Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR REPAIR ARTERY BLOCKAGE, EA

Facility

$1,547.25

Service Code	HCPCS 75964
Hospital Charge Code	2011280
Hospital Revenue Code	320
Min. Negotiated Rate	$232.09
Max. Negotiated Rate	$232.09
Rate for Payer: Qualcare PPO/HMO/WC	$232.09

IR REPAIR ARTERY BLOCKAGE, EA

Facility

$1,547.25

Service Code	HCPCS 75964
Hospital Charge Code	7411737
Hospital Revenue Code	320
Min. Negotiated Rate	$37.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$587.96
Rate for Payer: Aetna Medicare Advantage	$464.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.55
Rate for Payer: Cigna Commercial	$773.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$464.18
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.09
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$37.29
Rate for Payer: Wellpoint Medicaid Managed Care	$41.00

IR REPAIR ARTERY BLOCKAGE, EA

Facility

$1,547.25

Service Code	HCPCS 75964
Hospital Charge Code	7411737
Hospital Revenue Code	320
Min. Negotiated Rate	$232.09
Max. Negotiated Rate	$232.09
Rate for Payer: Qualcare PPO/HMO/WC	$232.09

IR REPAIR OF INFRARENAL AAA

Facility

$37,500.00

Service Code	HCPCS 34805
Hospital Charge Code	5700210
Hospital Revenue Code	361
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$5,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

IR REPAIR OF INFRARENAL AAA

Facility

$37,500.00

Service Code	HCPCS 34805
Hospital Charge Code	7411396
Hospital Revenue Code	361
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
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	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

IR REPAIR OF INFRARENAL AAA

Facility

$37,500.00

Service Code	HCPCS 34805
Hospital Charge Code	5700210
Hospital Revenue Code	361
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
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	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

IR REPAIR OF INFRARENAL AAA

Facility

$37,500.00

Service Code	HCPCS 34805
Hospital Charge Code	7411396
Hospital Revenue Code	361
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$5,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

IR REPAIR TUNNELED CV CATH

Facility

$4,914.50

Service Code	HCPCS 36576
Hospital Charge Code	366836576
Hospital Revenue Code	361
Min. Negotiated Rate	$737.17
Max. Negotiated Rate	$737.17
Rate for Payer: Qualcare PPO/HMO/WC	$737.17

IR REPAIR TUNNELED CV CATH

Facility

$6,404.20

Service Code	HCPCS 36576
Hospital Charge Code	321036576
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

IR REPAIR TUNNELED CV CATH

Facility

$4,914.50

Service Code	HCPCS 36576
Hospital Charge Code	366836576
Hospital Revenue Code	361
Min. Negotiated Rate	$118.44
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	$1,016.00
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	$1,870.14
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	$1,474.35
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$737.17
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$118.44
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	$130.23

IR REPAIR TUNNELED CV CATH

Facility

$6,404.20

Service Code	HCPCS 36576
Hospital Charge Code	321036576
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
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	$1,016.00
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	$1,870.14
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	$1,921.26
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
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	$169.71

IR REPAIR TUNNELED CV CATH

Facility

$4,914.50

Service Code	HCPCS 36576
Hospital Charge Code	411036576
Hospital Revenue Code	361
Min. Negotiated Rate	$737.17
Max. Negotiated Rate	$737.17
Rate for Payer: Qualcare PPO/HMO/WC	$737.17

IR REPAIR TUNNELED CV CATH

Facility

$6,404.20

Service Code	HCPCS 36576
Hospital Charge Code	2011277
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

IR REPAIR TUNNELED CV CATH

Facility

$2,024.90

Service Code	HCPCS 36576
Hospital Charge Code	7411463
Hospital Revenue Code	361
Min. Negotiated Rate	$303.74
Max. Negotiated Rate	$303.74
Rate for Payer: Qualcare PPO/HMO/WC	$303.74

