Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR LYMPHANGIOGRM LWR XTMY LEFT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600096
Hospital Revenue Code	320
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$2,690.13
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$521.67
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.43
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

IR LYMPHANGIOGRM LWR XTMY RGHT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600097
Hospital Revenue Code	320
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$2,690.13
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$521.67
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.43
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

IR LYMPHANGIOGRM LWR XTMY RGHT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600097
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRM UPR XTMY BLTL

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600101
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRM UPR XTMY BLTL

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600101
Hospital Revenue Code	320
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.43
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

IR LYMPHANGIOGRM UPR XTMY LEFT

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600102
Hospital Revenue Code	320
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.43
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

IR LYMPHANGIOGRM UPR XTMY LEFT

Facility

$1,224.75

Service Code	HCPCS 75803
Hospital Charge Code	2600102
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR LYMPHANGIOGRM UPR XTMY RGHT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600103
Hospital Revenue Code	320
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$2,690.13
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$521.67
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.43
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

IR LYMPHANGIOGRM UPR XTMY RGHT

Facility

$1,224.75

Service Code	HCPCS 75801
Hospital Charge Code	2600103
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

IR-LYMPHANGIO INJ-BI

Facility

$697.00

Service Code	HCPCS 3879050
Hospital Charge Code	2690575
Hospital Revenue Code	761
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.10
Rate for Payer: Oxford Commercial	$139.40
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$139.40
Rate for Payer: UnitedHealthcare Community & State	$16.80
Rate for Payer: Wellpoint Medicaid Managed Care	$18.47

IR-LYMPHANGIO INJ-BI

Facility

$697.00

Service Code	HCPCS 3879050
Hospital Charge Code	7411813
Hospital Revenue Code	761
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.10
Rate for Payer: Oxford Commercial	$139.40
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$139.40
Rate for Payer: UnitedHealthcare Community & State	$16.80
Rate for Payer: Wellpoint Medicaid Managed Care	$18.47

IR-LYMPHANGIO INJ-BI

Facility

$697.00

Service Code	HCPCS 3879050
Hospital Charge Code	7411813
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-BI

Facility

$697.00

Service Code	HCPCS 3879050
Hospital Charge Code	2690575
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-LT

Facility

$697.00

Service Code	HCPCS 38790LT
Hospital Charge Code	2691480
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-LT

Facility

$697.00

Service Code	HCPCS 38790LT
Hospital Charge Code	2691480
Hospital Revenue Code	761
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.10
Rate for Payer: Oxford Commercial	$139.40
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$139.40
Rate for Payer: UnitedHealthcare Community & State	$16.80
Rate for Payer: Wellpoint Medicaid Managed Care	$18.47

IR-LYMPHANGIO INJ-LT

Facility

$697.00

Service Code	HCPCS 38790LT
Hospital Charge Code	7411946
Hospital Revenue Code	761
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.10
Rate for Payer: Oxford Commercial	$139.40
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$139.40
Rate for Payer: UnitedHealthcare Community & State	$16.80
Rate for Payer: Wellpoint Medicaid Managed Care	$18.47

IR-LYMPHANGIO INJ-LT

Facility

$697.00

Service Code	HCPCS 38790LT
Hospital Charge Code	7411946
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-RT

Facility

$697.00

Service Code	HCPCS 38790RT
Hospital Charge Code	2691485
Hospital Revenue Code	761
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.10
Rate for Payer: Oxford Commercial	$139.40
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$139.40
Rate for Payer: UnitedHealthcare Community & State	$16.80
Rate for Payer: Wellpoint Medicaid Managed Care	$18.47

IR-LYMPHANGIO INJ-RT

Facility

$697.00

Service Code	HCPCS 38790RT
Hospital Charge Code	2691485
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-RT

Facility

$697.00

Service Code	HCPCS 38790RT
Hospital Charge Code	7411947
Hospital Revenue Code	761
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

IR-LYMPHANGIO INJ-RT

Facility

$697.00

Service Code	HCPCS 38790RT
Hospital Charge Code	7411947
Hospital Revenue Code	761
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$348.50
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.10
Rate for Payer: Oxford Commercial	$139.40
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$139.40
Rate for Payer: UnitedHealthcare Community & State	$16.80
Rate for Payer: Wellpoint Medicaid Managed Care	$18.47

IR-LYMPH NODE-SUPER-BI

Facility

$9,303.00

Service Code	HCPCS 3850550
Hospital Charge Code	2009145
Hospital Revenue Code	361
Min. Negotiated Rate	$1,395.45
Max. Negotiated Rate	$1,395.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45

IR-LYMPH NODE-SUPER-BI

Facility

$9,303.00

Service Code	HCPCS 3850550
Hospital Charge Code	2009145
Hospital Revenue Code	361
Min. Negotiated Rate	$224.20
Max. Negotiated Rate	$4,651.50
Rate for Payer: Aetna Commercial	$3,535.14
Rate for Payer: Aetna Medicare Advantage	$2,790.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,372.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,372.26
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	$2,372.26
Rate for Payer: Cigna Commercial	$4,651.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,790.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45
Rate for Payer: UnitedHealthcare Community & State	$224.20
Rate for Payer: Wellpoint Medicaid Managed Care	$246.53

IR-LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2009200
Hospital Revenue Code	361
Min. Negotiated Rate	$149.47
Max. Negotiated Rate	$3,101.00
Rate for Payer: Aetna Commercial	$2,356.76
Rate for Payer: Aetna Medicare Advantage	$1,860.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.51
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	$1,581.51
Rate for Payer: Cigna Commercial	$3,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,860.60
Rate for Payer: Qualcare PPO/HMO/WC	$930.30
Rate for Payer: UnitedHealthcare Community & State	$149.47
Rate for Payer: Wellpoint Medicaid Managed Care	$164.35

IR-LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2009200
Hospital Revenue Code	361
Min. Negotiated Rate	$930.30
Max. Negotiated Rate	$930.30
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

Know your out-of-pocket cost for care.

All Charges