Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DX-SPINAL SELECTIVE-LT

Facility

$8,633.00

Service Code	HCPCS 75705LT
Hospital Charge Code	7412000
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-SPINAL SELECTIVE-LT

Facility

$8,633.00

Service Code	HCPCS 75705LT
Hospital Charge Code	2691855
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-SPINAL SELECTIVE-RT

Facility

$8,633.00

Service Code	HCPCS 75705RT
Hospital Charge Code	2691860
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-SPINAL SELECTIVE-RT

Facility

$8,633.00

Service Code	HCPCS 75705RT
Hospital Charge Code	7412001
Hospital Revenue Code	320
Min. Negotiated Rate	$208.06
Max. Negotiated Rate	$4,316.50
Rate for Payer: Aetna Commercial	$3,280.54
Rate for Payer: Aetna Medicare Advantage	$2,589.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,201.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,201.41
Rate for Payer: Cigna Commercial	$4,316.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$208.06
Rate for Payer: Wellpoint Medicaid Managed Care	$228.77

DX-SPINAL SELECTIVE-RT

Facility

$8,633.00

Service Code	HCPCS 75705RT
Hospital Charge Code	2691860
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-SPINAL SELECTIVE-RT

Facility

$8,633.00

Service Code	HCPCS 75705RT
Hospital Charge Code	7412001
Hospital Revenue Code	320
Min. Negotiated Rate	$1,294.95
Max. Negotiated Rate	$1,294.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.95

DX-STERNOCLAVICULAR JT-BI

Facility

$250.00

Hospital Charge Code	2009340
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-STERNOCLAVICULAR JT-BI

Facility

$250.00

Hospital Charge Code	2009340
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX-STERNOCLAVICULAR JT-LT

Facility

$468.00

Hospital Charge Code	2009335
Hospital Revenue Code	320
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$177.84
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$11.28
Rate for Payer: Wellpoint Medicaid Managed Care	$12.40

DX-STERNOCLAVICULAR JT-LT

Facility

$468.00

Hospital Charge Code	2009335
Hospital Revenue Code	320
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$70.20
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

DX-STERNOCLAVICULAR JT-RT

Facility

$250.00

Hospital Charge Code	2009230
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-STERNOCLAVICULAR JT-RT

Facility

$250.00

Hospital Charge Code	2009230
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DX-STRTC GD FR BRST BX-BI

Facility

$802.00

Hospital Charge Code	2009175
Hospital Revenue Code	320
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$120.30
Rate for Payer: Qualcare PPO/HMO/WC	$120.30

DX-STRTC GD FR BRST BX-BI

Facility

$802.00

Hospital Charge Code	2009175
Hospital Revenue Code	320
Min. Negotiated Rate	$19.33
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$304.76
Rate for Payer: Aetna Medicare Advantage	$240.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.51
Rate for Payer: Cigna Commercial	$401.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$19.33
Rate for Payer: Wellpoint Medicaid Managed Care	$21.25

DX-STRTC GD FR BRST BX-LT

Facility

$802.00

Hospital Charge Code	2009285
Hospital Revenue Code	320
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$120.30
Rate for Payer: Qualcare PPO/HMO/WC	$120.30

DX-STRTC GD FR BRST BX-LT

Facility

$802.00

Hospital Charge Code	2009285
Hospital Revenue Code	320
Min. Negotiated Rate	$19.33
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$304.76
Rate for Payer: Aetna Medicare Advantage	$240.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.51
Rate for Payer: Cigna Commercial	$401.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$19.33
Rate for Payer: Wellpoint Medicaid Managed Care	$21.25

DX-STRTC GD FR BRST BX-RT

Facility

$802.00

Hospital Charge Code	2009290
Hospital Revenue Code	320
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$120.30
Rate for Payer: Qualcare PPO/HMO/WC	$120.30

DX-STRTC GD FR BRST BX-RT

Facility

$802.00

Hospital Charge Code	2009290
Hospital Revenue Code	320
Min. Negotiated Rate	$19.33
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$304.76
Rate for Payer: Aetna Medicare Advantage	$240.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.51
Rate for Payer: Cigna Commercial	$401.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$19.33
Rate for Payer: Wellpoint Medicaid Managed Care	$21.25

DX-SWALLOW FUNCT W/VIDEO FLUOR

Facility

$5,100.00

Service Code	HCPCS 74230
Hospital Charge Code	2007030
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-SWALLOW FUNCT W/VIDEO FLUOR

Facility

$5,100.00

Service Code	HCPCS 74230
Hospital Charge Code	2007030
Hospital Revenue Code	320
Min. Negotiated Rate	$78.47
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	$78.47
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	$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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

DX-TC INTRO OF IV STENT

Facility

$6,122.00

Hospital Charge Code	2009110
Hospital Revenue Code	320
Min. Negotiated Rate	$918.30
Max. Negotiated Rate	$918.30
Rate for Payer: Qualcare PPO/HMO/WC	$918.30

DX-TC INTRO OF IV STENT

Facility

$6,122.00

Hospital Charge Code	2009110
Hospital Revenue Code	320
Min. Negotiated Rate	$147.54
Max. Negotiated Rate	$3,061.00
Rate for Payer: Aetna Commercial	$2,326.36
Rate for Payer: Aetna Medicare Advantage	$1,836.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,561.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,561.11
Rate for Payer: Cigna Commercial	$3,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,836.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$918.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$147.54
Rate for Payer: Wellpoint Medicaid Managed Care	$162.23

DX-THUMB-LT

Facility

$412.00

Service Code	HCPCS 73140
Hospital Charge Code	2007060
Hospital Revenue Code	320
Min. Negotiated Rate	$61.80
Max. Negotiated Rate	$61.80
Rate for Payer: Qualcare PPO/HMO/WC	$61.80

DX-THUMB-LT

Facility

$412.00

Service Code	HCPCS 73140
Hospital Charge Code	2007060
Hospital Revenue Code	320
Min. Negotiated Rate	$9.93
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	$13.55
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	$123.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$9.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.92

DX-TOE 2ND DIGIT LT

Facility

$267.00

Service Code	HCPCS 7366050
Hospital Charge Code	2007055
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

Know your out-of-pocket cost for care.

All Charges