Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX ER ANKLE COMPLETE BILA

Facility

$250.00

Service Code	HCPCS 7361050
Hospital Charge Code	94270105
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 COMPLETE BILA

Facility

$250.00

Service Code	HCPCS 7361050
Hospital Charge Code	94270105
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 COMPLETE LT

Facility

$332.00

Service Code	HCPCS 73610LT
Hospital Charge Code	94270223
Hospital Revenue Code	320
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

DX ER ANKLE COMPLETE LT

Facility

$332.00

Service Code	HCPCS 73610LT
Hospital Charge Code	94270223
Hospital Revenue Code	320
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$126.16
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$8.80

DX ER ANKLE COMPLETE RT

Facility

$6,601.19

Service Code	HCPCS 73610RT
Hospital Charge Code	94270225
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

DX ER ANKLE COMPLETE RT

Facility

$6,601.19

Service Code	HCPCS 73610RT
Hospital Charge Code	94270225
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

DX ER BONE EVAL INFANT

Facility

$553.00

Service Code	HCPCS 77076
Hospital Charge Code	94270069
Hospital Revenue Code	320
Min. Negotiated Rate	$82.95
Max. Negotiated Rate	$82.95
Rate for Payer: Qualcare PPO/HMO/WC	$82.95

DX ER BONE EVAL INFANT

Facility

$553.00

Service Code	HCPCS 77076
Hospital Charge Code	94270069
Hospital Revenue Code	320
Min. Negotiated Rate	$13.33
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	$33.65
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	$165.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$13.33
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	$14.65

DX ER CERVICAL SPINE 2 VW

Facility

$378.00

Service Code	HCPCS 72040
Hospital Charge Code	94270039
Hospital Revenue Code	320
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$56.70
Rate for Payer: Qualcare PPO/HMO/WC	$56.70

DX ER CERVICAL SPINE 2 VW

Facility

$378.00

Service Code	HCPCS 72040
Hospital Charge Code	94270039
Hospital Revenue Code	320
Min. Negotiated Rate	$9.11
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	$34.36
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	$113.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.70
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$9.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19
Rate for Payer: Wellpoint Medicaid Managed Care	$10.02

DX ER CERVICAL SPINE COMP

Facility

$817.00

Service Code	HCPCS 72052
Hospital Charge Code	94270041
Hospital Revenue Code	320
Min. Negotiated Rate	$122.55
Max. Negotiated Rate	$122.55
Rate for Payer: Qualcare PPO/HMO/WC	$122.55

DX ER CERVICAL SPINE COMP

Facility

$817.00

Service Code	HCPCS 72052
Hospital Charge Code	94270041
Hospital Revenue Code	320
Min. Negotiated Rate	$19.69
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	$61.10
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	$245.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$122.55
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$19.69
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	$316.08
Rate for Payer: Wellpoint Medicaid Managed Care	$21.65

DX ER CERV SPINE CROSTABL

Facility

$250.00

Service Code	HCPCS 72020
Hospital Charge Code	94270037
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
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	$23.60
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	$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: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

DX ER CERV SPINE CROSTABL

Facility

$250.00

Service Code	HCPCS 72020
Hospital Charge Code	94270037
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 CHEST MULTIPLE VIEW

Facility

$416.00

Service Code	HCPCS 71030
Hospital Charge Code	94270027
Hospital Revenue Code	324
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$62.40

DX ER CHEST MULTIPLE VIEW

Facility

$416.00

Service Code	HCPCS 71030
Hospital Charge Code	94270027
Hospital Revenue Code	324
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: Wellpoint Medicaid Managed Care	$11.02

DX ER CHEST SINGLE VIEW

Facility

$582.98

Service Code	HCPCS 71010
Hospital Charge Code	94270023
Hospital Revenue Code	324
Min. Negotiated Rate	$87.45
Max. Negotiated Rate	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$87.45

DX ER CHEST SINGLE VIEW

Facility

$582.98

Service Code	HCPCS 71010
Hospital Charge Code	94270023
Hospital Revenue Code	324
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$221.53
Rate for Payer: Aetna Medicare Advantage	$174.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.66
Rate for Payer: Cigna Commercial	$291.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.89
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,236.59
Rate for Payer: Wellpoint Medicaid Managed Care	$15.45

DX ER CHEST TWO VIEWS

Facility

$610.00

Service Code	HCPCS 71020
Hospital Charge Code	94270025
Hospital Revenue Code	324
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

DX ER CHEST TWO VIEWS

Facility

$610.00

Service Code	HCPCS 71020
Hospital Charge Code	94270025
Hospital Revenue Code	324
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,236.59
Rate for Payer: Wellpoint Medicaid Managed Care	$16.16

DX ER CLAVICLE COMP BIL

Facility

$250.00

Service Code	HCPCS 7300050
Hospital Charge Code	94270073
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 CLAVICLE COMP BIL

Facility

$250.00

Service Code	HCPCS 7300050
Hospital Charge Code	94270073
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 CLAVICLE COMPLET LT

Facility

$284.00

Service Code	HCPCS 73000LT
Hospital Charge Code	94270129
Hospital Revenue Code	320
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$107.92
Rate for Payer: Aetna Medicare Advantage	$85.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.42
Rate for Payer: Cigna Commercial	$142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.60
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.84
Rate for Payer: Wellpoint Medicaid Managed Care	$7.53

DX ER CLAVICLE COMPLET LT

Facility

$284.00

Service Code	HCPCS 73000LT
Hospital Charge Code	94270129
Hospital Revenue Code	320
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$42.60
Rate for Payer: Qualcare PPO/HMO/WC	$42.60

DX ER CLAVICLE COMP RT

Facility

$250.00

Service Code	HCPCS 73000RT
Hospital Charge Code	94270131
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

Know your out-of-pocket cost for care.

All Charges