Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR ENDOVENOUS LASER VEIN ADDON

Facility

$12,426.40

Service Code	HCPCS 36479
Hospital Charge Code	5600122
Hospital Revenue Code	361
Min. Negotiated Rate	$1,863.96
Max. Negotiated Rate	$1,863.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96

XR ENDOVENOUS LASER VEIN ADDON

Facility

$12,426.40

Service Code	HCPCS 36479
Hospital Charge Code	5600122
Hospital Revenue Code	361
Min. Negotiated Rate	$299.48
Max. Negotiated Rate	$6,213.20
Rate for Payer: Aetna Commercial	$4,722.03
Rate for Payer: Aetna Medicare Advantage	$3,727.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,168.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,168.73
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	$3,168.73
Rate for Payer: Cigna Commercial	$6,213.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,727.92
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$299.48
Rate for Payer: Wellpoint Medicaid Managed Care	$329.30

XR ENDOVENOUS LASER VEIN ADDON

Facility

$12,426.40

Service Code	HCPCS 36479
Hospital Charge Code	7411444
Hospital Revenue Code	361
Min. Negotiated Rate	$299.48
Max. Negotiated Rate	$6,213.20
Rate for Payer: Aetna Commercial	$4,722.03
Rate for Payer: Aetna Medicare Advantage	$3,727.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,168.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,168.73
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	$3,168.73
Rate for Payer: Cigna Commercial	$6,213.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,727.92
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$299.48
Rate for Payer: Wellpoint Medicaid Managed Care	$329.30

XR ENDOVENOUS RF 1ST VEIN

Facility

$19,888.55

Service Code	HCPCS 36475
Hospital Charge Code	7411441
Hospital Revenue Code	361
Min. Negotiated Rate	$2,983.28
Max. Negotiated Rate	$2,983.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,983.28

XR ENDOVENOUS RF 1ST VEIN

Facility

$19,888.55

Service Code	HCPCS 36475
Hospital Charge Code	7411441
Hospital Revenue Code	361
Min. Negotiated Rate	$479.31
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	$5,966.56
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,983.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$479.31
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	$527.05

XR ENDOVENOUS RF VEIN ADD ON

Facility

$12,426.40

Service Code	HCPCS 36476
Hospital Charge Code	7411442
Hospital Revenue Code	361
Min. Negotiated Rate	$1,863.96
Max. Negotiated Rate	$1,863.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96

XR ENDOVENOUS RF VEIN ADD ON

Facility

$12,426.40

Service Code	HCPCS 36476
Hospital Charge Code	7411442
Hospital Revenue Code	361
Min. Negotiated Rate	$299.48
Max. Negotiated Rate	$6,213.20
Rate for Payer: Aetna Commercial	$4,722.03
Rate for Payer: Aetna Medicare Advantage	$3,727.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,168.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,168.73
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	$3,168.73
Rate for Payer: Cigna Commercial	$6,213.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,727.92
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$299.48
Rate for Payer: Wellpoint Medicaid Managed Care	$329.30

XR EPIDUROGRAPHY

Facility

$1,033.95

Service Code	HCPCS 72275
Hospital Charge Code	2011335
Hospital Revenue Code	320
Min. Negotiated Rate	$155.09
Max. Negotiated Rate	$155.09
Rate for Payer: Qualcare PPO/HMO/WC	$155.09

XR EPIDUROGRAPHY

Facility

$1,033.95

Service Code	HCPCS 72275
Hospital Charge Code	2011335
Hospital Revenue Code	320
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$392.90
Rate for Payer: Aetna Medicare Advantage	$310.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.66
Rate for Payer: Cigna Commercial	$516.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.19
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$155.09
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$24.92
Rate for Payer: Wellpoint Medicaid Managed Care	$27.40

XR ERCP

Facility

$5,100.00

Service Code	HCPCS 74330
Hospital Charge Code	2001584
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ERCP

Facility

$5,100.00

Service Code	HCPCS 74330
Hospital Charge Code	2001584
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) NJ Health	$147.14
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

XR ESOPHAGUS

Facility

$6,601.19

Service Code	HCPCS 74220
Hospital Charge Code	2000222
Hospital Revenue Code	320
Min. Negotiated Rate	$54.21
Max. Negotiated Rate	$1,980.36
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

XR ESOPHAGUS

Facility

$6,601.19

Service Code	HCPCS 74220
Hospital Charge Code	2000222
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ESTABLISH ACCESS TO ARTERY

Facility

$57.70

Service Code	HCPCS 36100
Hospital Charge Code	7411420
Hospital Revenue Code	361
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

XR ESTABLISH ACCESS TO ARTERY

Facility

$57.70

Service Code	HCPCS 36100
Hospital Charge Code	5600035
Hospital Revenue Code	361
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

XR ESTABLISH ACCESS TO ARTERY

Facility

$57.70

Service Code	HCPCS 36100
Hospital Charge Code	5600035
Hospital Revenue Code	361
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$21.93
Rate for Payer: Aetna Medicare Advantage	$17.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.71
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	$14.71
Rate for Payer: Cigna Commercial	$28.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.31
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

XR ESTABLISH ACCESS TO ARTERY

Facility

$57.70

Service Code	HCPCS 36100
Hospital Charge Code	7411420
Hospital Revenue Code	361
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$21.93
Rate for Payer: Aetna Medicare Advantage	$17.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.71
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	$14.71
Rate for Payer: Cigna Commercial	$28.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.31
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

XR EXTERNAL CANNULA DECLOTTING

Facility

$1,113.85

Service Code	HCPCS 36860
Hospital Charge Code	5600141
Hospital Revenue Code	361
Min. Negotiated Rate	$26.84
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	$334.15
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$26.84
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	$29.52

XR EXTERNAL CANNULA DECLOTTING

Facility

$1,113.85

Service Code	HCPCS 36860
Hospital Charge Code	5600141
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

XR EXTERNAL CANNULA DECLOTTING

Facility

$1,113.85

Service Code	HCPCS 36860
Hospital Charge Code	7411488
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

XR EXTERNAL CANNULA DECLOTTING

Facility

$1,113.85

Service Code	HCPCS 36860
Hospital Charge Code	7411488
Hospital Revenue Code	361
Min. Negotiated Rate	$26.84
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	$334.15
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$26.84
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	$29.52

XR EYE/FOREIGN BODY LT

Facility

$5,100.00

Service Code	HCPCS 70030LT
Hospital Charge Code	2000420
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR EYE/FOREIGN BODY LT

Facility

$5,100.00

Service Code	HCPCS 70030LT
Hospital Charge Code	2000420
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

XR EYE/FOREIGN BODY RT

Facility

$376.85

Service Code	HCPCS 70030RT
Hospital Charge Code	2000421
Hospital Revenue Code	320
Min. Negotiated Rate	$56.53
Max. Negotiated Rate	$56.53
Rate for Payer: Qualcare PPO/HMO/WC	$56.53

XR EYE/FOREIGN BODY RT

Facility

$376.85

Service Code	HCPCS 70030RT
Hospital Charge Code	2000421
Hospital Revenue Code	320
Min. Negotiated Rate	$9.08
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$143.20
Rate for Payer: Aetna Medicare Advantage	$113.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.10
Rate for Payer: Cigna Commercial	$188.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.06
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.53
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$9.08
Rate for Payer: Wellpoint Medicaid Managed Care	$9.99

Know your out-of-pocket cost for care.

All Charges