Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DXA CT BONE DENSITY AXIAL-PC

Facility

$53.45

Service Code	HCPCS 7708026
Hospital Charge Code	85000320
Hospital Revenue Code	320
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$20.31
Rate for Payer: Aetna Medicare Advantage	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.63
Rate for Payer: Cigna Commercial	$26.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.04
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.02
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$1.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

DXA CT BONE DENSITY AXIAL-TC

Facility

$278.30

Service Code	HCPCS 77080TC
Hospital Charge Code	85000315
Hospital Revenue Code	320
Min. Negotiated Rate	$41.74
Max. Negotiated Rate	$41.74
Rate for Payer: Qualcare PPO/HMO/WC	$41.74

DXA CT BONE DENSITY AXIAL-TC

Facility

$278.30

Service Code	HCPCS 77080TC
Hospital Charge Code	85000315
Hospital Revenue Code	320
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$105.75
Rate for Payer: Aetna Medicare Advantage	$83.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.97
Rate for Payer: Cigna Commercial	$139.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.49
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.74
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.71
Rate for Payer: Wellpoint Medicaid Managed Care	$7.37

DXA CT BONE DENSITY PERIPH-GL

Facility

$228.55

Service Code	HCPCS 77081
Hospital Charge Code	85000325
Hospital Revenue Code	320
Min. Negotiated Rate	$34.28
Max. Negotiated Rate	$34.28
Rate for Payer: Qualcare PPO/HMO/WC	$34.28

DXA CT BONE DENSITY PERIPH-GL

Facility

$228.55

Service Code	HCPCS 77081
Hospital Charge Code	85000325
Hospital Revenue Code	320
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.56
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.28
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.06

DXA CT BONE DENSITY PERIPH-PC

Facility

$59.05

Service Code	HCPCS 7708126
Hospital Charge Code	85000335
Hospital Revenue Code	320
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$8.86
Rate for Payer: Qualcare PPO/HMO/WC	$8.86

DXA CT BONE DENSITY PERIPH-PC

Facility

$59.05

Service Code	HCPCS 7708126
Hospital Charge Code	85000335
Hospital Revenue Code	320
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$22.44
Rate for Payer: Aetna Medicare Advantage	$17.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.06
Rate for Payer: Cigna Commercial	$29.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.71
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.86
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

DXA CT BONE DENSITY PERIPH-TC

Facility

$106.75

Service Code	HCPCS 77081TC
Hospital Charge Code	85000330
Hospital Revenue Code	320
Min. Negotiated Rate	$16.01
Max. Negotiated Rate	$16.01
Rate for Payer: Qualcare PPO/HMO/WC	$16.01

DXA CT BONE DENSITY PERIPH-TC

Facility

$106.75

Service Code	HCPCS 77081TC
Hospital Charge Code	85000330
Hospital Revenue Code	320
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$40.56
Rate for Payer: Aetna Medicare Advantage	$32.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.22
Rate for Payer: Cigna Commercial	$53.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.02
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.01
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.57
Rate for Payer: Wellpoint Medicaid Managed Care	$2.83

DXA CT BONE DENSITY VERT FX-PC

Facility

$46.10

Service Code	HCPCS 7708226
Hospital Charge Code	85000350
Hospital Revenue Code	320
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$6.92

DXA CT BONE DENSITY VERT FX-PC

Facility

$46.10

Service Code	HCPCS 7708226
Hospital Charge Code	85000350
Hospital Revenue Code	320
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$17.52
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.76
Rate for Payer: Cigna Commercial	$23.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.83
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.92
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

DXA CT BONE DENSITY VERT FX-TC

Facility

$120.85

Service Code	HCPCS 77082TC
Hospital Charge Code	85000345
Hospital Revenue Code	320
Min. Negotiated Rate	$18.13
Max. Negotiated Rate	$18.13
Rate for Payer: Qualcare PPO/HMO/WC	$18.13

DXA CT BONE DENSITY VERT FX-TC

Facility

$120.85

Service Code	HCPCS 77082TC
Hospital Charge Code	85000345
Hospital Revenue Code	320
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$45.92
Rate for Payer: Aetna Medicare Advantage	$36.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.82
Rate for Payer: Cigna Commercial	$60.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.26
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.13
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.91
Rate for Payer: Wellpoint Medicaid Managed Care	$3.20

DX-ADRENAL ANGIOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7573350
Hospital Charge Code	7411840
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-ADRENAL ANGIOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7573350
Hospital Charge Code	2690750
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-ADRENAL ANGIOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7573350
Hospital Charge Code	2690750
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-ADRENAL ANGIOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7573350
Hospital Charge Code	7411840
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-ADRENAL ANGIOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75731LT
Hospital Charge Code	2691885
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-ADRENAL ANGIOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75731LT
Hospital Charge Code	2691885
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-ADRENAL ANGIOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75731LT
Hospital Charge Code	7412006
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-ADRENAL ANGIOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75731LT
Hospital Charge Code	7412006
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-ADRENAL ANGIOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75731RT
Hospital Charge Code	7412007
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-ADRENAL ANGIOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75731RT
Hospital Charge Code	7412007
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-ADRENAL ANGIOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75731RT
Hospital Charge Code	2691890
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-ADRENAL ANGIOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75731RT
Hospital Charge Code	2691890
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

Know your out-of-pocket cost for care.

All Charges