Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XRAY UPPER GI W CONTRAST

Facility

$5,100.00

Service Code	HCPCS 74240
Hospital Charge Code	404174240
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XRAY UPPER GI W CONTRAST

Facility

$5,100.00

Service Code	HCPCS 74240
Hospital Charge Code	404174240
Hospital Revenue Code	320
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR BARIUM ENEMA SINGLE CONT

Facility

$5,100.00

Service Code	HCPCS 74270
Hospital Charge Code	2000263
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BARIUM ENEMA SINGLE CONT

Facility

$5,100.00

Service Code	HCPCS 74270
Hospital Charge Code	2000263
Hospital Revenue Code	320
Min. Negotiated Rate	$81.31
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR BARIUM ENEMA THERAPEUTIC

Facility

$521.00

Service Code	HCPCS 74283
Hospital Charge Code	2011309
Hospital Revenue Code	320
Min. Negotiated Rate	$12.56
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$12.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$13.81

XR BARIUM ENEMA THERAPEUTIC

Facility

$521.00

Service Code	HCPCS 74283
Hospital Charge Code	2011309
Hospital Revenue Code	320
Min. Negotiated Rate	$78.15
Max. Negotiated Rate	$78.15
Rate for Payer: Qualcare PPO/HMO/WC	$78.15

XR BARIUM ENEMA W/AIR CONT

Facility

$5,100.00

Service Code	HCPCS 74280
Hospital Charge Code	2001667
Hospital Revenue Code	320
Min. Negotiated Rate	$108.42
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR BARIUM ENEMA W/AIR CONT

Facility

$5,100.00

Service Code	HCPCS 74280
Hospital Charge Code	2001667
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR BILIARY DUCT CALCULUS RMVAL

Facility

$804.30

Service Code	HCPCS 74327
Hospital Charge Code	2011310
Hospital Revenue Code	320
Min. Negotiated Rate	$19.38
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$305.63
Rate for Payer: Aetna Medicare Advantage	$241.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.10
Rate for Payer: Cigna Commercial	$402.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.29
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.64
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$19.38
Rate for Payer: Wellpoint Medicaid Managed Care	$21.31

XR BILIARY DUCT CALCULUS RMVAL

Facility

$804.30

Service Code	HCPCS 74327
Hospital Charge Code	2011310
Hospital Revenue Code	320
Min. Negotiated Rate	$120.64
Max. Negotiated Rate	$120.64
Rate for Payer: Qualcare PPO/HMO/WC	$120.64

XR-BIOPSY KIDNEY-BI

Facility

$10,607.10

Service Code	HCPCS 5020050
Hospital Charge Code	2709019
Hospital Revenue Code	361
Min. Negotiated Rate	$1,591.07
Max. Negotiated Rate	$1,591.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,591.07

XR-BIOPSY KIDNEY-BI

Facility

$10,607.10

Service Code	HCPCS 5020050
Hospital Charge Code	2709019
Hospital Revenue Code	361
Min. Negotiated Rate	$255.63
Max. Negotiated Rate	$5,303.55
Rate for Payer: Aetna Commercial	$4,030.70
Rate for Payer: Aetna Medicare Advantage	$3,182.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,704.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,704.81
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	$2,704.81
Rate for Payer: Cigna Commercial	$5,303.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,182.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,591.07
Rate for Payer: UnitedHealthcare Community & State	$255.63
Rate for Payer: Wellpoint Medicaid Managed Care	$281.09

XR-BIOPSY KIDNEY-LT

Facility

$7,071.40

Service Code	HCPCS 50200LT
Hospital Charge Code	2709020
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

