Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-THORACOST(ABCE,HTX)-BI

Facility

$1,650.00

Service Code	HCPCS 3255150
Hospital Charge Code	2690395
Hospital Revenue Code	361
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
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	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

IR-THORACOST(ABCE,HTX)-BI

Facility

$1,650.00

Service Code	HCPCS 3255150
Hospital Charge Code	2690395
Hospital Revenue Code	361
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

IR-THORACOST(ABCE,HTX)-LT

Facility

$1,650.00

Hospital Charge Code	2009195
Hospital Revenue Code	361
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
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	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

IR-THORACOST(ABCE,HTX)-LT

Facility

$1,650.00

Hospital Charge Code	2009195
Hospital Revenue Code	361
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

IR-THORACOST(ABCE,HTX)-RT

Facility

$789.00

Service Code	HCPCS 32551RT
Hospital Charge Code	2691080
Hospital Revenue Code	361
Min. Negotiated Rate	$19.01
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$299.82
Rate for Payer: Aetna Medicare Advantage	$236.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.19
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	$201.19
Rate for Payer: Cigna Commercial	$394.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.70
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Community & State	$19.01
Rate for Payer: Wellpoint Medicaid Managed Care	$20.91

IR-THORACOST(ABCE,HTX)-RT

Facility

$789.00

Service Code	HCPCS 32551RT
Hospital Charge Code	7411887
Hospital Revenue Code	361
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

IR-THORACOST(ABCE,HTX)-RT

Facility

$789.00

Service Code	HCPCS 32551RT
Hospital Charge Code	2691080
Hospital Revenue Code	361
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$118.35
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

IR-THORACOST(ABCE,HTX)-RT

Facility

$789.00

Service Code	HCPCS 32551RT
Hospital Charge Code	7411887
Hospital Revenue Code	361
Min. Negotiated Rate	$19.01
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$299.82
Rate for Payer: Aetna Medicare Advantage	$236.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.19
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	$201.19
Rate for Payer: Cigna Commercial	$394.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.70
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Community & State	$19.01
Rate for Payer: Wellpoint Medicaid Managed Care	$20.91

IR THROMBO DECLOT VASC ACCESS

Facility

$8,322.45

Service Code	HCPCS 36870
Hospital Charge Code	7411490
Hospital Revenue Code	361
Min. Negotiated Rate	$1,248.37
Max. Negotiated Rate	$1,248.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,248.37

IR THROMBO DECLOT VASC ACCESS

Facility

$8,322.45

Service Code	HCPCS 36870
Hospital Charge Code	7411490
Hospital Revenue Code	361
Min. Negotiated Rate	$200.57
Max. Negotiated Rate	$4,161.23
Rate for Payer: Aetna Commercial	$3,162.53
Rate for Payer: Aetna Medicare Advantage	$2,496.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,122.22
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	$2,122.22
Rate for Payer: Cigna Commercial	$4,161.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,496.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,248.37
Rate for Payer: UnitedHealthcare Community & State	$200.57
Rate for Payer: Wellpoint Medicaid Managed Care	$220.54

IR THROMBO DECLOT VASC ACCESS

Facility

$8,322.45

Service Code	HCPCS 36870
Hospital Charge Code	2011171
Hospital Revenue Code	361
Min. Negotiated Rate	$200.57
Max. Negotiated Rate	$4,161.23
Rate for Payer: Aetna Commercial	$3,162.53
Rate for Payer: Aetna Medicare Advantage	$2,496.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,122.22
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	$2,122.22
Rate for Payer: Cigna Commercial	$4,161.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,496.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,248.37
Rate for Payer: UnitedHealthcare Community & State	$200.57
Rate for Payer: Wellpoint Medicaid Managed Care	$220.54

IR THROMBO DECLOT VASC ACCESS

Facility

$8,322.45

Service Code	HCPCS 36870
Hospital Charge Code	2011171
Hospital Revenue Code	361
Min. Negotiated Rate	$1,248.37
Max. Negotiated Rate	$1,248.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,248.37

