Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

CT HUMERUS W/O CONTRAST BILTRL

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205392
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 HUMERUS W/O CONTRAST BILTRL

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205392
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT HUMERUS W/O CONTRAST LEFT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205394
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 HUMERUS W/O CONTRAST LEFT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205394
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT HUMERUS W/O CONTRAST RIGHT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205393
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 HUMERUS W/O CONTRAST RIGHT

Facility

$1,120.75

Service Code	HCPCS 73200
Hospital Charge Code	2205393
Hospital Revenue Code	352
Min. Negotiated Rate	$168.11
Max. Negotiated Rate	$168.11
Rate for Payer: Qualcare PPO/HMO/WC	$168.11

CT HUMERUS W/+W/O CNTRST BLTRL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205386
Hospital Revenue Code	352
Min. Negotiated Rate	$639.13
Max. Negotiated Rate	$639.13
Rate for Payer: Qualcare PPO/HMO/WC	$639.13

CT HUMERUS W/+W/O CNTRST BLTRL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205386
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 HUMERUS W/+W/O CONTRST LEFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205387
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT HUMERUS W/+W/O CONTRST LEFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205387
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 HUMERUS W/+W/O CONTRST RGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205388
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 HUMERUS W/+W/O CONTRST RGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205388
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT KNEE W/ CONTRAST BILATERAL

Facility

$3,620.40

Service Code	HCPCS 7370150
Hospital Charge Code	2205398
Hospital Revenue Code	352
Min. Negotiated Rate	$543.06
Max. Negotiated Rate	$543.06
Rate for Payer: Qualcare PPO/HMO/WC	$543.06

CT KNEE W/ CONTRAST BILATERAL

Facility

$3,620.40

Service Code	HCPCS 7370150
Hospital Charge Code	2205398
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

CT KNEE W/ CONTRAST LEFT

Facility

$1,810.20

Service Code	HCPCS 73701LT
Hospital Charge Code	2205399
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT KNEE W/ CONTRAST LEFT

Facility

$1,810.20

Service Code	HCPCS 73701LT
Hospital Charge Code	2205399
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 KNEE W/ CONTRAST RIGHT

Facility

$1,810.20

Service Code	HCPCS 73701RT
Hospital Charge Code	2205400
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT KNEE W/ CONTRAST RIGHT

Facility

$1,810.20

Service Code	HCPCS 73701RT
Hospital Charge Code	2205400
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 KNEE W/O CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 73700
Hospital Charge Code	2205401
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 KNEE W/O CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 73700
Hospital Charge Code	2205401
Hospital Revenue Code	352
Min. Negotiated Rate	$86.94
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	$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: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CT KNEE W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2205402
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 KNEE W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2205402
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 KNEE W/O CONTRAST RIGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2205403
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 KNEE W/O CONTRAST RIGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2205403
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

Know your out-of-pocket cost for care.

All Charges