Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HIPS BILAT W/AP PELVIS

Facility

$250.00

Hospital Charge Code	94061113
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$593.26

Service Code	HCPCS 73521
Hospital Charge Code	75190635
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$593.26

Service Code	HCPCS 73521
Hospital Charge Code	2011596
Hospital Revenue Code	320
Min. Negotiated Rate	$14.30
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	$42.50
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	$177.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$15.72

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$593.26

Service Code	HCPCS 73521
Hospital Charge Code	94270260
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73521
Hospital Charge Code	94061480
Hospital Revenue Code	320
Min. Negotiated Rate	$42.50
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	$42.50
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	$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	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$593.26

Service Code	HCPCS 73521
Hospital Charge Code	2011596
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$6,601.19

Service Code	HCPCS 73521
Hospital Charge Code	2011560
Hospital Revenue Code	320
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$1,980.36
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	$42.50
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	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$593.26

Service Code	HCPCS 73521
Hospital Charge Code	75190635
Hospital Revenue Code	320
Min. Negotiated Rate	$14.30
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	$42.50
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	$177.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$15.72

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73521
Hospital Charge Code	94061480
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$6,601.19

Service Code	HCPCS 73521
Hospital Charge Code	2011560
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

HIPS BIL W/WO PELVIS 2 VIEWS

Facility

$593.26

Service Code	HCPCS 73521
Hospital Charge Code	94270260
Hospital Revenue Code	320
Min. Negotiated Rate	$14.30
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	$42.50
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	$177.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$15.72

HIP SELF CENTERING 45 GRY 28

Facility

$3,125.00

Hospital Charge Code	270657413
Hospital Revenue Code	278
Min. Negotiated Rate	$75.31
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$1,187.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Community & State	$75.31
Rate for Payer: Wellpoint Medicaid Managed Care	$82.81

HIP SELF CENTERING 45 GRY 28

Facility

$3,125.00

Hospital Charge Code	270657413
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

HIP SELF CENTERING 47 BRN 38

Facility

$3,125.00

Hospital Charge Code	270657415
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

HIP SELF CENTERING 47 BRN 38

Facility

$3,125.00

Hospital Charge Code	270657415
Hospital Revenue Code	278
Min. Negotiated Rate	$75.31
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$1,187.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Community & State	$75.31
Rate for Payer: Wellpoint Medicaid Managed Care	$82.81

HIPS INFANT/CHILD-BIL

Facility

$204.00

Hospital Charge Code	2009330
Hospital Revenue Code	322
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

HIPS INFANT/CHILD-BIL

Facility

$204.00

Hospital Charge Code	2009330
Hospital Revenue Code	322
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

HIP SPICA

Facility

$785.65

Hospital Charge Code	4000048
Hospital Revenue Code	270
Min. Negotiated Rate	$117.85
Max. Negotiated Rate	$117.85
Rate for Payer: Qualcare PPO/HMO/WC	$117.85

HIP SPICA

Facility

$785.65

Hospital Charge Code	4000048
Hospital Revenue Code	270
Min. Negotiated Rate	$18.93
Max. Negotiated Rate	$392.82
Rate for Payer: Aetna Commercial	$298.55
Rate for Payer: Aetna Medicare Advantage	$235.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.34
Rate for Payer: Cigna Commercial	$392.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.69
Rate for Payer: Oxford Commercial	$157.13
Rate for Payer: Qualcare PPO/HMO/WC	$117.85
Rate for Payer: UnitedHealthcare Commercial	$157.13
Rate for Payer: UnitedHealthcare Community & State	$18.93
Rate for Payer: Wellpoint Medicaid Managed Care	$20.82

HIP SPICA WITH PELVIC BAND

Facility

$3,046.45

Service Code	HCPCS L1686
Hospital Charge Code	270610655
Hospital Revenue Code	274
Min. Negotiated Rate	$73.42
Max. Negotiated Rate	$1,523.22
Rate for Payer: Aetna Commercial	$1,157.65
Rate for Payer: Aetna Medicare Advantage	$913.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$776.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$776.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$609.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$776.84
Rate for Payer: Cigna Commercial	$1,523.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$737.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$670.22
Rate for Payer: Qualcare PPO/HMO/WC	$456.97
Rate for Payer: UnitedHealthcare Community & State	$73.42
Rate for Payer: Wellpoint Medicaid Managed Care	$80.73

HIP SPICA WITH PELVIC BAND

Facility

$3,046.45

Service Code	HCPCS L1686
Hospital Charge Code	270610655
Hospital Revenue Code	274
Min. Negotiated Rate	$456.97
Max. Negotiated Rate	$737.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$609.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$737.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$670.22
Rate for Payer: Qualcare PPO/HMO/WC	$456.97

HIP STEM CEMENTED

Facility

$2,743.60

Hospital Charge Code	270660304
Hospital Revenue Code	278
Min. Negotiated Rate	$66.12
Max. Negotiated Rate	$1,371.80
Rate for Payer: Aetna Commercial	$1,042.57
Rate for Payer: Aetna Medicare Advantage	$823.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.62
Rate for Payer: Cigna Commercial	$1,371.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$603.59
Rate for Payer: Qualcare PPO/HMO/WC	$411.54
Rate for Payer: UnitedHealthcare Community & State	$66.12
Rate for Payer: Wellpoint Medicaid Managed Care	$72.71

HIP STEM CEMENTED

Facility

$2,743.60

Hospital Charge Code	270660304
Hospital Revenue Code	278
Min. Negotiated Rate	$411.54
Max. Negotiated Rate	$663.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$603.59
Rate for Payer: Qualcare PPO/HMO/WC	$411.54

HIP STEM C-TPR 127DEG 35x160MM

Facility

$14,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270672946
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.50
Max. Negotiated Rate	$3,593.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,593.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.50

HIP STEM C-TPR 127DEG 35x160MM

Facility

$14,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270672946
Hospital Revenue Code	278
Min. Negotiated Rate	$357.88
Max. Negotiated Rate	$7,425.00
Rate for Payer: Aetna Commercial	$5,643.00
Rate for Payer: Aetna Medicare Advantage	$4,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,786.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,786.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,786.75
Rate for Payer: Cigna Commercial	$7,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,593.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.50
Rate for Payer: UnitedHealthcare Community & State	$357.88
Rate for Payer: Wellpoint Medicaid Managed Care	$393.52

Know your out-of-pocket cost for care.

All Charges