Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR DIGITAL BILAT MAMMO SCRN

Facility

$1,462.32

Hospital Charge Code	2000911
Hospital Revenue Code	403
Min. Negotiated Rate	$35.24
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$555.68
Rate for Payer: Aetna Medicare Advantage	$438.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$372.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$372.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$372.89
Rate for Payer: Cigna Commercial	$731.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.70
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$219.35
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$35.24
Rate for Payer: Wellpoint Medicaid Managed Care	$38.75

XR DIGITAL BILAT MAMMO SCRN

Facility

$1,462.32

Service Code	HCPCS G0202
Hospital Charge Code	94064029
Hospital Revenue Code	403
Min. Negotiated Rate	$35.24
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$555.68
Rate for Payer: Aetna Medicare Advantage	$438.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$372.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$372.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$372.89
Rate for Payer: Cigna Commercial	$731.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.70
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$219.35
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$35.24
Rate for Payer: Wellpoint Medicaid Managed Care	$38.75

XR DIGITAL BILAT MAMMO SCRN

Facility

$1,462.32

Service Code	HCPCS G0202
Hospital Charge Code	94064029
Hospital Revenue Code	403
Min. Negotiated Rate	$219.35
Max. Negotiated Rate	$219.35
Rate for Payer: Qualcare PPO/HMO/WC	$219.35

XR DIGITAL UNILAT DIAG MAMMO

Facility

$437.50

Service Code	HCPCS G0206
Hospital Charge Code	94064035
Hospital Revenue Code	401
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$166.25
Rate for Payer: Aetna Medicare Advantage	$131.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.56
Rate for Payer: Cigna Commercial	$218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.62
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$10.54
Rate for Payer: Wellpoint Medicaid Managed Care	$11.59

XR DIGITAL UNILAT DIAG MAMMO

Facility

$437.50

Service Code	HCPCS G0206
Hospital Charge Code	94064035
Hospital Revenue Code	401
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$65.62
Rate for Payer: Qualcare PPO/HMO/WC	$65.62

XR DIGITAL UNILAT DIAG MAMMO

Facility

$437.50

Hospital Charge Code	2000912
Hospital Revenue Code	401
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$65.62
Rate for Payer: Qualcare PPO/HMO/WC	$65.62

XR DIGITAL UNILAT DIAG MAMMO

Facility

$437.50

Hospital Charge Code	2000912
Hospital Revenue Code	401
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$166.25
Rate for Payer: Aetna Medicare Advantage	$131.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.56
Rate for Payer: Cigna Commercial	$218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.62
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$10.54
Rate for Payer: Wellpoint Medicaid Managed Care	$11.59

XR DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Hospital Charge Code	2000915
Hospital Revenue Code	403
Min. Negotiated Rate	$22.90
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$361.08
Rate for Payer: Aetna Medicare Advantage	$285.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.30
Rate for Payer: Cigna Commercial	$475.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.06
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.53
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$22.90
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

XR DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Hospital Charge Code	2000915
Hospital Revenue Code	403
Min. Negotiated Rate	$142.53
Max. Negotiated Rate	$142.53
Rate for Payer: Qualcare PPO/HMO/WC	$142.53

XR DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Hospital Charge Code	94064031
Hospital Revenue Code	403
Min. Negotiated Rate	$22.90
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$361.08
Rate for Payer: Aetna Medicare Advantage	$285.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.30
Rate for Payer: Cigna Commercial	$475.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.06
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.53
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$22.90
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

XR DIGITAL UNILAT MAMMO SCRN

Facility

$950.20

Hospital Charge Code	94064031
Hospital Revenue Code	403
Min. Negotiated Rate	$142.53
Max. Negotiated Rate	$142.53
Rate for Payer: Qualcare PPO/HMO/WC	$142.53

XR DILATION PROC-ESOPHAGUS

Facility

$2,033.75

Service Code	HCPCS 74360
Hospital Charge Code	2004869
Hospital Revenue Code	320
Min. Negotiated Rate	$305.06
Max. Negotiated Rate	$305.06
Rate for Payer: Qualcare PPO/HMO/WC	$305.06

