Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THROMBO W/RFLX

Facility

$105.00

Hospital Charge Code	3035086C
Hospital Revenue Code	301
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

THROMBO W/RFLX

Facility

$105.00

Hospital Charge Code	3035086C
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

THROMBO W/RFLX

Facility

$111.00

Hospital Charge Code	3035086A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

THROMBO W/RFLX

Facility

$635.25

Hospital Charge Code	3035086
Hospital Revenue Code	301
Min. Negotiated Rate	$95.29
Max. Negotiated Rate	$95.29
Rate for Payer: Qualcare PPO/HMO/WC	$95.29

THROMBO W/RFLX

Facility

$105.00

Hospital Charge Code	3035086E
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

THROMBO W/RFLX

Facility

$105.00

Hospital Charge Code	3035086E
Hospital Revenue Code	301
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

THROMBO W/RFLX

Facility

$105.00

Hospital Charge Code	3035086D
Hospital Revenue Code	301
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

THROMBO W/RFLX

Facility

$111.00

Hospital Charge Code	3035086A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

THROMBO W/RFLX

Facility

$128.00

Hospital Charge Code	3035086F
Hospital Revenue Code	301
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

THROMBO W/RFLX

Facility

$128.00

Hospital Charge Code	3035086F
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

THROMBO W/RFLX

Facility

$111.00

Hospital Charge Code	3035086B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

THROMBO W/RFLX

Facility

$635.25

Hospital Charge Code	3035086
Hospital Revenue Code	301
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$317.62
Rate for Payer: Aetna Commercial	$241.40
Rate for Payer: Aetna Medicare Advantage	$190.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.99
Rate for Payer: Cigna Commercial	$317.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.29
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.31
Rate for Payer: Wellpoint Medicaid Managed Care	$16.83

THROMB+STENT PERIPH DIALYS SEG

Facility

$73,789.50

Service Code	HCPCS 36906
Hospital Charge Code	366836906
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
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	$22,136.85
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,068.42
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$1,778.33
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	$1,955.42

THROMB+STENT PERIPH DIALYS SEG

Facility

$73,789.50

Service Code	HCPCS 36906
Hospital Charge Code	366836906
Hospital Revenue Code	361
Min. Negotiated Rate	$11,068.42
Max. Negotiated Rate	$11,068.42
Rate for Payer: Qualcare PPO/HMO/WC	$11,068.42

THROMB+STENT PERIPH DIALYS SEG

Facility

$73,789.50

Service Code	HCPCS 36906
Hospital Charge Code	7412061
Hospital Revenue Code	361
Min. Negotiated Rate	$11,068.42
Max. Negotiated Rate	$11,068.42
Rate for Payer: Qualcare PPO/HMO/WC	$11,068.42

THROMB+STENT PERIPH DIALYS SEG

Facility

$73,789.50

Service Code	HCPCS 36906
Hospital Charge Code	7412061
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
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	$22,136.85
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,068.42
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$1,778.33
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	$1,955.42

THROMB+STENT PERIPH DIALYS SEG

Facility

$73,789.50

Service Code	HCPCS 36906
Hospital Charge Code	5100840
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
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	$22,136.85
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,068.42
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$1,778.33
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	$1,955.42

THROMB+STENT PERIPH DIALYS SEG

Facility

$89,914.40

Service Code	HCPCS 36906
Hospital Charge Code	2692132
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
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	$26,974.32
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,487.16
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$2,166.94
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	$2,382.73

THROMB+STENT PERIPH DIALYS SEG

Facility

$89,914.40

Service Code	HCPCS 36906
Hospital Charge Code	321036906
Hospital Revenue Code	361
Min. Negotiated Rate	$13,487.16
Max. Negotiated Rate	$13,487.16
Rate for Payer: Qualcare PPO/HMO/WC	$13,487.16

THROMB+STENT PERIPH DIALYS SEG

Facility

$89,914.40

Service Code	HCPCS 36906
Hospital Charge Code	321036906
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
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	$26,974.32
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,487.16
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$2,166.94
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	$2,382.73

THROMB+STENT PERIPH DIALYS SEG

Facility

$89,914.40

Service Code	HCPCS 36906
Hospital Charge Code	2692132
Hospital Revenue Code	361
Min. Negotiated Rate	$13,487.16
Max. Negotiated Rate	$13,487.16
Rate for Payer: Qualcare PPO/HMO/WC	$13,487.16

THROMB+STENT PERIPH DIALYS SEG

Facility

$73,789.50

Service Code	HCPCS 36906
Hospital Charge Code	2709027
Hospital Revenue Code	361
Min. Negotiated Rate	$11,068.42
Max. Negotiated Rate	$11,068.42
Rate for Payer: Qualcare PPO/HMO/WC	$11,068.42

THROMB+STENT PERIPH DIALYS SEG

Facility

$73,789.50

Service Code	HCPCS 36906
Hospital Charge Code	2709027
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
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	$22,136.85
Rate for Payer: Oxford Commercial	$11,667.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,068.42
Rate for Payer: UnitedHealthcare Commercial	$20,074.00
Rate for Payer: UnitedHealthcare Community & State	$1,778.33
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	$1,955.42

THROMB+STENT PERIPH DIALYS SEG

Facility

$73,789.50

Service Code	HCPCS 36906
Hospital Charge Code	5100840
Hospital Revenue Code	361
Min. Negotiated Rate	$11,068.42
Max. Negotiated Rate	$11,068.42
Rate for Payer: Qualcare PPO/HMO/WC	$11,068.42

THROMB+TBA PERIPH DIALYSIS SEG

Facility

$48,741.55

Service Code	HCPCS 36905
Hospital Charge Code	5100839
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

Know your out-of-pocket cost for care.

All Charges