Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HIP I VIEW W/WO PELVIS 1V LT

Facility

$358.23

Service Code	HCPCS 73501LT
Hospital Charge Code	94270265
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

HIP I VIEW W/WO PELVIS 1V LT

Facility

$5,100.00

Service Code	HCPCS 73501LT
Hospital Charge Code	2011550
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

HIP I VIEW W/WO PELVIS 1V LT

Facility

$5,100.00

Service Code	HCPCS 73501LT
Hospital Charge Code	94061485
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

HIP I VIEW W/WO PELVIS 1V LT

Facility

$5,100.00

Service Code	HCPCS 73501LT
Hospital Charge Code	2011550
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP I VIEW W/WO PELVIS 1V RT

Facility

$358.23

Service Code	HCPCS 73501RT
Hospital Charge Code	94270266
Hospital Revenue Code	320
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

HIP I VIEW W/WO PELVIS 1V RT

Facility

$5,100.00

Service Code	HCPCS 73501RT
Hospital Charge Code	2011551
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

HIP I VIEW W/WO PELVIS 1V RT

Facility

$5,100.00

Service Code	HCPCS 73501RT
Hospital Charge Code	94061486
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

HIP I VIEW W/WO PELVIS 1V RT

Facility

$5,100.00

Service Code	HCPCS 73501RT
Hospital Charge Code	94061486
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP I VIEW W/WO PELVIS 1V RT

Facility

$5,100.00

Service Code	HCPCS 73501RT
Hospital Charge Code	2011551
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP I VIEW W/WO PELVIS 1V RT

Facility

$358.23

Service Code	HCPCS 73501RT
Hospital Charge Code	94270266
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

HIP MAP 3105.001.000

Facility

$2,060.00

Hospital Charge Code	270698390
Hospital Revenue Code	270
Min. Negotiated Rate	$309.00
Max. Negotiated Rate	$309.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.00

HIP MAP 3105.001.000

Facility

$2,060.00

Hospital Charge Code	270698390
Hospital Revenue Code	270
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$1,030.00
Rate for Payer: Aetna Commercial	$782.80
Rate for Payer: Aetna Medicare Advantage	$618.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$525.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$525.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$525.30
Rate for Payer: Cigna Commercial	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.00
Rate for Payer: Oxford Commercial	$412.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.00
Rate for Payer: UnitedHealthcare Commercial	$412.00
Rate for Payer: UnitedHealthcare Community & State	$49.65
Rate for Payer: Wellpoint Medicaid Managed Care	$54.59

HIP ONE VIEW-LT

Facility

$250.00

Hospital Charge Code	94061353
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIP ONE VIEW-LT

Facility

$250.00

Hospital Charge Code	94061353
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

HIP ONE VIEW-RT

Facility

$250.00

Hospital Charge Code	94061355
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIP ONE VIEW-RT

Facility

$250.00

Hospital Charge Code	94061355
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

HIP PUSHLOCK 2.9MM

Facility

$1,475.00

Hospital Charge Code	270681575
Hospital Revenue Code	272
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.50
Rate for Payer: Oxford Commercial	$295.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$295.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

HIP PUSHLOCK 2.9MM

Facility

$1,475.00

Hospital Charge Code	270681575
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$94,903.69

Service Code	MSDRG 521
Min. Negotiated Rate	$28,896.96
Max. Negotiated Rate	$94,903.69
Rate for Payer: Aetna Commercial	$65,466.98
Rate for Payer: Aetna Medicare Advantage	$94,903.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69,550.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69,550.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30,417.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69,550.39
Rate for Payer: Cigna Commercial	$53,712.92
Rate for Payer: Cigna Medicare Advantage	$30,417.85
Rate for Payer: Clover Medicare Advantage	$28,896.96
Rate for Payer: EmblemHealth Commercial	$91,253.55
Rate for Payer: Humana Medicare Advantage	$31,330.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30,417.85
Rate for Payer: Oxford Commercial	$38,604.19
Rate for Payer: UnitedHealthcare Commercial	$67,693.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$30,417.85
Rate for Payer: Wellcare Medicare Advantage	$30,417.85

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$70,581.64

Service Code	MSDRG 522
Min. Negotiated Rate	$21,491.20
Max. Negotiated Rate	$70,581.64
Rate for Payer: Aetna Commercial	$48,754.97
Rate for Payer: Aetna Medicare Advantage	$70,581.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,080.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,080.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,622.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,080.71
Rate for Payer: Cigna Commercial	$39,630.64
Rate for Payer: Cigna Medicare Advantage	$22,622.32
Rate for Payer: Clover Medicare Advantage	$21,491.20
Rate for Payer: EmblemHealth Commercial	$67,866.96
Rate for Payer: Humana Medicare Advantage	$23,300.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,622.32
Rate for Payer: Oxford Commercial	$28,483.06
Rate for Payer: UnitedHealthcare Commercial	$49,945.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,622.32
Rate for Payer: Wellcare Medicare Advantage	$22,622.32

HIP RETRACTOR SINGLR PRONG

Facility

$2,941.85

Hospital Charge Code	270678487
Hospital Revenue Code	272
Min. Negotiated Rate	$441.28
Max. Negotiated Rate	$441.28
Rate for Payer: Qualcare PPO/HMO/WC	$441.28

HIP RETRACTOR SINGLR PRONG

Facility

$2,941.85

Hospital Charge Code	270678487
Hospital Revenue Code	272
Min. Negotiated Rate	$70.90
Max. Negotiated Rate	$1,470.92
Rate for Payer: Aetna Commercial	$1,117.90
Rate for Payer: Aetna Medicare Advantage	$882.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$750.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$750.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$750.17
Rate for Payer: Cigna Commercial	$1,470.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$882.55
Rate for Payer: Oxford Commercial	$588.37
Rate for Payer: Qualcare PPO/HMO/WC	$441.28
Rate for Payer: UnitedHealthcare Commercial	$588.37
Rate for Payer: UnitedHealthcare Community & State	$70.90
Rate for Payer: Wellpoint Medicaid Managed Care	$77.96

HIPS BILATERAL WITH PELVIS

Facility

$250.00

Hospital Charge Code	2002665
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

HIPS BILATERAL WITH PELVIS

Facility

$250.00

Hospital Charge Code	2002665
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIPS BILAT W/AP PELVIS

Facility

$250.00

Hospital Charge Code	94061113
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

Know your out-of-pocket cost for care.

All Charges