Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR INSTILL AIRWAY CONTRAST DYE

Facility

$2,480.00

Service Code	HCPCS 31656
Hospital Charge Code	2011235
Hospital Revenue Code	361
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

XR INSTILL AIRWAY CONTRAST DYE

Facility

$2,480.00

Service Code	HCPCS 31656
Hospital Charge Code	2011235
Hospital Revenue Code	361
Min. Negotiated Rate	$59.77
Max. Negotiated Rate	$1,240.00
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	$862.00
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 INTERNAL AUDITORY CANAL

Facility

$1,224.75

Service Code	HCPCS 70134
Hospital Charge Code	2001014
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

XR INTERNAL AUDITORY CANAL

Facility

$1,224.75

Service Code	HCPCS 70134
Hospital Charge Code	2001014
Hospital Revenue Code	320
Min. Negotiated Rate	$29.52
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	$53.24
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	$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: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

XR INTRAVENOUS PYELOGRAM

Facility

$5,100.00

Service Code	HCPCS 74400
Hospital Charge Code	2001501
Hospital Revenue Code	320
Min. Negotiated Rate	$89.58
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

XR INTRAVENOUS PYELOGRAM

Facility

$5,100.00

Service Code	HCPCS 74400
Hospital Charge Code	2001501
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR INTRNL AUDIO MEATI CMP BILA

Facility

$2,449.50

Service Code	HCPCS 7013450
Hospital Charge Code	2011349
Hospital Revenue Code	320
Min. Negotiated Rate	$59.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$930.81
Rate for Payer: Aetna Medicare Advantage	$734.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.62
Rate for Payer: Cigna Commercial	$1,224.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$734.85
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.43
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$59.03
Rate for Payer: Wellpoint Medicaid Managed Care	$64.91

XR INTRNL AUDIO MEATI CMP BILA

Facility

$2,449.50

Service Code	HCPCS 7013450
Hospital Charge Code	2011349
Hospital Revenue Code	320
Min. Negotiated Rate	$367.43
Max. Negotiated Rate	$367.43
Rate for Payer: Qualcare PPO/HMO/WC	$367.43

XR INTRNL AUDIO MEATI CMP LEFT

Facility

$1,224.75

Service Code	HCPCS 70134LT
Hospital Charge Code	2011350
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) 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 INTRNL AUDIO MEATI CMP LEFT

Facility

$1,224.75

Service Code	HCPCS 70134LT
Hospital Charge Code	2011350
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

XR INTRNL AUDIO MEATI CMP RGHT

Facility

$1,224.75

Service Code	HCPCS 70134RT
Hospital Charge Code	2011351
Hospital Revenue Code	320
Min. Negotiated Rate	$183.71
Max. Negotiated Rate	$183.71
Rate for Payer: Qualcare PPO/HMO/WC	$183.71

XR INTRNL AUDIO MEATI CMP RGHT

Facility

$1,224.75

Service Code	HCPCS 70134RT
Hospital Charge Code	2011351
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) 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 INTRODUCING TUBE

Facility

$1,268.00

Service Code	HCPCS 74340
Hospital Charge Code	2011130
Hospital Revenue Code	320
Min. Negotiated Rate	$190.20
Max. Negotiated Rate	$190.20
Rate for Payer: Qualcare PPO/HMO/WC	$190.20

XR INTRODUCING TUBE

Facility

$1,268.00

Service Code	HCPCS 74340
Hospital Charge Code	2011130
Hospital Revenue Code	320
Min. Negotiated Rate	$30.56
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$481.84
Rate for Payer: Aetna Medicare Advantage	$380.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$323.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$323.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$323.34
Rate for Payer: Cigna Commercial	$634.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.40
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$190.20
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$30.56
Rate for Payer: Wellpoint Medicaid Managed Care	$33.60

XR INTRO-GUIDE DILATE NEPH TRT

Facility

$8,535.00

Service Code	HCPCS 50395
Hospital Charge Code	2004927
Hospital Revenue Code	361
Min. Negotiated Rate	$1,280.25
Max. Negotiated Rate	$1,280.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.25

XR INTRO-GUIDE DILATE NEPH TRT

Facility

$8,535.00

Service Code	HCPCS 50395
Hospital Charge Code	2004927
Hospital Revenue Code	361
Min. Negotiated Rate	$205.69
Max. Negotiated Rate	$4,267.50
Rate for Payer: Aetna Commercial	$3,243.30
Rate for Payer: Aetna Medicare Advantage	$2,560.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,176.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,176.43
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	$2,176.43
Rate for Payer: Cigna Commercial	$4,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,560.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.25
Rate for Payer: UnitedHealthcare Community & State	$205.69
Rate for Payer: Wellpoint Medicaid Managed Care	$226.18

XR INTRO NDL/CATH EXT ART ADDL

Facility

$414.45

Service Code	HCPCS 36140
Hospital Charge Code	2011178
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 INTRO NDL/CATH EXT ART ADDL

Facility

$414.45

Service Code	HCPCS 36140
Hospital Charge Code	2011178
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INTRO NDL/CATH EXTREM ART

Facility

$414.45

Service Code	HCPCS 36140
Hospital Charge Code	2011177
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

XR INTRO NDL/CATH EXTREM ART

Facility

$414.45

Service Code	HCPCS 36140
Hospital Charge Code	2011177
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 INTUBATION ENDOTRACHEAL

Facility

$903.25

Service Code	HCPCS 31500
Hospital Charge Code	5700195
Hospital Revenue Code	361
Min. Negotiated Rate	$21.77
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
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	$1,015.70
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.98
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.49
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$21.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$640.73
Rate for Payer: Wellpoint Medicaid Managed Care	$628.17

XR INTUBATION ENDOTRACHEAL

Facility

$903.25

Service Code	HCPCS 31500
Hospital Charge Code	5700195
Hospital Revenue Code	361
Min. Negotiated Rate	$135.49
Max. Negotiated Rate	$135.49
Rate for Payer: Qualcare PPO/HMO/WC	$135.49

XR IVP NEPHROTOMOGRAPHY

Facility

$1,198.45

Service Code	HCPCS 74415
Hospital Charge Code	2000792
Hospital Revenue Code	320
Min. Negotiated Rate	$28.88
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$359.54
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$179.77
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$28.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$31.76

XR IVP NEPHROTOMOGRAPHY

Facility

$1,198.45

Service Code	HCPCS 74415
Hospital Charge Code	2000792
Hospital Revenue Code	320
Min. Negotiated Rate	$179.77
Max. Negotiated Rate	$179.77
Rate for Payer: Qualcare PPO/HMO/WC	$179.77

XR KNEE 3 VIEWS BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7356250
Hospital Charge Code	2011353
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

Know your out-of-pocket cost for care.

All Charges