Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CT HIGH CONT 400 & UP PER ML

Facility

$8.00

Hospital Charge Code	2209050
Hospital Revenue Code	255
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

CT HIGH CONT 400 & UP PER ML

Facility

$8.00

Hospital Charge Code	2209050
Hospital Revenue Code	255
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

CT HIP W/ CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 7370150
Hospital Charge Code	2205380
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT HIP W/ CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 7370150
Hospital Charge Code	2205380
Hospital Revenue Code	352
Min. Negotiated Rate	$228.95
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) 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 HIP W/ CONTRAST LEFT

Facility

$1,810.20

Service Code	HCPCS 73701LT
Hospital Charge Code	2205381
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

CT HIP W/ CONTRAST LEFT

Facility

$1,810.20

Service Code	HCPCS 73701LT
Hospital Charge Code	2205381
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT HIP W/O CONTRAST BILATERAL

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205383
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 HIP W/O CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 7370050
Hospital Charge Code	2205495
Hospital Revenue Code	352
Min. Negotiated Rate	$228.95
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) 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 HIP W/O CONTRAST BILATERAL

Facility

$1,120.75

Service Code	HCPCS 73700
Hospital Charge Code	2205383
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT HIP W/O CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 7370050
Hospital Charge Code	2205495
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT HIP W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2205384
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT HIP W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2205384
Hospital Revenue Code	352
Min. Negotiated Rate	$228.95
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) 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 HIP W/+W/O CONTRAST LEFT

Facility

$1,810.20

Service Code	HCPCS 73702LT
Hospital Charge Code	2205378
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT HIP W/+W/O CONTRAST LEFT

Facility

$1,810.20

Service Code	HCPCS 73702LT
Hospital Charge Code	2205378
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

CT HIP W/+W/O CONTRAST RIGHT

Facility

$1,810.20

Service Code	HCPCS 73702RT
Hospital Charge Code	2205379
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

CT HIP W/+W/O CONTRAST RIGHT

Facility

$1,810.20

Service Code	HCPCS 73702RT
Hospital Charge Code	2205379
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT HIP W/+W/O CONTRST BILATERL

Facility

$3,620.40

Service Code	HCPCS 7370250
Hospital Charge Code	2205377
Hospital Revenue Code	352
Min. Negotiated Rate	$543.06
Max. Negotiated Rate	$543.06
Rate for Payer: Qualcare PPO/HMO/WC	$543.06

CT HIP W/+W/O CONTRST BILATERL

Facility

$3,620.40

Service Code	HCPCS 7370250
Hospital Charge Code	2205377
Hospital Revenue Code	352
Min. Negotiated Rate	$87.25
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$1,375.75
Rate for Payer: Aetna Medicare Advantage	$1,086.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$923.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$923.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$923.20
Rate for Payer: Cigna Commercial	$1,810.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,086.12
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$543.06
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$87.25
Rate for Payer: Wellpoint Medicaid Managed Care	$95.94

CTH SLVERHWK LSM 6.0 P4052

Facility

$15,750.00

Hospital Charge Code	270642865C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$3,811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,465.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

CTH SLVERHWK LSM 6.0 P4052

Facility

$15,750.00

Hospital Charge Code	270642865C
Hospital Revenue Code	278
Min. Negotiated Rate	$379.57
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$5,985.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,465.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50
Rate for Payer: UnitedHealthcare Community & State	$379.57
Rate for Payer: Wellpoint Medicaid Managed Care	$417.38

CT HUMERUS W/ CONTRAST BILATRL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205389
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 HUMERUS W/ CONTRAST BILATRL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205389
Hospital Revenue Code	352
Min. Negotiated Rate	$533.05
Max. Negotiated Rate	$533.05
Rate for Payer: Qualcare PPO/HMO/WC	$533.05

CT HUMERUS W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205390
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 HUMERUS W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205390
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT HUMERUS W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205391
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

Know your out-of-pocket cost for care.

All Charges