XR-BIOPSY KIDNEY-LT

Facility

$7,071.40

Service Code	HCPCS 50200LT
Hospital Charge Code	2709020
Hospital Revenue Code	361
Min. Negotiated Rate	$170.42
Max. Negotiated Rate	$3,535.70
Rate for Payer: Aetna Commercial	$2,687.13
Rate for Payer: Aetna Medicare Advantage	$2,121.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,803.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,803.21
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	$1,803.21
Rate for Payer: Cigna Commercial	$3,535.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,121.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71
Rate for Payer: UnitedHealthcare Community & State	$170.42
Rate for Payer: Wellpoint Medicaid Managed Care	$187.39

XR-BIOPSY KIDNEY-RT

Facility

$7,071.40

Service Code	HCPCS 50200RT
Hospital Charge Code	2709021
Hospital Revenue Code	361
Min. Negotiated Rate	$170.42
Max. Negotiated Rate	$3,535.70
Rate for Payer: Aetna Commercial	$2,687.13
Rate for Payer: Aetna Medicare Advantage	$2,121.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,803.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,803.21
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	$1,803.21
Rate for Payer: Cigna Commercial	$3,535.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,121.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71
Rate for Payer: UnitedHealthcare Community & State	$170.42
Rate for Payer: Wellpoint Medicaid Managed Care	$187.39

XR-BIOPSY KIDNEY-RT

Facility

$7,071.40

Service Code	HCPCS 50200RT
Hospital Charge Code	2709021
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.71
Max. Negotiated Rate	$1,060.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,060.71

XR BIOPSY LUNG MED PERC

Facility

$1,065.00

Service Code	HCPCS 77002
Hospital Charge Code	2002236
Hospital Revenue Code	320
Min. Negotiated Rate	$25.67
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$404.70
Rate for Payer: Aetna Medicare Advantage	$319.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$271.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$271.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$271.57
Rate for Payer: Cigna Commercial	$532.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$25.67
Rate for Payer: Wellpoint Medicaid Managed Care	$28.22

XR BIOPSY LUNG MED PERC

Facility

$1,065.00

Service Code	HCPCS 77002
Hospital Charge Code	2002236
Hospital Revenue Code	320
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$159.75
Rate for Payer: Qualcare PPO/HMO/WC	$159.75

XR BIOPSY OF THYROID

Facility

$2,031.30

Service Code	HCPCS 60100
Hospital Charge Code	5600177
Hospital Revenue Code	361
Min. Negotiated Rate	$304.69
Max. Negotiated Rate	$304.69
Rate for Payer: Qualcare PPO/HMO/WC	$304.69

XR BIOPSY OF THYROID

Facility

$2,031.30

Service Code	HCPCS 60100
Hospital Charge Code	5600177
Hospital Revenue Code	361
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$609.39
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$304.69
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$48.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$53.83

XR BL DRAW > 3 YRS SCALP VEIN

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	7411438
Hospital Revenue Code	361
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$114.47
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
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	$76.82
Rate for Payer: Cigna Commercial	$150.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.38
Rate for Payer: Qualcare PPO/HMO/WC	$45.19
Rate for Payer: UnitedHealthcare Community & State	$7.26
Rate for Payer: Wellpoint Medicaid Managed Care	$7.98

XR BL DRAW > 3 YRS SCALP VEIN

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	7411438
Hospital Revenue Code	361
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$45.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

XR BL DRAW > 3 YRS SCALP VEIN

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	5600040
Hospital Revenue Code	361
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$114.47
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
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	$76.82
Rate for Payer: Cigna Commercial	$150.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.38
Rate for Payer: Qualcare PPO/HMO/WC	$45.19
Rate for Payer: UnitedHealthcare Community & State	$7.26
Rate for Payer: Wellpoint Medicaid Managed Care	$7.98

XR BL DRAW > 3 YRS SCALP VEIN

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	5600040
Hospital Revenue Code	361
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$45.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

XR BONE AGE WRISTS

Facility

$5,100.00

Service Code	HCPCS 77072
Hospital Charge Code	2002061
Hospital Revenue Code	320
Min. Negotiated Rate	$31.07
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	$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	$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	$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	$135.15

Know your out-of-pocket cost for care.

All Charges