Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CT DRAINAGE TRAY

Facility

$720.00

Hospital Charge Code	270669755R
Hospital Revenue Code	272
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$108.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.00

CT DRAINAGE TRAY

Facility

$720.00

Hospital Charge Code	270669755
Hospital Revenue Code	272
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna Commercial	$273.60
Rate for Payer: Aetna Medicare Advantage	$216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.60
Rate for Payer: Cigna Commercial	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.00
Rate for Payer: Oxford Commercial	$144.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.00
Rate for Payer: UnitedHealthcare Commercial	$144.00
Rate for Payer: UnitedHealthcare Community & State	$17.35
Rate for Payer: Wellpoint Medicaid Managed Care	$19.08

CT DRAINAGE TRAY

Facility

$720.00

Hospital Charge Code	270669755
Hospital Revenue Code	272
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$108.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.00

CT DRAINAGE TRAY

Facility

$650.00

Hospital Charge Code	270669755N
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

CT ELBOW W/ CONTAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205459
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT ELBOW W/ CONTAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205459
Hospital Revenue Code	352
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$675.20
Rate for Payer: Aetna Medicare Advantage	$533.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$453.10
Rate for Payer: Cigna Commercial	$888.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.05
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.53
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$42.82
Rate for Payer: Wellpoint Medicaid Managed Care	$47.09

CT ELBOW W/ CONTRAST BILATERAL

Facility

$1,521.90

Service Code	HCPCS 73200
Hospital Charge Code	2205458
Hospital Revenue Code	352
Min. Negotiated Rate	$228.28
Max. Negotiated Rate	$228.28
Rate for Payer: Qualcare PPO/HMO/WC	$228.28

CT ELBOW W/ CONTRAST BILATERAL

Facility

$1,521.90

Service Code	HCPCS 73200
Hospital Charge Code	2205458
Hospital Revenue Code	352
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$3,354.00
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	$242.00
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	$456.57
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$228.28
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$36.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$40.33

CT ELBOW W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205460
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT ELBOW W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205460
Hospital Revenue Code	352
Min. Negotiated Rate	$42.82
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$675.20
Rate for Payer: Aetna Medicare Advantage	$533.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$453.10
Rate for Payer: Cigna Commercial	$888.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.05
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.53
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$42.82
Rate for Payer: Wellpoint Medicaid Managed Care	$47.09

CT ELBOW W/O CONTRAST LEFT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205462
Hospital Revenue Code	352
Min. Negotiated Rate	$27.01
Max. Negotiated Rate	$3,354.00
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	$242.00
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	$336.23
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.11
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$27.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.70

CT ELBOW W/O CONTRAST LEFT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205462
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT ELBOW W/O CONTRAST RIGHT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205463
Hospital Revenue Code	352
Min. Negotiated Rate	$27.01
Max. Negotiated Rate	$3,354.00
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	$242.00
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	$336.23
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.11
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$27.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.70

CT ELBOW W/O CONTRAST RIGHT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205463
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT ELBOW W/O CONTRST BILATERAL

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205461
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT ELBOW W/O CONTRST BILATERAL

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205461
Hospital Revenue Code	352
Min. Negotiated Rate	$27.01
Max. Negotiated Rate	$3,354.00
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	$242.00
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	$336.23
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.11
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$27.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.70

CT ELBOW W&W/O CNTRST BILATERL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205455
Hospital Revenue Code	352
Min. Negotiated Rate	$639.13
Max. Negotiated Rate	$639.13
Rate for Payer: Qualcare PPO/HMO/WC	$639.13

CT ELBOW W&W/O CNTRST BILATERL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205455
Hospital Revenue Code	352
Min. Negotiated Rate	$102.69
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,619.14
Rate for Payer: Aetna Medicare Advantage	$1,278.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,086.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,086.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,086.53
Rate for Payer: Cigna Commercial	$2,130.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,278.27
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$639.13
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$102.69
Rate for Payer: Wellpoint Medicaid Managed Care	$112.91

CT ELBOW W&W/O CONTRAST LEFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205456
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT ELBOW W&W/O CONTRAST LEFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205456
Hospital Revenue Code	352
Min. Negotiated Rate	$51.34
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$809.57
Rate for Payer: Aetna Medicare Advantage	$639.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.26
Rate for Payer: Cigna Commercial	$1,065.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$639.13
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.57
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$51.34
Rate for Payer: Wellpoint Medicaid Managed Care	$56.46

CT ELBOW W&W/O CONTRAST RIGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205457
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT ELBOW W&W/O CONTRAST RIGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205457
Hospital Revenue Code	352
Min. Negotiated Rate	$51.34
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$809.57
Rate for Payer: Aetna Medicare Advantage	$639.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.26
Rate for Payer: Cigna Commercial	$1,065.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$639.13
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.57
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$51.34
Rate for Payer: Wellpoint Medicaid Managed Care	$56.46

C-TELOPEPTIDE, SERUM

Facility

$92.85

Service Code	HCPCS 82523
Hospital Charge Code	3038129
Hospital Revenue Code	300
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.81
Rate for Payer: Aetna Medicare Advantage	$60.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.43
Rate for Payer: Cigna Commercial	$46.42
Rate for Payer: Cigna Medicare Advantage	$18.68
Rate for Payer: Clover Medicare Advantage	$17.75
Rate for Payer: EmblemHealth Commercial	$56.04
Rate for Payer: Humana Medicare Advantage	$19.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.93
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.68
Rate for Payer: Wellcare Medicare Advantage	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.46

C-TELOPEPTIDE, SERUM

Facility

$92.85

Service Code	HCPCS 82523
Hospital Charge Code	3038129
Hospital Revenue Code	300
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$13.93
Rate for Payer: Qualcare PPO/HMO/WC	$13.93

CT ENDOCRINE SURGERY PROCEDURE

Facility

$21,205.25

Service Code	HCPCS 60699
Hospital Charge Code	2205492
Hospital Revenue Code	361
Min. Negotiated Rate	$511.05
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,361.57
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.79
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$511.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$561.94

Know your out-of-pocket cost for care.

All Charges