Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IRIS TRANSLIMBAL RETRACTOR

Facility

$490.00

Hospital Charge Code	270659778
Hospital Revenue Code	270
Min. Negotiated Rate	$11.81
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.95
Rate for Payer: Cigna Commercial	$245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.00
Rate for Payer: Oxford Commercial	$98.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.50
Rate for Payer: UnitedHealthcare Commercial	$98.00
Rate for Payer: UnitedHealthcare Community & State	$11.81
Rate for Payer: Wellpoint Medicaid Managed Care	$12.98

IR IVC FILTER

Facility

$7,400.85

Service Code	HCPCS 37619
Hospital Charge Code	7411537
Hospital Revenue Code	361
Min. Negotiated Rate	$1,110.13
Max. Negotiated Rate	$1,110.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.13

IR IVC FILTER

Facility

$7,400.85

Service Code	HCPCS 37619
Hospital Charge Code	5600016
Hospital Revenue Code	361
Min. Negotiated Rate	$1,110.13
Max. Negotiated Rate	$1,110.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.13

IR IVC FILTER

Facility

$7,400.85

Service Code	HCPCS 37619
Hospital Charge Code	7411537
Hospital Revenue Code	361
Min. Negotiated Rate	$178.36
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.26
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.13
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$178.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$196.12

IR IVC FILTER

Facility

$7,400.85

Service Code	HCPCS 37619
Hospital Charge Code	5600016
Hospital Revenue Code	361
Min. Negotiated Rate	$178.36
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.26
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.13
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$178.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$196.12

IR IVC FLTER PLCMNT PERCUTNOUS

Facility

$5,100.00

Hospital Charge Code	2600090
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

IR IVC FLTER PLCMNT PERCUTNOUS

Facility

$5,100.00

Hospital Charge Code	2600090
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

IR IV US EACH ADD VESSEL ADDON

Facility

$1,517.60

Hospital Charge Code	5700193
Hospital Revenue Code	361
Min. Negotiated Rate	$36.57
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$576.69
Rate for Payer: Aetna Medicare Advantage	$455.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$386.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$386.99
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	$386.99
Rate for Payer: Cigna Commercial	$758.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.28
Rate for Payer: Qualcare PPO/HMO/WC	$227.64
Rate for Payer: UnitedHealthcare Community & State	$36.57
Rate for Payer: Wellpoint Medicaid Managed Care	$40.22

IR IV US EACH ADD VESSEL ADDON

Facility

$1,517.60

Hospital Charge Code	5700193
Hospital Revenue Code	361
Min. Negotiated Rate	$227.64
Max. Negotiated Rate	$227.64
Rate for Payer: Qualcare PPO/HMO/WC	$227.64

IR IV US FIRST VESSEL ADD ON

Facility

$1,517.60

Hospital Charge Code	5700192
Hospital Revenue Code	361
Min. Negotiated Rate	$36.57
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$576.69
Rate for Payer: Aetna Medicare Advantage	$455.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$386.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$386.99
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	$386.99
Rate for Payer: Cigna Commercial	$758.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.28
Rate for Payer: Qualcare PPO/HMO/WC	$227.64
Rate for Payer: UnitedHealthcare Community & State	$36.57
Rate for Payer: Wellpoint Medicaid Managed Care	$40.22

IR IV US FIRST VESSEL ADD ON

Facility

$1,517.60

Hospital Charge Code	5700192
Hospital Revenue Code	361
Min. Negotiated Rate	$227.64
Max. Negotiated Rate	$227.64
Rate for Payer: Qualcare PPO/HMO/WC	$227.64

IR-KIDNEY XRAY INJ-BI

Facility

$185.00

Hospital Charge Code	2690645
Hospital Revenue Code	361
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

IR-KIDNEY XRAY INJ-BI

Facility

$185.00

Hospital Charge Code	2690645
Hospital Revenue Code	361
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
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	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

