Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLN DX PAT-FOOT AP & LAT-BILA

Facility

$250.00

Service Code	HCPCS 7362050
Hospital Charge Code	75190360
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-FOOT AP & LAT-BILA

Facility

$250.00

Service Code	HCPCS 7362050
Hospital Charge Code	75190360
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-FOOT AP & LAT-LT

Facility

$314.00

Service Code	HCPCS 73620LT
Hospital Charge Code	75190565
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

CLN DX PAT-FOOT AP & LAT-LT

Facility

$314.00

Service Code	HCPCS 73620LT
Hospital Charge Code	75190565
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

CLN DX PAT-FOOT AP & LAT-RT

Facility

$6,601.19

Service Code	HCPCS 73620RT
Hospital Charge Code	75190570
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

CLN DX PAT-FOOT AP & LAT-RT

Facility

$6,601.19

Service Code	HCPCS 73620RT
Hospital Charge Code	75190570
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

CLN DX PAT-HAND 3 VIEWS-BILA

Facility

$250.00

Service Code	HCPCS 7313050
Hospital Charge Code	75190320
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-HAND 3 VIEWS-BILA

Facility

$250.00

Service Code	HCPCS 7313050
Hospital Charge Code	75190320
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-HAND 3 VIEWS-LT

Facility

$308.00

Service Code	HCPCS 73130LT
Hospital Charge Code	75190425
Hospital Revenue Code	320
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$46.20

CLN DX PAT-HAND 3 VIEWS-LT

Facility

$308.00

Service Code	HCPCS 73130LT
Hospital Charge Code	75190425
Hospital Revenue Code	320
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$117.04
Rate for Payer: Aetna Medicare Advantage	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.54
Rate for Payer: Cigna Commercial	$154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.42
Rate for Payer: Wellpoint Medicaid Managed Care	$8.16

CLN DX PAT-HAND 3 VIEWS-RT

Facility

$308.00

Service Code	HCPCS 73130RT
Hospital Charge Code	75190430
Hospital Revenue Code	320
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$46.20
Rate for Payer: Qualcare PPO/HMO/WC	$46.20

CLN DX PAT-HAND 3 VIEWS-RT

Facility

$308.00

Service Code	HCPCS 73130RT
Hospital Charge Code	75190430
Hospital Revenue Code	320
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$117.04
Rate for Payer: Aetna Medicare Advantage	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.54
Rate for Payer: Cigna Commercial	$154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.42
Rate for Payer: Wellpoint Medicaid Managed Care	$8.16

CLN DX PAT-HIP COMPLETE-LT

Facility

$250.00

Hospital Charge Code	75190485
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-HIP COMPLETE-LT

Facility

$250.00

Hospital Charge Code	75190485
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-HIP COMPLETE-RT

Facility

$250.00

Hospital Charge Code	75190490
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-HIP COMPLETE-RT

Facility

$250.00

Hospital Charge Code	75190490
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-HIPS-BILAT

Facility

$250.00

Hospital Charge Code	75190280
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-HIPS-BILAT

Facility

$250.00

Hospital Charge Code	75190280
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-KNEE 1-2 VWS-BIL

Facility

$250.00

Service Code	HCPCS 7356050
Hospital Charge Code	75190330
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CLN DX PAT-KNEE 1-2 VWS-BIL

Facility

$250.00

Service Code	HCPCS 7356050
Hospital Charge Code	75190330
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CLN DX PAT-KNEE 1 OR 2 VW-LT

Facility

$306.00

Service Code	HCPCS 73560LT
Hospital Charge Code	75190505
Hospital Revenue Code	320
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$116.28
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.37
Rate for Payer: Wellpoint Medicaid Managed Care	$8.11

CLN DX PAT-KNEE 1 OR 2 VW-LT

Facility

$306.00

Service Code	HCPCS 73560LT
Hospital Charge Code	75190505
Hospital Revenue Code	320
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

CLN DX PAT-KNEE 1 OR 2 VW-RT

Facility

$6,601.19

Service Code	HCPCS 73560RT
Hospital Charge Code	75190510
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

CLN DX PAT-KNEE 1 OR 2 VW-RT

Facility

$6,601.19

Service Code	HCPCS 73560RT
Hospital Charge Code	75190510
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

CLN DX PAT-KNEE 3VWS-BIL

Facility

$250.00

Service Code	HCPCS 7356250
Hospital Charge Code	75190335
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

Know your out-of-pocket cost for care.

All Charges