Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$55.45
Max. Negotiated Rate	$4,346.30
Rate for Payer: Aetna Commercial	$3,303.19
Rate for Payer: Aetna Medicare Advantage	$2,607.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,216.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,216.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,216.61
Rate for Payer: Cigna Commercial	$4,346.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.78
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,303.89
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$209.49
Rate for Payer: Wellpoint Medicaid Managed Care	$230.35

XR FLUORO LOC INTRATHOR LESION

Facility

$1,065.00

Service Code	HCPCS 77002
Hospital Charge Code	2004885
Hospital Revenue Code	320
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$159.75
Rate for Payer: Qualcare PPO/HMO/WC	$159.75

XR FLUORO LOC INTRATHOR LESION

Facility

$1,065.00

Service Code	HCPCS 77002
Hospital Charge Code	2004885
Hospital Revenue Code	320
Min. Negotiated Rate	$25.67
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$404.70
Rate for Payer: Aetna Medicare Advantage	$319.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$271.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$271.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$271.57
Rate for Payer: Cigna Commercial	$532.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$25.67
Rate for Payer: Wellpoint Medicaid Managed Care	$28.22

XR FLUORO LOC NDL/CATH SPINE

Facility

$5,100.00

Service Code	HCPCS 77003
Hospital Charge Code	2004888
Hospital Revenue Code	320
Min. Negotiated Rate	$39.15
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) NJ Health	$39.15
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 FLUORO LOC NDL/CATH SPINE

Facility

$5,100.00

Service Code	HCPCS 77003
Hospital Charge Code	2004888
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FLUORO LUMBA PUNC SPIN TAP

Facility

$5,100.00

Service Code	HCPCS 77002
Hospital Charge Code	2004406
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FLUORO LUMBA PUNC SPIN TAP

Facility

$5,100.00

Service Code	HCPCS 77002
Hospital Charge Code	2004406
Hospital Revenue Code	320
Min. Negotiated Rate	$55.45
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) NJ Health	$55.45
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 FLUOROSCOPY UNLISTED PRCDRE

Facility

$471.30

Service Code	HCPCS 76496
Hospital Charge Code	2011339
Hospital Revenue Code	320
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$70.69
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

XR FLUOROSCOPY UNLISTED PRCDRE

Facility

$471.30

Service Code	HCPCS 76496
Hospital Charge Code	2011339
Hospital Revenue Code	320
Min. Negotiated Rate	$11.36
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) 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	$141.39
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.69
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$11.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$12.49

XR FNA W/IMAGE

Facility

$2,031.25

Service Code	HCPCS 10022
Hospital Charge Code	5600100
Hospital Revenue Code	361
Min. Negotiated Rate	$304.69
Max. Negotiated Rate	$304.69
Rate for Payer: Qualcare PPO/HMO/WC	$304.69

XR FNA W/IMAGE

Facility

$2,031.25

Service Code	HCPCS 10022
Hospital Charge Code	5600100
Hospital Revenue Code	361
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$771.88
Rate for Payer: Aetna Medicare Advantage	$609.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.97
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	$517.97
Rate for Payer: Cigna Commercial	$1,015.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$609.38
Rate for Payer: Qualcare PPO/HMO/WC	$304.69
Rate for Payer: UnitedHealthcare Community & State	$48.95
Rate for Payer: Wellpoint Medicaid Managed Care	$53.83

XR FOOT 2 VIEWS BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7362050
Hospital Charge Code	2011340
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 FOOT 2 VIEWS BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7362050
Hospital Charge Code	2011340
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR FOOT COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7363050
Hospital Charge Code	2011341
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 FOOT COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7363050
Hospital Charge Code	2011341
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR FOOT LT

Facility

$6,601.19

Service Code	HCPCS 73630LT
Hospital Charge Code	2000164
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR FOOT LT

Facility

$6,601.19

Service Code	HCPCS 73630LT
Hospital Charge Code	2000164
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 FOOT LT 2ND DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T1
Hospital Charge Code	2001005
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FOOT LT 2ND DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T1
Hospital Charge Code	2001005
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 FOOT LT 3RD DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T2
Hospital Charge Code	2001010
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 FOOT LT 3RD DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T2
Hospital Charge Code	2001010
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FOOT LT 4TH DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T3
Hospital Charge Code	2001015
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR FOOT LT 4TH DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T3
Hospital Charge Code	2001015
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 FOOT LT 5TH DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T4
Hospital Charge Code	2001020
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 FOOT LT 5TH DIGIT

Facility

$5,100.00

Service Code	HCPCS 73660T4
Hospital Charge Code	2001020
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges