Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR TRANS BAL ANGIO OPEN VENOUS

Facility

$21,962.30

Service Code	HCPCS 35460
Hospital Charge Code	7411405
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR TRANS BAL ANGIO OPEN VENOUS

Facility

$21,962.30

Service Code	HCPCS 35460
Hospital Charge Code	7411405
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

XR TRANS BAL ANGIO OPEN VENOUS

Facility

$21,962.30

Service Code	HCPCS 35460
Hospital Charge Code	5600109
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

XR TRANS BAL ANGIO OPEN VENOUS

Facility

$21,962.30

Service Code	HCPCS 35460
Hospital Charge Code	5600109
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

XR TRANSCATHETER THEARPY INFUS

Facility

$7,142.25

Hospital Charge Code	5600145
Hospital Revenue Code	361
Min. Negotiated Rate	$1,071.34
Max. Negotiated Rate	$1,071.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.34

XR TRANSCATHETER THEARPY INFUS

Facility

$7,142.25

Hospital Charge Code	5600145
Hospital Revenue Code	361
Min. Negotiated Rate	$172.13
Max. Negotiated Rate	$3,571.12
Rate for Payer: Aetna Commercial	$2,714.05
Rate for Payer: Aetna Medicare Advantage	$2,142.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,821.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,821.27
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	$1,821.27
Rate for Payer: Cigna Commercial	$3,571.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,142.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.34
Rate for Payer: UnitedHealthcare Community & State	$172.13
Rate for Payer: Wellpoint Medicaid Managed Care	$189.27

XR TRANSCATH IV STENT OPEN

Facility

$41,896.20

Hospital Charge Code	5600146
Hospital Revenue Code	361
Min. Negotiated Rate	$1,009.70
Max. Negotiated Rate	$20,948.10
Rate for Payer: Aetna Commercial	$15,920.56
Rate for Payer: Aetna Medicare Advantage	$12,568.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,683.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,683.53
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	$10,683.53
Rate for Payer: Cigna Commercial	$20,948.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,568.86
Rate for Payer: Qualcare PPO/HMO/WC	$6,284.43
Rate for Payer: UnitedHealthcare Community & State	$1,009.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1,110.25

XR TRANSCATH IV STENT OPEN

Facility

$41,896.20

Hospital Charge Code	5600146
Hospital Revenue Code	361
Min. Negotiated Rate	$6,284.43
Max. Negotiated Rate	$6,284.43
Rate for Payer: Qualcare PPO/HMO/WC	$6,284.43

XR TRANSCATH IV STENT/OPEN ADD

Facility

$41,896.20

Hospital Charge Code	5600147
Hospital Revenue Code	361
Min. Negotiated Rate	$6,284.43
Max. Negotiated Rate	$6,284.43
Rate for Payer: Qualcare PPO/HMO/WC	$6,284.43

XR TRANSCATH IV STENT/OPEN ADD

Facility

$41,896.20

Hospital Charge Code	5600147
Hospital Revenue Code	361
Min. Negotiated Rate	$1,009.70
Max. Negotiated Rate	$20,948.10
Rate for Payer: Aetna Commercial	$15,920.56
Rate for Payer: Aetna Medicare Advantage	$12,568.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,683.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,683.53
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	$10,683.53
Rate for Payer: Cigna Commercial	$20,948.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,568.86
Rate for Payer: Qualcare PPO/HMO/WC	$6,284.43
Rate for Payer: UnitedHealthcare Community & State	$1,009.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1,110.25

XR TRANSCATH OCCLUSION NON CNS

Facility

$40,990.35

Service Code	HCPCS 61626
Hospital Charge Code	7411643
Hospital Revenue Code	361
Min. Negotiated Rate	$987.87
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
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	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,297.10
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$987.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.24

XR TRANSCATH OCCLUSION NON CNS

Facility

$40,990.35

Service Code	HCPCS 61626
Hospital Charge Code	7411643
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 TRANSCATH OCCLUSION NON CNS

Facility

$40,990.35

Service Code	HCPCS 61626
Hospital Charge Code	5600178
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 TRANSCATH OCCLUSION NON CNS

