Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIGITAL DIAG ADD VIEWS LT

Facility

$438.00

Service Code	HCPCS G0206
Hospital Charge Code	94061457
Hospital Revenue Code	401
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$166.44
Rate for Payer: Aetna Medicare Advantage	$131.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.69
Rate for Payer: Cigna Commercial	$219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.40
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.70
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$10.56
Rate for Payer: Wellpoint Medicaid Managed Care	$11.61

DIGITAL DIAG ADD VIEWS RT

Facility

$438.00

Service Code	HCPCS G0206
Hospital Charge Code	94061459
Hospital Revenue Code	401
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$166.44
Rate for Payer: Aetna Medicare Advantage	$131.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.69
Rate for Payer: Cigna Commercial	$219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.40
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.70
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$10.56
Rate for Payer: Wellpoint Medicaid Managed Care	$11.61

DIGITAL DIAG ADD VIEWS RT

Facility

$438.00

Service Code	HCPCS G0206
Hospital Charge Code	94061459
Hospital Revenue Code	401
Min. Negotiated Rate	$65.70
Max. Negotiated Rate	$65.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.70

DIGITAL DIAG MAMMO BIL

Facility

$784.00

Service Code	HCPCS G0204
Hospital Charge Code	94061447
Hospital Revenue Code	401
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$117.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.60

DIGITAL DIAG MAMMO BIL

Facility

$784.00

Service Code	HCPCS G0204
Hospital Charge Code	94061447
Hospital Revenue Code	401
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$297.92
Rate for Payer: Aetna Medicare Advantage	$235.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.92
Rate for Payer: Cigna Commercial	$392.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.20
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.60
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$18.89
Rate for Payer: Wellpoint Medicaid Managed Care	$20.78

DIGITAL DIAG MAMMO LT

Facility

$438.00

Service Code	HCPCS G0206
Hospital Charge Code	94061449
Hospital Revenue Code	401
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$166.44
Rate for Payer: Aetna Medicare Advantage	$131.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.69
Rate for Payer: Cigna Commercial	$219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.40
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.70
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$10.56
Rate for Payer: Wellpoint Medicaid Managed Care	$11.61

DIGITAL DIAG MAMMO LT

Facility

$438.00

Service Code	HCPCS G0206
Hospital Charge Code	94061449
Hospital Revenue Code	401
Min. Negotiated Rate	$65.70
Max. Negotiated Rate	$65.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.70

DIGITAL MAMMO UNI RT

Facility

$438.00

Service Code	HCPCS G0206
Hospital Charge Code	94061451
Hospital Revenue Code	401
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$166.44
Rate for Payer: Aetna Medicare Advantage	$131.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.69
Rate for Payer: Cigna Commercial	$219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.40
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.70
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$10.56
Rate for Payer: Wellpoint Medicaid Managed Care	$11.61

DIGITAL MAMMO UNI RT

Facility

$438.00

Service Code	HCPCS G0206
Hospital Charge Code	94061451
Hospital Revenue Code	401
Min. Negotiated Rate	$65.70
Max. Negotiated Rate	$65.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.70

DIGITAL RECTAL EXAM

Facility

$67.00

Service Code	HCPCS G0102
Hospital Charge Code	87502815
Hospital Revenue Code	510
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

DIGITAL RECTAL EXAM

Facility

$67.00

Service Code	HCPCS G0102
Hospital Charge Code	87502670
Hospital Revenue Code	770
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.10
Rate for Payer: Oxford Commercial	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$13.40
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

DIGITAL RECTAL EXAM

Facility

$67.00

Service Code	HCPCS G0102
Hospital Charge Code	87502670
Hospital Revenue Code	770
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

DIGITAL RECTAL EXAM

Facility

$67.00

Service Code	HCPCS G0102
Hospital Charge Code	87502815
Hospital Revenue Code	510
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Service Code	HCPCS G020252
Hospital Charge Code	94061475
Hospital Revenue Code	403
Min. Negotiated Rate	$142.53
Max. Negotiated Rate	$142.53
Rate for Payer: Qualcare PPO/HMO/WC	$142.53

DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Service Code	HCPCS G020252
Hospital Charge Code	94061475
Hospital Revenue Code	403
Min. Negotiated Rate	$22.90
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$361.08
Rate for Payer: Aetna Medicare Advantage	$285.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.30
Rate for Payer: Cigna Commercial	$475.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.06
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.53
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$22.90
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

DIGITOXIN

Facility

$292.00

Service Code	HCPCS 80299
Hospital Charge Code	38472404
Hospital Revenue Code	301
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

DIGITOXIN

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39900481
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DIGITOXIN

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39900481
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DIGITOXIN

Facility

$253.45

Service Code	HCPCS 82937
Hospital Charge Code	3001088
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

DIGITOXIN

Facility

$253.45

Service Code	HCPCS 82937
Hospital Charge Code	3001088
Hospital Revenue Code	301
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$126.72
Rate for Payer: Aetna Commercial	$96.31
Rate for Payer: Aetna Medicare Advantage	$76.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.63
Rate for Payer: Cigna Commercial	$126.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.72

DIGITOXIN

Facility

$292.00

Service Code	HCPCS 80299
Hospital Charge Code	38472404
Hospital Revenue Code	301
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$146.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$146.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.74

DIGOXIN

Facility

$146.00

Service Code	HCPCS 80162
Hospital Charge Code	38472275
Hospital Revenue Code	301
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.12
Rate for Payer: Aetna Medicare Advantage	$43.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.94
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: Cigna Medicare Advantage	$13.28
Rate for Payer: Clover Medicare Advantage	$12.62
Rate for Payer: EmblemHealth Commercial	$39.84
Rate for Payer: Humana Medicare Advantage	$13.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.28
Rate for Payer: Wellcare Medicare Advantage	$13.28
Rate for Payer: Wellpoint Medicaid Managed Care	$3.87

DIGOXIN

Facility

$146.00

Service Code	HCPCS 80162
Hospital Charge Code	38472275
Hospital Revenue Code	301
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

DIGOXIN 0.25MG/5ML ORAL SOLUTI

Facility

$93.80

Service Code	NDC 54005746
Hospital Charge Code	60630171
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$46.90
Rate for Payer: Aetna Commercial	$35.64
Rate for Payer: Aetna Medicare Advantage	$28.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.92
Rate for Payer: Cigna Commercial	$46.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.14
Rate for Payer: Oxford Commercial	$18.76
Rate for Payer: Qualcare PPO/HMO/WC	$14.07
Rate for Payer: UnitedHealthcare Commercial	$18.76
Rate for Payer: UnitedHealthcare Community & State	$2.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.49

DIGOXIN 0.25MG/5ML ORAL SOLUTI

Facility

$93.80

Service Code	NDC 54005746
Hospital Charge Code	60630171
Hospital Revenue Code	250
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$14.07
Rate for Payer: Qualcare PPO/HMO/WC	$14.07

Know your out-of-pocket cost for care.

All Charges