Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR PERQ STENT CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0075T
Hospital Charge Code	36680075T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

IR PERQ STENT CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0075T
Hospital Charge Code	41100075T
Hospital Revenue Code	361
Min. Negotiated Rate	$906.51
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,284.31
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$906.51
Rate for Payer: Wellpoint Medicaid Managed Care	$996.78

IR PERQ STENT CHEST VERT ART

Facility

$37,614.35

Service Code	HCPCS 0075T
Hospital Charge Code	41100075T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

IR PICC TRAY

Facility

$43.00

Hospital Charge Code	7412026
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

IR PICC TRAY

Facility

$43.00

Hospital Charge Code	7412026
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

IR PICC TRAY

Facility

$43.00

Service Code	HCPCS A4310
Hospital Charge Code	2680395
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

IR PICC TRAY

Facility

$43.00

Service Code	HCPCS A4310
Hospital Charge Code	2680395
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

IR-PLACE BRSTCLIP PRCT-BI

Facility

$471.00

Hospital Charge Code	2690315
Hospital Revenue Code	361
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$178.98
Rate for Payer: Aetna Medicare Advantage	$141.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.11
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	$120.11
Rate for Payer: Cigna Commercial	$235.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$70.65
Rate for Payer: UnitedHealthcare Community & State	$11.35
Rate for Payer: Wellpoint Medicaid Managed Care	$12.48

IR-PLACE BRSTCLIP PRCT-BI

Facility

$471.00

Hospital Charge Code	2690315
Hospital Revenue Code	361
Min. Negotiated Rate	$70.65
Max. Negotiated Rate	$70.65
Rate for Payer: Qualcare PPO/HMO/WC	$70.65

IR-PLACE BRSTCLIP PRCT-LT

Facility

$471.00

Hospital Charge Code	2690910
Hospital Revenue Code	361
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$178.98
Rate for Payer: Aetna Medicare Advantage	$141.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.11
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	$120.11
Rate for Payer: Cigna Commercial	$235.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$70.65
Rate for Payer: UnitedHealthcare Community & State	$11.35
Rate for Payer: Wellpoint Medicaid Managed Care	$12.48

IR-PLACE BRSTCLIP PRCT-LT

Facility

$471.00

Hospital Charge Code	2690910
Hospital Revenue Code	361
Min. Negotiated Rate	$70.65
Max. Negotiated Rate	$70.65
Rate for Payer: Qualcare PPO/HMO/WC	$70.65

IR-PLACE BRSTCLIP PRCT-RT

Facility

$471.00

Hospital Charge Code	2690915
Hospital Revenue Code	361
Min. Negotiated Rate	$70.65
Max. Negotiated Rate	$70.65
Rate for Payer: Qualcare PPO/HMO/WC	$70.65

IR-PLACE BRSTCLIP PRCT-RT

Facility

$471.00

Hospital Charge Code	2690915
Hospital Revenue Code	361
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$178.98
Rate for Payer: Aetna Medicare Advantage	$141.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.11
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	$120.11
Rate for Payer: Cigna Commercial	$235.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$70.65
Rate for Payer: UnitedHealthcare Community & State	$11.35
Rate for Payer: Wellpoint Medicaid Managed Care	$12.48

IR PLACE CATH IN VEIN BILATERL

Facility

$2,918.60

Service Code	HCPCS 3601250
Hospital Charge Code	2600142
Hospital Revenue Code	361
Min. Negotiated Rate	$437.79
Max. Negotiated Rate	$437.79
Rate for Payer: Qualcare PPO/HMO/WC	$437.79

IR PLACE CATH IN VEIN BILATERL

Facility

$2,918.60

Service Code	HCPCS 3601250
Hospital Charge Code	2600142
Hospital Revenue Code	361
Min. Negotiated Rate	$70.34
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,109.07
Rate for Payer: Aetna Medicare Advantage	$875.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.24
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	$744.24
Rate for Payer: Cigna Commercial	$1,459.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$875.58
Rate for Payer: Qualcare PPO/HMO/WC	$437.79
Rate for Payer: UnitedHealthcare Community & State	$70.34
Rate for Payer: Wellpoint Medicaid Managed Care	$77.34