Facility

$40,990.35

Service Code	HCPCS 61626
Hospital Charge Code	5600178
Hospital Revenue Code	361
Min. Negotiated Rate	$987.87
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
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	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,297.10
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$987.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.24

XR TRANSCATH RET OF FOR BODY

Facility

$3,214.45

Hospital Charge Code	5100585
Hospital Revenue Code	361
Min. Negotiated Rate	$77.47
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,221.49
Rate for Payer: Aetna Medicare Advantage	$964.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$819.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$819.68
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	$819.68
Rate for Payer: Cigna Commercial	$1,607.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$964.34
Rate for Payer: Qualcare PPO/HMO/WC	$482.17
Rate for Payer: UnitedHealthcare Community & State	$77.47
Rate for Payer: Wellpoint Medicaid Managed Care	$85.18

XR TRANSCATH RET OF FOR BODY

Facility

$3,214.45

Hospital Charge Code	5100585
Hospital Revenue Code	361
Min. Negotiated Rate	$482.17
Max. Negotiated Rate	$482.17
Rate for Payer: Qualcare PPO/HMO/WC	$482.17

XR TRANSCATH RET PERC INT F B

Facility

$2,238.00

Service Code	HCPCS 75961
Hospital Charge Code	5100357
Hospital Revenue Code	323
Min. Negotiated Rate	$53.94
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$850.44
Rate for Payer: Aetna Medicare Advantage	$671.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.69
Rate for Payer: Cigna Commercial	$1,119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.70
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$53.94
Rate for Payer: Wellpoint Medicaid Managed Care	$59.31

XR TRANSCATH RET PERC INT F B

Facility

$2,238.00

Service Code	HCPCS 75961
Hospital Charge Code	5100357
Hospital Revenue Code	323
Min. Negotiated Rate	$335.70
Max. Negotiated Rate	$335.70
Rate for Payer: Qualcare PPO/HMO/WC	$335.70

XR TRANSLUM BAL ANG OPN VENOUS

Facility

$12,642.00

Service Code	HCPCS 35460ZX
Hospital Charge Code	2001354
Hospital Revenue Code	361
Min. Negotiated Rate	$1,896.30
Max. Negotiated Rate	$1,896.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,896.30

XR TRANSLUM BAL ANG OPN VENOUS

Facility

$12,642.00

Service Code	HCPCS 35460ZX
Hospital Charge Code	2001354
Hospital Revenue Code	361
Min. Negotiated Rate	$304.67
Max. Negotiated Rate	$6,321.00
Rate for Payer: Aetna Commercial	$4,803.96
Rate for Payer: Aetna Medicare Advantage	$3,792.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,223.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,223.71
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	$3,223.71
Rate for Payer: Cigna Commercial	$6,321.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,792.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,896.30
Rate for Payer: UnitedHealthcare Community & State	$304.67
Rate for Payer: Wellpoint Medicaid Managed Care	$335.01

XR T-TUBE CHOLANGIOGRAM

Facility

$775.25

Hospital Charge Code	2000313
Hospital Revenue Code	320
Min. Negotiated Rate	$116.29
Max. Negotiated Rate	$116.29
Rate for Payer: Qualcare PPO/HMO/WC	$116.29

XR T-TUBE CHOLANGIOGRAM

Facility

$775.25

Hospital Charge Code	2000313
Hospital Revenue Code	320
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$294.60
Rate for Payer: Aetna Medicare Advantage	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.69
Rate for Payer: Cigna Commercial	$387.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.57
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.29
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

XR UE LT INFANT MIN 2VW

Facility

$5,100.00

Service Code	HCPCS 73092LT
Hospital Charge Code	2002194
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 UE LT INFANT MIN 2VW

Facility

$5,100.00

Service Code	HCPCS 73092LT
Hospital Charge Code	2002194
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR UE RT INFANT MIN 2VW

Facility

$5,100.00

Service Code	HCPCS 73092RT
Hospital Charge Code	2002195
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

Know your out-of-pocket cost for care.

All Charges