Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RIMXR HIP RT COMPL 2VW

Facility

$124.00

Service Code	HCPCS 73510RT
Hospital Charge Code	2010081
Hospital Revenue Code	320
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

RIMXR HUMERUS RT

Facility

$329.00

Service Code	HCPCS 73606RT
Hospital Charge Code	2011022
Hospital Revenue Code	320
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

RIMXR HUMERUS RT

Facility

$329.00

Service Code	HCPCS 73606RT
Hospital Charge Code	2011022
Hospital Revenue Code	320
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$125.02
Rate for Payer: Aetna Medicare Advantage	$98.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.89
Rate for Payer: Cigna Commercial	$164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.93
Rate for Payer: Wellpoint Medicaid Managed Care	$8.72

RIMXR KNEE LT 2 VIEWS

Facility

$165.00

Service Code	HCPCS 735060LT
Hospital Charge Code	2010098
Hospital Revenue Code	320
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$62.70
Rate for Payer: Aetna Medicare Advantage	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.08
Rate for Payer: Cigna Commercial	$82.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

RIMXR KNEE LT 2 VIEWS

Facility

$165.00

Service Code	HCPCS 735060LT
Hospital Charge Code	2010098
Hospital Revenue Code	320
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.75

RIMXR KNEE RT 2 VIEWS

Facility

$165.00

Service Code	HCPCS 73560RT
Hospital Charge Code	2010099
Hospital Revenue Code	320
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.75

RIMXR KNEE RT 2 VIEWS

Facility

$165.00

Service Code	HCPCS 73560RT
Hospital Charge Code	2010099
Hospital Revenue Code	320
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$62.70
Rate for Payer: Aetna Medicare Advantage	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.08
Rate for Payer: Cigna Commercial	$82.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

RIMXR L-S SPINE 2 VIEWS

Facility

$101.00

Service Code	HCPCS 72100
Hospital Charge Code	2010056
Hospital Revenue Code	320
Min. Negotiated Rate	$2.43
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	$42.59
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	$30.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

RIMXR L-S SPINE 2 VIEWS

Facility

$101.00

Service Code	HCPCS 72100
Hospital Charge Code	2010056
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR LT HUMERUS

Facility

$329.00

Service Code	HCPCS 73060LT
Hospital Charge Code	2011021
Hospital Revenue Code	320
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$125.02
Rate for Payer: Aetna Medicare Advantage	$98.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.89
Rate for Payer: Cigna Commercial	$164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.93
Rate for Payer: Wellpoint Medicaid Managed Care	$8.72

RIMXR LT HUMERUS

Facility

$329.00

Service Code	HCPCS 73060LT
Hospital Charge Code	2011021
Hospital Revenue Code	320
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

RIMXR PELVIS 3 VIEWS

Facility

$101.00

Service Code	HCPCS 72190
Hospital Charge Code	2010064
Hospital Revenue Code	320
Min. Negotiated Rate	$2.43
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	$38.72
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	$30.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

RIMXR PELVIS 3 VIEWS

Facility

$101.00

Service Code	HCPCS 72190
Hospital Charge Code	2010064
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR SHOULDER LT COMPL 2VW

Facility

$113.00

Service Code	HCPCS 73030LT
Hospital Charge Code	2010072
Hospital Revenue Code	320
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$42.94
Rate for Payer: Aetna Medicare Advantage	$33.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.82
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

RIMXR SHOULDER LT COMPL 2VW

Facility

$113.00

Service Code	HCPCS 73030LT
Hospital Charge Code	2010072
Hospital Revenue Code	320
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

RIMXR SHOULDER RT COMPL 2VW

Facility

$113.00

Service Code	HCPCS 73030RT
Hospital Charge Code	2010073
Hospital Revenue Code	320
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

RIMXR SHOULDER RT COMPL 2VW

Facility

$113.00

Service Code	HCPCS 73030RT
Hospital Charge Code	2010073
Hospital Revenue Code	320
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$42.94
Rate for Payer: Aetna Medicare Advantage	$33.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.82
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

RIMXR SKULL 4 VIEWS

Facility

$124.00

Service Code	HCPCS 70260
Hospital Charge Code	2010031
Hospital Revenue Code	320
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

RIMXR SKULL 4 VIEWS

Facility

$124.00

Service Code	HCPCS 70260
Hospital Charge Code	2010031
Hospital Revenue Code	320
Min. Negotiated Rate	$2.99
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	$53.24
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	$37.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

RIMXR TIBIA/FIBULA LT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73590LT
Hospital Charge Code	2011039
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR TIBIA/FIBULA LT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73590LT
Hospital Charge Code	2011039
Hospital Revenue Code	320
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

RIMXR TIBIA/FIBULA RT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73590RT
Hospital Charge Code	2011040
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR TIBIA/FIBULA RT 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73590RT
Hospital Charge Code	2011040
Hospital Revenue Code	320
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

RIMXR WRIST LT COMPL 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73100LT
Hospital Charge Code	2011013
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR WRIST LT COMPL 2 VIEWS

Facility

$101.00

Service Code	HCPCS 73100LT
Hospital Charge Code	2011013
Hospital Revenue Code	320
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

Know your out-of-pocket cost for care.

All Charges