Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-INJ FOR URETOPYELOG-RT

Facility

$942.00

Service Code	HCPCS 50690RT
Hospital Charge Code	2691705
Hospital Revenue Code	761
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$471.00
Rate for Payer: Aetna Commercial	$357.96
Rate for Payer: Aetna Medicare Advantage	$282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.21
Rate for Payer: Cigna Commercial	$471.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$282.60
Rate for Payer: Oxford Commercial	$188.40
Rate for Payer: Qualcare PPO/HMO/WC	$141.30
Rate for Payer: UnitedHealthcare Commercial	$188.40
Rate for Payer: UnitedHealthcare Community & State	$22.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.96

IR-INJ FOR URETOPYELOG-RT

Facility

$942.00

Service Code	HCPCS 50690RT
Hospital Charge Code	2691705
Hospital Revenue Code	761
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

IR-INJ FOR URETOPYELOG-RT

Facility

$942.00

Service Code	HCPCS 50690RT
Hospital Charge Code	7411981
Hospital Revenue Code	761
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$471.00
Rate for Payer: Aetna Commercial	$357.96
Rate for Payer: Aetna Medicare Advantage	$282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.21
Rate for Payer: Cigna Commercial	$471.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$282.60
Rate for Payer: Oxford Commercial	$188.40
Rate for Payer: Qualcare PPO/HMO/WC	$141.30
Rate for Payer: UnitedHealthcare Commercial	$188.40
Rate for Payer: UnitedHealthcare Community & State	$22.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.96

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	411020501
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	411020501
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	7411343
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	2004455
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	321020501
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	366820501
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	321020501
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	2004455
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	366820501
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

IR INJ OF TRACT SINOGRAM DIAG

Facility

$414.45

Service Code	HCPCS 20501
Hospital Charge Code	7411343
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

IR INJ PROC ANKLE ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 27648
Hospital Charge Code	7411372
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC ANKLE ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 27648
Hospital Charge Code	7411372
Hospital Revenue Code	361
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

IR INJ PROC ANKLE ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 27648
Hospital Charge Code	2680105
Hospital Revenue Code	361
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

IR INJ PROC ANKLE ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 27648
Hospital Charge Code	2680105
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC CHOLANG THRU CATH

Facility

$414.45

Hospital Charge Code	2000939
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

IR INJ PROC CHOLANG THRU CATH

Facility

$414.45

Hospital Charge Code	2000939
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ. PROC.ELBOW ARTHROGRAPH

Facility

$414.00

Service Code	HCPCS 24220
Hospital Charge Code	2680065
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ. PROC.ELBOW ARTHROGRAPH

Facility

$414.00

Service Code	HCPCS 24220
Hospital Charge Code	2680065
Hospital Revenue Code	361
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

IR INJ. PROC.ELBOW ARTHROGRAPH

Facility

$414.00

Service Code	HCPCS 24220
Hospital Charge Code	7411362
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ. PROC.ELBOW ARTHROGRAPH

Facility

$414.00

Service Code	HCPCS 24220
Hospital Charge Code	7411362
Hospital Revenue Code	361
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

IR INJ PROC HIP ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 27093
Hospital Charge Code	321027093
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC HIP ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 27093
Hospital Charge Code	2680080
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

Know your out-of-pocket cost for care.

All Charges