Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR DECLOT VASCULAR DEVICE

Facility

$1,487.70

Service Code	HCPCS 36593
Hospital Charge Code	411036593
Hospital Revenue Code	361
Min. Negotiated Rate	$35.85
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	$446.31
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.16
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$35.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$39.42

XR DECLOT VASCULAR DEVICE

Facility

$1,113.85

Service Code	HCPCS 36593
Hospital Charge Code	7411474
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

XR DECLOT VASCULAR DEVICE

Facility

$15,468.50

Service Code	HCPCS 36593
Hospital Charge Code	5600137
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$4,640.55
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	$4,640.55
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

XR DECLOT VASCULAR DEVICE

Facility

$15,468.50

Service Code	HCPCS 36593
Hospital Charge Code	5600137
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

XR DECLOT VASCULAR DEVICE

Facility

$1,487.70

Service Code	HCPCS 36593
Hospital Charge Code	366836593
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

$15,468.50

Service Code	HCPCS 36593
Hospital Charge Code	321036593
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

XR DECLOT VASCULAR DEVICE

Facility

$1,487.70

Service Code	HCPCS 36593
Hospital Charge Code	366836593
Hospital Revenue Code	361
Min. Negotiated Rate	$35.85
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	$446.31
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.16
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$35.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$39.42

XR DECLOT VASCULAR DEVICE

Facility

$15,468.50

Service Code	HCPCS 36593
Hospital Charge Code	321036593
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$4,640.55
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	$4,640.55
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

XR DEXA FOREARM BMD LT

Facility

$607.50

Service Code	HCPCS 77081LT
Hospital Charge Code	2004117
Hospital Revenue Code	320
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$230.85
Rate for Payer: Aetna Medicare Advantage	$182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.91
Rate for Payer: Cigna Commercial	$303.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.64
Rate for Payer: Wellpoint Medicaid Managed Care	$16.10

XR DEXA FOREARM BMD LT

Facility

$607.50

Service Code	HCPCS 77081LT
Hospital Charge Code	2004117
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

XR DEXA FOREARM BMD LT

Facility

$5,100.00

Service Code	HCPCS 77081LT
Hospital Charge Code	2004117A
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
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) 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 DEXA FOREARM BMD LT

Facility

$5,100.00

Service Code	HCPCS 77081LT
Hospital Charge Code	2004117A
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR DEXA FOREARM BMD RT

Facility

$607.50

Service Code	HCPCS 77081RT
Hospital Charge Code	2004118
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

XR DEXA FOREARM BMD RT

Facility

$607.50

Service Code	HCPCS 77081RT
Hospital Charge Code	2004118
Hospital Revenue Code	320
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$230.85
Rate for Payer: Aetna Medicare Advantage	$182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.91
Rate for Payer: Cigna Commercial	$303.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.64
Rate for Payer: Wellpoint Medicaid Managed Care	$16.10

XR DEXA FOREARM BMD RT

Facility

$607.50

Service Code	HCPCS 77081RT
Hospital Charge Code	2004118A
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

XR DEXA FOREARM BMD RT

Facility

$607.50

Service Code	HCPCS 77081RT
Hospital Charge Code	2004118A
Hospital Revenue Code	320
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$230.85
Rate for Payer: Aetna Medicare Advantage	$182.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.91
Rate for Payer: Cigna Commercial	$303.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.64
Rate for Payer: Wellpoint Medicaid Managed Care	$16.10

XR DEXA HIP AND/OR SPINE BMD

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	2004109
Hospital Revenue Code	320
Min. Negotiated Rate	$86.94
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	$125.84
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: Wellpoint Medicaid Managed Care	$135.15

XR DEXA HIP AND/OR SPINE BMD

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	2004109A
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR DEXA HIP AND/OR SPINE BMD

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	2004109A
Hospital Revenue Code	320
Min. Negotiated Rate	$86.94
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	$125.84
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: Wellpoint Medicaid Managed Care	$135.15

XR DEXA HIP AND/OR SPINE BMD

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	2004109
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR DIGITAL BILAT DIAG MAMMO

Facility

$783.75

Service Code	HCPCS G0204
Hospital Charge Code	94064033
Hospital Revenue Code	401
Min. Negotiated Rate	$117.56
Max. Negotiated Rate	$117.56
Rate for Payer: Qualcare PPO/HMO/WC	$117.56

XR DIGITAL BILAT DIAG MAMMO

Facility

$783.75

Service Code	HCPCS G0204
Hospital Charge Code	94064033
Hospital Revenue Code	401
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$297.82
Rate for Payer: Aetna Medicare Advantage	$235.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.86
Rate for Payer: Cigna Commercial	$391.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.12
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.56
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$18.89
Rate for Payer: Wellpoint Medicaid Managed Care	$20.77

XR DIGITAL BILAT DIAG MAMMO

Facility

$783.75

Hospital Charge Code	2000910
Hospital Revenue Code	401
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$297.82
Rate for Payer: Aetna Medicare Advantage	$235.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.86
Rate for Payer: Cigna Commercial	$391.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.12
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.56
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$18.89
Rate for Payer: Wellpoint Medicaid Managed Care	$20.77

XR DIGITAL BILAT DIAG MAMMO

Facility

$783.75

Hospital Charge Code	2000910
Hospital Revenue Code	401
Min. Negotiated Rate	$117.56
Max. Negotiated Rate	$117.56
Rate for Payer: Qualcare PPO/HMO/WC	$117.56

XR DIGITAL BILAT MAMMO SCRN

Facility

$1,462.32

Hospital Charge Code	2000911
Hospital Revenue Code	403
Min. Negotiated Rate	$219.35
Max. Negotiated Rate	$219.35
Rate for Payer: Qualcare PPO/HMO/WC	$219.35

Know your out-of-pocket cost for care.

All Charges