Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-INJECT KNEE ARTHRO-RT

Facility

$719.00

Service Code	HCPCS 27370RT
Hospital Charge Code	2690985
Hospital Revenue Code	761
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$359.50
Rate for Payer: Aetna Commercial	$273.22
Rate for Payer: Aetna Medicare Advantage	$215.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.34
Rate for Payer: Cigna Commercial	$359.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.70
Rate for Payer: Oxford Commercial	$143.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.85
Rate for Payer: UnitedHealthcare Commercial	$143.80
Rate for Payer: UnitedHealthcare Community & State	$17.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.05

IR-INJECT WRIST ARTHRO-BI

Facility

$638.00

Service Code	HCPCS 2524650
Hospital Charge Code	7411775
Hospital Revenue Code	361
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$242.44
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.70
Rate for Payer: UnitedHealthcare Community & State	$15.38
Rate for Payer: Wellpoint Medicaid Managed Care	$16.91

IR-INJECT WRIST ARTHRO-BI

Facility

$638.00

Service Code	HCPCS 2524650
Hospital Charge Code	7411775
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-BI

Facility

$638.00

Service Code	HCPCS 2524650
Hospital Charge Code	2690335
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-BI

Facility

$638.00

Service Code	HCPCS 2524650
Hospital Charge Code	2690335
Hospital Revenue Code	361
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$242.44
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.70
Rate for Payer: UnitedHealthcare Community & State	$15.38
Rate for Payer: Wellpoint Medicaid Managed Care	$16.91

IR-INJECT WRIST ARTHRO-LT

Facility

$638.00

Service Code	HCPCS 25246LT
Hospital Charge Code	321025246L
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-LT

Facility

$638.00

Service Code	HCPCS 25246LT
Hospital Charge Code	7411869
Hospital Revenue Code	361
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$242.44
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.70
Rate for Payer: UnitedHealthcare Community & State	$15.38
Rate for Payer: Wellpoint Medicaid Managed Care	$16.91

IR-INJECT WRIST ARTHRO-LT

Facility

$638.00

Service Code	HCPCS 25246LT
Hospital Charge Code	2690950
Hospital Revenue Code	361
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$242.44
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.70
Rate for Payer: UnitedHealthcare Community & State	$15.38
Rate for Payer: Wellpoint Medicaid Managed Care	$16.91

IR-INJECT WRIST ARTHRO-LT

Facility

$638.00

Service Code	HCPCS 25246LT
Hospital Charge Code	2690950
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-LT

Facility

$638.00

Service Code	HCPCS 25246LT
Hospital Charge Code	321025246L
Hospital Revenue Code	361
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$242.44
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.70
Rate for Payer: UnitedHealthcare Community & State	$15.38
Rate for Payer: Wellpoint Medicaid Managed Care	$16.91

IR-INJECT WRIST ARTHRO-LT

Facility

$638.00

Service Code	HCPCS 25246LT
Hospital Charge Code	7411869
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-RT

Facility

$638.00

Service Code	HCPCS 25246RT
Hospital Charge Code	7411870
Hospital Revenue Code	361
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$242.44
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.70
Rate for Payer: UnitedHealthcare Community & State	$15.38
Rate for Payer: Wellpoint Medicaid Managed Care	$16.91

IR-INJECT WRIST ARTHRO-RT

Facility

$638.00

Service Code	HCPCS 25246RT
Hospital Charge Code	7411870
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJECT WRIST ARTHRO-RT

Facility

$638.00

Service Code	HCPCS 25246RT
Hospital Charge Code	2690955
Hospital Revenue Code	361
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$242.44
Rate for Payer: Aetna Medicare Advantage	$191.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.69
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	$162.69
Rate for Payer: Cigna Commercial	$319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.70
Rate for Payer: UnitedHealthcare Community & State	$15.38
Rate for Payer: Wellpoint Medicaid Managed Care	$16.91

IR-INJECT WRIST ARTHRO-RT

Facility

$638.00

Service Code	HCPCS 25246RT
Hospital Charge Code	2690955
Hospital Revenue Code	361
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

IR-INJ ELBOW ARTHRO-BILAT

Facility

$646.00

Service Code	HCPCS 2422050
Hospital Charge Code	2690330
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-BILAT

Facility

$646.00

Service Code	HCPCS 2422050
Hospital Charge Code	7411774
Hospital Revenue Code	361
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
Rate for Payer: UnitedHealthcare Community & State	$15.57
Rate for Payer: Wellpoint Medicaid Managed Care	$17.12

IR-INJ ELBOW ARTHRO-BILAT

Facility

$646.00

Service Code	HCPCS 2422050
Hospital Charge Code	7411774
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-BILAT

Facility

$646.00

Service Code	HCPCS 2422050
Hospital Charge Code	2690330
Hospital Revenue Code	361
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
Rate for Payer: UnitedHealthcare Community & State	$15.57
Rate for Payer: Wellpoint Medicaid Managed Care	$17.12

IR-INJ ELBOW ARTHRO-LT

Facility

$646.00

Service Code	HCPCS 24220LT
Hospital Charge Code	2690940
Hospital Revenue Code	361
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
Rate for Payer: UnitedHealthcare Community & State	$15.57
Rate for Payer: Wellpoint Medicaid Managed Care	$17.12

IR-INJ ELBOW ARTHRO-LT

Facility

$646.00

Service Code	HCPCS 24220LT
Hospital Charge Code	2690940
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-LT

Facility

$646.00

Service Code	HCPCS 24220LT
Hospital Charge Code	7411867
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-LT

Facility

$646.00

Service Code	HCPCS 24220LT
Hospital Charge Code	7411867
Hospital Revenue Code	361
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
Rate for Payer: UnitedHealthcare Community & State	$15.57
Rate for Payer: Wellpoint Medicaid Managed Care	$17.12

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	7411868
Hospital Revenue Code	361
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

IR-INJ ELBOW ARTHRO-RT

Facility

$646.00

Service Code	HCPCS 24220RT
Hospital Charge Code	7411868
Hospital Revenue Code	361
Min. Negotiated Rate	$15.57
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna Medicare Advantage	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.73
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	$164.73
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
Rate for Payer: UnitedHealthcare Community & State	$15.57
Rate for Payer: Wellpoint Medicaid Managed Care	$17.12

Know your out-of-pocket cost for care.

All Charges