XR DILATION PROC-ESOPHAGUS

Facility

$2,033.75

Service Code	HCPCS 74360
Hospital Charge Code	2004869
Hospital Revenue Code	320
Min. Negotiated Rate	$49.01
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$772.83
Rate for Payer: Aetna Medicare Advantage	$610.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$518.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$518.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$518.61
Rate for Payer: Cigna Commercial	$1,016.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$610.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$305.06
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$49.01
Rate for Payer: Wellpoint Medicaid Managed Care	$53.89

XR DISKOGRAPHY CERVICAL

Facility

$4,315.65

Service Code	HCPCS 72285
Hospital Charge Code	2011329
Hospital Revenue Code	320
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$1,623.92
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,294.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$647.35
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$104.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,656.68
Rate for Payer: Wellpoint Medicaid Managed Care	$114.36

XR DISKOGRAPHY CERVICAL

Facility

$4,315.65

Service Code	HCPCS 72285
Hospital Charge Code	2011329
Hospital Revenue Code	320
Min. Negotiated Rate	$647.35
Max. Negotiated Rate	$647.35
Rate for Payer: Qualcare PPO/HMO/WC	$647.35

XR DISKOGRAPHY LUMBAR

Facility

$4,315.65

Service Code	HCPCS 72295
Hospital Charge Code	2011330
Hospital Revenue Code	320
Min. Negotiated Rate	$647.35
Max. Negotiated Rate	$647.35
Rate for Payer: Qualcare PPO/HMO/WC	$647.35

XR DISKOGRAPHY LUMBAR

Facility

$4,315.65

Service Code	HCPCS 72295
Hospital Charge Code	2011330
Hospital Revenue Code	320
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$1,623.92
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,294.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$647.35
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$104.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$556.68
Rate for Payer: Wellpoint Medicaid Managed Care	$114.36

XR DISKOGRAPHY THORACIC

Facility

$4,315.65

Service Code	HCPCS 72285
Hospital Charge Code	2011331
Hospital Revenue Code	320
Min. Negotiated Rate	$647.35
Max. Negotiated Rate	$647.35
Rate for Payer: Qualcare PPO/HMO/WC	$647.35

XR DISKOGRAPHY THORACIC

Facility

$4,315.65

Service Code	HCPCS 72285
Hospital Charge Code	2011331
Hospital Revenue Code	320
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$1,623.92
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,294.69
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$647.35
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$104.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,656.68
Rate for Payer: Wellpoint Medicaid Managed Care	$114.36

XR DORSAL (THORACIC) SPINE

Facility

$6,601.19

Service Code	HCPCS 72070
Hospital Charge Code	2000669
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR DORSAL (THORACIC) SPINE

Facility

$6,601.19

Service Code	HCPCS 72070
Hospital Charge Code	2000669
Hospital Revenue Code	320
Min. Negotiated Rate	$36.11
Max. Negotiated Rate	$1,980.36
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	$36.11
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	$1,980.36
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: 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	$174.93

XR DRAIN PELVIC ABSCESS PERC

Facility

$8,984.95

Hospital Charge Code	5600176
Hospital Revenue Code	361
Min. Negotiated Rate	$1,347.74
Max. Negotiated Rate	$1,347.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,347.74

XR DRAIN PELVIC ABSCESS PERC

Facility

$8,984.95

Hospital Charge Code	5600176
Hospital Revenue Code	361
Min. Negotiated Rate	$216.54
Max. Negotiated Rate	$4,492.48
Rate for Payer: Aetna Commercial	$3,414.28
Rate for Payer: Aetna Medicare Advantage	$2,695.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,291.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,291.16
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	$2,291.16
Rate for Payer: Cigna Commercial	$4,492.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,347.74
Rate for Payer: UnitedHealthcare Community & State	$216.54
Rate for Payer: Wellpoint Medicaid Managed Care	$238.10

XR DRAW BLOOD OFF VENOUS DEVIC

Facility

$335.40

Service Code	HCPCS 36591
Hospital Charge Code	5600135
Hospital Revenue Code	361
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.62
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.31
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$8.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$8.89

XR DRAW BLOOD OFF VENOUS DEVIC

Facility

$335.40

Service Code	HCPCS 36591
Hospital Charge Code	5600135
Hospital Revenue Code	361
Min. Negotiated Rate	$50.31
Max. Negotiated Rate	$50.31
Rate for Payer: Qualcare PPO/HMO/WC	$50.31

Know your out-of-pocket cost for care.

All Charges