2690210
Hospital Revenue Code	761
Min. Negotiated Rate	$261.63
Max. Negotiated Rate	$22,993.64
Rate for Payer: Aetna Commercial	$17,326.29
Rate for Payer: Aetna Medicare Advantage	$20,638.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,369.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,993.64
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: Cigna Medicare Advantage	$6,369.96
Rate for Payer: Clover Medicare Advantage	$6,051.46
Rate for Payer: EmblemHealth Commercial	$19,109.88
Rate for Payer: Humana Medicare Advantage	$6,561.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,369.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,256.80
Rate for Payer: Oxford Commercial	$2,171.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,628.40
Rate for Payer: UnitedHealthcare Commercial	$2,171.20
Rate for Payer: UnitedHealthcare Community & State	$261.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,369.96
Rate for Payer: Wellcare Medicare Advantage	$6,369.96
Rate for Payer: Wellpoint Medicaid Managed Care	$287.68

IR-INTERSTIT PLACE NDL/CA

Facility

$10,856.00

Service Code	HCPCS 55875
Hospital Charge Code	7411635
Hospital Revenue Code	761
Min. Negotiated Rate	$1,628.40
Max. Negotiated Rate	$1,628.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,628.40

IR-INTR0 GUIDE REN PEL-BI

Facility

$5,397.00

Service Code	HCPCS 5039550
Hospital Charge Code	2690650
Hospital Revenue Code	761
Min. Negotiated Rate	$809.55
Max. Negotiated Rate	$809.55
Rate for Payer: Qualcare PPO/HMO/WC	$809.55

IR-INTR0 GUIDE REN PEL-BI

Facility

$5,397.00

Service Code	HCPCS 5039550
Hospital Charge Code	2690650
Hospital Revenue Code	761
Min. Negotiated Rate	$130.07
Max. Negotiated Rate	$2,698.50
Rate for Payer: Aetna Commercial	$2,050.86
Rate for Payer: Aetna Medicare Advantage	$1,619.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,376.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,376.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,376.23
Rate for Payer: Cigna Commercial	$2,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,619.10
Rate for Payer: Oxford Commercial	$1,079.40
Rate for Payer: Qualcare PPO/HMO/WC	$809.55
Rate for Payer: UnitedHealthcare Commercial	$1,079.40
Rate for Payer: UnitedHealthcare Community & State	$130.07
Rate for Payer: Wellpoint Medicaid Managed Care	$143.02

IR-INTR0 GUIDE REN PEL-BI

Facility

$5,397.00

Service Code	HCPCS 5039550
Hospital Charge Code	7411824
Hospital Revenue Code	761
Min. Negotiated Rate	$130.07
Max. Negotiated Rate	$2,698.50
Rate for Payer: Aetna Commercial	$2,050.86
Rate for Payer: Aetna Medicare Advantage	$1,619.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,376.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,376.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,376.23
Rate for Payer: Cigna Commercial	$2,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,619.10
Rate for Payer: Oxford Commercial	$1,079.40
Rate for Payer: Qualcare PPO/HMO/WC	$809.55
Rate for Payer: UnitedHealthcare Commercial	$1,079.40
Rate for Payer: UnitedHealthcare Community & State	$130.07
Rate for Payer: Wellpoint Medicaid Managed Care	$143.02

IR-INTR0 GUIDE REN PEL-BI

Facility

$5,397.00

Service Code	HCPCS 5039550
Hospital Charge Code	7411824
Hospital Revenue Code	761
Min. Negotiated Rate	$809.55
Max. Negotiated Rate	$809.55
Rate for Payer: Qualcare PPO/HMO/WC	$809.55

IR INTRAVASCULAR US

Facility

$897.55

Hospital Charge Code	5700194
Hospital Revenue Code	323
Min. Negotiated Rate	$134.63
Max. Negotiated Rate	$134.63
Rate for Payer: Qualcare PPO/HMO/WC	$134.63

IR INTRAVASCULAR US

Facility

$897.55

Hospital Charge Code	5700194
Hospital Revenue Code	323
Min. Negotiated Rate	$21.63
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$341.07
Rate for Payer: Aetna Medicare Advantage	$269.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.88
Rate for Payer: Cigna Commercial	$448.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.63
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$21.63
Rate for Payer: Wellpoint Medicaid Managed Care	$23.79

IR INTRAVASCULAR US ADD ON

Facility

$450.00

Hospital Charge Code	5700294
Hospital Revenue Code	323
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

IR INTRAVASCULAR US ADD ON

Facility

$450.00

Hospital Charge Code	5700294
Hospital Revenue Code	323
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

IR-INTRAVERTEBRAL DISK

Facility

$3,392.55

Service Code	HCPCS 62267
Hospital Charge Code	2690225
Hospital Revenue Code	361
Min. Negotiated Rate	$81.76
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.76
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$508.88
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$89.90

IR-INTRAVERTEBRAL DISK

Facility

$3,392.55

Service Code	HCPCS 62267
Hospital Charge Code	2690225
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

IR-INTRAVERTEBRAL DISK

Facility

$3,392.55

Service Code	HCPCS 62267
Hospital Charge Code	321062267
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

IR-INTRAVERTEBRAL DISK

Facility

$3,392.55

Service Code	HCPCS 62267
Hospital Charge Code	7411647
Hospital Revenue Code	361
Min. Negotiated Rate	$81.76
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.76
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$508.88
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$89.90

IR-INTRAVERTEBRAL DISK

Facility

$3,392.55

Service Code	HCPCS 62267
Hospital Charge Code	7411647
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

IR-INTRAVERTEBRAL DISK

Facility

$3,392.55

Service Code	HCPCS 62267
Hospital Charge Code	321062267
Hospital Revenue Code	361
Min. Negotiated Rate	$81.76
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.76
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$508.88
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$89.90

IR INTRO CATH VENA CAVA I OR S

Facility

$414.45

Service Code	HCPCS 36010
Hospital Charge Code	366836010
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INTRO CATH VENA CAVA I OR S

Facility

$414.45

Service Code	HCPCS 36010
Hospital Charge Code	366836010
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 INTRO CATH VENA CAVA I OR S

Facility

$414.45

Service Code	HCPCS 36010
Hospital Charge Code	411036010
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 INTRO CATH VENA CAVA I OR S

Facility

$414.45

Service Code	HCPCS 36010
Hospital Charge Code	411036010
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INTRO CATH VENA CAVA I OR S

Facility

$414.45

Service Code	HCPCS 36010
Hospital Charge Code	7411414
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 INTRO CATH VENA CAVA I OR S

Facility

$414.45

Service Code	HCPCS 36010
Hospital Charge Code	7411414
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INTRO CATH VENA CAVA I OR S

Facility

$414.45

Service Code	HCPCS 36010
Hospital Charge Code	321036010
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 INTRO CATH VENA CAVA I OR S

Facility

$414.45

Service Code	HCPCS 36010
Hospital Charge Code	2004711
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

Know your out-of-pocket cost for care.

All Charges