Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XRAYS BONE LENGTH STUDIES-PC

Facility

$79.30

Service Code	HCPCS 7707326
Hospital Charge Code	85000230
Hospital Revenue Code	320
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$11.89
Rate for Payer: Qualcare PPO/HMO/WC	$11.89

XRAYS BONE LENGTH STUDIES-TC

Facility

$147.10

Service Code	HCPCS 77073TC
Hospital Charge Code	85000225
Hospital Revenue Code	320
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$55.90
Rate for Payer: Aetna Medicare Advantage	$44.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.51
Rate for Payer: Cigna Commercial	$73.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.07
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$3.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

XRAYS BONE LENGTH STUDIES-TC

Facility

$147.10

Service Code	HCPCS 77073TC
Hospital Charge Code	85000225
Hospital Revenue Code	320
Min. Negotiated Rate	$22.07
Max. Negotiated Rate	$22.07
Rate for Payer: Qualcare PPO/HMO/WC	$22.07

XRAYS BONE SURVEY CMPL-GL

Facility

$459.43

Service Code	HCPCS 77075
Hospital Charge Code	85000250
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 SURVEY CMPL-GL

Facility

$459.43

Service Code	HCPCS 77075
Hospital Charge Code	85000250
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	$54.23
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$12.17

XRAYS BONE SURVEY CMPL-PC

Facility

$143.65

Service Code	HCPCS 7707526
Hospital Charge Code	85000260
Hospital Revenue Code	320
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.63
Rate for Payer: Cigna Commercial	$71.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.09
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.55
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$3.46
Rate for Payer: Wellpoint Medicaid Managed Care	$3.81

XRAYS BONE SURVEY CMPL-PC

Facility

$143.65

Service Code	HCPCS 7707526
Hospital Charge Code	85000260
Hospital Revenue Code	320
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$21.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.55

XRAYS BONE SURVEY CMPL-TC

Facility

$447.85

Service Code	HCPCS 77075TC
Hospital Charge Code	85000255
Hospital Revenue Code	320
Min. Negotiated Rate	$10.79
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$170.18
Rate for Payer: Aetna Medicare Advantage	$134.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.20
Rate for Payer: Cigna Commercial	$223.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.35
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$10.79
Rate for Payer: Wellpoint Medicaid Managed Care	$11.87

XRAYS BONE SURVEY CMPL-TC

Facility

$447.85

Service Code	HCPCS 77075TC
Hospital Charge Code	85000255
Hospital Revenue Code	320
Min. Negotiated Rate	$67.18
Max. Negotiated Rate	$67.18
Rate for Payer: Qualcare PPO/HMO/WC	$67.18

XRAYS BONE SURVEY INFANT-GL

Facility

$459.43

Service Code	HCPCS 77076
Hospital Charge Code	85000265
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 SURVEY INFANT-GL

Facility

$459.43

Service Code	HCPCS 77076
Hospital Charge Code	85000265
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	$33.65
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$12.17

XRAYS BONE SURVEY INFANT-PC

Facility

$186.00

Service Code	HCPCS 7707626
Hospital Charge Code	85000275
Hospital Revenue Code	320
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

XRAYS BONE SURVEY INFANT-PC

Facility

$186.00

Service Code	HCPCS 7707626
Hospital Charge Code	85000275
Hospital Revenue Code	320
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

XRAYS BONE SURVEY INFANT-TC

Facility

$445.85

Service Code	HCPCS 77076TC
Hospital Charge Code	85000270
Hospital Revenue Code	320
Min. Negotiated Rate	$66.88
Max. Negotiated Rate	$66.88
Rate for Payer: Qualcare PPO/HMO/WC	$66.88

XRAYS BONE SURVEY INFANT-TC

Facility

$445.85

Service Code	HCPCS 77076TC
Hospital Charge Code	85000270
Hospital Revenue Code	320
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$169.42
Rate for Payer: Aetna Medicare Advantage	$133.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.69
Rate for Payer: Cigna Commercial	$222.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.75
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

XRAYS BONE SURVEY LTD-GL

Facility

$459.43

Service Code	HCPCS 77074
Hospital Charge Code	85000235
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 SURVEY LTD-GL

Facility

$459.43

Service Code	HCPCS 77074
Hospital Charge Code	85000235
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	$36.24
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$12.17

XRAYS BONE SURVEY LTD-PC

Facility

$119.60

Service Code	HCPCS 7707426
Hospital Charge Code	85000245
Hospital Revenue Code	320
Min. Negotiated Rate	$17.94
Max. Negotiated Rate	$17.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.94

XRAYS BONE SURVEY LTD-PC

Facility

$119.60

Service Code	HCPCS 7707426
Hospital Charge Code	85000245
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

XRAYS BONE SURVEY LTD-TC

Facility

$288.40

Service Code	HCPCS 77074TC
Hospital Charge Code	85000240
Hospital Revenue Code	320
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$109.59
Rate for Payer: Aetna Medicare Advantage	$86.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.54
Rate for Payer: Cigna Commercial	$144.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.26
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.95
Rate for Payer: Wellpoint Medicaid Managed Care	$7.64

XRAYS BONE SURVEY LTD-TC

Facility

$288.40

Service Code	HCPCS 77074TC
Hospital Charge Code	85000240
Hospital Revenue Code	320
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$43.26
Rate for Payer: Qualcare PPO/HMO/WC	$43.26

XRAY STRESS VIEW

Facility

$298.01

Service Code	HCPCS 77071
Hospital Charge Code	85000200
Hospital Revenue Code	320
Min. Negotiated Rate	$44.70
Max. Negotiated Rate	$44.70
Rate for Payer: Qualcare PPO/HMO/WC	$44.70

XRAY STRESS VIEW

Facility

$298.01

Service Code	HCPCS 77071
Hospital Charge Code	85000200
Hospital Revenue Code	320
Min. Negotiated Rate	$7.18
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	$23.87
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	$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	$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	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$7.90

XRAY UPER GI TRACT

Facility

$510.00

Service Code	HCPCS 74241
Hospital Charge Code	94061139
Hospital Revenue Code	320
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

XRAY UPER GI TRACT

Facility

$510.00

Service Code	HCPCS 74241
Hospital Charge Code	94061139
Hospital Revenue Code	320
Min. Negotiated Rate	$12.29
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.05
Rate for Payer: Cigna Commercial	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$12.29
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$13.52

Know your out-of-pocket cost for care.

All Charges