IR-KIDNEY XRAY INJ-LT

Facility

$185.00

Hospital Charge Code	2691620
Hospital Revenue Code	361
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
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	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

IR-KIDNEY XRAY INJ-LT

Facility

$185.00

Hospital Charge Code	2691620
Hospital Revenue Code	361
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

IR-KIDNEY XRAY INJ-RT

Facility

$185.00

Hospital Charge Code	2691625
Hospital Revenue Code	361
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

IR-KIDNEY XRAY INJ-RT

Facility

$185.00

Hospital Charge Code	2691625
Hospital Revenue Code	361
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
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	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

IR KNEE,ARTHROGRAPHY,RADIOL

Facility

$1,667.37

Service Code	HCPCS 73580
Hospital Charge Code	7411669
Hospital Revenue Code	322
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$500.21
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.11
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$40.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,627.00
Rate for Payer: Wellpoint Medicaid Managed Care	$44.19

IR KNEE,ARTHROGRAPHY,RADIOL

Facility

$1,667.37

Service Code	HCPCS 73580
Hospital Charge Code	7411669
Hospital Revenue Code	322
Min. Negotiated Rate	$250.11
Max. Negotiated Rate	$250.11
Rate for Payer: Qualcare PPO/HMO/WC	$250.11

IR KNEE,ARTHROGRAPHY,RADIOL

Facility

$1,667.37

Service Code	HCPCS 73580
Hospital Charge Code	2680290
Hospital Revenue Code	322
Min. Negotiated Rate	$250.11
Max. Negotiated Rate	$250.11
Rate for Payer: Qualcare PPO/HMO/WC	$250.11

IR KNEE,ARTHROGRAPHY,RADIOL

Facility

$1,667.37

Service Code	HCPCS 73580
Hospital Charge Code	2680290
Hospital Revenue Code	322
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$500.21
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.11
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$40.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,627.00
Rate for Payer: Wellpoint Medicaid Managed Care	$44.19

IR LIGATION OF COMMON ILIAC VE

Facility

$30,356.90

Service Code	HCPCS 37660
Hospital Charge Code	7411538
Hospital Revenue Code	361
Min. Negotiated Rate	$731.60
Max. Negotiated Rate	$15,178.45
Rate for Payer: Aetna Commercial	$11,535.62
Rate for Payer: Aetna Medicare Advantage	$9,107.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,741.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,741.01
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	$7,741.01
Rate for Payer: Cigna Commercial	$15,178.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,107.07
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,553.53
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$731.60
Rate for Payer: Wellpoint Medicaid Managed Care	$804.46

IR LIGATION OF COMMON ILIAC VE

Facility

$30,356.90

Service Code	HCPCS 37660
Hospital Charge Code	2680190
Hospital Revenue Code	361
Min. Negotiated Rate	$4,553.53
Max. Negotiated Rate	$4,553.53
Rate for Payer: Qualcare PPO/HMO/WC	$4,553.53

IR LIGATION OF COMMON ILIAC VE

Facility

$30,356.90

Service Code	HCPCS 37660
Hospital Charge Code	7411538
Hospital Revenue Code	361
Min. Negotiated Rate	$4,553.53
Max. Negotiated Rate	$4,553.53
Rate for Payer: Qualcare PPO/HMO/WC	$4,553.53

IR LIGATION OF COMMON ILIAC VE

Facility

$30,356.90

Service Code	HCPCS 37660
Hospital Charge Code	2680190
Hospital Revenue Code	361
Min. Negotiated Rate	$731.60
Max. Negotiated Rate	$15,178.45
Rate for Payer: Aetna Commercial	$11,535.62
Rate for Payer: Aetna Medicare Advantage	$9,107.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,741.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,741.01
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	$7,741.01
Rate for Payer: Cigna Commercial	$15,178.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,107.07
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,553.53
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$731.60
Rate for Payer: Wellpoint Medicaid Managed Care	$804.46

Know your out-of-pocket cost for care.

All Charges