Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$343.45
Max. Negotiated Rate	$343.45
Rate for Payer: Qualcare PPO/HMO/WC	$343.45

IR-PREOP PLA NDL-BREST-BI

Facility

$240.00

Hospital Charge Code	2009140
Hospital Revenue Code	761
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

IR-PREOP PLA NDL-BREST-BI

Facility

$240.00

Hospital Charge Code	2009140
Hospital Revenue Code	761
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.00
Rate for Payer: Oxford Commercial	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$48.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

IR-PREOP PLA NDL-BREST-LT

Facility

$240.00

Hospital Charge Code	2009185
Hospital Revenue Code	761
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.00
Rate for Payer: Oxford Commercial	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$48.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

IR-PREOP PLA NDL-BREST-LT

Facility

$240.00

Hospital Charge Code	2009185
Hospital Revenue Code	761
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

IR-PREOP PLA NDL-BREST-RT

Facility

$240.00

Hospital Charge Code	2009190
Hospital Revenue Code	761
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

IR-PREOP PLA NDL-BREST-RT

Facility

$240.00

Hospital Charge Code	2009190
Hospital Revenue Code	761
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.00
Rate for Payer: Oxford Commercial	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$48.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

IR-PRE-OP PLCMNT NDDLE LOC WIR

Facility

$996.00

Hospital Charge Code	2680015
Hospital Revenue Code	361
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$378.48
Rate for Payer: Aetna Medicare Advantage	$298.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.98
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	$253.98
Rate for Payer: Cigna Commercial	$498.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.80
Rate for Payer: Qualcare PPO/HMO/WC	$149.40
Rate for Payer: UnitedHealthcare Community & State	$24.00
Rate for Payer: Wellpoint Medicaid Managed Care	$26.39

IR-PRE-OP PLCMNT NDDLE LOC WIR

Facility

$996.00

Hospital Charge Code	2680015
Hospital Revenue Code	361
Min. Negotiated Rate	$149.40
Max. Negotiated Rate	$149.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.40

IR-PREP BLADDER XRAY INJ

Facility

$634.00

Service Code	HCPCS 51605
Hospital Charge Code	2690185
Hospital Revenue Code	361
Min. Negotiated Rate	$15.28
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$240.92
Rate for Payer: Aetna Medicare Advantage	$190.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.67
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	$161.67
Rate for Payer: Cigna Commercial	$317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$15.28
Rate for Payer: Wellpoint Medicaid Managed Care	$16.80

IR-PREP BLADDER XRAY INJ

Facility

$634.00

Service Code	HCPCS 51605
Hospital Charge Code	2690185
Hospital Revenue Code	361
Min. Negotiated Rate	$95.10
Max. Negotiated Rate	$95.10
Rate for Payer: Qualcare PPO/HMO/WC	$95.10

IR-PREP BLADDER XRAY INJ

Facility

$634.00

Service Code	HCPCS 51605
Hospital Charge Code	7411624
Hospital Revenue Code	361
Min. Negotiated Rate	$95.10
Max. Negotiated Rate	$95.10
Rate for Payer: Qualcare PPO/HMO/WC	$95.10

IR-PREP BLADDER XRAY INJ

Facility

$634.00

Service Code	HCPCS 51605
Hospital Charge Code	7411624
Hospital Revenue Code	361
Min. Negotiated Rate	$15.28
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$240.92
Rate for Payer: Aetna Medicare Advantage	$190.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.67
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	$161.67
Rate for Payer: Cigna Commercial	$317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$15.28
Rate for Payer: Wellpoint Medicaid Managed Care	$16.80

IR PRIMPERC TRAN MEC THROMB AD

Facility

$27,397.00

Service Code	HCPCS 37184
Hospital Charge Code	2001359
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR PRIMPERC TRAN MEC THROMB AD

Facility

$27,397.00

Service Code	HCPCS 37184
Hospital Charge Code	321037184
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR PRIMPERC TRAN MEC THROMB AD

Facility

$27,397.00

Service Code	HCPCS 37184
Hospital Charge Code	2001359
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$78,613.74
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,613.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$78,613.74
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR PRIMPERC TRAN MEC THROMB AD

Facility

$27,397.00

Service Code	HCPCS 37184
Hospital Charge Code	321037184
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR PRIMPERC TRAN MEC THROMB SG

Facility

$12,129.00

Service Code	HCPCS 37185
Hospital Charge Code	321037185
Hospital Revenue Code	361
Min. Negotiated Rate	$1,819.35
Max. Negotiated Rate	$1,819.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35

IR PRIMPERC TRAN MEC THROMB SG

Facility

$12,129.00

Service Code	HCPCS 37185
Hospital Charge Code	2001358
Hospital Revenue Code	361
Min. Negotiated Rate	$1,819.35
Max. Negotiated Rate	$1,819.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35

IR PRIMPERC TRAN MEC THROMB SG

Facility

$12,129.00

Service Code	HCPCS 37185
Hospital Charge Code	321037185
Hospital Revenue Code	361
Min. Negotiated Rate	$292.31
Max. Negotiated Rate	$6,064.50
Rate for Payer: Aetna Commercial	$4,609.02
Rate for Payer: Aetna Medicare Advantage	$3,638.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,092.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,092.89
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	$3,092.89
Rate for Payer: Cigna Commercial	$6,064.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,638.70
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$292.31
Rate for Payer: Wellpoint Medicaid Managed Care	$321.42

IR PRIMPERC TRAN MEC THROMB SG

Facility

$12,129.00

Service Code	HCPCS 37185
Hospital Charge Code	2001358
Hospital Revenue Code	361
Min. Negotiated Rate	$292.31
Max. Negotiated Rate	$6,064.50
Rate for Payer: Aetna Commercial	$4,609.02
Rate for Payer: Aetna Medicare Advantage	$3,638.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,092.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,092.89
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	$3,092.89
Rate for Payer: Cigna Commercial	$6,064.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,638.70
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$292.31
Rate for Payer: Wellpoint Medicaid Managed Care	$321.42

IR PSA - PSEUDOANEURYSM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	7411412
Hospital Revenue Code	361
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$3,593.00
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	$1,626.00
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	$745.25
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	$315.90
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.95
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$25.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$27.90

IR PSA - PSEUDOANEURYSM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	5600117
Hospital Revenue Code	361
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$3,593.00
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	$1,626.00
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	$745.25
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	$315.90
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.95
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$25.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$27.90

IR PSA - PSEUDOANEURYSM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	5600117
Hospital Revenue Code	361
Min. Negotiated Rate	$157.95
Max. Negotiated Rate	$157.95
Rate for Payer: Qualcare PPO/HMO/WC	$157.95

IR PSA - PSEUDOANEURYSM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	7411412
Hospital Revenue Code	361
Min. Negotiated Rate	$157.95
Max. Negotiated Rate	$157.95
Rate for Payer: Qualcare PPO/HMO/WC	$157.95

Know your out-of-pocket cost for care.

All Charges