Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR DUODENOGRAPHY HYPOTONIC

Facility

$813.75

Service Code	HCPCS 74260
Hospital Charge Code	2011332
Hospital Revenue Code	320
Min. Negotiated Rate	$122.06
Max. Negotiated Rate	$122.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.06

XR DUODENOGRAPHY HYPOTONIC

Facility

$813.75

Service Code	HCPCS 74260
Hospital Charge Code	2011332
Hospital Revenue Code	320
Min. Negotiated Rate	$19.61
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$309.23
Rate for Payer: Aetna Medicare Advantage	$244.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.51
Rate for Payer: Cigna Commercial	$406.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$122.06
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$19.61
Rate for Payer: Wellpoint Medicaid Managed Care	$21.56

XR ECHO GUIDE FOR BIOPSY

Facility

$1,097.60

Service Code	HCPCS 76942
Hospital Charge Code	5600181
Hospital Revenue Code	361
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$164.64
Rate for Payer: Qualcare PPO/HMO/WC	$164.64

XR ECHO GUIDE FOR BIOPSY

Facility

$1,097.60

Service Code	HCPCS 76942
Hospital Charge Code	5600181
Hospital Revenue Code	361
Min. Negotiated Rate	$26.45
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$417.09
Rate for Payer: Aetna Medicare Advantage	$329.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.89
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	$279.89
Rate for Payer: Cigna Commercial	$548.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.28
Rate for Payer: Qualcare PPO/HMO/WC	$164.64
Rate for Payer: UnitedHealthcare Community & State	$26.45
Rate for Payer: Wellpoint Medicaid Managed Care	$29.09

XR ELBOW 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7307050
Hospital Charge Code	2011333
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR ELBOW 2 VIEWS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7307050
Hospital Charge Code	2011333
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 ELBOW COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7308050
Hospital Charge Code	2011334
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ELBOW COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7308050
Hospital Charge Code	2011334
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 ELBOW LT 2 VIEWS

Facility

$259.25

Service Code	HCPCS 73070LT
Hospital Charge Code	2002418
Hospital Revenue Code	320
Min. Negotiated Rate	$38.89
Max. Negotiated Rate	$38.89
Rate for Payer: Qualcare PPO/HMO/WC	$38.89

XR ELBOW LT 2 VIEWS

Facility

$259.25

Service Code	HCPCS 73070LT
Hospital Charge Code	2002418
Hospital Revenue Code	320
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$98.52
Rate for Payer: Aetna Medicare Advantage	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.11
Rate for Payer: Cigna Commercial	$129.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.89
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.25
Rate for Payer: Wellpoint Medicaid Managed Care	$6.87

XR ELBOW MIN 3 VWS LT

Facility

$6,601.19

Service Code	HCPCS 73080LT
Hospital Charge Code	2000040
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ELBOW MIN 3 VWS LT

Facility

$6,601.19

Service Code	HCPCS 73080LT
Hospital Charge Code	2000040
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 ELBOW MIN 3 VWS RT

Facility

$6,601.19

Service Code	HCPCS 73080RT
Hospital Charge Code	2000041
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR ELBOW MIN 3 VWS RT

Facility

$6,601.19

Service Code	HCPCS 73080RT
Hospital Charge Code	2000041
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 ELBOW RT 2 VIEWS

Facility

$259.25

Service Code	HCPCS 73070RT
Hospital Charge Code	2002419
Hospital Revenue Code	320
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$98.52
Rate for Payer: Aetna Medicare Advantage	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.11
Rate for Payer: Cigna Commercial	$129.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.89
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.25
Rate for Payer: Wellpoint Medicaid Managed Care	$6.87

XR ELBOW RT 2 VIEWS

Facility

$259.25

Service Code	HCPCS 73070RT
Hospital Charge Code	2002419
Hospital Revenue Code	320
Min. Negotiated Rate	$38.89
Max. Negotiated Rate	$38.89
Rate for Payer: Qualcare PPO/HMO/WC	$38.89

XR ENDOVAS REPR AAA INFRARENAL

Facility

$1,600.00

Service Code	HCPCS 34800
Hospital Charge Code	2600154
Hospital Revenue Code	361
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

XR ENDOVAS REPR AAA INFRARENAL

Facility

$1,600.00

Service Code	HCPCS 34800
Hospital Charge Code	2600154
Hospital Revenue Code	361
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$608.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
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	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Community & State	$38.56
Rate for Payer: Wellpoint Medicaid Managed Care	$42.40

XR ENDOVAS REPR AAA INFRARENAL

Facility

$1,600.00

Service Code	HCPCS 34800
Hospital Charge Code	7411392
Hospital Revenue Code	361
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$608.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
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	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Community & State	$38.56
Rate for Payer: Wellpoint Medicaid Managed Care	$42.40

XR ENDOVAS REPR AAA INFRARENAL

Facility

$1,600.00

Service Code	HCPCS 34800
Hospital Charge Code	7411392
Hospital Revenue Code	361
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

XR ENDOVENOUS LASER 1ST VEIN

Facility

$12,426.40

Service Code	HCPCS 36478
Hospital Charge Code	5600121
Hospital Revenue Code	361
Min. Negotiated Rate	$1,863.96
Max. Negotiated Rate	$1,863.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96

XR ENDOVENOUS LASER 1ST VEIN

Facility

$12,426.40

Service Code	HCPCS 36478
Hospital Charge Code	5600121
Hospital Revenue Code	361
Min. Negotiated Rate	$299.48
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,727.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$299.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$329.30

XR ENDOVENOUS LASER 1ST VEIN

Facility

$12,426.40

Service Code	HCPCS 36478
Hospital Charge Code	7411443
Hospital Revenue Code	361
Min. Negotiated Rate	$1,863.96
Max. Negotiated Rate	$1,863.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96

XR ENDOVENOUS LASER 1ST VEIN

Facility

$12,426.40

Service Code	HCPCS 36478
Hospital Charge Code	7411443
Hospital Revenue Code	361
Min. Negotiated Rate	$299.48
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,727.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$299.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$329.30

XR ENDOVENOUS LASER VEIN ADDON

Facility

$12,426.40

Service Code	HCPCS 36479
Hospital Charge Code	7411444
Hospital Revenue Code	361
Min. Negotiated Rate	$1,863.96
Max. Negotiated Rate	$1,863.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.96

Know your out-of-pocket cost for care.

All Charges