Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX ER ORTHOPANTOGRAM

Facility

$361.00

Service Code	HCPCS 70355
Hospital Charge Code	94270019
Hospital Revenue Code	320
Min. Negotiated Rate	$8.70
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	$27.10
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	$108.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$9.57

DX ER ORTHOPANTOGRAM

Facility

$361.00

Service Code	HCPCS 70355
Hospital Charge Code	94270019
Hospital Revenue Code	320
Min. Negotiated Rate	$54.15
Max. Negotiated Rate	$54.15
Rate for Payer: Qualcare PPO/HMO/WC	$54.15

DX ER PARANASAL SINUS 3VW

Facility

$761.00

Service Code	HCPCS 70220
Hospital Charge Code	94270011
Hospital Revenue Code	320
Min. Negotiated Rate	$18.34
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	$53.24
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	$228.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$18.34
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	$20.17

DX ER PARANASAL SINUS 3VW

Facility

$761.00

Service Code	HCPCS 70220
Hospital Charge Code	94270011
Hospital Revenue Code	320
Min. Negotiated Rate	$114.15
Max. Negotiated Rate	$114.15
Rate for Payer: Qualcare PPO/HMO/WC	$114.15

DX ER PELVIS

Facility

$358.00

Service Code	HCPCS 72170
Hospital Charge Code	94270049
Hospital Revenue Code	320
Min. Negotiated Rate	$53.70
Max. Negotiated Rate	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.70

DX ER PELVIS

Facility

$358.00

Service Code	HCPCS 72170
Hospital Charge Code	94270049
Hospital Revenue Code	320
Min. Negotiated Rate	$8.63
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	$31.94
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	$107.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.70
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
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	$9.49

DX ER PELVIS MULTIPLE VWS

Facility

$603.00

Service Code	HCPCS 72190
Hospital Charge Code	94270051
Hospital Revenue Code	320
Min. Negotiated Rate	$90.45
Max. Negotiated Rate	$90.45
Rate for Payer: Qualcare PPO/HMO/WC	$90.45

DX ER PELVIS MULTIPLE VWS

Facility

$603.00

Service Code	HCPCS 72190
Hospital Charge Code	94270051
Hospital Revenue Code	320
Min. Negotiated Rate	$14.53
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	$180.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.53
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	$15.98

DX ER RIBS 2VIEWS LT

Facility

$569.00

Service Code	HCPCS 71100LT
Hospital Charge Code	94270119
Hospital Revenue Code	320
Min. Negotiated Rate	$13.71
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$216.22
Rate for Payer: Aetna Medicare Advantage	$170.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.09
Rate for Payer: Cigna Commercial	$284.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.35
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$13.71
Rate for Payer: Wellpoint Medicaid Managed Care	$15.08

DX ER RIBS 2VIEWS LT

Facility

$569.00

Service Code	HCPCS 71100LT
Hospital Charge Code	94270119
Hospital Revenue Code	320
Min. Negotiated Rate	$85.35
Max. Negotiated Rate	$85.35
Rate for Payer: Qualcare PPO/HMO/WC	$85.35

DX ER RIBS 2 VIEWS RT

Facility

$250.00

Service Code	HCPCS 71100RT
Hospital Charge Code	94270121
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 RIBS 2 VIEWS RT

Facility

$250.00

Service Code	HCPCS 71100RT
Hospital Charge Code	94270121
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 RIBS 2VWS RT

Facility

$569.00

Service Code	HCPCS 71100
Hospital Charge Code	94270029
Hospital Revenue Code	320
Min. Negotiated Rate	$85.35
Max. Negotiated Rate	$85.35
Rate for Payer: Qualcare PPO/HMO/WC	$85.35

DX ER RIBS 2VWS RT

Facility

$569.00

Service Code	HCPCS 71100
Hospital Charge Code	94270029
Hospital Revenue Code	320
Min. Negotiated Rate	$13.71
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	$170.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.35
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$13.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$15.08

DX ER RIBS BILAT

Facility

$625.00

Service Code	HCPCS 71110
Hospital Charge Code	94270031
Hospital Revenue Code	320
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

DX ER RIBS BILAT

Facility

$625.00

Service Code	HCPCS 71110
Hospital Charge Code	94270031
Hospital Revenue Code	320
Min. Negotiated Rate	$15.06
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	$187.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

DX ER RIBS & CHEST LT

Facility

$523.00

Service Code	HCPCS 71101LT
Hospital Charge Code	94270125
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$78.45
Rate for Payer: Qualcare PPO/HMO/WC	$78.45

DX ER RIBS & CHEST LT

Facility

$523.00

Service Code	HCPCS 71101LT
Hospital Charge Code	94270125
Hospital Revenue Code	320
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$198.74
Rate for Payer: Aetna Medicare Advantage	$156.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.37
Rate for Payer: Cigna Commercial	$261.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$12.60
Rate for Payer: Wellpoint Medicaid Managed Care	$13.86

DX ER RIBS + CHEST LT

Facility

$250.00

Service Code	HCPCS 71101LT
Hospital Charge Code	94270123
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 RIBS + CHEST LT

Facility

$250.00

Service Code	HCPCS 71101LT
Hospital Charge Code	94270123
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 RIBS + CHEST RT

Facility

$523.00

Service Code	HCPCS 71101RT
Hospital Charge Code	94270127
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$78.45
Rate for Payer: Qualcare PPO/HMO/WC	$78.45

DX ER RIBS + CHEST RT

Facility

$523.00

Service Code	HCPCS 71101RT
Hospital Charge Code	94270127
Hospital Revenue Code	320
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$198.74
Rate for Payer: Aetna Medicare Advantage	$156.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.37
Rate for Payer: Cigna Commercial	$261.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$12.60
Rate for Payer: Wellpoint Medicaid Managed Care	$13.86

DX ER RIBS W/CHEST BILAT

Facility

$697.00

Service Code	HCPCS 71111
Hospital Charge Code	94270033
Hospital Revenue Code	320
Min. Negotiated Rate	$16.80
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	$67.76
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	$209.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$16.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$18.47

DX ER RIBS W/CHEST BILAT

Facility

$697.00

Service Code	HCPCS 71111
Hospital Charge Code	94270033
Hospital Revenue Code	320
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

DX ER SACRUM&COCCYX 2 VWS

Facility

$250.00

Service Code	HCPCS 72220
Hospital Charge Code	94270053
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

Know your out-of-pocket cost for care.

All Charges