Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR INJECTION FOR BRONCHUS XRAY

Facility

$2,480.00

Hospital Charge Code	2011220
Hospital Revenue Code	361
Min. Negotiated Rate	$59.77
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$942.40
Rate for Payer: Aetna Medicare Advantage	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.40
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	$632.40
Rate for Payer: Cigna Commercial	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00
Rate for Payer: UnitedHealthcare Community & State	$59.77
Rate for Payer: Wellpoint Medicaid Managed Care	$65.72

XR INJECTION FOR BRONCHUS XRAY

Facility

$2,480.00

Hospital Charge Code	2011220
Hospital Revenue Code	361
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

XR INJECTION FOR URETER X RAY

Facility

$1,766.25

Service Code	HCPCS 50684
Hospital Charge Code	7411615
Hospital Revenue Code	361
Min. Negotiated Rate	$264.94
Max. Negotiated Rate	$264.94
Rate for Payer: Qualcare PPO/HMO/WC	$264.94

XR INJECTION FOR URETER X RAY

Facility

$1,766.25

Service Code	HCPCS 50684
Hospital Charge Code	5600173
Hospital Revenue Code	361
Min. Negotiated Rate	$264.94
Max. Negotiated Rate	$264.94
Rate for Payer: Qualcare PPO/HMO/WC	$264.94

XR INJECTION FOR URETER X RAY

Facility

$1,766.25

Service Code	HCPCS 50684
Hospital Charge Code	5600173
Hospital Revenue Code	361
Min. Negotiated Rate	$42.57
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$671.17
Rate for Payer: Aetna Medicare Advantage	$529.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.39
Rate for Payer: Cigna Commercial	$883.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.88
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.94
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$42.57
Rate for Payer: Wellpoint Medicaid Managed Care	$46.81

XR INJECTION FOR URETER X RAY

Facility

$1,766.25

Service Code	HCPCS 50684
Hospital Charge Code	7411615
Hospital Revenue Code	361
Min. Negotiated Rate	$42.57
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$671.17
Rate for Payer: Aetna Medicare Advantage	$529.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.39
Rate for Payer: Cigna Commercial	$883.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.88
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.94
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$42.57
Rate for Payer: Wellpoint Medicaid Managed Care	$46.81

XR INJ HIP ARTHROGR W/O ANESTH

Facility

$414.45

Service Code	HCPCS 27093
Hospital Charge Code	2004299
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

XR INJ HIP ARTHROGR W/O ANESTH

Facility

$414.45

Service Code	HCPCS 27093
Hospital Charge Code	2004299
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ HYSTEROSALPING

Facility

$497.65

Service Code	HCPCS 58340
Hospital Charge Code	2004448
Hospital Revenue Code	361
Min. Negotiated Rate	$74.65
Max. Negotiated Rate	$74.65
Rate for Payer: Qualcare PPO/HMO/WC	$74.65

XR INJ HYSTEROSALPING

Facility

$497.65

Service Code	HCPCS 58340
Hospital Charge Code	2004448
Hospital Revenue Code	361
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$189.11
Rate for Payer: Aetna Medicare Advantage	$149.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.90
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	$126.90
Rate for Payer: Cigna Commercial	$248.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.29
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$11.99
Rate for Payer: Wellpoint Medicaid Managed Care	$13.19

XR INJ IL COND/URETEROPYLOGRAM

Facility

$414.45

Service Code	HCPCS 50690
Hospital Charge Code	2004349
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

XR INJ IL COND/URETEROPYLOGRAM

Facility

$414.45

Service Code	HCPCS 50690
Hospital Charge Code	2004349
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ INTRAOP PANCREATOGRAPHY

Facility

$631.70

Service Code	HCPCS 48400
Hospital Charge Code	2011210
Hospital Revenue Code	361
Min. Negotiated Rate	$15.22
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$240.05
Rate for Payer: Aetna Medicare Advantage	$189.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.08
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	$161.08
Rate for Payer: Cigna Commercial	$315.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.51
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.75
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$15.22
Rate for Payer: Wellpoint Medicaid Managed Care	$16.74

XR INJ INTRAOP PANCREATOGRAPHY

Facility

$631.70

Service Code	HCPCS 48400
Hospital Charge Code	2011210
Hospital Revenue Code	361
Min. Negotiated Rate	$94.75
Max. Negotiated Rate	$94.75
Rate for Payer: Qualcare PPO/HMO/WC	$94.75

XR INJ MAJOR JNT ARTHROCENTESI

Facility

$740.00

Service Code	HCPCS 20610
Hospital Charge Code	2004936
Hospital Revenue Code	361
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

XR INJ MAJOR JNT ARTHROCENTESI

Facility

$740.00

Service Code	HCPCS 20610
Hospital Charge Code	2004936
Hospital Revenue Code	361
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$17.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$19.61

XR INJ MAJOR JOINT ARTHROCENT

Facility

$740.00

Service Code	HCPCS 20610
Hospital Charge Code	2011071
Hospital Revenue Code	361
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

XR INJ MAJOR JOINT ARTHROCENT

Facility

$740.00

Service Code	HCPCS 20610
Hospital Charge Code	2011071
Hospital Revenue Code	361
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$17.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$19.61

XR INJ PROC ANKLE ART

Facility

$414.45

Service Code	HCPCS 27648
Hospital Charge Code	2011301
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROC ANKLE ART

Facility

$414.45

Service Code	HCPCS 27648
Hospital Charge Code	2011301
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

XR INJ PROC CHOLANGIO T-TUBE

Facility

$414.45

Service Code	HCPCS 47505
Hospital Charge Code	2004653
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

XR INJ PROC CHOLANGIO T-TUBE

Facility

$414.45

Service Code	HCPCS 47505
Hospital Charge Code	2004653
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROC CYSTOGRAPHY/VCU

Facility

$414.45

Service Code	HCPCS 51600
Hospital Charge Code	2004844
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

XR INJ PROC CYSTOGRAPHY/VCU

Facility

$414.45

Service Code	HCPCS 51600
Hospital Charge Code	2004844
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INJ PROCEDURE GALACTOGRAM

Facility

$1,094.45

Service Code	HCPCS 19030
Hospital Charge Code	2004449
Hospital Revenue Code	361
Min. Negotiated Rate	$26.38
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$415.89
Rate for Payer: Aetna Medicare Advantage	$328.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.08
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	$279.08
Rate for Payer: Cigna Commercial	$547.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$26.38
Rate for Payer: Wellpoint Medicaid Managed Care	$29.00

Know your out-of-pocket cost for care.

All Charges