Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR AC JOINTS BILATERAL W/ WTS

Facility

$258.70

Service Code	HCPCS 73050
Hospital Charge Code	2011306
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR AC JOINTS BILATERAL W/ WTS

Facility

$258.70

Service Code	HCPCS 73050
Hospital Charge Code	2011306
Hospital Revenue Code	320
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$1,975.00
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	$34.85
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	$72.37
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	$77.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

XR ACROMIOCL JNTS BI

Facility

$5,100.00

Service Code	HCPCS 73050
Hospital Charge Code	2000099
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ACROMIOCL JNTS BI

Facility

$5,100.00

Service Code	HCPCS 73050
Hospital Charge Code	2000099
Hospital Revenue Code	320
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$1,975.00
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	$34.85
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	$72.37
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	$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	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR ANGIOPLASTY FEMORAL ARTE***

Facility

$2,063.00

Service Code	HCPCS 75962
Hospital Charge Code	2002376
Hospital Revenue Code	329
Min. Negotiated Rate	$309.45
Max. Negotiated Rate	$309.45
Rate for Payer: Qualcare PPO/HMO/WC	$309.45

XR ANGIOPLASTY FEMORAL ARTE***

Facility

$2,063.00

Service Code	HCPCS 75962
Hospital Charge Code	2002376
Hospital Revenue Code	329
Min. Negotiated Rate	$49.72
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$783.94
Rate for Payer: Aetna Medicare Advantage	$618.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.07
Rate for Payer: Cigna Commercial	$1,031.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.90
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$49.72
Rate for Payer: Wellpoint Medicaid Managed Care	$54.67

XR ANGIOPLASTY ILIAC ARTERY***

Facility

$1,815.00

Service Code	HCPCS 75962
Hospital Charge Code	2002368
Hospital Revenue Code	329
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$689.70
Rate for Payer: Aetna Medicare Advantage	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$462.82
Rate for Payer: Cigna Commercial	$907.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$272.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$43.74
Rate for Payer: Wellpoint Medicaid Managed Care	$48.10

XR ANGIOPLASTY ILIAC ARTERY***

Facility

$1,815.00

Service Code	HCPCS 75962
Hospital Charge Code	2002368
Hospital Revenue Code	329
Min. Negotiated Rate	$272.25
Max. Negotiated Rate	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$272.25

XR ANGIOPLASTY RENAL ARTERY***

Facility

$1,932.00

Service Code	HCPCS 75966
Hospital Charge Code	2002384
Hospital Revenue Code	329
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$289.80
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

XR ANGIOPLASTY RENAL ARTERY***

Facility

$1,932.00

Service Code	HCPCS 75966
Hospital Charge Code	2002384
Hospital Revenue Code	329
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

XR ANKLE 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7360050
Hospital Charge Code	2011307
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ANKLE 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7360050
Hospital Charge Code	2011307
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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: Wellpoint Medicaid Managed Care	$135.15

XR ANKLE COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7361050
Hospital Charge Code	2011308
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ANKLE COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7361050
Hospital Charge Code	2011308
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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: Wellpoint Medicaid Managed Care	$174.93

XR ANKLE LT

Facility

$6,601.19

Service Code	HCPCS 73610LT
Hospital Charge Code	2000156
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ANKLE LT

Facility

$6,601.19

Service Code	HCPCS 73610LT
Hospital Charge Code	2000156
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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: Wellpoint Medicaid Managed Care	$174.93

XR ANKLE LT TWO VIEWS

Facility

$5,100.00

Service Code	HCPCS 73600LT
Hospital Charge Code	2002442
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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: Wellpoint Medicaid Managed Care	$135.15

XR ANKLE LT TWO VIEWS

Facility

$5,100.00

Service Code	HCPCS 73600LT
Hospital Charge Code	2002442
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ANKLE RT

Facility

$6,601.19

Service Code	HCPCS 73610RT
Hospital Charge Code	2000157
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ANKLE RT

Facility

$6,601.19

Service Code	HCPCS 73610RT
Hospital Charge Code	2000157
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
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: Wellpoint Medicaid Managed Care	$174.93

XR ANKLE RT TWO VIEWS

Facility

$5,100.00

Service Code	HCPCS 73600RT
Hospital Charge Code	2002443
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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: Wellpoint Medicaid Managed Care	$135.15

XR ANKLE RT TWO VIEWS

Facility

$5,100.00

Service Code	HCPCS 73600RT
Hospital Charge Code	2002443
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ANTHROGRAM ANKLE BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7361550
Hospital Charge Code	2011447
Hospital Revenue Code	322
Min. Negotiated Rate	$59.69
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$941.18
Rate for Payer: Aetna Medicare Advantage	$743.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.58
Rate for Payer: Cigna Commercial	$1,238.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.04
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.52
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$59.69
Rate for Payer: Wellpoint Medicaid Managed Care	$65.64

XR ANTHROGRAM ANKLE BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7361550
Hospital Charge Code	2011447
Hospital Revenue Code	322
Min. Negotiated Rate	$371.52
Max. Negotiated Rate	$371.52
Rate for Payer: Qualcare PPO/HMO/WC	$371.52

XR ANTHROGRAM ELBOW BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7308550
Hospital Charge Code	2011437
Hospital Revenue Code	322
Min. Negotiated Rate	$59.69
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$941.18
Rate for Payer: Aetna Medicare Advantage	$743.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.58
Rate for Payer: Cigna Commercial	$1,238.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.04
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.52
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$59.69
Rate for Payer: Wellpoint Medicaid Managed Care	$65.64

Know your out-of-pocket cost for care.

All Charges