Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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	2004711
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 CTH-EXT ARTERY

Facility

$1,443.00

Service Code	HCPCS 3614050
Hospital Charge Code	411036140B
Hospital Revenue Code	361
Min. Negotiated Rate	$216.45
Max. Negotiated Rate	$216.45
Rate for Payer: Qualcare PPO/HMO/WC	$216.45

IR-INTRO CTH-EXT ARTERY

Facility

$1,443.00

Service Code	HCPCS 3614050
Hospital Charge Code	2670190
Hospital Revenue Code	361
Min. Negotiated Rate	$34.78
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$548.34
Rate for Payer: Aetna Medicare Advantage	$432.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$367.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$367.96
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	$367.96
Rate for Payer: Cigna Commercial	$721.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.90
Rate for Payer: Qualcare PPO/HMO/WC	$216.45
Rate for Payer: UnitedHealthcare Community & State	$34.78
Rate for Payer: Wellpoint Medicaid Managed Care	$38.24

IR-INTRO CTH-EXT ARTERY

Facility

$1,443.00

Service Code	HCPCS 3614050
Hospital Charge Code	3668361405
Hospital Revenue Code	361
Min. Negotiated Rate	$34.78
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$548.34
Rate for Payer: Aetna Medicare Advantage	$432.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$367.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$367.96
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	$367.96
Rate for Payer: Cigna Commercial	$721.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.90
Rate for Payer: Qualcare PPO/HMO/WC	$216.45
Rate for Payer: UnitedHealthcare Community & State	$34.78
Rate for Payer: Wellpoint Medicaid Managed Care	$38.24

IR-INTRO CTH-EXT ARTERY

Facility

$1,443.00

Service Code	HCPCS 3614050
Hospital Charge Code	2670190
Hospital Revenue Code	361
Min. Negotiated Rate	$216.45
Max. Negotiated Rate	$216.45
Rate for Payer: Qualcare PPO/HMO/WC	$216.45

IR-INTRO CTH-EXT ARTERY

Facility

$1,443.00

Service Code	HCPCS 3614050
Hospital Charge Code	321036140B
Hospital Revenue Code	361
Min. Negotiated Rate	$34.78
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$548.34
Rate for Payer: Aetna Medicare Advantage	$432.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$367.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$367.96
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	$367.96
Rate for Payer: Cigna Commercial	$721.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.90
Rate for Payer: Qualcare PPO/HMO/WC	$216.45
Rate for Payer: UnitedHealthcare Community & State	$34.78
Rate for Payer: Wellpoint Medicaid Managed Care	$38.24

IR-INTRO CTH-EXT ARTERY

Facility

$1,443.00

Service Code	HCPCS 3614050
Hospital Charge Code	321036140B
Hospital Revenue Code	361
Min. Negotiated Rate	$216.45
Max. Negotiated Rate	$216.45
Rate for Payer: Qualcare PPO/HMO/WC	$216.45

IR-INTRO CTH-EXT ARTERY

Facility

$1,443.00

Service Code	HCPCS 3614050
Hospital Charge Code	3668361405
Hospital Revenue Code	361
Min. Negotiated Rate	$216.45
Max. Negotiated Rate	$216.45
Rate for Payer: Qualcare PPO/HMO/WC	$216.45

IR-INTRO CTH-EXT ARTERY

Facility

$1,443.00

Service Code	HCPCS 3614050
Hospital Charge Code	411036140B
Hospital Revenue Code	361
Min. Negotiated Rate	$34.78
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$548.34
Rate for Payer: Aetna Medicare Advantage	$432.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$367.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$367.96
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	$367.96
Rate for Payer: Cigna Commercial	$721.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.90
Rate for Payer: Qualcare PPO/HMO/WC	$216.45
Rate for Payer: UnitedHealthcare Community & State	$34.78
Rate for Payer: Wellpoint Medicaid Managed Care	$38.24

IR-INTRO GASTRO TUBE

Facility

$576.00

Service Code	HCPCS 44500
Hospital Charge Code	2690120
Hospital Revenue Code	361
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$86.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.40

IR-INTRO GASTRO TUBE

Facility

$576.00

Service Code	HCPCS 44500
Hospital Charge Code	2690120
Hospital Revenue Code	361
Min. Negotiated Rate	$13.88
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.80
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.40
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$13.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$15.26

IR-INTRO GASTRO TUBE

Facility

$576.00

Service Code	HCPCS 44500
Hospital Charge Code	7411550
Hospital Revenue Code	361
Min. Negotiated Rate	$13.88
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
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	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.80
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.40
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$13.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$15.26

IR-INTRO GASTRO TUBE

Facility

$576.00

Service Code	HCPCS 44500
Hospital Charge Code	7411550
Hospital Revenue Code	361
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$86.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.40

IR-INTRO GUIDE REN PEL-LT

Facility

$5,397.00

Service Code	HCPCS 50395LT
Hospital Charge Code	7411968
Hospital Revenue Code	761
Min. Negotiated Rate	$809.55
Max. Negotiated Rate	$809.55
Rate for Payer: Qualcare PPO/HMO/WC	$809.55

IR-INTRO GUIDE REN PEL-LT

Facility

$5,397.00

Service Code	HCPCS 50395LT
Hospital Charge Code	2691630
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-INTRO GUIDE REN PEL-LT

Facility

$5,397.00

Service Code	HCPCS 50395LT
Hospital Charge Code	7411968
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-INTRO GUIDE REN PEL-LT

Facility

$5,397.00

Service Code	HCPCS 50395LT
Hospital Charge Code	2691630
Hospital Revenue Code	761
Min. Negotiated Rate	$809.55
Max. Negotiated Rate	$809.55
Rate for Payer: Qualcare PPO/HMO/WC	$809.55

IR-INTRO GUIDE REN PEL-RT

Facility

$5,397.00

Service Code	HCPCS 50395RT
Hospital Charge Code	2691635
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-INTRO GUIDE REN PEL-RT

Facility

$5,397.00

Service Code	HCPCS 50395RT
Hospital Charge Code	2691635
Hospital Revenue Code	761
Min. Negotiated Rate	$809.55
Max. Negotiated Rate	$809.55
Rate for Payer: Qualcare PPO/HMO/WC	$809.55

IR-INTRO GUIDE REN PEL-RT

Facility

$5,397.00

Service Code	HCPCS 50395RT
Hospital Charge Code	7411969
Hospital Revenue Code	761
Min. Negotiated Rate	$809.55
Max. Negotiated Rate	$809.55
Rate for Payer: Qualcare PPO/HMO/WC	$809.55

IR-INTRO GUIDE REN PEL-RT

Facility

$5,397.00

Service Code	HCPCS 50395RT
Hospital Charge Code	7411969
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 INTRO NDL/CATH EXTR ART

Facility

$414.45

Service Code	HCPCS 36140
Hospital Charge Code	2004190
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 NDL/CATH EXTR ART

Facility

$414.45

Service Code	HCPCS 36140
Hospital Charge Code	2004190
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
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

IR INTRO NDL/CATH EXTR ART

Facility

$414.45

Service Code	HCPCS 36140
Hospital Charge Code	321036140
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
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

Know your out-of-pocket cost for care.

All Charges