Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-PSEUDOAN INJ-BI

Facility

$610.00

Service Code	HCPCS 3600250
Hospital Charge Code	2690420
Hospital Revenue Code	361
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

IR-PSEUDOAN INJ-BI

Facility

$610.00

Service Code	HCPCS 3600250
Hospital Charge Code	7411788
Hospital Revenue Code	361
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
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	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

IR-PSEUDOAN INJ-BI

Facility

$610.00

Service Code	HCPCS 3600250
Hospital Charge Code	7411788
Hospital Revenue Code	361
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

IR-PSEUDOAN INJ-BI

Facility

$610.00

Service Code	HCPCS 3600250
Hospital Charge Code	2690420
Hospital Revenue Code	361
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
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	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

IR-PSEUDOAN INJ-LT

Facility

$610.00

Service Code	HCPCS 36002LT
Hospital Charge Code	2691135
Hospital Revenue Code	761
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Oxford Commercial	$122.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$122.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

IR-PSEUDOAN INJ-LT

Facility

$610.00

Service Code	HCPCS 36002LT
Hospital Charge Code	7411893
Hospital Revenue Code	761
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

IR-PSEUDOAN INJ-LT

Facility

$610.00

Service Code	HCPCS 36002LT
Hospital Charge Code	2691135
Hospital Revenue Code	761
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

IR-PSEUDOAN INJ-LT

Facility

$610.00

Service Code	HCPCS 36002LT
Hospital Charge Code	7411893
Hospital Revenue Code	761
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Oxford Commercial	$122.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$122.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

IR-PSEUDOAN INJ-RT

Facility

$3,630.70

Service Code	HCPCS 36002RT
Hospital Charge Code	321036002R
Hospital Revenue Code	361
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$544.61
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

IR-PSEUDOAN INJ-RT

Facility

$3,630.70

Service Code	HCPCS 36002RT
Hospital Charge Code	2691140
Hospital Revenue Code	361
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$544.61
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

IR-PSEUDOAN INJ-RT

Facility

$3,630.70

Service Code	HCPCS 36002RT
Hospital Charge Code	321036002R
Hospital Revenue Code	361
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$1,815.35
Rate for Payer: Aetna Commercial	$1,379.67
Rate for Payer: Aetna Medicare Advantage	$1,089.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.83
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	$925.83
Rate for Payer: Cigna Commercial	$1,815.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.21
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: UnitedHealthcare Community & State	$87.50
Rate for Payer: Wellpoint Medicaid Managed Care	$96.21

IR-PSEUDOAN INJ-RT

Facility

$3,630.70

Service Code	HCPCS 36002RT
Hospital Charge Code	2691140
Hospital Revenue Code	361
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$1,815.35
Rate for Payer: Aetna Commercial	$1,379.67
Rate for Payer: Aetna Medicare Advantage	$1,089.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.83
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	$925.83
Rate for Payer: Cigna Commercial	$1,815.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.21
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: UnitedHealthcare Community & State	$87.50
Rate for Payer: Wellpoint Medicaid Managed Care	$96.21

IR-PSEUDOAN INJ-RT

Facility

$610.00

Service Code	HCPCS 36002RT
Hospital Charge Code	7411894
Hospital Revenue Code	761
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

IR-PSEUDOAN INJ-RT

Facility

$610.00

Service Code	HCPCS 36002RT
Hospital Charge Code	7411894
Hospital Revenue Code	761
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Oxford Commercial	$122.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$122.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

IR PTA BALLOON AORTIC

Facility

$7,074.45

Service Code	HCPCS 35472
Hospital Charge Code	2000844
Hospital Revenue Code	361
Min. Negotiated Rate	$170.49
Max. Negotiated Rate	$3,537.22
Rate for Payer: Aetna Commercial	$2,688.29
Rate for Payer: Aetna Medicare Advantage	$2,122.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,803.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,803.98
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	$1,803.98
Rate for Payer: Cigna Commercial	$3,537.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,122.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,061.17
Rate for Payer: UnitedHealthcare Community & State	$170.49
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

IR PTA BALLOON AORTIC

Facility

$7,074.45

Service Code	HCPCS 35472
Hospital Charge Code	2000844
Hospital Revenue Code	361
Min. Negotiated Rate	$1,061.17
Max. Negotiated Rate	$1,061.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,061.17

IR PTA BALLOON BRACH TRUNK

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	2000846
Hospital Revenue Code	361
Min. Negotiated Rate	$3,313.09
Max. Negotiated Rate	$3,313.09
Rate for Payer: Qualcare PPO/HMO/WC	$3,313.09

IR PTA BALLOON BRACH TRUNK

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	2000846
Hospital Revenue Code	361
Min. Negotiated Rate	$532.30
Max. Negotiated Rate	$11,043.65
Rate for Payer: Aetna Commercial	$8,393.17
Rate for Payer: Aetna Medicare Advantage	$6,626.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,632.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,632.26
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	$5,632.26
Rate for Payer: Cigna Commercial	$11,043.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,626.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,313.09
Rate for Payer: UnitedHealthcare Community & State	$532.30
Rate for Payer: Wellpoint Medicaid Managed Care	$585.31

IR PTA BALLOON BRACH TRUNK

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	7411408
Hospital Revenue Code	361
Min. Negotiated Rate	$3,313.09
Max. Negotiated Rate	$3,313.09
Rate for Payer: Qualcare PPO/HMO/WC	$3,313.09

IR PTA BALLOON BRACH TRUNK

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	7411408
Hospital Revenue Code	361
Min. Negotiated Rate	$532.30
Max. Negotiated Rate	$11,043.65
Rate for Payer: Aetna Commercial	$8,393.17
Rate for Payer: Aetna Medicare Advantage	$6,626.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,632.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,632.26
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	$5,632.26
Rate for Payer: Cigna Commercial	$11,043.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,626.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,313.09
Rate for Payer: UnitedHealthcare Community & State	$532.30
Rate for Payer: Wellpoint Medicaid Managed Care	$585.31

IR PTA BALLOON ILIAC BILAT

Facility

$21,962.30

Hospital Charge Code	2011175A
Hospital Revenue Code	360
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR PTA BALLOON ILIAC BILAT

Facility

$21,962.30

Hospital Charge Code	2011175
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON ILIAC BILAT

Facility

$21,962.30

Hospital Charge Code	2011175
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

IR PTA BALLOON ILIAC BILAT

Facility

$21,962.30

Hospital Charge Code	2011175A
Hospital Revenue Code	360
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

IR PTA BALLOON ILIAC UNILAT

Facility

$21,962.30

Hospital Charge Code	2011170
Hospital Revenue Code	480
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

Know your out-of-pocket cost for care.

All Charges