Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR ARTHROGRAM HIP RT

Facility

$5,100.00

Service Code	HCPCS 73525
Hospital Charge Code	2004282
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

XR ARTHROGRAM HIP RT

Facility

$5,100.00

Service Code	HCPCS 73525
Hospital Charge Code	2004282
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 KNEE LT

Facility

$5,100.00

Service Code	HCPCS 73580
Hospital Charge Code	2000974
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 KNEE LT

Facility

$5,100.00

Service Code	HCPCS 73580
Hospital Charge Code	2000974
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

XR ARTHROGRAM KNEE RT

Facility

$5,100.00

Service Code	HCPCS 73580
Hospital Charge Code	2000975
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

XR ARTHROGRAM KNEE RT

Facility

$5,100.00

Service Code	HCPCS 73580
Hospital Charge Code	2000975
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 SHOULDER BILTERL

Facility

$2,520.00

Service Code	HCPCS 7304050
Hospital Charge Code	2011442
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 ARTHROGRAM SHOULDER BILTERL

Facility

$2,520.00

Service Code	HCPCS 7304050
Hospital Charge Code	2011442
Hospital Revenue Code	322
Min. Negotiated Rate	$378.00
Max. Negotiated Rate	$378.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.00

XR ARTHROGRAM SHOULDER LT

Facility

$5,100.00

Service Code	HCPCS 73040
Hospital Charge Code	2002269
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: Wellpoint Medicaid Managed Care	$135.15

XR ARTHROGRAM SHOULDER LT

Facility

$5,100.00

Service Code	HCPCS 73040
Hospital Charge Code	2002269
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 SHOULDER RT

Facility

$5,100.00

Service Code	HCPCS 73040
Hospital Charge Code	2002270
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 SHOULDER RT

Facility

$5,100.00

Service Code	HCPCS 73040
Hospital Charge Code	2002270
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: Wellpoint Medicaid Managed Care	$135.15

XR ARTHROGRAM TMJ BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7033250
Hospital Charge Code	2011443
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 ARTHROGRAM TMJ BILATERAL

Facility

$2,476.80

Service Code	HCPCS 7033250
Hospital Charge Code	2011443
Hospital Revenue Code	322
Min. Negotiated Rate	$371.52
Max. Negotiated Rate	$371.52
Rate for Payer: Qualcare PPO/HMO/WC	$371.52

XR ARTHROGRAM TMJ LEFT

Facility

$1,238.40

Service Code	HCPCS 70332LT
Hospital Charge Code	2011444
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 TMJ LEFT

Facility

$1,238.40

Service Code	HCPCS 70332LT
Hospital Charge Code	2011444
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 ARTHROGRAM TMJ RIGHT

Facility

$1,238.40

Service Code	HCPCS 70332RT
Hospital Charge Code	2011445
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 TMJ RIGHT

Facility

$1,238.40

Service Code	HCPCS 70332RT
Hospital Charge Code	2011445
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 ARTHROGRAM WRIST BILATERAL

Facility

$2,520.00

Service Code	HCPCS 7311550
Hospital Charge Code	2011446
Hospital Revenue Code	322
Min. Negotiated Rate	$378.00
Max. Negotiated Rate	$378.00
Rate for Payer: Qualcare PPO/HMO/WC	$378.00

XR ARTHROGRAM WRIST BILATERAL

Facility

$2,520.00

Service Code	HCPCS 7311550
Hospital Charge Code	2011446
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 ARTHROGRAPHY WRIST LEFT

Facility

$5,100.00

Service Code	HCPCS 73115
Hospital Charge Code	2004942
Hospital Revenue Code	322
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ARTHROGRAPHY WRIST LEFT

Facility

$5,100.00

Service Code	HCPCS 73115
Hospital Charge Code	2004942
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: Wellpoint Medicaid Managed Care	$135.15

XR ARTHROGRAPHY WRIST RIGHT

Facility

$1,260.00

Service Code	HCPCS 73115
Hospital Charge Code	2004940
Hospital Revenue Code	322
Min. Negotiated Rate	$30.37
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	$378.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$30.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$33.39

XR ARTHROGRAPHY WRIST RIGHT

Facility

$1,260.00

Service Code	HCPCS 73115
Hospital Charge Code	2004940
Hospital Revenue Code	322
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$189.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.00

XR ATHERECTOMY OPEN BRACHIO EA

Facility

$40,991.00

Hospital Charge Code	5600110
Hospital Revenue Code	361
Min. Negotiated Rate	$987.88
Max. Negotiated Rate	$20,495.50
Rate for Payer: Aetna Commercial	$15,576.58
Rate for Payer: Aetna Medicare Advantage	$12,297.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.70
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	$10,452.70
Rate for Payer: Cigna Commercial	$20,495.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,297.30
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.65
Rate for Payer: UnitedHealthcare Community & State	$987.88
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.26

Know your out-of-pocket cost for care.

All Charges