Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX ER TMJ'S OPEN&CLSD BIL

Facility

$759.00

Service Code	HCPCS 70330
Hospital Charge Code	94270017
Hospital Revenue Code	320
Min. Negotiated Rate	$113.85
Max. Negotiated Rate	$113.85
Rate for Payer: Qualcare PPO/HMO/WC	$113.85

DX ER TMJ'S OPEN&CLSD BIL

Facility

$759.00

Service Code	HCPCS 70330
Hospital Charge Code	94270017
Hospital Revenue Code	320
Min. Negotiated Rate	$18.29
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	$38.72
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	$227.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.85
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$18.29
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	$20.11

DX ER TOE LEFT 2ND DIGIT

Facility

$314.00

Service Code	HCPCS 73660T1
Hospital Charge Code	94270239
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOE LEFT 2ND DIGIT

Facility

$314.00

Service Code	HCPCS 73660T1
Hospital Charge Code	94270239
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE LEFT 3RD DIGIT

Facility

$314.00

Service Code	HCPCS 73660T2
Hospital Charge Code	94270241
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE LEFT 3RD DIGIT

Facility

$314.00

Service Code	HCPCS 73660T2
Hospital Charge Code	94270241
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOE LEFT 4TH DIGIT

Facility

$314.00

Service Code	HCPCS 73660T3
Hospital Charge Code	94270243
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE LEFT 4TH DIGIT

Facility

$314.00

Service Code	HCPCS 73660T3
Hospital Charge Code	94270243
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOE LEFT 5TH DIGIT

Facility

$314.00

Service Code	HCPCS 73660T4
Hospital Charge Code	94270245
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE LEFT 5TH DIGIT

Facility

$314.00

Service Code	HCPCS 73660T4
Hospital Charge Code	94270245
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOE LEFT GREAT TOE

Facility

$314.00

Service Code	HCPCS 73660TA
Hospital Charge Code	94270257
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOE LEFT GREAT TOE

Facility

$314.00

Service Code	HCPCS 73660TA
Hospital Charge Code	94270257
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE RIGHT 2ND DIGIT

Facility

$314.00

Service Code	HCPCS 73660T6
Hospital Charge Code	94270249
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE RIGHT 2ND DIGIT

Facility

$314.00

Service Code	HCPCS 73660T6
Hospital Charge Code	94270249
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOE RIGHT 3RD DIGIT

Facility

$314.00

Service Code	HCPCS 73660T7
Hospital Charge Code	94270251
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOE RIGHT 3RD DIGIT

Facility

$314.00

Service Code	HCPCS 73660T7
Hospital Charge Code	94270251
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE RIGHT 4TH DIGIT

Facility

$314.00

Service Code	HCPCS 73660T8
Hospital Charge Code	94270253
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE RIGHT 4TH DIGIT

Facility

$314.00

Service Code	HCPCS 73660T8
Hospital Charge Code	94270253
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOE RIGHT 5TH DIGIT

Facility

$314.00

Service Code	HCPCS 73660T9
Hospital Charge Code	94270255
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE RIGHT 5TH DIGIT

Facility

$314.00

Service Code	HCPCS 73660T9
Hospital Charge Code	94270255
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOE RIGHT GREAT TOE

Facility

$314.00

Service Code	HCPCS 73660T5
Hospital Charge Code	94270247
Hospital Revenue Code	320
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

DX ER TOE RIGHT GREAT TOE

Facility

$314.00

Service Code	HCPCS 73660T5
Hospital Charge Code	94270247
Hospital Revenue Code	320
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

DX ER TOES BILAT

Facility

$250.00

Service Code	HCPCS 7366050
Hospital Charge Code	94270113
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 TOES BILAT

Facility

$250.00

Service Code	HCPCS 7366050
Hospital Charge Code	94270113
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 WRIST 3 VIEWS BILAT

Facility

$250.00

Service Code	HCPCS 7311050
Hospital Charge Code	94270089
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