Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR ANTHROGRAM ELBOW BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7308550
Hospital Charge Code	2011437
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 HIP BILATERAL

Facility

$2,520.00

Service Code	HCPCS 7352550
Hospital Charge Code	2011438
Hospital Revenue Code	322
Min. Negotiated Rate	$378.00
Max. Negotiated Rate	$378.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.00

XR ANTHROGRAM HIP BILATERAL

Facility

$2,520.00

Service Code	HCPCS 7352550
Hospital Charge Code	2011438
Hospital Revenue Code	322
Min. Negotiated Rate	$60.73
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$957.60
Rate for Payer: Aetna Medicare Advantage	$756.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$642.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$642.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$642.60
Rate for Payer: Cigna Commercial	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$60.73
Rate for Payer: Wellpoint Medicaid Managed Care	$66.78

XR ANTHROGRAM KNEE

Facility

$1,238.40

Service Code	HCPCS 73580
Hospital Charge Code	2011439
Hospital Revenue Code	322
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Qualcare PPO/HMO/WC	$185.76

XR ANTHROGRAM KNEE

Facility

$1,238.40

Service Code	HCPCS 73580
Hospital Charge Code	2011439
Hospital Revenue Code	322
Min. Negotiated Rate	$29.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.76
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,627.00
Rate for Payer: Wellpoint Medicaid Managed Care	$32.82

XR ANTHROGRAM KNEE BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7358050
Hospital Charge Code	2011440
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 KNEE BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7358050
Hospital Charge Code	2011440
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 SACROILIAC JOINT

Facility

$1,238.40

Hospital Charge Code	2011441
Hospital Revenue Code	322
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Qualcare PPO/HMO/WC	$185.76

XR ANTHROGRAM SACROILIAC JOINT

Facility

$1,238.40

Hospital Charge Code	2011441
Hospital Revenue Code	322
Min. Negotiated Rate	$29.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$470.59
Rate for Payer: Aetna Medicare Advantage	$371.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.79
Rate for Payer: Cigna Commercial	$619.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.76
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.85
Rate for Payer: Wellpoint Medicaid Managed Care	$32.82

XR ARTERIOGRAM EXTREMITY BI***

Facility

$394.00

Service Code	HCPCS 75716
Hospital Charge Code	2000859
Hospital Revenue Code	323
Min. Negotiated Rate	$59.10
Max. Negotiated Rate	$59.10
Rate for Payer: Qualcare PPO/HMO/WC	$59.10

XR ARTERIOGRAM EXTREMITY BI***

Facility

$394.00

Service Code	HCPCS 75716
Hospital Charge Code	2000859
Hospital Revenue Code	323
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$2,625.82
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.10
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$9.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$10.44

XR ARTHERECTOMY OPEN TIBIOPERO

Facility

$40,990.35

Hospital Charge Code	5600111
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

XR ARTHERECTOMY OPEN TIBIOPERO

Facility

$40,990.35

Hospital Charge Code	5600111
Hospital Revenue Code	361
Min. Negotiated Rate	$987.87
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$15,576.33
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
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	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,297.10
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55
Rate for Payer: UnitedHealthcare Community & State	$987.87
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.24

XR ARTHROGRAM ANKLE

Facility

$1,238.40

Service Code	HCPCS 73615
Hospital Charge Code	2011436
Hospital Revenue Code	322
Min. Negotiated Rate	$29.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.76
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$32.82

XR ARTHROGRAM ANKLE

Facility

$1,238.40

Service Code	HCPCS 73615
Hospital Charge Code	2011436
Hospital Revenue Code	322
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Qualcare PPO/HMO/WC	$185.76

XR ARTHROGRAM ANKLE LT

Facility

$1,238.40

Service Code	HCPCS 73615
Hospital Charge Code	2000978
Hospital Revenue Code	322
Min. Negotiated Rate	$29.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.76
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$32.82

XR ARTHROGRAM ANKLE LT

Facility

$1,238.40

Service Code	HCPCS 73615
Hospital Charge Code	2000978
Hospital Revenue Code	322
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Qualcare PPO/HMO/WC	$185.76

XR ARTHROGRAM ANKLE RT

Facility

$1,238.40

Service Code	HCPCS 73615
Hospital Charge Code	2000979
Hospital Revenue Code	322
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Qualcare PPO/HMO/WC	$185.76

XR ARTHROGRAM ANKLE RT

Facility

$1,238.40

Service Code	HCPCS 73615
Hospital Charge Code	2000979
Hospital Revenue Code	322
Min. Negotiated Rate	$29.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.76
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$32.82

XR ARTHROGRAM ELBOW LT

Facility

$1,238.40

Service Code	HCPCS 73085
Hospital Charge Code	2000976
Hospital Revenue Code	322
Min. Negotiated Rate	$29.85
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.76
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$607.00
Rate for Payer: Wellpoint Medicaid Managed Care	$32.82

XR ARTHROGRAM ELBOW LT

Facility

$1,238.40

Service Code	HCPCS 73085
Hospital Charge Code	2000976
Hospital Revenue Code	322
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Qualcare PPO/HMO/WC	$185.76

XR ARTHROGRAM ELBOW RT

Facility

$5,100.00

Service Code	HCPCS 73085
Hospital Charge Code	2000977
Hospital Revenue Code	322
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ARTHROGRAM ELBOW RT

Facility

$5,100.00

Service Code	HCPCS 73085
Hospital Charge Code	2000977
Hospital Revenue Code	322
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
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	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$607.00
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR ARTHROGRAM HIP LT

Facility

$5,100.00

Service Code	HCPCS 73525
Hospital Charge Code	2004281
Hospital Revenue Code	322
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ARTHROGRAM HIP LT

Facility

$5,100.00

Service Code	HCPCS 73525
Hospital Charge Code	2004281
Hospital Revenue Code	322
Min. Negotiated Rate	$40.66
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
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	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,627.00
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

Know your out-of-pocket cost for care.

All Charges