Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

X-RAY EXAM PERITONEUM S&I

Facility

$1,404.94

Service Code	HCPCS 74190
Hospital Charge Code	2408010
Hospital Revenue Code	320
Min. Negotiated Rate	$33.86
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.48
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.74
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$33.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$37.23

X-RAY EXAM PERITONEUM S&I

Facility

$1,404.94

Service Code	HCPCS 74190
Hospital Charge Code	2408010
Hospital Revenue Code	320
Min. Negotiated Rate	$210.74
Max. Negotiated Rate	$210.74
Rate for Payer: Qualcare PPO/HMO/WC	$210.74

XRAY FOR BONE AGE-26

Facility

$49.65

Service Code	HCPCS 7707226
Hospital Charge Code	85000215
Hospital Revenue Code	320
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$7.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.45

XRAY FOR BONE AGE-26

Facility

$49.65

Service Code	HCPCS 7707226
Hospital Charge Code	85000215
Hospital Revenue Code	320
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$18.87
Rate for Payer: Aetna Medicare Advantage	$14.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.66
Rate for Payer: Cigna Commercial	$24.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.89
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

XRAY FOR BONE AGE-GL

Facility

$298.01

Service Code	HCPCS 77072
Hospital Charge Code	85000205
Hospital Revenue Code	320
Min. Negotiated Rate	$7.18
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	$31.07
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	$89.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.70
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.18
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	$7.90

XRAY FOR BONE AGE-GL

Facility

$298.01

Service Code	HCPCS 77072
Hospital Charge Code	85000205
Hospital Revenue Code	320
Min. Negotiated Rate	$44.70
Max. Negotiated Rate	$44.70
Rate for Payer: Qualcare PPO/HMO/WC	$44.70

XRAY FOR BONE AGE-TC

Facility

$84.55

Service Code	HCPCS 77072TC
Hospital Charge Code	85000210
Hospital Revenue Code	320
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$12.68
Rate for Payer: Qualcare PPO/HMO/WC	$12.68

XRAY FOR BONE AGE-TC

Facility

$84.55

Service Code	HCPCS 77072TC
Hospital Charge Code	85000210
Hospital Revenue Code	320
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$32.13
Rate for Payer: Aetna Medicare Advantage	$25.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.56
Rate for Payer: Cigna Commercial	$42.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.68
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

XRAY JACKET MASTER COLOR RED

Facility

$499.30

Hospital Charge Code	270658995
Hospital Revenue Code	270
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$249.65
Rate for Payer: Aetna Commercial	$189.73
Rate for Payer: Aetna Medicare Advantage	$149.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.32
Rate for Payer: Cigna Commercial	$249.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.79
Rate for Payer: Oxford Commercial	$99.86
Rate for Payer: Qualcare PPO/HMO/WC	$74.89
Rate for Payer: UnitedHealthcare Commercial	$99.86
Rate for Payer: UnitedHealthcare Community & State	$12.03
Rate for Payer: Wellpoint Medicaid Managed Care	$13.23

XRAY JACKET MASTER COLOR RED

Facility

$499.30

Hospital Charge Code	270658995
Hospital Revenue Code	270
Min. Negotiated Rate	$74.89
Max. Negotiated Rate	$74.89
Rate for Payer: Qualcare PPO/HMO/WC	$74.89

XRAY OF MAMM DUCT-GL

Facility

$1,656.79

Service Code	HCPCS 77053
Hospital Charge Code	85000095
Hospital Revenue Code	320
Min. Negotiated Rate	$248.52
Max. Negotiated Rate	$248.52
Rate for Payer: Qualcare PPO/HMO/WC	$248.52

XRAY OF MAMM DUCT-GL

Facility

$1,656.79

Service Code	HCPCS 77053
Hospital Charge Code	85000095
Hospital Revenue Code	320
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.04
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.52
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$39.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$43.90

XRAY OF MAMM DUCT-PC

Facility

$92.00

Service Code	HCPCS 7705326
Hospital Charge Code	85000105
Hospital Revenue Code	320
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$34.96
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

XRAY OF MAMM DUCT-PC

Facility

$92.00

Service Code	HCPCS 7705326
Hospital Charge Code	85000105
Hospital Revenue Code	320
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

XRAY OF MAMM DUCTS-GL

Facility

$1,656.79

Service Code	HCPCS 77054
Hospital Charge Code	85000110
Hospital Revenue Code	320
Min. Negotiated Rate	$248.52
Max. Negotiated Rate	$248.52
Rate for Payer: Qualcare PPO/HMO/WC	$248.52

XRAY OF MAMM DUCTS-GL

Facility

$1,656.79

Service Code	HCPCS 77054
Hospital Charge Code	85000110
Hospital Revenue Code	320
Min. Negotiated Rate	$39.93
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.04
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.52
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$39.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$43.90

XRAY OF MAMM DUCTS-PC

Facility

$119.60

Service Code	HCPCS 7705426
Hospital Charge Code	85000120
Hospital Revenue Code	320
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$17.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.94

XRAY OF MAMM DUCTS-PC

Facility

$119.60

Service Code	HCPCS 7705426
Hospital Charge Code	85000120
Hospital Revenue Code	320
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$45.45
Rate for Payer: Aetna Medicare Advantage	$35.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.50
Rate for Payer: Cigna Commercial	$59.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.88
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.94
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.17

XRAY OF MAMM DUCTS-TC

Facility

$383.25

Service Code	HCPCS 77054TC
Hospital Charge Code	85000115
Hospital Revenue Code	320
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

XRAY OF MAMM DUCTS-TC

Facility

$383.25

Service Code	HCPCS 77054TC
Hospital Charge Code	85000115
Hospital Revenue Code	320
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$145.63
Rate for Payer: Aetna Medicare Advantage	$114.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.73
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.97
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$9.24
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

XRAY OF MAMM DUCT-TC

Facility

$276.30

Service Code	HCPCS 77053TC
Hospital Charge Code	85000100
Hospital Revenue Code	320
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$104.99
Rate for Payer: Aetna Medicare Advantage	$82.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.46
Rate for Payer: Cigna Commercial	$138.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.89
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.45
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.66
Rate for Payer: Wellpoint Medicaid Managed Care	$7.32

XRAY OF MAMM DUCT-TC

Facility

$276.30

Service Code	HCPCS 77053TC
Hospital Charge Code	85000100
Hospital Revenue Code	320
Min. Negotiated Rate	$41.45
Max. Negotiated Rate	$41.45
Rate for Payer: Qualcare PPO/HMO/WC	$41.45

XRAYS BONE LENGTH STUDIES-GL

Facility

$459.43

Service Code	HCPCS 77073
Hospital Charge Code	85000220
Hospital Revenue Code	320
Min. Negotiated Rate	$68.91
Max. Negotiated Rate	$68.91
Rate for Payer: Qualcare PPO/HMO/WC	$68.91

XRAYS BONE LENGTH STUDIES-GL

Facility

$459.43

Service Code	HCPCS 77073
Hospital Charge Code	85000220
Hospital Revenue Code	320
Min. Negotiated Rate	$11.07
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	$25.09
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	$137.83
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.91
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$11.07
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	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$12.17

XRAYS BONE LENGTH STUDIES-PC

Facility

$79.30

Service Code	HCPCS 7707326
Hospital Charge Code	85000230
Hospital Revenue Code	320
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$23.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.22
Rate for Payer: Cigna Commercial	$39.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.79
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.89
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$1.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.10

Know your out-of-pocket cost for care.

All Charges