Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-PL CATH ART AD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	411036218
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART AD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	411036218
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART AD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	2690470
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART AD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621850
Hospital Charge Code	2690470
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART AD T/B-LT

Facility

$486.00

Service Code	HCPCS 36218LT
Hospital Charge Code	2691250
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART AD T/B-LT

Facility

$486.00

Service Code	HCPCS 36218LT
Hospital Charge Code	2691250
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART AD T/B-LT

Facility

$486.00

Service Code	HCPCS 36218LT
Hospital Charge Code	7411908
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART AD T/B-LT

Facility

$486.00

Service Code	HCPCS 36218LT
Hospital Charge Code	7411908
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART AD T/B-RT

Facility

$486.00

Service Code	HCPCS 36218RT
Hospital Charge Code	7411909
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART AD T/B-RT

Facility

$486.00

Service Code	HCPCS 36218RT
Hospital Charge Code	7411909
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR-PL CATH ART AD T/B-RT

Facility

$486.00

Service Code	HCPCS 36218RT
Hospital Charge Code	2691255
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IR-PL CATH ART AD T/B-RT

Facility

$486.00

Service Code	HCPCS 36218RT
Hospital Charge Code	2691255
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

IR PLCMT ENTEROCLYSIS TUBE S&I

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	2101176
Hospital Revenue Code	320
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$94.12
Rate for Payer: Qualcare PPO/HMO/WC	$94.12

IR PLCMT ENTEROCLYSIS TUBE S&I

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	7411674
Hospital Revenue Code	320
Min. Negotiated Rate	$94.12
Max. Negotiated Rate	$94.12
Rate for Payer: Qualcare PPO/HMO/WC	$94.12

IR PLCMT ENTEROCLYSIS TUBE S&I

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	7411674
Hospital Revenue Code	320
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$238.45
Rate for Payer: Aetna Medicare Advantage	$188.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.01
Rate for Payer: Cigna Commercial	$313.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.12
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$15.12
Rate for Payer: Wellpoint Medicaid Managed Care	$16.63

IR PLCMT ENTEROCLYSIS TUBE S&I

Facility

$627.50

Service Code	HCPCS 74355
Hospital Charge Code	2101176
Hospital Revenue Code	320
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$238.45
Rate for Payer: Aetna Medicare Advantage	$188.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.01
Rate for Payer: Cigna Commercial	$313.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.12
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$15.12
Rate for Payer: Wellpoint Medicaid Managed Care	$16.63

IR PLCMT URETERAL STENT NEW

Facility

$20,157.00

Service Code	HCPCS 50694
Hospital Charge Code	5701113
Hospital Revenue Code	361
Min. Negotiated Rate	$3,023.55
Max. Negotiated Rate	$3,023.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,023.55

IR PLCMT URETERAL STENT NEW

Facility

$20,157.00

Service Code	HCPCS 50694
Hospital Charge Code	5701113
Hospital Revenue Code	361
Min. Negotiated Rate	$485.78
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,047.10
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,023.55
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$485.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$534.16

IR-PLEURA BIOPSY NEEDLE

Facility

$4,021.35

Service Code	HCPCS 32400
Hospital Charge Code	2680120
Hospital Revenue Code	361
Min. Negotiated Rate	$603.20
Max. Negotiated Rate	$603.20
Rate for Payer: Qualcare PPO/HMO/WC	$603.20

IR-PLEURA BIOPSY NEEDLE

Facility

$4,021.35

Service Code	HCPCS 32400
Hospital Charge Code	7411376
Hospital Revenue Code	361
Min. Negotiated Rate	$96.91
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$603.20
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$96.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$106.57

IR-PLEURA BIOPSY NEEDLE

Facility

$4,021.35

Service Code	HCPCS 32400
Hospital Charge Code	2680120
Hospital Revenue Code	361
Min. Negotiated Rate	$96.91
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$603.20
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$96.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$106.57

IR-PLEURA BIOPSY NEEDLE

Facility

$4,021.35

Service Code	HCPCS 32400
Hospital Charge Code	7411376
Hospital Revenue Code	361
Min. Negotiated Rate	$603.20
Max. Negotiated Rate	$603.20
Rate for Payer: Qualcare PPO/HMO/WC	$603.20

IR PNEUMONOSTOMY;W/P/C DRAINAG

Facility

$2,289.68

Service Code	HCPCS 49405
Hospital Charge Code	7411582
Hospital Revenue Code	361
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$686.90
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$343.45
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$55.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$60.68

IR PNEUMONOSTOMY;W/P/C DRAINAG

Facility

$2,289.68

Service Code	HCPCS 49405
Hospital Charge Code	2680115
Hospital Revenue Code	361
Min. Negotiated Rate	$343.45
Max. Negotiated Rate	$343.45
Rate for Payer: Qualcare PPO/HMO/WC	$343.45

IR PNEUMONOSTOMY;W/P/C DRAINAG

Facility

$2,289.68

Service Code	HCPCS 49405
Hospital Charge Code	2680115
Hospital Revenue Code	361
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$686.90
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$343.45
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$55.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$60.68

Know your out-of-pocket cost for care.

All Charges