Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR BRONCHOGRAM UNI

Facility

$481.65

Hospital Charge Code	2000586
Hospital Revenue Code	320
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$72.25
Rate for Payer: Qualcare PPO/HMO/WC	$72.25

XR BRONCHOGRAM UNI

Facility

$481.65

Hospital Charge Code	2000586
Hospital Revenue Code	320
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$183.03
Rate for Payer: Aetna Medicare Advantage	$144.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.82
Rate for Payer: Cigna Commercial	$240.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.25
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$11.61
Rate for Payer: Wellpoint Medicaid Managed Care	$12.76

XR BRONCHOGRAPHY BILATERAL

Facility

$602.00

Service Code	HCPCS 71060
Hospital Charge Code	2011311
Hospital Revenue Code	320
Min. Negotiated Rate	$14.51
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$228.76
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: Wellpoint Medicaid Managed Care	$15.95

XR BRONCHOGRAPHY BILATERAL

Facility

$602.00

Service Code	HCPCS 71060
Hospital Charge Code	2011311
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR BRONCHOGRAPHY RIGHT

Facility

$602.00

Service Code	HCPCS 71040
Hospital Charge Code	2011312
Hospital Revenue Code	320
Min. Negotiated Rate	$14.51
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$228.76
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: Wellpoint Medicaid Managed Care	$15.95

XR BRONCHOGRAPHY RIGHT

Facility

$602.00

Service Code	HCPCS 71040
Hospital Charge Code	2011312
Hospital Revenue Code	320
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

XR BRONCHOSCOPY INJ FOR XRAY

Facility

$2,480.00

Hospital Charge Code	2011230
Hospital Revenue Code	361
Min. Negotiated Rate	$59.77
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$942.40
Rate for Payer: Aetna Medicare Advantage	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.40
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	$632.40
Rate for Payer: Cigna Commercial	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00
Rate for Payer: UnitedHealthcare Community & State	$59.77
Rate for Payer: Wellpoint Medicaid Managed Care	$65.72

XR BRONCHOSCOPY INJ FOR XRAY

Facility

$2,480.00

Hospital Charge Code	2011230
Hospital Revenue Code	361
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

XR BRST PREOP PLMNT EA ADD WIR

Facility

$414.45

Service Code	HCPCS 19282
Hospital Charge Code	2004620
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

XR BRST PREOP PLMNT EA ADD WIR

Facility

$414.45

Service Code	HCPCS 19282
Hospital Charge Code	2004620
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR CANNULA DECLOTTING

Facility

$6,733.80

Service Code	HCPCS 36861
Hospital Charge Code	2011265
Hospital Revenue Code	361
Min. Negotiated Rate	$1,010.07
Max. Negotiated Rate	$1,010.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,010.07

XR CANNULA DECLOTTING

Facility

$6,733.80

Service Code	HCPCS 36861
Hospital Charge Code	2011265
Hospital Revenue Code	361
Min. Negotiated Rate	$162.28
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,020.14
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,010.07
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$162.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$178.45

XR CARDIAC SERIES MIN 4 VWS

Facility

$354.45

Service Code	HCPCS 71030
Hospital Charge Code	2001048
Hospital Revenue Code	324
Min. Negotiated Rate	$8.54
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$134.69
Rate for Payer: Aetna Medicare Advantage	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.38
Rate for Payer: Cigna Commercial	$177.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.33
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.17
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9.39

XR CARDIAC SERIES MIN 4 VWS

Facility

$354.45

Service Code	HCPCS 71030
Hospital Charge Code	2001048
Hospital Revenue Code	324
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$53.17
Rate for Payer: Qualcare PPO/HMO/WC	$53.17

XR C-ARM FLUORO <1 hr

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	2002137
Hospital Revenue Code	320
Min. Negotiated Rate	$95.83
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	$95.83
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	$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	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR C-ARM FLUORO <1 hr

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	2002137
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR CATH PLACEMENT VEN 2ND LT

Facility

$2,919.00

Service Code	HCPCS 36012LT
Hospital Charge Code	2004703
Hospital Revenue Code	361
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,109.22
Rate for Payer: Aetna Medicare Advantage	$875.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.35
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	$744.35
Rate for Payer: Cigna Commercial	$1,459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$875.70
Rate for Payer: Qualcare PPO/HMO/WC	$437.85
Rate for Payer: UnitedHealthcare Community & State	$70.35
Rate for Payer: Wellpoint Medicaid Managed Care	$77.35

XR CATH PLACEMENT VEN 2ND LT

Facility

$2,919.00

Service Code	HCPCS 36012LT
Hospital Charge Code	2004703
Hospital Revenue Code	361
Min. Negotiated Rate	$437.85
Max. Negotiated Rate	$437.85
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

XR CATH PLACEMENT VEN 2ND RT

Facility

$2,919.00

Service Code	HCPCS 36012RT
Hospital Charge Code	2709018
Hospital Revenue Code	361
Min. Negotiated Rate	$437.85
Max. Negotiated Rate	$437.85
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

XR CATH PLACEMENT VEN 2ND RT

Facility

$2,919.00

Service Code	HCPCS 36012RT
Hospital Charge Code	2709018
Hospital Revenue Code	361
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$1,109.22
Rate for Payer: Aetna Medicare Advantage	$875.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.35
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	$744.35
Rate for Payer: Cigna Commercial	$1,459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$875.70
Rate for Payer: Qualcare PPO/HMO/WC	$437.85
Rate for Payer: UnitedHealthcare Community & State	$70.35
Rate for Payer: Wellpoint Medicaid Managed Care	$77.35

XR CATH PLACEMENT VENOUS 1STO

Facility

$414.45

Service Code	HCPCS 36011
Hospital Charge Code	2004695
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR CATH PLACEMENT VENOUS 1STO

Facility

$414.45

Service Code	HCPCS 36011
Hospital Charge Code	2004695
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99

XR CATH PLMNT VENOUS ORGAN SAM

Facility

$621.65

Service Code	HCPCS 36500
Hospital Charge Code	2004729
Hospital Revenue Code	361
Min. Negotiated Rate	$93.25
Max. Negotiated Rate	$93.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.25

XR CATH PLMNT VENOUS ORGAN SAM

Facility

$621.65

Service Code	HCPCS 36500
Hospital Charge Code	2004729
Hospital Revenue Code	361
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$236.23
Rate for Payer: Aetna Medicare Advantage	$186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.52
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	$158.52
Rate for Payer: Cigna Commercial	$310.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.50
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.25
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$14.98
Rate for Payer: Wellpoint Medicaid Managed Care	$16.47

XR CEPHALOGRAM ORTHODONTIC

Facility

$258.70

Service Code	HCPCS 70350
Hospital Charge Code	2011317
Hospital Revenue Code	320
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

Know your out-of-pocket cost for care.

All Charges