Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR ATHERECTOMY OPEN BRACHIO EA

Facility

$40,991.00

Hospital Charge Code	5600110
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.65
Max. Negotiated Rate	$6,148.65
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.65

XR ATHERECTOMY PERQ AORTIC

Facility

$40,990.35

Hospital Charge Code	5600113
Hospital Revenue Code	361
Min. Negotiated Rate	$987.87
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$15,576.33
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
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	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,297.10
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55
Rate for Payer: UnitedHealthcare Community & State	$987.87
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.24

XR ATHERECTOMY PERQ AORTIC

Facility

$40,990.35

Hospital Charge Code	5600113
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ATHERECTOMY PERQ BRACHIO EA

Facility

$40,990.35

Hospital Charge Code	5600115
Hospital Revenue Code	361
Min. Negotiated Rate	$987.87
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$15,576.33
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
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	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,297.10
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55
Rate for Payer: UnitedHealthcare Community & State	$987.87
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.24

XR ATHERECTOMY PERQ BRACHIO EA

Facility

$40,990.35

Hospital Charge Code	5600115
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ATHERECTOMY PERQ ILIAC

Facility

$40,990.35

Hospital Charge Code	5600114
Hospital Revenue Code	361
Min. Negotiated Rate	$987.87
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$15,576.33
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
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	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,297.10
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55
Rate for Payer: UnitedHealthcare Community & State	$987.87
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.24

XR ATHERECTOMY PERQ ILIAC

Facility

$40,990.35

Hospital Charge Code	5600114
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ATHERECTOMY PERQ RENAL ARTE

Facility

$40,990.35

Hospital Charge Code	5600112
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ATHERECTOMY PERQ RENAL ARTE

Facility

$40,990.35

Hospital Charge Code	5600112
Hospital Revenue Code	361
Min. Negotiated Rate	$987.87
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$15,576.33
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
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	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,297.10
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55
Rate for Payer: UnitedHealthcare Community & State	$987.87
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.24

XR AV FISTULA OR GRAFT ARTERIA

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	5600183
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

XR AV FISTULA OR GRAFT ARTERIA

Facility

$22,087.30

Service Code	HCPCS 35475
Hospital Charge Code	5600183
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

X-RAY AORTA LEG ARTERIES

Facility

$12,462.85

Service Code	HCPCS 75630
Hospital Charge Code	366875630
Hospital Revenue Code	323
Min. Negotiated Rate	$1,869.43
Max. Negotiated Rate	$1,869.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43

X-RAY AORTA LEG ARTERIES

Facility

$12,462.85

Service Code	HCPCS 75630
Hospital Charge Code	366875630
Hospital Revenue Code	323
Min. Negotiated Rate	$169.40
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	$169.40
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	$2,625.82
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	$3,738.86
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$300.35
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	$330.27

X-RAY AORTA LEG ARTERIES

Facility

$12,462.85

Service Code	HCPCS 75630
Hospital Charge Code	411075630
Hospital Revenue Code	323
Min. Negotiated Rate	$169.40
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	$169.40
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	$2,625.82
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	$3,738.86
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$300.35
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	$330.27

X-RAY AORTA LEG ARTERIES

Facility

$12,462.85

Service Code	HCPCS 75630
Hospital Charge Code	411075630
Hospital Revenue Code	323
Min. Negotiated Rate	$1,869.43
Max. Negotiated Rate	$1,869.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43

X-RAY C/T SPINE DISK

Facility

$6,593.09

Service Code	HCPCS 72285
Hospital Charge Code	2011395
Hospital Revenue Code	320
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$1,623.92
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,977.93
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$988.96
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$158.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,656.68
Rate for Payer: Wellpoint Medicaid Managed Care	$174.72

X-RAY C/T SPINE DISK

Facility

$6,593.09

Service Code	HCPCS 72285
Hospital Charge Code	2011395
Hospital Revenue Code	320
Min. Negotiated Rate	$988.96
Max. Negotiated Rate	$988.96
Rate for Payer: Qualcare PPO/HMO/WC	$988.96

XRAY ENDOVASC THOR AO REPR

Facility

$5,100.00

Service Code	HCPCS 75957
Hospital Charge Code	321075957
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XRAY ENDOVASC THOR AO REPR

Facility

$5,100.00

Service Code	HCPCS 75957
Hospital Charge Code	321075957
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XRAY ENDOVASC THOR AO REPR

Facility

$5,100.00

Service Code	HCPCS 75957
Hospital Charge Code	5701111
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XRAY ENDOVASC THOR AO REPR

Facility

$5,100.00

Service Code	HCPCS 75957
Hospital Charge Code	5701111
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XRAY ENDOVASC THOR AO REPR

Facility

$1,645.10

Service Code	HCPCS 75957
Hospital Charge Code	7411735
Hospital Revenue Code	320
Min. Negotiated Rate	$39.65
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$625.14
Rate for Payer: Aetna Medicare Advantage	$493.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$419.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$419.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$419.50
Rate for Payer: Cigna Commercial	$822.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.53
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$246.76
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$39.65
Rate for Payer: Wellpoint Medicaid Managed Care	$43.60

XRAY ENDOVASC THOR AO REPR

Facility

$1,645.10

Service Code	HCPCS 75957
Hospital Charge Code	7411735
Hospital Revenue Code	320
Min. Negotiated Rate	$246.76
Max. Negotiated Rate	$246.76
Rate for Payer: Qualcare PPO/HMO/WC	$246.76

X-ray exam of forearm

Facility

$181.95

Service Code	HCPCS 73090
Hospital Charge Code	2002201
Hospital Revenue Code	320
Min. Negotiated Rate	$27.29
Max. Negotiated Rate	$27.29
Rate for Payer: Qualcare PPO/HMO/WC	$27.29

X-ray exam of forearm

Facility

$181.95

Service Code	HCPCS 73090
Hospital Charge Code	2002201
Hospital Revenue Code	320
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.59
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.29
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$4.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.82

Know your out-of-pocket cost for care.

All Charges