Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX ER CLAVICLE COMP RT

Facility

$250.00

Service Code	HCPCS 73000RT
Hospital Charge Code	94270131
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX-ERCP COMMON BILE DUCT

Facility

$1,927.00

Service Code	HCPCS 74328
Hospital Charge Code	2007001
Hospital Revenue Code	320
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$732.26
Rate for Payer: Aetna Medicare Advantage	$578.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$491.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$491.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$491.38
Rate for Payer: Cigna Commercial	$963.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$578.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$289.05
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$46.44
Rate for Payer: Wellpoint Medicaid Managed Care	$51.07

DX-ERCP COMMON BILE DUCT

Facility

$1,927.00

Service Code	HCPCS 74328
Hospital Charge Code	2007001
Hospital Revenue Code	320
Min. Negotiated Rate	$289.05
Max. Negotiated Rate	$289.05
Rate for Payer: Qualcare PPO/HMO/WC	$289.05

DX ERCP PANCREATIC

Facility

$1,927.00

Service Code	HCPCS 74329
Hospital Charge Code	2011535
Hospital Revenue Code	320
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$732.26
Rate for Payer: Aetna Medicare Advantage	$578.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$491.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$491.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$491.38
Rate for Payer: Cigna Commercial	$963.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$578.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$289.05
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$46.44
Rate for Payer: Wellpoint Medicaid Managed Care	$51.07

DX ERCP PANCREATIC

Facility

$1,927.00

Service Code	HCPCS 74329
Hospital Charge Code	2011535
Hospital Revenue Code	320
Min. Negotiated Rate	$289.05
Max. Negotiated Rate	$289.05
Rate for Payer: Qualcare PPO/HMO/WC	$289.05

DX ER ELBOW 3 VIEWS BILA

Facility

$250.00

Service Code	HCPCS 7308050
Hospital Charge Code	94270081
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 ELBOW 3 VIEWS BILA

Facility

$250.00

Service Code	HCPCS 7308050
Hospital Charge Code	94270081
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 ELBOW 3 VIEWS LT

Facility

$306.00

Service Code	HCPCS 73080LT
Hospital Charge Code	94270147
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 ELBOW 3 VIEWS LT

Facility

$306.00

Service Code	HCPCS 73080LT
Hospital Charge Code	94270147
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: Wellpoint Medicaid Managed Care	$8.11

DX ER ELBOW 3 VIEWS RT

Facility

$306.00

Service Code	HCPCS 73080RT
Hospital Charge Code	94270149
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: Wellpoint Medicaid Managed Care	$8.11

DX ER ELBOW 3 VIEWS RT

Facility

$306.00

Service Code	HCPCS 73080RT
Hospital Charge Code	94270149
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 FACIAL BONES

Facility

$631.00

Service Code	HCPCS 70150
Hospital Charge Code	94270005
Hospital Revenue Code	320
Min. Negotiated Rate	$94.65
Max. Negotiated Rate	$94.65
Rate for Payer: Qualcare PPO/HMO/WC	$94.65

DX ER FACIAL BONES

Facility

$631.00

Service Code	HCPCS 70150
Hospital Charge Code	94270005
Hospital Revenue Code	320
Min. Negotiated Rate	$15.21
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	$38.72
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	$189.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$15.21
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	$16.72

DX ER FACIAL BONES <3VIEW

Facility

$396.00

Service Code	HCPCS 70140
Hospital Charge Code	94270003
Hospital Revenue Code	320
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$59.40
Rate for Payer: Qualcare PPO/HMO/WC	$59.40

DX ER FACIAL BONES <3VIEW

Facility

$396.00

Service Code	HCPCS 70140
Hospital Charge Code	94270003
Hospital Revenue Code	320
Min. Negotiated Rate	$9.54
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	$29.04
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	$118.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.40
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$9.54
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	$10.49

DX ER FEMUR AP & LAT BILA

Facility

$250.00

Hospital Charge Code	94270093
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 FEMUR AP & LAT BILA

Facility

$250.00

Hospital Charge Code	94270093
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 FEMUR AP & LAT LT

Facility

$332.00

Hospital Charge Code	94270199
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 FEMUR AP & LAT LT

Facility

$332.00

Hospital Charge Code	94270199
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 FEMUR AP & LAT RT

Facility

$332.00

Hospital Charge Code	94270201
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 FEMUR AP & LAT RT

Facility

$332.00

Hospital Charge Code	94270201
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 FINGER LT 2ND DIGIT

Facility

$251.00

Service Code	HCPCS 73140F1
Hospital Charge Code	94270171
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 FINGER LT 2ND DIGIT

Facility

$251.00

Service Code	HCPCS 73140F1
Hospital Charge Code	94270171
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 FINGER LT 3RD DIGIT

Facility

$251.00

Service Code	HCPCS 73140F2
Hospital Charge Code	94270173
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 FINGER LT 3RD DIGIT

Facility

$251.00

Service Code	HCPCS 73140F2
Hospital Charge Code	94270173
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

Know your out-of-pocket cost for care.

All Charges