Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX-ADRENAL VENOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7584250
Hospital Charge Code	2690765
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 VENOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7584250
Hospital Charge Code	7411842
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 VENOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7584250
Hospital Charge Code	7411842
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 VENOGRAPHY-BI

Facility

$8,633.00

Service Code	HCPCS 7584250
Hospital Charge Code	2690765
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 VENOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75840LT
Hospital Charge Code	7412016
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 VENOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75840LT
Hospital Charge Code	7412016
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 VENOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75840LT
Hospital Charge Code	2691950
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 VENOGRAPHY-LT

Facility

$8,633.00

Service Code	HCPCS 75840LT
Hospital Charge Code	2691950
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 VENOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75840RT
Hospital Charge Code	2691955
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 VENOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75840RT
Hospital Charge Code	7412017
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 VENOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75840RT
Hospital Charge Code	7412017
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 VENOGRAPHY-RT

Facility

$8,633.00

Service Code	HCPCS 75840RT
Hospital Charge Code	2691955
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-ANGIO AV DIALYIS SHUNT

Facility

$2,117.00

Hospital Charge Code	2009085
Hospital Revenue Code	323
Min. Negotiated Rate	$51.02
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$804.46
Rate for Payer: Aetna Medicare Advantage	$635.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$539.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$539.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$539.84
Rate for Payer: Cigna Commercial	$1,058.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$317.55
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$51.02
Rate for Payer: Wellpoint Medicaid Managed Care	$56.10

DX-ANGIO AV DIALYIS SHUNT

Facility

$2,117.00

Hospital Charge Code	2009085
Hospital Revenue Code	323
Min. Negotiated Rate	$317.55
Max. Negotiated Rate	$317.55
Rate for Payer: Qualcare PPO/HMO/WC	$317.55

DX-ANGIO PULMONARY-BILAT

Facility

$8,275.00

Hospital Charge Code	2009080
Hospital Revenue Code	323
Min. Negotiated Rate	$1,241.25
Max. Negotiated Rate	$1,241.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,241.25

DX-ANGIO PULMONARY-BILAT

Facility

$8,275.00

Hospital Charge Code	2009080
Hospital Revenue Code	323
Min. Negotiated Rate	$199.43
Max. Negotiated Rate	$4,137.50
Rate for Payer: Aetna Commercial	$3,144.50
Rate for Payer: Aetna Medicare Advantage	$2,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,110.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,110.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,110.12
Rate for Payer: Cigna Commercial	$4,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,482.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,241.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$199.43
Rate for Payer: Wellpoint Medicaid Managed Care	$219.29

DX-ARTERIO EXTR UNILA

Facility

$6,122.00

Hospital Charge Code	2009060
Hospital Revenue Code	323
Min. Negotiated Rate	$147.54
Max. Negotiated Rate	$3,061.00
Rate for Payer: Aetna Commercial	$2,326.36
Rate for Payer: Aetna Medicare Advantage	$1,836.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.11
Rate for Payer: Cigna Commercial	$3,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,836.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$918.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$147.54
Rate for Payer: Wellpoint Medicaid Managed Care	$162.23

DX-ARTERIO EXTR UNILA

Facility

$6,122.00

Hospital Charge Code	2009060
Hospital Revenue Code	323
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

DX-ARTHO SHOULDER-RT

Facility

$918.00

Hospital Charge Code	2009235
Hospital Revenue Code	320
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$137.70
Rate for Payer: Qualcare PPO/HMO/WC	$137.70

DX-ARTHO SHOULDER-RT

Facility

$918.00

Hospital Charge Code	2009235
Hospital Revenue Code	320
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$348.84
Rate for Payer: Aetna Medicare Advantage	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.09
Rate for Payer: Cigna Commercial	$459.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$137.70
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$24.33

DX-ARTHROGRAM KNEE-LT

Facility

$1,447.00

Hospital Charge Code	2009240
Hospital Revenue Code	320
Min. Negotiated Rate	$34.87
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$549.86
Rate for Payer: Aetna Medicare Advantage	$434.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$368.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$368.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$368.99
Rate for Payer: Cigna Commercial	$723.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.05
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$34.87
Rate for Payer: Wellpoint Medicaid Managed Care	$38.35

DX-ARTHROGRAM KNEE-LT

Facility

$1,447.00

Hospital Charge Code	2009240
Hospital Revenue Code	320
Min. Negotiated Rate	$217.05
Max. Negotiated Rate	$217.05
Rate for Payer: Qualcare PPO/HMO/WC	$217.05

DX-ARTHROGRAM KNEE-RT

Facility

$1,051.00

Hospital Charge Code	2009245
Hospital Revenue Code	320
Min. Negotiated Rate	$157.65
Max. Negotiated Rate	$157.65
Rate for Payer: Qualcare PPO/HMO/WC	$157.65

DX-ARTHROGRAM KNEE-RT

Facility

$1,051.00

Hospital Charge Code	2009245
Hospital Revenue Code	320
Min. Negotiated Rate	$25.33
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$399.38
Rate for Payer: Aetna Medicare Advantage	$315.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$268.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$268.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$268.00
Rate for Payer: Cigna Commercial	$525.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$25.33
Rate for Payer: Wellpoint Medicaid Managed Care	$27.85

DX-BARIUM SWALLOW

Facility

$5,100.00

Service Code	HCPCS 74210
Hospital Charge Code	2008020
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges