Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CT FOREARM W/+W/O CONTRST RGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205359
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 FOREARM W/+W/O CONTRST RGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205359
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT GASTROSTOMY TUBE PLACE PERC

Facility

$8,686.35

Service Code	HCPCS 49440
Hospital Charge Code	2200010
Hospital Revenue Code	361
Min. Negotiated Rate	$1,302.95
Max. Negotiated Rate	$1,302.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,302.95

CT GASTROSTOMY TUBE PLACE PERC

Facility

$8,686.35

Service Code	HCPCS 49440
Hospital Charge Code	2200010
Hospital Revenue Code	361
Min. Negotiated Rate	$209.34
Max. Negotiated Rate	$8,229.07
Rate for Payer: Aetna Commercial	$6,200.81
Rate for Payer: Aetna Medicare Advantage	$7,386.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,279.71
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	$8,229.07
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Cigna Medicare Advantage	$2,279.71
Rate for Payer: Clover Medicare Advantage	$2,165.72
Rate for Payer: EmblemHealth Commercial	$6,839.13
Rate for Payer: Humana Medicare Advantage	$2,348.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,279.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,605.91
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,302.95
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$209.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,279.71
Rate for Payer: Wellcare Medicare Advantage	$2,279.71
Rate for Payer: Wellpoint Medicaid Managed Care	$230.19

CT/GC, TMA RECTAL

Facility

$175.45

Service Code	HCPCS 87591
Hospital Charge Code	401087591
Hospital Revenue Code	306
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$126.66
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$87.72
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.32
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.65

CT/GC, TMA RECTAL

Facility

$175.45

Service Code	HCPCS 87591
Hospital Charge Code	401087591
Hospital Revenue Code	306
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$26.32
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

CT GUIDANCE FOR INJECTION

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205366
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 GUIDANCE FOR INJECTION

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2205366
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 GUIDANCE NEEDLE BIOPSY

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2200236
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 GUIDANCE NEEDLE BIOPSY

Facility

$9,500.00

Service Code	HCPCS 77012
Hospital Charge Code	2200236
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 GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	7411757
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 GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2690270
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 GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	321077012
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 GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	2690270
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	321077012
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	7411757
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT GUIDE PERCUTANE VERTBRPLSTY

Facility

$935.50

Service Code	HCPCS 72292
Hospital Charge Code	2205367
Hospital Revenue Code	359
Min. Negotiated Rate	$140.32
Max. Negotiated Rate	$140.32
Rate for Payer: Qualcare PPO/HMO/WC	$140.32

CT GUIDE PERCUTANE VERTBRPLSTY

Facility

$935.50

Service Code	HCPCS 72292
Hospital Charge Code	2205367
Hospital Revenue Code	359
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$355.49
Rate for Payer: Aetna Medicare Advantage	$280.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.55
Rate for Payer: Cigna Commercial	$467.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.65
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.32
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$22.55
Rate for Payer: Wellpoint Medicaid Managed Care	$24.79

CT GUI MONITOR TIS ABLATION

Facility

$1,605.00

Service Code	HCPCS 77013
Hospital Charge Code	2200240
Hospital Revenue Code	350
Min. Negotiated Rate	$38.68
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$609.90
Rate for Payer: Aetna Medicare Advantage	$481.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$409.27
Rate for Payer: Cigna Commercial	$802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$481.50
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.75
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$38.68
Rate for Payer: Wellpoint Medicaid Managed Care	$42.53

CT GUI MONITOR TIS ABLATION

Facility

$1,605.00

Service Code	HCPCS 77013
Hospital Charge Code	2200240
Hospital Revenue Code	350
Min. Negotiated Rate	$240.75
Max. Negotiated Rate	$240.75
Rate for Payer: Qualcare PPO/HMO/WC	$240.75

CT HAND W/ CONTRAST BILATERAL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205371
Hospital Revenue Code	352
Min. Negotiated Rate	$533.05
Max. Negotiated Rate	$533.05
Rate for Payer: Qualcare PPO/HMO/WC	$533.05

CT HAND W/ CONTRAST BILATERAL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205371
Hospital Revenue Code	352
Min. Negotiated Rate	$85.64
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,350.41
Rate for Payer: Aetna Medicare Advantage	$1,066.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$906.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$906.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$906.19
Rate for Payer: Cigna Commercial	$1,776.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.11
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$533.05
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$85.64
Rate for Payer: Wellpoint Medicaid Managed Care	$94.17

CT HAND W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205372
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT HAND W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205372
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 HAND W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205373
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

Know your out-of-pocket cost for care.

All Charges