Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TORCH IGG

Facility

$390.00

Service Code	HCPCS 86777
Hospital Charge Code	3004406D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TORCH IGG

Facility

$390.00

Service Code	HCPCS 86762
Hospital Charge Code	3004406C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TORCH IGG

Facility

$390.00

Service Code	HCPCS 86696
Hospital Charge Code	3004406B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$52.63
Rate for Payer: Aetna Medicare Advantage	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.35
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Medicare Advantage	$19.35
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TORCH IGG

Facility

$390.00

Service Code	HCPCS 86695
Hospital Charge Code	3004406A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TORCH IGG

Facility

$390.00

Service Code	HCPCS 86696
Hospital Charge Code	3004406B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TORCH IGM

Facility

$153.65

Service Code	HCPCS 86762
Hospital Charge Code	3004407B
Hospital Revenue Code	302
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

TORCH IGM

Facility

$153.65

Service Code	HCPCS 86762
Hospital Charge Code	3004407B
Hospital Revenue Code	302
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

TORCH IGM

Facility

$141.65

Service Code	HCPCS 86778
Hospital Charge Code	3004407C
Hospital Revenue Code	302
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

TORCH IGM

Facility

$141.65

Service Code	HCPCS 86778
Hospital Charge Code	3004407C
Hospital Revenue Code	302
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.20
Rate for Payer: Aetna Medicare Advantage	$46.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$14.41
Rate for Payer: Clover Medicare Advantage	$13.69
Rate for Payer: EmblemHealth Commercial	$43.23
Rate for Payer: Humana Medicare Advantage	$14.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.41
Rate for Payer: Wellcare Medicare Advantage	$14.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

TORCH PROFILE IGM

Facility

$416.00

Hospital Charge Code	3004407
Hospital Revenue Code	302
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$158.08
Rate for Payer: Aetna Medicare Advantage	$124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.08
Rate for Payer: Cigna Commercial	$208.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.03
Rate for Payer: Wellpoint Medicaid Managed Care	$11.02

TORCH PROFILE IGM

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3004407A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.94
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

TORCH PROFILE IGM

Facility

$138.70

Service Code	HCPCS 86694
Hospital Charge Code	3004407A
Hospital Revenue Code	302
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.80

TORCH PROFILE IGM

Facility

$416.00

Hospital Charge Code	3004407
Hospital Revenue Code	302
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$62.40

TORPEDO 3.5 MM X 7 CM

Facility

$505.00

Hospital Charge Code	270690696
Hospital Revenue Code	272
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

TORPEDO 3.5 MM X 7 CM

Facility

$505.00

Hospital Charge Code	270690696
Hospital Revenue Code	272
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Commercial	$101.00
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

TORPEDO CURVED 4.0 MM X 13 CM

Facility

$505.00

Hospital Charge Code	270683618
Hospital Revenue Code	272
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Commercial	$101.00
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

TORPEDO CURVED 4.0 MM X 13 CM

Facility

$505.00

Hospital Charge Code	270683618
Hospital Revenue Code	272
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

TORPEDO CURVE HL 4.2 X 19CM

Facility

$505.00

Hospital Charge Code	270687987
Hospital Revenue Code	272
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

TORPEDO CURVE HL 4.2 X 19CM

Facility

$505.00

Hospital Charge Code	270687987
Hospital Revenue Code	272
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Commercial	$101.00
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

TORPEDO SHAVER 3.5

Facility

$505.00

Hospital Charge Code	270687616
Hospital Revenue Code	272
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Commercial	$101.00
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

TORPEDO SHAVER 3.5

Facility

$505.00

Hospital Charge Code	270687616
Hospital Revenue Code	272
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

TORPEDO SHAVER 4.0

Facility

$505.00

Hospital Charge Code	270682019
Hospital Revenue Code	272
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Commercial	$101.00
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

TORPEDO SHAVER 4.0

Facility

$505.00

Hospital Charge Code	270682019
Hospital Revenue Code	272
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

TORQUE CATHETER 5FR,H1H TIP

Facility

$156.00

Hospital Charge Code	270332315
Hospital Revenue Code	272
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$59.28
Rate for Payer: Aetna Medicare Advantage	$46.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.78
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$31.20
Rate for Payer: UnitedHealthcare Community & State	$3.76
Rate for Payer: Wellpoint Medicaid Managed Care	$4.13

TORQUE CATHETER 5FR,H1H TIP

Facility

$156.00

Hospital Charge Code	270332315
Hospital Revenue Code	272
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

Know your out-of-pocket cost for care.

All Charges