Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CT TX PROX HUMERAL FX,W MANIP

Facility

$14,872.30

Service Code	HCPCS 23605
Hospital Charge Code	1600000531
Hospital Revenue Code	360
Min. Negotiated Rate	$2,230.84
Max. Negotiated Rate	$2,230.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,230.84

CT UPPER EXTRMTY W/CNTST BLTRL

Facility

$1,521.90

Service Code	HCPCS 73702
Hospital Charge Code	2205437
Hospital Revenue Code	352
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$338.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$40.33

CT UPPER EXTRMTY W/CNTST BLTRL

Facility

$1,521.90

Service Code	HCPCS 73702
Hospital Charge Code	2205437
Hospital Revenue Code	352
Min. Negotiated Rate	$228.28
Max. Negotiated Rate	$228.28
Rate for Payer: Qualcare PPO/HMO/WC	$228.28

CT UPR XTRMTY W/&W/O CNST BLTL

Facility

$1,810.20

Service Code	HCPCS 73202
Hospital Charge Code	2205438
Hospital Revenue Code	352
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
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	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$47.97

CT UPR XTRMTY W/&W/O CNST BLTL

Facility

$1,810.20

Service Code	HCPCS 73202
Hospital Charge Code	2205438
Hospital Revenue Code	352
Min. Negotiated Rate	$271.53
Max. Negotiated Rate	$271.53
Rate for Payer: Qualcare PPO/HMO/WC	$271.53

CT UPR XTRMTY W/&W/O CNST RGHT

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205439
Hospital Revenue Code	352
Min. Negotiated Rate	$639.13
Max. Negotiated Rate	$639.13
Rate for Payer: Qualcare PPO/HMO/WC	$639.13

CT UPR XTRMTY W/&W/O CNST RGHT

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205439
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 WRIST W/ CONTRAST BILATERAL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205443
Hospital Revenue Code	352
Min. Negotiated Rate	$533.05
Max. Negotiated Rate	$533.05
Rate for Payer: Qualcare PPO/HMO/WC	$533.05

CT WRIST W/ CONTRAST BILATERAL

Facility

$3,553.70

Service Code	HCPCS 7320150
Hospital Charge Code	2205443
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 WRIST W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205444
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 WRIST W/ CONTRAST LEFT

Facility

$1,776.85

Service Code	HCPCS 73201LT
Hospital Charge Code	2205444
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT WRIST W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205445
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 WRIST W/ CONTRAST RIGHT

Facility

$1,776.85

Service Code	HCPCS 73201RT
Hospital Charge Code	2205445
Hospital Revenue Code	352
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

CT WRIST W/O CONTRAST LEFT

Facility

$1,568.00

Service Code	HCPCS 73200LT
Hospital Charge Code	2205447
Hospital Revenue Code	352
Min. Negotiated Rate	$235.20
Max. Negotiated Rate	$235.20
Rate for Payer: Qualcare PPO/HMO/WC	$235.20

CT WRIST W/O CONTRAST LEFT

Facility

$1,568.00

Service Code	HCPCS 73200LT
Hospital Charge Code	2205447
Hospital Revenue Code	352
Min. Negotiated Rate	$37.79
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$595.84
Rate for Payer: Aetna Medicare Advantage	$470.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.84
Rate for Payer: Cigna Commercial	$784.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.40
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$235.20
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$37.79
Rate for Payer: Wellpoint Medicaid Managed Care	$41.55

CT WRIST W/O CONTRAST RIGHT

Facility

$1,568.00

Service Code	HCPCS 73200RT
Hospital Charge Code	2205448
Hospital Revenue Code	352
Min. Negotiated Rate	$235.20
Max. Negotiated Rate	$235.20
Rate for Payer: Qualcare PPO/HMO/WC	$235.20

CT WRIST W/O CONTRAST RIGHT

Facility

$1,568.00

Service Code	HCPCS 73200RT
Hospital Charge Code	2205448
Hospital Revenue Code	352
Min. Negotiated Rate	$37.79
Max. Negotiated Rate	$3,354.00
Rate for Payer: Aetna Commercial	$595.84
Rate for Payer: Aetna Medicare Advantage	$470.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.84
Rate for Payer: Cigna Commercial	$784.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.40
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$235.20
Rate for Payer: UnitedHealthcare Commercial	$3,354.00
Rate for Payer: UnitedHealthcare Community & State	$37.79
Rate for Payer: Wellpoint Medicaid Managed Care	$41.55

CT WRIST W/&W/O CONTRAST BLTRL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205440
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 WRIST W/&W/O CONTRAST BLTRL

Facility

$4,260.90

Service Code	HCPCS 7320250
Hospital Charge Code	2205440
Hospital Revenue Code	352
Min. Negotiated Rate	$639.13
Max. Negotiated Rate	$639.13
Rate for Payer: Qualcare PPO/HMO/WC	$639.13

CT WRIST W/&W/O CONTRAST LEFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205441
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 WRIST W/&W/O CONTRAST LEFT

Facility

$2,130.45

Service Code	HCPCS 73202LT
Hospital Charge Code	2205441
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT WRIST W/&W/O CONTRAST RIGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205442
Hospital Revenue Code	352
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

CT WRIST W/&W/O CONTRAST RIGHT

Facility

$2,130.45

Service Code	HCPCS 73202RT
Hospital Charge Code	2205442
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

CUBES CANCELLOUS 30CC

Facility

$2,809.65

Hospital Charge Code	270607538
Hospital Revenue Code	278
Min. Negotiated Rate	$421.45
Max. Negotiated Rate	$679.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$561.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$679.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$618.12
Rate for Payer: Qualcare PPO/HMO/WC	$421.45

CUBES CANCELLOUS 30CC

Facility

$2,809.65

Hospital Charge Code	270607538
Hospital Revenue Code	278
Min. Negotiated Rate	$67.71
Max. Negotiated Rate	$1,404.83
Rate for Payer: Aetna Commercial	$1,067.67
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$716.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$716.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$561.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$716.46
Rate for Payer: Cigna Commercial	$1,404.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$679.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$618.12
Rate for Payer: Qualcare PPO/HMO/WC	$421.45
Rate for Payer: UnitedHealthcare Community & State	$67.71
Rate for Payer: Wellpoint Medicaid Managed Care	$74.46

Know your out-of-pocket cost for care.

All Charges