Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX ER WRIST 3 VIEWS BILAT

Facility

$250.00

Service Code	HCPCS 7311050
Hospital Charge Code	94270089
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 WRIST 3 VIEWS LT

Facility

$306.00

Service Code	HCPCS 73110LT
Hospital Charge Code	94270163
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 WRIST 3 VIEWS LT

Facility

$306.00

Service Code	HCPCS 73110LT
Hospital Charge Code	94270163
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 WRIST 3 VIEWS RT

Facility

$306.00

Service Code	HCPCS 73110RT
Hospital Charge Code	94270165
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 WRIST 3 VIEWS RT

Facility

$306.00

Service Code	HCPCS 73110RT
Hospital Charge Code	94270165
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 WRIST AP&LA POST LT

Facility

$254.00

Service Code	HCPCS 73100LT
Hospital Charge Code	94270157
Hospital Revenue Code	320
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$38.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.10

DX ER WRIST AP&LA POST LT

Facility

$254.00

Service Code	HCPCS 73100LT
Hospital Charge Code	94270157
Hospital Revenue Code	320
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$96.52
Rate for Payer: Aetna Medicare Advantage	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.77
Rate for Payer: Cigna Commercial	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.12
Rate for Payer: Wellpoint Medicaid Managed Care	$6.73

DX ER WRIST AP&LA POST RT

Facility

$254.00

Service Code	HCPCS 73100RT
Hospital Charge Code	94270161
Hospital Revenue Code	320
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$96.52
Rate for Payer: Aetna Medicare Advantage	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.77
Rate for Payer: Cigna Commercial	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.12
Rate for Payer: Wellpoint Medicaid Managed Care	$6.73

DX ER WRIST AP&LA POST RT

Facility

$254.00

Service Code	HCPCS 73100RT
Hospital Charge Code	94270161
Hospital Revenue Code	320
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$38.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.10

DX ER WRIST AP & LAT 2 LT

Facility

$254.00

Service Code	HCPCS 73100LT
Hospital Charge Code	94270155
Hospital Revenue Code	320
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$38.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.10

DX ER WRIST AP & LAT 2 LT

Facility

$254.00

Service Code	HCPCS 73100LT
Hospital Charge Code	94270155
Hospital Revenue Code	320
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$96.52
Rate for Payer: Aetna Medicare Advantage	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.77
Rate for Payer: Cigna Commercial	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.12
Rate for Payer: Wellpoint Medicaid Managed Care	$6.73

DX ER WRIST AP & LAT 2 RT

Facility

$254.00

Service Code	HCPCS 73100RT
Hospital Charge Code	94270159
Hospital Revenue Code	320
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$96.52
Rate for Payer: Aetna Medicare Advantage	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.77
Rate for Payer: Cigna Commercial	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.12
Rate for Payer: Wellpoint Medicaid Managed Care	$6.73

DX ER WRIST AP & LAT 2 RT

Facility

$254.00

Service Code	HCPCS 73100RT
Hospital Charge Code	94270159
Hospital Revenue Code	320
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$38.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.10

DX ER WRIST AP & LAT BILA

Facility

$250.00

Service Code	HCPCS 7310050
Hospital Charge Code	94270085
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 AP & LAT BILA

Facility

$250.00

Service Code	HCPCS 7310050
Hospital Charge Code	94270085
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 WRIST APLT POST BIL

Facility

$250.00

Service Code	HCPCS 7310050
Hospital Charge Code	94270087
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 APLT POST BIL

Facility

$250.00

Service Code	HCPCS 7310050
Hospital Charge Code	94270087
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX-EXT. CAROTID-LT

Facility

$13,605.00

Hospital Charge Code	2691820
Hospital Revenue Code	323
Min. Negotiated Rate	$327.88
Max. Negotiated Rate	$6,802.50
Rate for Payer: Aetna Commercial	$5,169.90
Rate for Payer: Aetna Medicare Advantage	$4,081.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,469.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,469.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,469.28
Rate for Payer: Cigna Commercial	$6,802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,081.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$327.88
Rate for Payer: Wellpoint Medicaid Managed Care	$360.53

DX-EXT. CAROTID-LT

Facility

$13,605.00

Hospital Charge Code	2691820
Hospital Revenue Code	323
Min. Negotiated Rate	$2,040.75
Max. Negotiated Rate	$2,040.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.75

DX-EXT. CAROTID-RT

Facility

$13,605.00

Hospital Charge Code	2691825
Hospital Revenue Code	323
Min. Negotiated Rate	$327.88
Max. Negotiated Rate	$6,802.50
Rate for Payer: Aetna Commercial	$5,169.90
Rate for Payer: Aetna Medicare Advantage	$4,081.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,469.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,469.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,469.28
Rate for Payer: Cigna Commercial	$6,802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,081.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$327.88
Rate for Payer: Wellpoint Medicaid Managed Care	$360.53

DX-EXT. CAROTID-RT

Facility

$13,605.00

Hospital Charge Code	2691825
Hospital Revenue Code	323
Min. Negotiated Rate	$2,040.75
Max. Negotiated Rate	$2,040.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.75

DX-FLUORO GUIDE NDL PLCMT

Facility

$3,032.40

Hospital Charge Code	2009170
Hospital Revenue Code	320
Min. Negotiated Rate	$454.86
Max. Negotiated Rate	$454.86
Rate for Payer: Qualcare PPO/HMO/WC	$454.86

DX-FLUORO GUIDE NDL PLCMT

Facility

$3,032.40

Hospital Charge Code	2009170
Hospital Revenue Code	320
Min. Negotiated Rate	$73.08
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,152.31
Rate for Payer: Aetna Medicare Advantage	$909.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$773.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$773.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$773.26
Rate for Payer: Cigna Commercial	$1,516.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$909.72
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$454.86
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$73.08
Rate for Payer: Wellpoint Medicaid Managed Care	$80.36

DX-GI SERIES

Facility

$1,173.00

Service Code	HCPCS 74240
Hospital Charge Code	2007045
Hospital Revenue Code	320
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$175.95
Rate for Payer: Qualcare PPO/HMO/WC	$175.95

DX-GI SERIES

Facility

$1,173.00

Service Code	HCPCS 74240
Hospital Charge Code	2007045
Hospital Revenue Code	320
Min. Negotiated Rate	$28.27
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$28.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$31.08

Know your out-of-pocket cost for care.

All Charges