Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR CLAVICLE LT COMPL

Facility

$6,601.19

Service Code	HCPCS 73000LT
Hospital Charge Code	2000016
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR COCCYX

Facility

$627.25

Service Code	HCPCS 72220
Hospital Charge Code	2000727
Hospital Revenue Code	320
Min. Negotiated Rate	$15.12
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	$31.94
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	$188.18
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.09
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$15.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19
Rate for Payer: Wellpoint Medicaid Managed Care	$16.62

XR COCCYX

Facility

$627.25

Service Code	HCPCS 72220
Hospital Charge Code	2000727
Hospital Revenue Code	320
Min. Negotiated Rate	$94.09
Max. Negotiated Rate	$94.09
Rate for Payer: Qualcare PPO/HMO/WC	$94.09

XR COMPLETE CLAVICLE RT

Facility

$6,601.19

Service Code	HCPCS 73000RT
Hospital Charge Code	2000017
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 COMPLETE CLAVICLE RT

Facility

$6,601.19

Service Code	HCPCS 73000RT
Hospital Charge Code	2000017
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR COMPLEX DYN PHARYN VIDEO EV

Facility

$959.25

Service Code	HCPCS 70371
Hospital Charge Code	2002764
Hospital Revenue Code	320
Min. Negotiated Rate	$23.12
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	$81.31
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	$287.77
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$143.89
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$23.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$25.42

XR COMPLEX DYN PHARYN VIDEO EV

Facility

$959.25

Service Code	HCPCS 70371
Hospital Charge Code	2002764
Hospital Revenue Code	320
Min. Negotiated Rate	$143.89
Max. Negotiated Rate	$143.89
Rate for Payer: Qualcare PPO/HMO/WC	$143.89

XR COMPUTER MAMMO ADD ON DIAG

Facility

$180.35

Service Code	HCPCS 77051
Hospital Charge Code	94064039
Hospital Revenue Code	401
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$68.53
Rate for Payer: Aetna Medicare Advantage	$54.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.99
Rate for Payer: Cigna Commercial	$90.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.10
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.05
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$4.35
Rate for Payer: Wellpoint Medicaid Managed Care	$4.78

XR COMPUTER MAMMO ADD ON DIAG

Facility

$180.35

Service Code	HCPCS 77051
Hospital Charge Code	2002586
Hospital Revenue Code	401
Min. Negotiated Rate	$27.05
Max. Negotiated Rate	$27.05
Rate for Payer: Qualcare PPO/HMO/WC	$27.05

XR COMPUTER MAMMO ADD ON DIAG

Facility

$180.35

Service Code	HCPCS 77051
Hospital Charge Code	2002586
Hospital Revenue Code	401
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$68.53
Rate for Payer: Aetna Medicare Advantage	$54.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.99
Rate for Payer: Cigna Commercial	$90.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.10
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.05
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$4.35
Rate for Payer: Wellpoint Medicaid Managed Care	$4.78

XR COMPUTER MAMMO ADD ON DIAG

Facility

$180.35

Service Code	HCPCS 77051
Hospital Charge Code	94064039
Hospital Revenue Code	401
Min. Negotiated Rate	$27.05
Max. Negotiated Rate	$27.05
Rate for Payer: Qualcare PPO/HMO/WC	$27.05

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2002587
Hospital Revenue Code	403
Min. Negotiated Rate	$28.97
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$456.74
Rate for Payer: Aetna Medicare Advantage	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.50
Rate for Payer: Cigna Commercial	$600.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.58
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.29
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$28.97
Rate for Payer: Wellpoint Medicaid Managed Care	$31.85

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2002587
Hospital Revenue Code	403
Min. Negotiated Rate	$180.29
Max. Negotiated Rate	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$180.29

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	94064041
Hospital Revenue Code	403
Min. Negotiated Rate	$180.29
Max. Negotiated Rate	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$180.29

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	94064041
Hospital Revenue Code	403
Min. Negotiated Rate	$28.97
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$456.74
Rate for Payer: Aetna Medicare Advantage	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.50
Rate for Payer: Cigna Commercial	$600.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.58
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.29
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$28.97
Rate for Payer: Wellpoint Medicaid Managed Care	$31.85

XR COMPUTER MAMMOGRAM ADD ON

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2011270
Hospital Revenue Code	403
Min. Negotiated Rate	$180.29
Max. Negotiated Rate	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$180.29

XR COMPUTER MAMMOGRAM ADD ON

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2011240
Hospital Revenue Code	403
Min. Negotiated Rate	$28.97
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$456.74
Rate for Payer: Aetna Medicare Advantage	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.50
Rate for Payer: Cigna Commercial	$600.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.58
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.29
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$28.97
Rate for Payer: Wellpoint Medicaid Managed Care	$31.85

XR COMPUTER MAMMOGRAM ADD ON

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2011270
Hospital Revenue Code	403
Min. Negotiated Rate	$28.97
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$456.74
Rate for Payer: Aetna Medicare Advantage	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.50
Rate for Payer: Cigna Commercial	$600.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.58
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.29
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$28.97
Rate for Payer: Wellpoint Medicaid Managed Care	$31.85

XR COMPUTER MAMMOGRAM ADD ON

Facility

$1,201.95

Service Code	HCPCS 77052
Hospital Charge Code	2011240
Hospital Revenue Code	403
Min. Negotiated Rate	$180.29
Max. Negotiated Rate	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$180.29

XR CYSTOGRAM MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 74430
Hospital Charge Code	2001485
Hospital Revenue Code	320
Min. Negotiated Rate	$40.66
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
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	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR CYSTOGRAM MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 74430
Hospital Charge Code	2001485
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR DACRYOCYSTOGRAPHY

Facility

$1,224.75

Service Code	HCPCS 70170
Hospital Charge Code	2011328
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

XR DACRYOCYSTOGRAPHY

Facility

$1,224.75

Service Code	HCPCS 70170
Hospital Charge Code	2011328
Hospital Revenue Code	320
Min. Negotiated Rate	$29.52
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	$51.38
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	$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: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

XR DECLOT VASCULAR DEVICE

Facility

$1,487.70

Service Code	HCPCS 36593
Hospital Charge Code	411036593
Hospital Revenue Code	361
Min. Negotiated Rate	$223.16
Max. Negotiated Rate	$223.16
Rate for Payer: Qualcare PPO/HMO/WC	$223.16

XR DECLOT VASCULAR DEVICE

Facility

$1,113.85

Service Code	HCPCS 36593
Hospital Charge Code	7411474
Hospital Revenue Code	361
Min. Negotiated Rate	$26.84
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
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	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$392.41
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.15
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$26.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$29.52

Know your out-of-pocket cost for care.

All Charges