Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	404138222
Hospital Revenue Code	361
Min. Negotiated Rate	$373.46
Max. Negotiated Rate	$12,456.64
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,456.64
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,648.85
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$373.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$410.65

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	321738222
Hospital Revenue Code	361
Min. Negotiated Rate	$2,324.42
Max. Negotiated Rate	$2,324.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	404338222
Hospital Revenue Code	361
Min. Negotiated Rate	$2,324.42
Max. Negotiated Rate	$2,324.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	321738222
Hospital Revenue Code	361
Min. Negotiated Rate	$373.46
Max. Negotiated Rate	$12,456.64
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,456.64
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,648.85
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$373.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$410.65

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	404338222
Hospital Revenue Code	361
Min. Negotiated Rate	$373.46
Max. Negotiated Rate	$12,456.64
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,456.64
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,648.85
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$373.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$410.65

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	404138222
Hospital Revenue Code	361
Min. Negotiated Rate	$2,324.42
Max. Negotiated Rate	$2,324.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42

DX-BONE SURVEY-COMPLETE

Facility

$450.00

Service Code	HCPCS 77075
Hospital Charge Code	2007040
Hospital Revenue Code	320
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$1,975.00
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	$54.23
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	$135.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

DX-BONE SURVEY-COMPLETE

Facility

$450.00

Service Code	HCPCS 77075
Hospital Charge Code	2007040
Hospital Revenue Code	320
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

DX-BRACHIAL RETRO-BI

Facility

$8,633.00

Service Code	HCPCS 7565850
Hospital Charge Code	2690735
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-BRACHIAL RETRO-BI

Facility

$8,633.00

Service Code	HCPCS 7565850
Hospital Charge Code	2690735
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-BRACHIAL RETRO-BI

Facility

$8,633.00

Service Code	HCPCS 7565850
Hospital Charge Code	7411838
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-BRACHIAL RETRO-BI

Facility

$8,633.00

Service Code	HCPCS 7565850
Hospital Charge Code	7411838
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-BRACHIAL RETRO-LT

Facility

$8,633.00

Service Code	HCPCS 75658LT
Hospital Charge Code	2691810
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-BRACHIAL RETRO-LT

Facility

$8,633.00

Service Code	HCPCS 75658LT
Hospital Charge Code	2691810
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-BRACHIAL RETRO-LT

Facility

$8,633.00

Service Code	HCPCS 75658LT
Hospital Charge Code	7411998
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-BRACHIAL RETRO-LT

Facility

$8,633.00

Service Code	HCPCS 75658LT
Hospital Charge Code	7411998
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-BRACHIAL RETRO-RT

Facility

$8,633.00

Service Code	HCPCS 75658RT
Hospital Charge Code	7411999
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-BRACHIAL RETRO-RT

Facility

$8,633.00

Service Code	HCPCS 75658RT
Hospital Charge Code	7411999
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-BRACHIAL RETRO-RT

Facility

$8,633.00

Service Code	HCPCS 75658RT
Hospital Charge Code	2691815
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-BRACHIAL RETRO-RT

Facility

$8,633.00

Service Code	HCPCS 75658RT
Hospital Charge Code	2691815
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-BREAST OR OTH SURG SPECIMEN

Facility

$2,525.90

Service Code	HCPCS 76098
Hospital Charge Code	2007025
Hospital Revenue Code	320
Min. Negotiated Rate	$378.88
Max. Negotiated Rate	$378.88
Rate for Payer: Qualcare PPO/HMO/WC	$378.88

DX-BREAST OR OTH SURG SPECIMEN

Facility

$2,525.90

Service Code	HCPCS 76098
Hospital Charge Code	2007025
Hospital Revenue Code	320
Min. Negotiated Rate	$29.04
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
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	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$66.94

DX-CHANGE ABSCESS CATH

Facility

$1,062.00

Hospital Charge Code	2009135
Hospital Revenue Code	320
Min. Negotiated Rate	$25.59
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$403.56
Rate for Payer: Aetna Medicare Advantage	$318.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.81
Rate for Payer: Cigna Commercial	$531.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$25.59
Rate for Payer: Wellpoint Medicaid Managed Care	$28.14

DX-CHANGE ABSCESS CATH

Facility

$1,062.00

Hospital Charge Code	2009135
Hospital Revenue Code	320
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$159.30
Rate for Payer: Qualcare PPO/HMO/WC	$159.30

Know your out-of-pocket cost for care.

All Charges