IR REPAIR TUNNELED CV CATH

Facility

$4,914.50

Service Code	HCPCS 36576
Hospital Charge Code	411036576
Hospital Revenue Code	361
Min. Negotiated Rate	$118.44
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	$1,016.00
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	$1,870.14
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	$1,474.35
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$737.17
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$118.44
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	$130.23

IR REPAIR TUNNELED CV CATH

Facility

$2,024.90

Service Code	HCPCS 36576
Hospital Charge Code	7411463
Hospital Revenue Code	361
Min. Negotiated Rate	$48.80
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	$1,016.00
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	$1,870.14
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	$607.47
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$303.74
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$48.80
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	$53.66

IR REPAIR TUNNELED CV CATH

Facility

$6,404.20

Service Code	HCPCS 36576
Hospital Charge Code	2011277
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
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	$1,016.00
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	$1,870.14
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	$1,921.26
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
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	$169.71

IR REP INFRARENAL AAA BIFURCAT

Facility

$10,452.70

Service Code	HCPCS 34804
Hospital Charge Code	7411395
Hospital Revenue Code	361
Min. Negotiated Rate	$251.91
Max. Negotiated Rate	$5,226.35
Rate for Payer: Aetna Commercial	$3,972.03
Rate for Payer: Aetna Medicare Advantage	$3,135.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,665.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,665.44
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	$2,665.44
Rate for Payer: Cigna Commercial	$5,226.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,135.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,567.90
Rate for Payer: UnitedHealthcare Community & State	$251.91
Rate for Payer: Wellpoint Medicaid Managed Care	$277.00

IR REP INFRARENAL AAA BIFURCAT

Facility

$10,452.70

Service Code	HCPCS 34804
Hospital Charge Code	7411395
Hospital Revenue Code	361
Min. Negotiated Rate	$1,567.90
Max. Negotiated Rate	$1,567.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,567.90

IR REP INFRARENAL AAA BIFURCAT

Facility

$10,952.70

Service Code	HCPCS 34804
Hospital Charge Code	5700205
Hospital Revenue Code	361
Min. Negotiated Rate	$1,642.90
Max. Negotiated Rate	$1,642.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,642.90

IR REP INFRARENAL AAA BIFURCAT

Facility

$10,952.70

Service Code	HCPCS 34804
Hospital Charge Code	5700205
Hospital Revenue Code	361
Min. Negotiated Rate	$263.96
Max. Negotiated Rate	$5,476.35
Rate for Payer: Aetna Commercial	$4,162.03
Rate for Payer: Aetna Medicare Advantage	$3,285.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,792.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,792.94
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	$2,792.94
Rate for Payer: Cigna Commercial	$5,476.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,642.90
Rate for Payer: UnitedHealthcare Community & State	$263.96
Rate for Payer: Wellpoint Medicaid Managed Care	$290.25

IR REPLACE PICC CATH

Facility

$6,404.20

Service Code	HCPCS 36584
Hospital Charge Code	321036584
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

IR REPLACE PICC CATH

Facility

$6,404.20

Service Code	HCPCS 36584
Hospital Charge Code	2011284
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
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	$862.00
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	$1,870.14
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	$1,921.26
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
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	$169.71

IR REPLACE PICC CATH

Facility

$4,914.50

Service Code	HCPCS 36584
Hospital Charge Code	411036584
Hospital Revenue Code	361
Min. Negotiated Rate	$118.44
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	$862.00
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	$1,870.14
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	$1,474.35
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$737.17
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$118.44
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	$130.23

IR REPLACE PICC CATH

Facility

$4,914.50

Service Code	HCPCS 36584
Hospital Charge Code	411036584
Hospital Revenue Code	361
Min. Negotiated Rate	$737.17
Max. Negotiated Rate	$737.17
Rate for Payer: Qualcare PPO/HMO/WC	$737.17

Know your out-of-pocket cost for care.

All Charges