Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLUOR GRID RF ABL BONE-LT

Facility

$6,649.00

Service Code	HCPCS 20999LT
Hospital Charge Code	7411863
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-LT

Facility

$6,649.00

Service Code	HCPCS 20999LT
Hospital Charge Code	2690920
Hospital Revenue Code	361
Min. Negotiated Rate	$160.24
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$2,526.62
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,994.70
Rate for Payer: Qualcare PPO/HMO/WC	$997.35
Rate for Payer: UnitedHealthcare Community & State	$160.24
Rate for Payer: Wellpoint Medicaid Managed Care	$176.20

FLUOR GRID RF ABL BONE-LT

Facility

$6,649.00

Service Code	HCPCS 20999LT
Hospital Charge Code	2690920
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-LT

Facility

$6,649.00

Service Code	HCPCS 20999LT
Hospital Charge Code	7411863
Hospital Revenue Code	361
Min. Negotiated Rate	$160.24
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$2,526.62
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,994.70
Rate for Payer: Qualcare PPO/HMO/WC	$997.35
Rate for Payer: UnitedHealthcare Community & State	$160.24
Rate for Payer: Wellpoint Medicaid Managed Care	$176.20

FLUOR GRID RF ABL BONE-RT

Facility

$6,649.00

Service Code	HCPCS 20999RT
Hospital Charge Code	2690925
Hospital Revenue Code	361
Min. Negotiated Rate	$160.24
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$2,526.62
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,994.70
Rate for Payer: Qualcare PPO/HMO/WC	$997.35
Rate for Payer: UnitedHealthcare Community & State	$160.24
Rate for Payer: Wellpoint Medicaid Managed Care	$176.20

FLUOR GRID RF ABL BONE-RT

Facility

$6,649.00

Service Code	HCPCS 20999RT
Hospital Charge Code	2690925
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR GRID RF ABL BONE-RT

Facility

$6,649.00

Service Code	HCPCS 20999RT
Hospital Charge Code	7411864
Hospital Revenue Code	361
Min. Negotiated Rate	$160.24
Max. Negotiated Rate	$3,324.50
Rate for Payer: Aetna Commercial	$2,526.62
Rate for Payer: Aetna Medicare Advantage	$1,994.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,695.49
Rate for Payer: Cigna Commercial	$3,324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,994.70
Rate for Payer: Qualcare PPO/HMO/WC	$997.35
Rate for Payer: UnitedHealthcare Community & State	$160.24
Rate for Payer: Wellpoint Medicaid Managed Care	$176.20

FLUOR GRID RF ABL BONE-RT

Facility

$6,649.00

Service Code	HCPCS 20999RT
Hospital Charge Code	7411864
Hospital Revenue Code	361
Min. Negotiated Rate	$997.35
Max. Negotiated Rate	$997.35
Rate for Payer: Qualcare PPO/HMO/WC	$997.35

FLUOR-I-STRIP/9MG/EACH

Facility

$276.00

Hospital Charge Code	60633002
Hospital Revenue Code	250
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$104.88
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.80
Rate for Payer: Oxford Commercial	$55.20
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$55.20
Rate for Payer: UnitedHealthcare Community & State	$6.65
Rate for Payer: Wellpoint Medicaid Managed Care	$7.31

FLUOR-I-STRIP/9MG/EACH

Facility

$276.00

Hospital Charge Code	60633002
Hospital Revenue Code	250
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

FLUOR I STRIPS

Facility

$2.00

Hospital Charge Code	60635294
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

FLUOR I STRIPS

Facility

$2.00

Hospital Charge Code	60635294
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

FLUOR NON-INFECT ANTIBODY

Facility

$314.00

Service Code	HCPCS 86255
Hospital Charge Code	38479407
Hospital Revenue Code	302
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$157.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

FLUOR NON-INFECT ANTIBODY

Facility

$314.00

Service Code	HCPCS 86255
Hospital Charge Code	38479407
Hospital Revenue Code	302
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

FLUORO

Facility

$3,032.40

Hospital Charge Code	2009165
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

FLUORO

Facility

$3,032.40

Hospital Charge Code	2009165
Hospital Revenue Code	320
Min. Negotiated Rate	$454.86
Max. Negotiated Rate	$454.86
Rate for Payer: Qualcare PPO/HMO/WC	$454.86

FLUORO EXAM OF G/COLON TUBE

Facility

$929.24

Service Code	HCPCS 49465
Hospital Charge Code	16000752
Hospital Revenue Code	360
Min. Negotiated Rate	$22.39
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.77
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.39
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$22.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$24.62

FLUORO EXAM OF G/COLON TUBE

Facility

$929.24

Service Code	HCPCS 49465
Hospital Charge Code	16000752
Hospital Revenue Code	360
Min. Negotiated Rate	$139.39
Max. Negotiated Rate	$139.39
Rate for Payer: Qualcare PPO/HMO/WC	$139.39

FLUORO GUIDED NEEDLE PLCMT

Facility

$5,100.00

Service Code	HCPCS 77002
Hospital Charge Code	5100827
Hospital Revenue Code	320
Min. Negotiated Rate	$55.45
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) NJ Health	$55.45
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

FLUORO GUIDED NEEDLE PLCMT

Facility

$5,100.00

Service Code	HCPCS 77002
Hospital Charge Code	5100827
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUOROGUIDE FOR SPINE INJ

Facility

$457.84

Service Code	HCPCS 77001
Hospital Charge Code	1600000590
Hospital Revenue Code	360
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$173.98
Rate for Payer: Aetna Medicare Advantage	$137.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.75
Rate for Payer: Cigna Commercial	$228.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.35
Rate for Payer: Qualcare PPO/HMO/WC	$68.68
Rate for Payer: UnitedHealthcare Community & State	$11.03
Rate for Payer: Wellpoint Medicaid Managed Care	$12.13

FLUOROGUIDE FOR SPINE INJ

Facility

$457.84

Service Code	HCPCS 77001
Hospital Charge Code	1600000590
Hospital Revenue Code	360
Min. Negotiated Rate	$68.68
Max. Negotiated Rate	$68.68
Rate for Payer: Qualcare PPO/HMO/WC	$68.68

FLUOROMETHALONE 0.25%

Facility

$122.25

Hospital Charge Code	6007355
Hospital Revenue Code	251
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$46.45
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.67
Rate for Payer: Oxford Commercial	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$24.45
Rate for Payer: UnitedHealthcare Community & State	$2.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

FLUOROMETHALONE 0.25%

Facility

$122.25

Hospital Charge Code	6007355
Hospital Revenue Code	251
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

FLUOROMETHOLONE OPH SSP 0.1%

Facility

$170.45

Hospital Charge Code	60628038
Hospital Revenue Code	250
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$85.22
Rate for Payer: Aetna Commercial	$64.77
Rate for Payer: Aetna Medicare Advantage	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$85.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.13
Rate for Payer: Oxford Commercial	$34.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.57
Rate for Payer: UnitedHealthcare Commercial	$34.09
Rate for Payer: UnitedHealthcare Community & State	$4.11
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

Know your out-of-pocket cost for care.

All Charges