Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX-DIL OF NEPHROSTOMY-RT

Facility

$10,187.80

Service Code	HCPCS 74485RT
Hospital Charge Code	321074485R
Hospital Revenue Code	320
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

DX-DIL OF NEPHROSTOMY-RT

Facility

$10,187.80

Service Code	HCPCS 74485RT
Hospital Charge Code	411074485
Hospital Revenue Code	320
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

DX-DIL OF NEPHROSTOMY-RT

Facility

$5,055.00

Service Code	HCPCS 74485RT
Hospital Charge Code	7411997
Hospital Revenue Code	320
Min. Negotiated Rate	$121.83
Max. Negotiated Rate	$2,527.50
Rate for Payer: Aetna Commercial	$1,920.90
Rate for Payer: Aetna Medicare Advantage	$1,516.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,289.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,289.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,289.03
Rate for Payer: Cigna Commercial	$2,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,516.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$758.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$121.83
Rate for Payer: Wellpoint Medicaid Managed Care	$133.96

DX-DIL OF NEPHROSTOMY-RT

Facility

$10,187.80

Service Code	HCPCS 74485RT
Hospital Charge Code	366874485R
Hospital Revenue Code	320
Min. Negotiated Rate	$1,528.17
Max. Negotiated Rate	$1,528.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17

DX-DIL OF NEPHROSTOMY-RT

Facility

$10,187.80

Service Code	HCPCS 74485RT
Hospital Charge Code	366874485R
Hospital Revenue Code	320
Min. Negotiated Rate	$245.53
Max. Negotiated Rate	$5,093.90
Rate for Payer: Aetna Commercial	$3,871.36
Rate for Payer: Aetna Medicare Advantage	$3,056.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,597.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,597.89
Rate for Payer: Cigna Commercial	$5,093.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,056.34
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,528.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$245.53
Rate for Payer: Wellpoint Medicaid Managed Care	$269.98

DX ELBOW AP AND LAT - BILAT

Facility

$244.00

Service Code	HCPCS 73070
Hospital Charge Code	2011520
Hospital Revenue Code	320
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

DX ELBOW AP AND LAT - BILAT

Facility

$244.00

Service Code	HCPCS 73070
Hospital Charge Code	2011520
Hospital Revenue Code	320
Min. Negotiated Rate	$5.88
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	$31.94
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	$73.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.47

DX ER ABD COMPL INC CHEST

Facility

$788.00

Service Code	HCPCS 74022
Hospital Charge Code	94270065
Hospital Revenue Code	320
Min. Negotiated Rate	$18.99
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	$53.24
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	$236.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$18.99
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	$20.88

DX ER ABD COMPL INC CHEST

Facility

$788.00

Service Code	HCPCS 74022
Hospital Charge Code	94270065
Hospital Revenue Code	320
Min. Negotiated Rate	$118.20
Max. Negotiated Rate	$118.20
Rate for Payer: Qualcare PPO/HMO/WC	$118.20

DX ER ABDOMEN MULTIPLE VW

Facility

$416.00

Service Code	HCPCS 74020
Hospital Charge Code	94270063
Hospital Revenue Code	320
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$62.40

DX ER ABDOMEN MULTIPLE VW

Facility

$416.00

Service Code	HCPCS 74020
Hospital Charge Code	94270063
Hospital Revenue Code	320
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$158.08
Rate for Payer: Aetna Medicare Advantage	$124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.08
Rate for Payer: Cigna Commercial	$208.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.40
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$10.03
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$11.02

DX ER ABDOMEN SINGLE VIEW

Facility

$306.00

Service Code	HCPCS 74000
Hospital Charge Code	94270059
Hospital Revenue Code	320
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

DX ER ABDOMEN SINGLE VIEW

Facility

$306.00

Service Code	HCPCS 74000
Hospital Charge Code	94270059
Hospital Revenue Code	320
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$116.28
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.37
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19
Rate for Payer: Wellpoint Medicaid Managed Care	$8.11

DX ER ANKLE AP&LA POST LT

Facility

$251.00

Service Code	HCPCS 73600LT
Hospital Charge Code	94270217
Hospital Revenue Code	320
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$37.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

DX ER ANKLE AP&LA POST LT

Facility

$251.00

Service Code	HCPCS 73600LT
Hospital Charge Code	94270217
Hospital Revenue Code	320
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

DX ER ANKLE AP&LAT BIL

Facility

$250.00

Service Code	HCPCS 7360050
Hospital Charge Code	94270103
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX ER ANKLE AP&LAT BIL

Facility

$250.00

Service Code	HCPCS 7360050
Hospital Charge Code	94270103
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

DX ER ANKLE AP&LAT LT

Facility

$251.00

Service Code	HCPCS 73600LT
Hospital Charge Code	94270215
Hospital Revenue Code	320
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$37.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

DX ER ANKLE AP&LAT LT

Facility

$251.00

Service Code	HCPCS 73600LT
Hospital Charge Code	94270215
Hospital Revenue Code	320
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

DX ER ANKLE APLAT POST BI

Facility

$250.00

Service Code	HCPCS 7360050
Hospital Charge Code	94270101
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX ER ANKLE APLAT POST BI

Facility

$250.00

Service Code	HCPCS 7360050
Hospital Charge Code	94270101
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

DX ER ANKLE APLAT POST RT

Facility

$250.00

Service Code	HCPCS 73600RT
Hospital Charge Code	94270219
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX ER ANKLE APLAT POST RT

Facility

$250.00

Service Code	HCPCS 73600RT
Hospital Charge Code	94270219
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

DX ER ANKLE AP&LAT RT

Facility

$251.00

Service Code	HCPCS 73600RT
Hospital Charge Code	94270221
Hospital Revenue Code	320
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

DX ER ANKLE AP&LAT RT

Facility

$251.00

Service Code	HCPCS 73600RT
Hospital Charge Code	94270221
Hospital Revenue Code	320
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$37.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

Know your out-of-pocket cost for care.

All Charges