Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX LARYNGOSCOPY EXCL NB

Facility

$9,976.00

Service Code	HCPCS 31525
Hospital Charge Code	1600000452
Hospital Revenue Code	360
Min. Negotiated Rate	$240.42
Max. Negotiated Rate	$7,632.96
Rate for Payer: Aetna Commercial	$5,751.63
Rate for Payer: Aetna Medicare Advantage	$6,851.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,632.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,632.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,114.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,632.96
Rate for Payer: Cigna Commercial	$4,238.63
Rate for Payer: Cigna Medicare Advantage	$2,114.57
Rate for Payer: Clover Medicare Advantage	$2,008.84
Rate for Payer: EmblemHealth Commercial	$6,343.71
Rate for Payer: Humana Medicare Advantage	$2,178.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,114.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,992.80
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.40
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$240.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,114.57
Rate for Payer: Wellcare Medicare Advantage	$2,114.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,594.28
Rate for Payer: Wellpoint Medicaid Managed Care	$4,504.20

DX-MAMMOGRAPHY-LT

Facility

$208.00

Hospital Charge Code	2009305
Hospital Revenue Code	401
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

DX-MAMMOGRAPHY-LT

Facility

$208.00

Hospital Charge Code	2009305
Hospital Revenue Code	401
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$79.04
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

DX-MAMMOGRAPHY-RT

Facility

$208.00

Hospital Charge Code	2009310
Hospital Revenue Code	401
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

DX-MAMMOGRAPHY-RT

Facility

$208.00

Hospital Charge Code	2009310
Hospital Revenue Code	401
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$79.04
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

DX-MAMMO GUIDE NDL PLC-LT

Facility

$1,119.00

Hospital Charge Code	2009295
Hospital Revenue Code	320
Min. Negotiated Rate	$167.85
Max. Negotiated Rate	$167.85
Rate for Payer: Qualcare PPO/HMO/WC	$167.85

DX-MAMMO GUIDE NDL PLC-LT

Facility

$1,119.00

Hospital Charge Code	2009295
Hospital Revenue Code	320
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$425.22
Rate for Payer: Aetna Medicare Advantage	$335.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.35
Rate for Payer: Cigna Commercial	$559.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.85
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$26.97
Rate for Payer: Wellpoint Medicaid Managed Care	$29.65

DX-MAMMO GUID NDL PLCM-BI

Facility

$1,119.00

Hospital Charge Code	2009180
Hospital Revenue Code	320
Min. Negotiated Rate	$167.85
Max. Negotiated Rate	$167.85
Rate for Payer: Qualcare PPO/HMO/WC	$167.85

DX-MAMMO GUID NDL PLCM-BI

Facility

$1,119.00

Hospital Charge Code	2009180
Hospital Revenue Code	320
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$425.22
Rate for Payer: Aetna Medicare Advantage	$335.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.35
Rate for Payer: Cigna Commercial	$559.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.85
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$26.97
Rate for Payer: Wellpoint Medicaid Managed Care	$29.65

DX-MAMMO GUID NDL PLMT-RT

Facility

$1,119.00

Hospital Charge Code	2009300
Hospital Revenue Code	320
Min. Negotiated Rate	$167.85
Max. Negotiated Rate	$167.85
Rate for Payer: Qualcare PPO/HMO/WC	$167.85

DX-MAMMO GUID NDL PLMT-RT

Facility

$1,119.00

Hospital Charge Code	2009300
Hospital Revenue Code	320
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$425.22
Rate for Payer: Aetna Medicare Advantage	$335.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.35
Rate for Payer: Cigna Commercial	$559.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.85
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$26.97
Rate for Payer: Wellpoint Medicaid Managed Care	$29.65

DX MASTOIDS LTD< 3 VWS

Facility

$267.00

Service Code	HCPCS 70120
Hospital Charge Code	2011510
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

DX MASTOIDS LTD< 3 VWS

Facility

$267.00

Service Code	HCPCS 70120
Hospital Charge Code	2011510
Hospital Revenue Code	320
Min. Negotiated Rate	$6.43
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	$33.34
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	$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: 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	$7.08

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	321074425B
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	321074425B
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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: Wellpoint Medicaid Managed Care	$135.15

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	2690710
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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: Wellpoint Medicaid Managed Care	$135.15

DX-NEPHROSTOGRAM-BIL

Facility

$759.00

Service Code	HCPCS 7442550
Hospital Charge Code	7411835
Hospital Revenue Code	320
Min. Negotiated Rate	$18.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$288.42
Rate for Payer: Aetna Medicare Advantage	$227.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.54
Rate for Payer: Cigna Commercial	$379.50
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: Wellpoint Medicaid Managed Care	$20.11

DX-NEPHROSTOGRAM-BIL

Facility

$759.00

Service Code	HCPCS 7442550
Hospital Charge Code	7411835
Hospital Revenue Code	320
Min. Negotiated Rate	$113.85
Max. Negotiated Rate	$113.85
Rate for Payer: Qualcare PPO/HMO/WC	$113.85

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	411074425B
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	2690710
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	411074425B
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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: Wellpoint Medicaid Managed Care	$135.15

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	3668744255
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-BIL

Facility

$5,100.00

Service Code	HCPCS 7442550
Hospital Charge Code	3668744255
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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: Wellpoint Medicaid Managed Care	$135.15

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	366874425L
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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: Wellpoint Medicaid Managed Care	$135.15

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	366874425L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges