Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLN DX PAT-WRIST 3 VIEWS-LT

Facility

$6,601.19

Service Code	HCPCS 73110LT
Hospital Charge Code	75190415
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-WRIST 3 VIEWS-RT

Facility

$306.00

Service Code	HCPCS 73110RT
Hospital Charge Code	75190420
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-WRIST 3 VIEWS-RT

Facility

$306.00

Service Code	HCPCS 73110RT
Hospital Charge Code	75190420
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-WRIST AP&LAT 2-LT

Facility

$254.00

Service Code	HCPCS 73100LT
Hospital Charge Code	75190405
Hospital Revenue Code	320
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$38.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.10

CLN DX PAT-WRIST AP&LAT 2-LT

Facility

$254.00

Service Code	HCPCS 73100LT
Hospital Charge Code	75190405
Hospital Revenue Code	320
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$96.52
Rate for Payer: Aetna Medicare Advantage	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.77
Rate for Payer: Cigna Commercial	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.12
Rate for Payer: Wellpoint Medicaid Managed Care	$6.73

CLN DX PAT-WRIST AP&LAT 2-RT

Facility

$254.00

Service Code	HCPCS 73100RT
Hospital Charge Code	75190410
Hospital Revenue Code	320
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$96.52
Rate for Payer: Aetna Medicare Advantage	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.77
Rate for Payer: Cigna Commercial	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.12
Rate for Payer: Wellpoint Medicaid Managed Care	$6.73

CLN DX PAT-WRIST AP&LAT 2-RT

Facility

$254.00

Service Code	HCPCS 73100RT
Hospital Charge Code	75190410
Hospital Revenue Code	320
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$38.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.10

CLN DX PAT-WRIST AP&LAT-BIL

Facility

$250.00

Service Code	HCPCS 7310050
Hospital Charge Code	75190310
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-WRIST AP&LAT-BIL

Facility

$250.00

Service Code	HCPCS 7310050
Hospital Charge Code	75190310
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 EXC BENIGN DIAM 1.1-2.0 CM

Facility

$3,472.65

Service Code	HCPCS 11442
Hospital Charge Code	75190085
Hospital Revenue Code	761
Min. Negotiated Rate	$520.90
Max. Negotiated Rate	$520.90
Rate for Payer: Qualcare PPO/HMO/WC	$520.90

CLN EXC BENIGN DIAM 1.1-2.0 CM

Facility

$3,472.65

Service Code	HCPCS 11442
Hospital Charge Code	75190085
Hospital Revenue Code	761
Min. Negotiated Rate	$83.69
Max. Negotiated Rate	$3,036.77
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$107.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,041.80
Rate for Payer: Oxford Commercial	$694.53
Rate for Payer: Qualcare PPO/HMO/WC	$520.90
Rate for Payer: UnitedHealthcare Commercial	$694.53
Rate for Payer: UnitedHealthcare Community & State	$83.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$92.03

CLN EXC EXT THROMBOSED HEMOR

Facility

$10,145.56

Service Code	HCPCS 46320
Hospital Charge Code	75190150
Hospital Revenue Code	361
Min. Negotiated Rate	$244.51
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,131.69
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,043.67
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,521.83
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$244.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$268.86

CLN EXC EXT THROMBOSED HEMOR

Facility

$10,145.56

Service Code	HCPCS 46320
Hospital Charge Code	75190150
Hospital Revenue Code	361
Min. Negotiated Rate	$1,521.83
Max. Negotiated Rate	$1,521.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,521.83

CLN FNA BREAST BX

Facility

$669.90

Service Code	HCPCS 10021
Hospital Charge Code	75190001
Hospital Revenue Code	761
Min. Negotiated Rate	$100.48
Max. Negotiated Rate	$100.48
Rate for Payer: Qualcare PPO/HMO/WC	$100.48

CLN FNA BREAST BX

Facility

$669.90

Service Code	HCPCS 10021
Hospital Charge Code	75190001
Hospital Revenue Code	761
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$161.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.97
Rate for Payer: Oxford Commercial	$133.98
Rate for Payer: Qualcare PPO/HMO/WC	$100.48
Rate for Payer: UnitedHealthcare Commercial	$133.98
Rate for Payer: UnitedHealthcare Community & State	$16.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

CLN INJ TRIGGER POINTS,=/>3

Facility

$1,091.00

Service Code	HCPCS 20553
Hospital Charge Code	75190125
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

CLN INJ TRIGGER POINTS,=/>3

Facility

$1,091.00

Service Code	HCPCS 20553
Hospital Charge Code	75190125
Hospital Revenue Code	361
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$26.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$28.91

CLNOSCOPY PROXIMAL W/BIOPSY***

Facility

$1,026.00

Hospital Charge Code	2300011
Hospital Revenue Code	759
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$153.90
Rate for Payer: Qualcare PPO/HMO/WC	$153.90

CLNOSCOPY PROXIMAL W/BIOPSY***

Facility

$1,026.00

Hospital Charge Code	2300011
Hospital Revenue Code	759
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$513.00
Rate for Payer: Aetna Commercial	$389.88
Rate for Payer: Aetna Medicare Advantage	$307.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.63
Rate for Payer: Cigna Commercial	$513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.80
Rate for Payer: Qualcare PPO/HMO/WC	$153.90
Rate for Payer: UnitedHealthcare Community & State	$24.73
Rate for Payer: Wellpoint Medicaid Managed Care	$27.19

CLN OV EP COMPREHENSIVE

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	75190230
Hospital Revenue Code	510
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.14
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$29.25
Rate for Payer: Wellpoint Medicaid Managed Care	$32.17

CLN OV EP COMPREHENSIVE

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	75190230
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

CLN OV EP DETAILED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	75190225
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

CLN OV EP DETAILED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	75190225
Hospital Revenue Code	510
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.64
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$19.97
Rate for Payer: Wellpoint Medicaid Managed Care	$21.96

CLN OV EP PROBLEM FOCUSED

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	75190210
Hospital Revenue Code	510
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

CLN OV EP PROBLEM FOCUSED

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	75190210
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

Know your out-of-pocket cost for care.

All Charges