Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

XR STEREO BX PROBE

Facility

$1,488.00

Service Code	HCPCS 19081
Hospital Charge Code	2000926
Hospital Revenue Code	361
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$446.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.20
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$35.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$39.43

XR STEREO BX PROBE

Facility

$1,488.00

Service Code	HCPCS 19081
Hospital Charge Code	2000926
Hospital Revenue Code	361
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$223.20
Rate for Payer: Qualcare PPO/HMO/WC	$223.20

XR STEREO LOC BREAST BX EACH

Facility

$1,872.50

Service Code	HCPCS 19081
Hospital Charge Code	2000922
Hospital Revenue Code	361
Min. Negotiated Rate	$280.88
Max. Negotiated Rate	$280.88
Rate for Payer: Qualcare PPO/HMO/WC	$280.88

XR STEREO LOC BREAST BX EACH

Facility

$1,872.50

Service Code	HCPCS 19081
Hospital Charge Code	2000922
Hospital Revenue Code	361
Min. Negotiated Rate	$45.13
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.75
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$280.88
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$45.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$49.62

XR STERNOCLAV JOINTS

Facility

$5,100.00

Service Code	HCPCS 71130
Hospital Charge Code	2000610
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR STERNOCLAV JOINTS

Facility

$5,100.00

Service Code	HCPCS 71130
Hospital Charge Code	2000610
Hospital Revenue Code	320
Min. Negotiated Rate	$38.72
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	$38.72
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: Wellpoint Medicaid Managed Care	$135.15

XR STERNUM

Facility

$5,100.00

Service Code	HCPCS 71120
Hospital Charge Code	2000602
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR STERNUM

Facility

$5,100.00

Service Code	HCPCS 71120
Hospital Charge Code	2000602
Hospital Revenue Code	320
Min. Negotiated Rate	$35.04
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	$35.04
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: Wellpoint Medicaid Managed Care	$135.15

XR TEETH COMPLETE FULL MOUTH

Facility

$284.35

Service Code	HCPCS 70320
Hospital Charge Code	2011396
Hospital Revenue Code	320
Min. Negotiated Rate	$42.65
Max. Negotiated Rate	$42.65
Rate for Payer: Qualcare PPO/HMO/WC	$42.65

XR TEETH COMPLETE FULL MOUTH

Facility

$284.35

Service Code	HCPCS 70320
Hospital Charge Code	2011396
Hospital Revenue Code	320
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$1,975.00
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	$29.04
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	$198.43
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	$85.31
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$817.38
Rate for Payer: Wellpoint Medicaid Managed Care	$7.54

XR TEETH PARTIAL

Facility

$284.35

Service Code	HCPCS 70310
Hospital Charge Code	2011397
Hospital Revenue Code	320
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$7,747.00
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	$23.95
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	$198.43
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	$85.31
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,747.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.54

XR TEETH PARTIAL

Facility

$284.35

Service Code	HCPCS 70310
Hospital Charge Code	2011397
Hospital Revenue Code	320
Min. Negotiated Rate	$42.65
Max. Negotiated Rate	$42.65
Rate for Payer: Qualcare PPO/HMO/WC	$42.65

XR TEETH SINGLE VIEW

Facility

$284.35

Service Code	HCPCS 70300
Hospital Charge Code	2011398
Hospital Revenue Code	320
Min. Negotiated Rate	$6.85
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	$9.68
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	$85.31
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.65
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.85
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	$7.54

XR TEETH SINGLE VIEW

Facility

$284.35

Service Code	HCPCS 70300
Hospital Charge Code	2011398
Hospital Revenue Code	320
Min. Negotiated Rate	$42.65
Max. Negotiated Rate	$42.65
Rate for Payer: Qualcare PPO/HMO/WC	$42.65

XR THORACENTESIS FOR ASPIRATIO

Facility

$2,422.65

Hospital Charge Code	5600104
Hospital Revenue Code	361
Min. Negotiated Rate	$58.39
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$920.61
Rate for Payer: Aetna Medicare Advantage	$726.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.78
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	$617.78
Rate for Payer: Cigna Commercial	$1,211.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.79
Rate for Payer: Qualcare PPO/HMO/WC	$363.40
Rate for Payer: UnitedHealthcare Community & State	$58.39
Rate for Payer: Wellpoint Medicaid Managed Care	$64.20

XR THORACENTESIS FOR ASPIRATIO

Facility

$2,422.65

Hospital Charge Code	5600104
Hospital Revenue Code	361
Min. Negotiated Rate	$363.40
Max. Negotiated Rate	$363.40
Rate for Payer: Qualcare PPO/HMO/WC	$363.40

XR THORACENTESIS W IMAGING

Facility

$2,429.50

Service Code	HCPCS 32555
Hospital Charge Code	2004059
Hospital Revenue Code	361
Min. Negotiated Rate	$58.55
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.85
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$364.43
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$58.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$64.38

XR THORACENTESIS W IMAGING

Facility

$2,429.50

Service Code	HCPCS 32555
Hospital Charge Code	2004059
Hospital Revenue Code	361
Min. Negotiated Rate	$364.43
Max. Negotiated Rate	$364.43
Rate for Payer: Qualcare PPO/HMO/WC	$364.43

XR THORACENTESIS,W/INSERTION

Facility

$370.00

Service Code	HCPCS 32002
Hospital Charge Code	2004067
Hospital Revenue Code	361
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
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	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Community & State	$8.92
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

XR THORACENTESIS,W/INSERTION

Facility

$370.00

Service Code	HCPCS 32002
Hospital Charge Code	2004067
Hospital Revenue Code	361
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

XR THORACENTESIS W/TUBE INSERT

Facility

$2,422.65

Hospital Charge Code	5600105
Hospital Revenue Code	361
Min. Negotiated Rate	$58.39
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$920.61
Rate for Payer: Aetna Medicare Advantage	$726.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.78
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	$617.78
Rate for Payer: Cigna Commercial	$1,211.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.79
Rate for Payer: Qualcare PPO/HMO/WC	$363.40
Rate for Payer: UnitedHealthcare Community & State	$58.39
Rate for Payer: Wellpoint Medicaid Managed Care	$64.20

XR THORACENTESIS W/TUBE INSERT

Facility

$2,422.65

Hospital Charge Code	5600105
Hospital Revenue Code	361
Min. Negotiated Rate	$363.40
Max. Negotiated Rate	$363.40
Rate for Payer: Qualcare PPO/HMO/WC	$363.40

XR TIBIA & FIBULA AP & LAT LT

Facility

$6,601.19

Service Code	HCPCS 73590LT
Hospital Charge Code	2000149
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 TIBIA & FIBULA AP & LAT LT

Facility

$6,601.19

Service Code	HCPCS 73590LT
Hospital Charge Code	2000149
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR TIBIA & FIBULA AP & LAT RT

Facility

$6,601.19

Service Code	HCPCS 73590RT
Hospital Charge Code	2000150
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