Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR FACIAL BONES < 3 VIEW

Facility

$5,100.00

Service Code	HCPCS 70140
Hospital Charge Code	2011085
Hospital Revenue Code	320
Min. Negotiated Rate	$29.04
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	$29.04
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	$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	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR FACIAL BONES < 3 VIEW

Facility

$5,100.00

Service Code	HCPCS 70140
Hospital Charge Code	2011085
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FACIAL BONES MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	2000362
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FACIAL BONES MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	2000362
Hospital Revenue Code	320
Min. Negotiated Rate	$38.72
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	$38.72
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: Wellcare New Jersey Medicaid/Family Care	$316.08
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR FALLOPIAN TUBE CATHERZATION

Facility

$1,224.75

Service Code	HCPCS 74742
Hospital Charge Code	2011336
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) NJ Health	$133.53
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 FALLOPIAN TUBE CATHERZATION

Facility

$1,224.75

Service Code	HCPCS 74742
Hospital Charge Code	2011336
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

XR FEMUR BILATERAL

Facility

$590.50

Hospital Charge Code	2011337
Hospital Revenue Code	320
Min. Negotiated Rate	$88.58
Max. Negotiated Rate	$88.58
Rate for Payer: Qualcare PPO/HMO/WC	$88.58

XR FEMUR BILATERAL

Facility

$590.50

Hospital Charge Code	2011337
Hospital Revenue Code	320
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$224.39
Rate for Payer: Aetna Medicare Advantage	$177.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.58
Rate for Payer: Cigna Commercial	$295.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.15
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.58
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.23
Rate for Payer: Wellpoint Medicaid Managed Care	$15.65

XR FEMUR LT

Facility

$307.00

Hospital Charge Code	2000131
Hospital Revenue Code	320
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$116.66
Rate for Payer: Aetna Medicare Advantage	$92.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.28
Rate for Payer: Cigna Commercial	$153.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.05
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.40
Rate for Payer: Wellpoint Medicaid Managed Care	$8.14

XR FEMUR LT

Facility

$307.00

Hospital Charge Code	2000131
Hospital Revenue Code	320
Min. Negotiated Rate	$46.05
Max. Negotiated Rate	$46.05
Rate for Payer: Qualcare PPO/HMO/WC	$46.05

XR FEMUR RT

Facility

$295.25

Hospital Charge Code	2000132
Hospital Revenue Code	320
Min. Negotiated Rate	$44.29
Max. Negotiated Rate	$44.29
Rate for Payer: Qualcare PPO/HMO/WC	$44.29

XR FEMUR RT

Facility

$295.25

Hospital Charge Code	2000132
Hospital Revenue Code	320
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$112.19
Rate for Payer: Aetna Medicare Advantage	$88.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.29
Rate for Payer: Cigna Commercial	$147.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.58
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.29
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$7.12
Rate for Payer: Wellpoint Medicaid Managed Care	$7.82

XR FILM SCREEN DIAG BI CONVERT

Facility

$1,058.75

Service Code	HCPCS 77056
Hospital Charge Code	2002566
Hospital Revenue Code	401
Min. Negotiated Rate	$158.81
Max. Negotiated Rate	$158.81
Rate for Payer: Qualcare PPO/HMO/WC	$158.81

XR FILM SCREEN DIAG BI CONVERT

Facility

$1,058.75

Service Code	HCPCS 77056
Hospital Charge Code	2002566
Hospital Revenue Code	401
Min. Negotiated Rate	$25.52
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$402.32
Rate for Payer: Aetna Medicare Advantage	$317.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.98
Rate for Payer: Cigna Commercial	$529.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$317.62
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$158.81
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$25.52
Rate for Payer: Wellpoint Medicaid Managed Care	$28.06

XR FILM SCREEN DIAG UNI CONV

Facility

$777.50

Service Code	HCPCS 77055
Hospital Charge Code	2002582
Hospital Revenue Code	401
Min. Negotiated Rate	$116.62
Max. Negotiated Rate	$116.62
Rate for Payer: Qualcare PPO/HMO/WC	$116.62

XR FILM SCREEN DIAG UNI CONV

Facility

$777.50

Service Code	HCPCS 77055
Hospital Charge Code	2002582
Hospital Revenue Code	401
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$295.45
Rate for Payer: Aetna Medicare Advantage	$233.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.26
Rate for Payer: Cigna Commercial	$388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.62
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$18.74
Rate for Payer: Wellpoint Medicaid Managed Care	$20.60

XR FINE NDL ASPIR W/IMAGE GUID

Facility

$2,403.20

Service Code	HCPCS 10022
Hospital Charge Code	2001635
Hospital Revenue Code	361
Min. Negotiated Rate	$57.92
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$913.22
Rate for Payer: Aetna Medicare Advantage	$720.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.82
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	$612.82
Rate for Payer: Cigna Commercial	$1,201.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.96
Rate for Payer: Qualcare PPO/HMO/WC	$360.48
Rate for Payer: UnitedHealthcare Community & State	$57.92
Rate for Payer: Wellpoint Medicaid Managed Care	$63.68

XR FINE NDL ASPIR W/IMAGE GUID

Facility

$2,403.20

Service Code	HCPCS 10022
Hospital Charge Code	2001635
Hospital Revenue Code	361
Min. Negotiated Rate	$360.48
Max. Negotiated Rate	$360.48
Rate for Payer: Qualcare PPO/HMO/WC	$360.48

XR FISTULOGRAM

Facility

$5,100.00

Service Code	HCPCS 76080
Hospital Charge Code	2000321
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FISTULOGRAM

Facility

$5,100.00

Service Code	HCPCS 76080
Hospital Charge Code	2000321
Hospital Revenue Code	320
Min. Negotiated Rate	$40.66
Max. Negotiated Rate	$2,343.27
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
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	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$454.41
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
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	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR FLUORO BRONCH BX*****

Facility

$210.00

Service Code	HCPCS 71038
Hospital Charge Code	2004463
Hospital Revenue Code	329
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$5.57

XR FLUORO BRONCH BX*****

Facility

$210.00

Service Code	HCPCS 71038
Hospital Charge Code	2004463
Hospital Revenue Code	329
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

XR FLUORO EXAM OF G/COLON TUBE

Facility

$604.00

Service Code	HCPCS 49465
Hospital Charge Code	5600166
Hospital Revenue Code	361
Min. Negotiated Rate	$90.60
Max. Negotiated Rate	$90.60
Rate for Payer: Qualcare PPO/HMO/WC	$90.60

XR FLUORO EXAM OF G/COLON TUBE

Facility

$604.00

Service Code	HCPCS 49465
Hospital Charge Code	5600166
Hospital Revenue Code	361
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$2,220.00
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	$1,626.00
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	$283.47
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	$181.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.60
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$14.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$16.01

XR FLUORO GUIDE CV ACCESS DEV

Facility

$8,692.60

Service Code	HCPCS 77001
Hospital Charge Code	2004405
Hospital Revenue Code	320
Min. Negotiated Rate	$1,303.89
Max. Negotiated Rate	$1,303.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,303.89

Know your out-of-pocket cost for care.

All Charges