Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

US ECHOENCEPHALOGRAPHY

Facility

$629.65

Service Code	HCPCS 76506
Hospital Charge Code	2101112
Hospital Revenue Code	402
Min. Negotiated Rate	$94.45
Max. Negotiated Rate	$94.45
Rate for Payer: Qualcare PPO/HMO/WC	$94.45

US ECHOENCEPHALOGRAPHY

Facility

$629.65

Service Code	HCPCS 76506
Hospital Charge Code	2101112
Hospital Revenue Code	402
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$2,517.00
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	$81.31
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	$124.20
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	$188.90
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.45
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$15.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$16.69

US-ECHO EXAM FETAL HEART

Facility

$526.00

Hospital Charge Code	2309030
Hospital Revenue Code	402
Min. Negotiated Rate	$78.90
Max. Negotiated Rate	$78.90
Rate for Payer: Qualcare PPO/HMO/WC	$78.90

US-ECHO EXAM FETAL HEART

Facility

$526.00

Hospital Charge Code	2309030
Hospital Revenue Code	402
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$199.88
Rate for Payer: Aetna Medicare Advantage	$157.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.13
Rate for Payer: Cigna Commercial	$263.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.80
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.90
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$12.68
Rate for Payer: Wellpoint Medicaid Managed Care	$13.94

US-ECHO FETAL HEART F/U

Facility

$462.00

Hospital Charge Code	2309035
Hospital Revenue Code	402
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$69.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.30

US-ECHO FETAL HEART F/U

Facility

$462.00

Hospital Charge Code	2309035
Hospital Revenue Code	402
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$175.56
Rate for Payer: Aetna Medicare Advantage	$138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.81
Rate for Payer: Cigna Commercial	$231.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.60
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.30
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$11.13
Rate for Payer: Wellpoint Medicaid Managed Care	$12.24

US ECHO INFANT HIPS DYNAMIC

Facility

$421.65

Service Code	HCPCS 76885
Hospital Charge Code	2100016
Hospital Revenue Code	402
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$103.39
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.50
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.25
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$10.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.17

US ECHO INFANT HIPS DYNAMIC

Facility

$421.65

Service Code	HCPCS 76885
Hospital Charge Code	2100016
Hospital Revenue Code	402
Min. Negotiated Rate	$63.25
Max. Negotiated Rate	$63.25
Rate for Payer: Qualcare PPO/HMO/WC	$63.25

US ECHO INFANT HIPS STATIC

Facility

$6,700.00

Service Code	HCPCS 76886
Hospital Charge Code	2100017
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US ECHO INFANT HIPS STATIC

Facility

$6,700.00

Service Code	HCPCS 76886
Hospital Charge Code	2100017
Hospital Revenue Code	402
Min. Negotiated Rate	$77.87
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$103.39
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US ECHO INTRAOPERATIVE

Facility

$1,981.25

Service Code	HCPCS 76998
Hospital Charge Code	2101128
Hospital Revenue Code	402
Min. Negotiated Rate	$297.19
Max. Negotiated Rate	$297.19
Rate for Payer: Qualcare PPO/HMO/WC	$297.19

US ECHO INTRAOPERATIVE

Facility

$1,981.25

Service Code	HCPCS 76998
Hospital Charge Code	2101128
Hospital Revenue Code	402
Min. Negotiated Rate	$47.75
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$752.88
Rate for Payer: Aetna Medicare Advantage	$594.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$505.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$505.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$505.22
Rate for Payer: Cigna Commercial	$990.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$594.38
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$297.19
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$47.75
Rate for Payer: Wellpoint Medicaid Managed Care	$52.50

US EXT NON VASC COMPLETE LT

Facility

$6,700.00

Service Code	HCPCS 76881LT
Hospital Charge Code	2307025
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US EXT NON VASC COMPLETE LT

Facility

$6,700.00

Service Code	HCPCS 76881LT
Hospital Charge Code	2307025
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXT NON VASC COMPLETE RT

Facility

$6,700.00

Service Code	HCPCS 76881RT
Hospital Charge Code	2307020
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXT NON VASC COMPLETE RT

Facility

$6,700.00

Service Code	HCPCS 76881RT
Hospital Charge Code	2307020
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US EXT NON VASC LTD BIL

Facility

$891.00

Service Code	HCPCS 7688250
Hospital Charge Code	2308010
Hospital Revenue Code	402
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$338.58
Rate for Payer: Aetna Medicare Advantage	$267.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.21
Rate for Payer: Cigna Commercial	$445.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.30
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.65
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$21.47
Rate for Payer: Wellpoint Medicaid Managed Care	$23.61

US EXT NON VASC LTD BIL

Facility

$891.00

Service Code	HCPCS 7688250
Hospital Charge Code	2308010
Hospital Revenue Code	402
Min. Negotiated Rate	$133.65
Max. Negotiated Rate	$133.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.65

US EXT NON VASC LTD BIL

Facility

$891.00

Service Code	HCPCS 7688250
Hospital Charge Code	7412035
Hospital Revenue Code	891
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$445.50
Rate for Payer: Aetna Commercial	$338.58
Rate for Payer: Aetna Medicare Advantage	$267.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.21
Rate for Payer: Cigna Commercial	$445.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.30
Rate for Payer: Oxford Commercial	$178.20
Rate for Payer: Qualcare PPO/HMO/WC	$133.65
Rate for Payer: UnitedHealthcare Commercial	$178.20
Rate for Payer: UnitedHealthcare Community & State	$21.47
Rate for Payer: Wellpoint Medicaid Managed Care	$23.61

US EXT NON VASC LTD BIL

Facility

$891.00

Service Code	HCPCS 7688250
Hospital Charge Code	7412035
Hospital Revenue Code	891
Min. Negotiated Rate	$133.65
Max. Negotiated Rate	$133.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.65

US EXTREMITY NON-VASCULAR BLTL

Facility

$359.75

Hospital Charge Code	2301009
Hospital Revenue Code	402
Min. Negotiated Rate	$53.96
Max. Negotiated Rate	$53.96
Rate for Payer: Qualcare PPO/HMO/WC	$53.96

US EXTREMITY NON-VASCULAR BLTL

Facility

$359.75

Hospital Charge Code	2301009
Hospital Revenue Code	402
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$136.71
Rate for Payer: Aetna Medicare Advantage	$107.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.74
Rate for Payer: Cigna Commercial	$179.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.92
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.96
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$8.67
Rate for Payer: Wellpoint Medicaid Managed Care	$9.53

US EXTREMITY NON-VASCULAR COMP

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	2100263
Hospital Revenue Code	402
Min. Negotiated Rate	$98.81
Max. Negotiated Rate	$2,517.00
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	$98.81
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	$124.20
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	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US EXTREMITY NON-VASCULAR COMP

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	2100263M
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXTREMITY NON-VASCULAR COMP

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	2100263
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

Know your out-of-pocket cost for care.

All Charges