IR PLACE CATH IN VEIN BILATRL

Facility

$5,837.20

Service Code	HCPCS 3601250
Hospital Charge Code	7411791
Hospital Revenue Code	361
Min. Negotiated Rate	$140.68
Max. Negotiated Rate	$2,918.60
Rate for Payer: Aetna Commercial	$2,218.14
Rate for Payer: Aetna Medicare Advantage	$1,751.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,488.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,488.49
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	$1,488.49
Rate for Payer: Cigna Commercial	$2,918.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.16
Rate for Payer: Qualcare PPO/HMO/WC	$875.58
Rate for Payer: UnitedHealthcare Community & State	$140.68
Rate for Payer: Wellpoint Medicaid Managed Care	$154.69

IR PLACE CATH IN VEIN BILATRL

Facility

$5,837.20

Service Code	HCPCS 3601250
Hospital Charge Code	7411791
Hospital Revenue Code	361
Min. Negotiated Rate	$875.58
Max. Negotiated Rate	$875.58
Rate for Payer: Qualcare PPO/HMO/WC	$875.58

IR PLACE CATH IN VEIN BILATRL

Facility

$5,837.20

Service Code	HCPCS 3601250
Hospital Charge Code	2004950
Hospital Revenue Code	361
Min. Negotiated Rate	$140.68
Max. Negotiated Rate	$2,918.60
Rate for Payer: Aetna Commercial	$2,218.14
Rate for Payer: Aetna Medicare Advantage	$1,751.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,488.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,488.49
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	$1,488.49
Rate for Payer: Cigna Commercial	$2,918.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.16
Rate for Payer: Qualcare PPO/HMO/WC	$875.58
Rate for Payer: UnitedHealthcare Community & State	$140.68
Rate for Payer: Wellpoint Medicaid Managed Care	$154.69

IR PLACE CATH IN VEIN BILATRL

Facility

$5,837.20

Service Code	HCPCS 3601250
Hospital Charge Code	2004950
Hospital Revenue Code	361
Min. Negotiated Rate	$875.58
Max. Negotiated Rate	$875.58
Rate for Payer: Qualcare PPO/HMO/WC	$875.58

IR PLACE CATH IN VEIN LEFT

Facility

$2,919.00

Service Code	HCPCS 36012LT
Hospital Charge Code	2600143
Hospital Revenue Code	361
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,109.22
Rate for Payer: Aetna Medicare Advantage	$875.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.35
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	$744.35
Rate for Payer: Cigna Commercial	$1,459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$875.70
Rate for Payer: Qualcare PPO/HMO/WC	$437.85
Rate for Payer: UnitedHealthcare Community & State	$70.35
Rate for Payer: Wellpoint Medicaid Managed Care	$77.35

IR PLACE CATH IN VEIN LEFT

Facility

$2,919.00

Service Code	HCPCS 36012LT
Hospital Charge Code	321036012L
Hospital Revenue Code	361
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,109.22
Rate for Payer: Aetna Medicare Advantage	$875.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.35
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	$744.35
Rate for Payer: Cigna Commercial	$1,459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$875.70
Rate for Payer: Qualcare PPO/HMO/WC	$437.85
Rate for Payer: UnitedHealthcare Community & State	$70.35
Rate for Payer: Wellpoint Medicaid Managed Care	$77.35

IR PLACE CATH IN VEIN LEFT

Facility

$2,919.00

Service Code	HCPCS 36012LT
Hospital Charge Code	2600143
Hospital Revenue Code	361
Min. Negotiated Rate	$437.85
Max. Negotiated Rate	$437.85
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

IR PLACE CATH IN VEIN LEFT

Facility

$2,919.00

Service Code	HCPCS 36012LT
Hospital Charge Code	321036012L
Hospital Revenue Code	361
Min. Negotiated Rate	$437.85
Max. Negotiated Rate	$437.85
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

IR PLACE CATH IN VEIN LEFT

Facility

$2,918.60

Service Code	HCPCS 36012LT
Hospital Charge Code	7411899
Hospital Revenue Code	361
Min. Negotiated Rate	$70.34
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,109.07
Rate for Payer: Aetna Medicare Advantage	$875.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.24
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	$744.24
Rate for Payer: Cigna Commercial	$1,459.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$875.58
Rate for Payer: Qualcare PPO/HMO/WC	$437.79
Rate for Payer: UnitedHealthcare Community & State	$70.34
Rate for Payer: Wellpoint Medicaid Managed Care	$77.34

IR PLACE CATH IN VEIN LEFT

Facility

$2,918.60

Service Code	HCPCS 36012LT
Hospital Charge Code	7411899
Hospital Revenue Code	361
Min. Negotiated Rate	$437.79
Max. Negotiated Rate	$437.79
Rate for Payer: Qualcare PPO/HMO/WC	$437.79

Know your out-of-pocket cost for care.

All Charges