Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX-HEPATIC VENO W/HEMO EV

Facility

$3,431.00

Hospital Charge Code	2009100
Hospital Revenue Code	320
Min. Negotiated Rate	$514.65
Max. Negotiated Rate	$514.65
Rate for Payer: Qualcare PPO/HMO/WC	$514.65

DX-HEPATIC VENO W/HEMO EV

Facility

$3,431.00

Hospital Charge Code	2009100
Hospital Revenue Code	320
Min. Negotiated Rate	$82.69
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,303.78
Rate for Payer: Aetna Medicare Advantage	$1,029.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$874.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$874.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$874.90
Rate for Payer: Cigna Commercial	$1,715.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$514.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$82.69
Rate for Payer: Wellpoint Medicaid Managed Care	$90.92

DX-HIP 1 VIEW-RT

Facility

$267.00

Hospital Charge Code	2008015
Hospital Revenue Code	320
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$101.46
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$133.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.43
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

DX-HIP 1 VIEW-RT

Facility

$267.00

Hospital Charge Code	2008015
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

DX HIP O.R. RT

Facility

$585.00

Hospital Charge Code	2011025
Hospital Revenue Code	320
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$87.75
Rate for Payer: Qualcare PPO/HMO/WC	$87.75

DX HIP O.R. RT

Facility

$585.00

Hospital Charge Code	2011025
Hospital Revenue Code	320
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$222.30
Rate for Payer: Aetna Medicare Advantage	$175.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.18
Rate for Payer: Cigna Commercial	$292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: Wellpoint Medicaid Managed Care	$15.50

DX-INTERNAL MAMMARY-LT

Facility

$15,468.50

Service Code	HCPCS 75756LT
Hospital Charge Code	2691905
Hospital Revenue Code	320
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

DX-INTERNAL MAMMARY-LT

Facility

$3,054.00

Service Code	HCPCS 75756LT
Hospital Charge Code	7412010
Hospital Revenue Code	320
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,160.52
Rate for Payer: Aetna Medicare Advantage	$916.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$778.77
Rate for Payer: Cigna Commercial	$1,527.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$916.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$73.60
Rate for Payer: Wellpoint Medicaid Managed Care	$80.93

DX-INTERNAL MAMMARY-LT

Facility

$3,054.00

Service Code	HCPCS 75756LT
Hospital Charge Code	7412010
Hospital Revenue Code	320
Min. Negotiated Rate	$458.10
Max. Negotiated Rate	$458.10
Rate for Payer: Qualcare PPO/HMO/WC	$458.10

DX-INTERNAL MAMMARY-LT

Facility

$15,468.50

Service Code	HCPCS 75756LT
Hospital Charge Code	321075756L
Hospital Revenue Code	320
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$5,878.03
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

DX-INTERNAL MAMMARY-LT

Facility

$15,468.50

Service Code	HCPCS 75756LT
Hospital Charge Code	321075756L
Hospital Revenue Code	320
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

DX-INTERNAL MAMMARY-LT

Facility

$15,468.50

Service Code	HCPCS 75756LT
Hospital Charge Code	2691905
Hospital Revenue Code	320
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$5,878.03
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

DX-INTERNAL MAMMARY-RT

Facility

$15,468.50

Service Code	HCPCS 75756RT
Hospital Charge Code	321075756R
Hospital Revenue Code	320
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

DX-INTERNAL MAMMARY-RT

Facility

$15,468.50

Service Code	HCPCS 75756RT
Hospital Charge Code	321075756R
Hospital Revenue Code	320
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$5,878.03
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

DX-INTERNAL MAMMARY-RT

Facility

$3,054.00

Service Code	HCPCS 75756RT
Hospital Charge Code	7412011
Hospital Revenue Code	320
Min. Negotiated Rate	$458.10
Max. Negotiated Rate	$458.10
Rate for Payer: Qualcare PPO/HMO/WC	$458.10

DX-INTERNAL MAMMARY-RT

Facility

$15,468.50

Service Code	HCPCS 75756RT
Hospital Charge Code	2691910
Hospital Revenue Code	320
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

DX-INTERNAL MAMMARY-RT

Facility

$15,468.50

Service Code	HCPCS 75756RT
Hospital Charge Code	2691910
Hospital Revenue Code	320
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$5,878.03
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

DX-INTERNAL MAMMARY-RT

Facility

$3,054.00

Service Code	HCPCS 75756RT
Hospital Charge Code	7412011
Hospital Revenue Code	320
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,160.52
Rate for Payer: Aetna Medicare Advantage	$916.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$778.77
Rate for Payer: Cigna Commercial	$1,527.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$916.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$73.60
Rate for Payer: Wellpoint Medicaid Managed Care	$80.93

DX KNEE 3 VWS

Facility

$5,100.00

Service Code	HCPCS 73562
Hospital Charge Code	2011530
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX KNEE 3 VWS

Facility

$5,100.00

Service Code	HCPCS 73562
Hospital Charge Code	2011530
Hospital Revenue Code	320
Min. Negotiated Rate	$31.94
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	$31.94
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	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
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	$135.15

DX- KNEE ARTHROSCOPY

Facility

$25,603.80

Service Code	HCPCS 29870
Hospital Charge Code	16000921
Hospital Revenue Code	360
Min. Negotiated Rate	$3,840.57
Max. Negotiated Rate	$3,840.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57

DX- KNEE ARTHROSCOPY

Facility

$25,603.80

Service Code	HCPCS 29870
Hospital Charge Code	16000921
Hospital Revenue Code	360
Min. Negotiated Rate	$617.05
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,681.14
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$617.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$678.50

DX KNOTLESS FIBERTAK INSTAB IM

Facility

$9,012.50

Service Code	HCPCS C1765
Hospital Charge Code	270703517
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.88
Max. Negotiated Rate	$2,181.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,181.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,982.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,351.88

DX KNOTLESS FIBERTAK INSTAB IM

Facility

$9,012.50

Service Code	HCPCS C1765
Hospital Charge Code	270703517
Hospital Revenue Code	278
Min. Negotiated Rate	$217.20
Max. Negotiated Rate	$4,506.25
Rate for Payer: Aetna Commercial	$3,424.75
Rate for Payer: Aetna Medicare Advantage	$2,703.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,298.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,298.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,802.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,298.19
Rate for Payer: Cigna Commercial	$4,506.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,181.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,982.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,351.88
Rate for Payer: UnitedHealthcare Community & State	$217.20
Rate for Payer: Wellpoint Medicaid Managed Care	$238.83

DX LARYNGOSCOPY EXCL NB

Facility

$9,976.00

Service Code	HCPCS 31525
Hospital Charge Code	1600000452
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.40
Max. Negotiated Rate	$1,496.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.40

Know your out-of-pocket cost for care.

All Charges