Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CT ANKLE W/&W/O CONTRAST LEFT

Facility

$1,810.20

Service Code	HCPCS 73702LT
Hospital Charge Code	2205453
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT ANKLE W/&W/O CONTRAST RIGHT

Facility

$1,810.20

Service Code	HCPCS 73702RT
Hospital Charge Code	2205454
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT ANKLE W/&W/O CONTRAST RIGHT

Facility

$1,810.20

Service Code	HCPCS 73702RT
Hospital Charge Code	2205454
Hospital Revenue Code	352
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$687.88
Rate for Payer: Aetna Medicare Advantage	$543.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.60
Rate for Payer: Cigna Commercial	$905.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.06
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.53
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$43.63
Rate for Payer: Wellpoint Medicaid Managed Care	$47.97

C-TAPER LFIT HEAD 26MM +7.5MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270670750
Hospital Revenue Code	278
Min. Negotiated Rate	$86.16
Max. Negotiated Rate	$1,787.50
Rate for Payer: Aetna Commercial	$1,358.50
Rate for Payer: Aetna Medicare Advantage	$1,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$911.62
Rate for Payer: Cigna Commercial	$1,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$536.25
Rate for Payer: UnitedHealthcare Community & State	$86.16
Rate for Payer: Wellpoint Medicaid Managed Care	$94.74

C-TAPER LFIT HEAD 26MM +7.5MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270670750
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$865.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

CT ASPIRATION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205321
Hospital Revenue Code	350
Min. Negotiated Rate	$117.63
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,854.75
Rate for Payer: Aetna Medicare Advantage	$1,464.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.63
Rate for Payer: Cigna Commercial	$2,440.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.28
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.14
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$117.63
Rate for Payer: Wellpoint Medicaid Managed Care	$129.34

CT ASPIRATION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205321
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT ASPIRATION RENAL LEFT

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205322
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT ASPIRATION RENAL LEFT

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205322
Hospital Revenue Code	350
Min. Negotiated Rate	$117.63
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,854.75
Rate for Payer: Aetna Medicare Advantage	$1,464.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.63
Rate for Payer: Cigna Commercial	$2,440.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.28
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.14
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$117.63
Rate for Payer: Wellpoint Medicaid Managed Care	$129.34

CT ASPIRATION RENAL RIGHT

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205323
Hospital Revenue Code	350
Min. Negotiated Rate	$117.63
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,854.75
Rate for Payer: Aetna Medicare Advantage	$1,464.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.63
Rate for Payer: Cigna Commercial	$2,440.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.28
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.14
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$117.63
Rate for Payer: Wellpoint Medicaid Managed Care	$129.34

CT ASPIRATION RENAL RIGHT

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205323
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT BARIUM CONTRAST

Facility

$110.00

Hospital Charge Code	2209010
Hospital Revenue Code	344
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

CT BARIUM CONTRAST

Facility

$110.00

Hospital Charge Code	2209010
Hospital Revenue Code	344
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

CT BIOPSY

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205324
Hospital Revenue Code	350
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT BIOPSY

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205324
Hospital Revenue Code	350
Min. Negotiated Rate	$222.89
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT BIOPSY ABDOMEN

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205325
Hospital Revenue Code	350
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT BIOPSY ABDOMEN

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205325
Hospital Revenue Code	350
Min. Negotiated Rate	$222.89
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT BIOPSY BONE

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205326
Hospital Revenue Code	350
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT BIOPSY BONE

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205326
Hospital Revenue Code	350
Min. Negotiated Rate	$222.89
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT BIOPSY LIVER

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205327
Hospital Revenue Code	350
Min. Negotiated Rate	$117.63
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,854.75
Rate for Payer: Aetna Medicare Advantage	$1,464.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.63
Rate for Payer: Cigna Commercial	$2,440.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.28
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.14
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$117.63
Rate for Payer: Wellpoint Medicaid Managed Care	$129.34

CT BIOPSY LIVER

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205327
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT BIOPSY LUNG LEFT

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205328
Hospital Revenue Code	350
Min. Negotiated Rate	$117.63
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,854.75
Rate for Payer: Aetna Medicare Advantage	$1,464.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.63
Rate for Payer: Cigna Commercial	$2,440.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.28
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.14
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$117.63
Rate for Payer: Wellpoint Medicaid Managed Care	$129.34

CT BIOPSY LUNG LEFT

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2205328
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT BIOPSY LUNG RIGHT

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205329
Hospital Revenue Code	350
Min. Negotiated Rate	$222.89
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT BIOPSY LUNG RIGHT

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205329
Hospital Revenue Code	350
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

Know your out-of-pocket cost for care.

All Charges