Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	321037186
Hospital Revenue Code	361
Min. Negotiated Rate	$292.31
Max. Negotiated Rate	$6,064.50
Rate for Payer: Aetna Commercial	$4,609.02
Rate for Payer: Aetna Medicare Advantage	$3,638.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,092.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,092.89
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	$3,092.89
Rate for Payer: Cigna Commercial	$6,064.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,638.70
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$292.31
Rate for Payer: Wellpoint Medicaid Managed Care	$321.42

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	5600142
Hospital Revenue Code	361
Min. Negotiated Rate	$292.31
Max. Negotiated Rate	$6,064.50
Rate for Payer: Aetna Commercial	$4,609.02
Rate for Payer: Aetna Medicare Advantage	$3,638.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,092.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,092.89
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	$3,092.89
Rate for Payer: Cigna Commercial	$6,064.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,638.70
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$292.31
Rate for Payer: Wellpoint Medicaid Managed Care	$321.42

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	366837186
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	5600142
Hospital Revenue Code	361
Min. Negotiated Rate	$1,819.35
Max. Negotiated Rate	$1,819.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	411037186
Hospital Revenue Code	361
Min. Negotiated Rate	$441.22
Max. Negotiated Rate	$9,153.90
Rate for Payer: Aetna Commercial	$6,956.96
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$9,153.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,492.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$441.22
Rate for Payer: Wellpoint Medicaid Managed Care	$485.16

XR SELLA TURCICA

Facility

$376.85

Service Code	HCPCS 70240
Hospital Charge Code	2000461
Hospital Revenue Code	320
Min. Negotiated Rate	$9.08
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	$31.94
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	$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: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$9.99

XR SELLA TURCICA

Facility

$376.85

Service Code	HCPCS 70240
Hospital Charge Code	2000461
Hospital Revenue Code	320
Min. Negotiated Rate	$56.53
Max. Negotiated Rate	$56.53
Rate for Payer: Qualcare PPO/HMO/WC	$56.53

XR SHOULDER 1 VIEW BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7302050
Hospital Charge Code	2011382
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER 1 VIEW BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7302050
Hospital Charge Code	2011382
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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: Wellpoint Medicaid Managed Care	$174.93

XR SHOULDER COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7303050
Hospital Charge Code	2011383
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7303050
Hospital Charge Code	2011383
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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: Wellpoint Medicaid Managed Care	$174.93

XR SHOULDER LT 1 VIEW

Facility

$6,601.19

Service Code	HCPCS 73020LT
Hospital Charge Code	2002400
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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: Wellpoint Medicaid Managed Care	$174.93

XR SHOULDER LT 1 VIEW

Facility

$6,601.19

Service Code	HCPCS 73020LT
Hospital Charge Code	2002400
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER MIN 2 VWS LT

Facility

$6,601.19

Service Code	HCPCS 73030LT
Hospital Charge Code	2000024
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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: Wellpoint Medicaid Managed Care	$174.93

XR SHOULDER MIN 2 VWS LT

Facility

$6,601.19

Service Code	HCPCS 73030LT
Hospital Charge Code	2000024
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER MIN 2 VWS RT

Facility

$6,601.19

Service Code	HCPCS 73030RT
Hospital Charge Code	2000025
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER MIN 2 VWS RT

Facility

$6,601.19

Service Code	HCPCS 73030RT
Hospital Charge Code	2000025
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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: Wellpoint Medicaid Managed Care	$174.93

XR SHOULDER RT 1 VIEW

Facility

$6,601.19

Service Code	HCPCS 73020RT
Hospital Charge Code	2002401
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER RT 1 VIEW

Facility

$6,601.19

Service Code	HCPCS 73020RT
Hospital Charge Code	2002401
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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: Wellpoint Medicaid Managed Care	$174.93

XR SHUNTOGRAM NON-VASCULAR

Facility

$602.00

Service Code	HCPCS 75809
Hospital Charge Code	2011384
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR SHUNTOGRAM NON-VASCULAR

Facility

$602.00

Service Code	HCPCS 75809
Hospital Charge Code	2011384
Hospital Revenue Code	320
Min. Negotiated Rate	$14.51
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$15.95

XR SHUNTOGRAM NON-VASCULAR

Facility

$602.00

Service Code	HCPCS 75809
Hospital Charge Code	404675809
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR SHUNTOGRAM NON-VASCULAR

Facility

$602.00

Service Code	HCPCS 75809
Hospital Charge Code	404675809
Hospital Revenue Code	320
Min. Negotiated Rate	$14.51
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$15.95

XR SIALOGRAM

Facility

$802.45

Service Code	HCPCS 70390
Hospital Charge Code	2001311
Hospital Revenue Code	320
Min. Negotiated Rate	$120.37
Max. Negotiated Rate	$120.37
Rate for Payer: Qualcare PPO/HMO/WC	$120.37

XR SIALOGRAM

Facility

$802.45

Service Code	HCPCS 70390
Hospital Charge Code	2001311
Hospital Revenue Code	320
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.74
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.37
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$19.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$21.26

Know your out-of-pocket cost for care.

All Charges