Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR CHEST DECUBITUS LEFT

Facility

$258.70

Service Code	HCPCS 71035LT
Hospital Charge Code	2011320
Hospital Revenue Code	324
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$98.31
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.97
Rate for Payer: Cigna Commercial	$129.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.23
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

XR CHEST DECUBITUS LEFT

Facility

$258.70

Service Code	HCPCS 71035LT
Hospital Charge Code	2011320
Hospital Revenue Code	324
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR CHEST DECUBITUS RIGHT

Facility

$258.70

Service Code	HCPCS 71035RT
Hospital Charge Code	2011321
Hospital Revenue Code	324
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR CHEST DECUBITUS RIGHT

Facility

$258.70

Service Code	HCPCS 71035RT
Hospital Charge Code	2011321
Hospital Revenue Code	324
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$98.31
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.97
Rate for Payer: Cigna Commercial	$129.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.23
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

XR CHEST MIN 4 VIEW W/FLURSCPY

Facility

$471.30

Service Code	HCPCS 71034
Hospital Charge Code	2011322
Hospital Revenue Code	324
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$179.09
Rate for Payer: Aetna Medicare Advantage	$141.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.18
Rate for Payer: Cigna Commercial	$235.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.39
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.69
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$11.36
Rate for Payer: Wellpoint Medicaid Managed Care	$12.49

XR CHEST MIN 4 VIEW W/FLURSCPY

Facility

$471.30

Service Code	HCPCS 71034
Hospital Charge Code	2011322
Hospital Revenue Code	324
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$70.69
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

XR CHEST PORTABLE

Facility

$278.45

Service Code	HCPCS 71010
Hospital Charge Code	2002772
Hospital Revenue Code	324
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$105.81
Rate for Payer: Aetna Medicare Advantage	$83.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.00
Rate for Payer: Cigna Commercial	$139.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.53
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.77
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,236.59
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

XR CHEST PORTABLE

Facility

$278.45

Service Code	HCPCS 71010
Hospital Charge Code	2002772
Hospital Revenue Code	324
Min. Negotiated Rate	$41.77
Max. Negotiated Rate	$41.77
Rate for Payer: Qualcare PPO/HMO/WC	$41.77

XR CHEST SPECIAL VIEW

Facility

$258.70

Service Code	HCPCS 71035
Hospital Charge Code	2002319
Hospital Revenue Code	324
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR CHEST SPECIAL VIEW

Facility

$258.70

Service Code	HCPCS 71035
Hospital Charge Code	2002319
Hospital Revenue Code	324
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$98.31
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.97
Rate for Payer: Cigna Commercial	$129.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,236.59
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

XR CHEST STEREO FRONTAL

Facility

$258.70

Service Code	HCPCS 71015
Hospital Charge Code	2011323
Hospital Revenue Code	324
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$98.31
Rate for Payer: Aetna Medicare Advantage	$77.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.97
Rate for Payer: Cigna Commercial	$129.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.61
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.23
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

XR CHEST STEREO FRONTAL

Facility

$258.70

Service Code	HCPCS 71015
Hospital Charge Code	2011323
Hospital Revenue Code	324
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

XR CHEST W/APICAL

Facility

$448.00

Service Code	HCPCS 71021
Hospital Charge Code	2002301
Hospital Revenue Code	324
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$67.20

XR CHEST W/APICAL

Facility

$448.00

Service Code	HCPCS 71021
Hospital Charge Code	2002301
Hospital Revenue Code	324
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$170.24
Rate for Payer: Aetna Medicare Advantage	$134.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.24
Rate for Payer: Cigna Commercial	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.87

XR CHEST W/ OBLIQUE

Facility

$326.45

Service Code	HCPCS 71022
Hospital Charge Code	2002293
Hospital Revenue Code	324
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$124.05
Rate for Payer: Aetna Medicare Advantage	$97.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.24
Rate for Payer: Cigna Commercial	$163.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.94
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.97
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.87
Rate for Payer: Wellpoint Medicaid Managed Care	$8.65

XR CHEST W/ OBLIQUE

Facility

$326.45

Service Code	HCPCS 71022
Hospital Charge Code	2002293
Hospital Revenue Code	324
Min. Negotiated Rate	$48.97
Max. Negotiated Rate	$48.97
Rate for Payer: Qualcare PPO/HMO/WC	$48.97

XR CHOLAGIOGRAM PERC TRNSHPATC

Facility

$1,224.75

Service Code	HCPCS 74320
Hospital Charge Code	2011324
Hospital Revenue Code	320
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$465.40
Rate for Payer: Aetna Medicare Advantage	$367.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.31
Rate for Payer: Cigna Commercial	$612.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.43
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.71
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$29.52
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

XR CHOLAGIOGRAM PERC TRNSHPATC

Facility

$1,224.75

Service Code	HCPCS 74320
Hospital Charge Code	2011324
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

XR CHOLANGIOGRAM OPERATIVE

Facility

$5,100.00

Service Code	HCPCS 74300
Hospital Charge Code	2001444
Hospital Revenue Code	320
Min. Negotiated Rate	$85.18
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
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: Wellpoint Medicaid Managed Care	$135.15

XR CHOLANGIOGRAM OPERATIVE

Facility

$5,100.00

Service Code	HCPCS 74300
Hospital Charge Code	2001444
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR CISTRENOGRAPHY

Facility

$1,033.95

Service Code	HCPCS 70015
Hospital Charge Code	2011325
Hospital Revenue Code	320
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$3,361.79
Rate for Payer: Aetna Commercial	$2,533.19
Rate for Payer: Aetna Medicare Advantage	$3,017.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$931.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,361.79
Rate for Payer: Cigna Commercial	$1,866.82
Rate for Payer: Cigna Medicare Advantage	$651.92
Rate for Payer: Clover Medicare Advantage	$884.75
Rate for Payer: EmblemHealth Commercial	$2,793.96
Rate for Payer: Humana Medicare Advantage	$959.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$931.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.19
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$155.09
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$24.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$931.32
Rate for Payer: Wellcare Medicare Advantage	$931.32
Rate for Payer: Wellpoint Medicaid Managed Care	$27.40

XR CISTRENOGRAPHY

Facility

$1,033.95

Service Code	HCPCS 70015
Hospital Charge Code	2011325
Hospital Revenue Code	320
Min. Negotiated Rate	$155.09
Max. Negotiated Rate	$155.09
Rate for Payer: Qualcare PPO/HMO/WC	$155.09

XR CLAVICLE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7300050
Hospital Charge Code	2011326
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

XR CLAVICLE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7300050
Hospital Charge Code	2011326
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR CLAVICLE LT COMPL

Facility

$6,601.19

Service Code	HCPCS 73000LT
Hospital Charge Code	2000016
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

Know your out-of-pocket cost for care.

All Charges