IR THROMBOLYTIC VENOUS TX

Facility

$7,142.25

Service Code	HCPCS 37212
Hospital Charge Code	7411503
Hospital Revenue Code	361
Min. Negotiated Rate	$1,071.34
Max. Negotiated Rate	$1,071.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.34

IR THROMBOLYTIC VENOUS TX

Facility

$15,468.50

Service Code	HCPCS 37212
Hospital Charge Code	321037212
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

IR THROMBOLYTIC VENOUS TX

Facility

$7,142.25

Service Code	HCPCS 37212
Hospital Charge Code	7411503
Hospital Revenue Code	361
Min. Negotiated Rate	$172.13
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,142.68
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.34
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$172.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$189.27

IR THROMBOLYTIC VENOUS TX

Facility

$15,468.50

Service Code	HCPCS 37212
Hospital Charge Code	321037212
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR THROMBOLYTIC VENOUS TX

Facility

$15,468.50

Service Code	HCPCS 37212
Hospital Charge Code	2011166
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

IR THROMBOLYTIC VENOUS TX

Facility

$15,468.50

Service Code	HCPCS 37212
Hospital Charge Code	2011166
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

IR TIB/PER REVASC ADD-ON

Facility

$47,642.70

Service Code	HCPCS 37232
Hospital Charge Code	5600213
Hospital Revenue Code	361
Min. Negotiated Rate	$1,148.19
Max. Negotiated Rate	$23,821.35
Rate for Payer: Aetna Commercial	$18,104.23
Rate for Payer: Aetna Medicare Advantage	$14,292.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,148.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,148.89
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	$12,148.89
Rate for Payer: Cigna Commercial	$23,821.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,292.81
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,146.40
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,148.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1,262.53

IR TIB/PER REVASC ADD-ON

Facility

$15,877.00

Service Code	HCPCS 37232
Hospital Charge Code	366837232
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

IR TIB/PER REVASC ADD-ON

Facility

$47,642.70

Service Code	HCPCS 37232
Hospital Charge Code	5600213
Hospital Revenue Code	361
Min. Negotiated Rate	$7,146.40
Max. Negotiated Rate	$7,146.40
Rate for Payer: Qualcare PPO/HMO/WC	$7,146.40

IR TIB/PER REVASC ADD-ON

Facility

$47,642.70

Service Code	HCPCS 37232
Hospital Charge Code	321037232
Hospital Revenue Code	361
Min. Negotiated Rate	$1,148.19
Max. Negotiated Rate	$23,821.35
Rate for Payer: Aetna Commercial	$18,104.23
Rate for Payer: Aetna Medicare Advantage	$14,292.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,148.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,148.89
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	$12,148.89
Rate for Payer: Cigna Commercial	$23,821.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,292.81
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,146.40
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,148.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1,262.53

IR TIB/PER REVASC ADD-ON

Facility

$47,642.70

Service Code	HCPCS 37232
Hospital Charge Code	321037232
Hospital Revenue Code	361
Min. Negotiated Rate	$7,146.40
Max. Negotiated Rate	$7,146.40
Rate for Payer: Qualcare PPO/HMO/WC	$7,146.40

IR TIB/PER REVASC ADD-ON

Facility

$47,642.70

Service Code	HCPCS 37232
Hospital Charge Code	7411522
Hospital Revenue Code	361
Min. Negotiated Rate	$1,148.19
Max. Negotiated Rate	$23,821.35
Rate for Payer: Aetna Commercial	$18,104.23
Rate for Payer: Aetna Medicare Advantage	$14,292.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,148.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,148.89
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	$12,148.89
Rate for Payer: Cigna Commercial	$23,821.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,292.81
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,146.40
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,148.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1,262.53

IR TIB/PER REVASC ADD-ON

Facility

$15,877.00

Service Code	HCPCS 37232
Hospital Charge Code	366837232
Hospital Revenue Code	361
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,763.10
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$382.64
Rate for Payer: Wellpoint Medicaid Managed Care	$420.74

Know your out-of-pocket cost for care.

All Charges