Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ADHESIOLYSIS TUBE OVARY

Facility

$11,114.05

Service Code	HCPCS 58740
Hospital Charge Code	1600000752
Hospital Revenue Code	360
Min. Negotiated Rate	$267.85
Max. Negotiated Rate	$8,157.00
Rate for Payer: Aetna Commercial	$4,223.34
Rate for Payer: Aetna Medicare Advantage	$3,334.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,834.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,834.08
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	$2,834.08
Rate for Payer: Cigna Commercial	$5,557.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,334.22
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,667.11
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$267.85
Rate for Payer: Wellpoint Medicaid Managed Care	$294.52

ADHESIOLYSIS TUBE OVARY

Facility

$11,114.05

Service Code	HCPCS 58740
Hospital Charge Code	1600000752
Hospital Revenue Code	360
Min. Negotiated Rate	$1,667.11
Max. Negotiated Rate	$1,667.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,667.11

ADHESIVE INDERMIL 0566IND012

Facility

$94.00

Hospital Charge Code	270632492
Hospital Revenue Code	272
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$14.10
Rate for Payer: Qualcare PPO/HMO/WC	$14.10

ADHESIVE INDERMIL 0566IND012

Facility

$94.00

Hospital Charge Code	270632492
Hospital Revenue Code	272
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$47.00
Rate for Payer: Aetna Commercial	$35.72
Rate for Payer: Aetna Medicare Advantage	$28.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.97
Rate for Payer: Cigna Commercial	$47.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.20
Rate for Payer: Oxford Commercial	$18.80
Rate for Payer: Qualcare PPO/HMO/WC	$14.10
Rate for Payer: UnitedHealthcare Commercial	$18.80
Rate for Payer: UnitedHealthcare Community & State	$2.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.49

ADHESIVE LIQUID AMPS 0.75 ML

Facility

$7.70

Hospital Charge Code	6012173
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

ADHESIVE LIQUID AMPS 0.75 ML

Facility

$7.70

Hospital Charge Code	6012173
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

ADHESIVE LIQUID BOTTLE 4OZ

Facility

$207.40

Hospital Charge Code	6012181
Hospital Revenue Code	250
Min. Negotiated Rate	$31.11
Max. Negotiated Rate	$31.11
Rate for Payer: Qualcare PPO/HMO/WC	$31.11

ADHESIVE LIQUID BOTTLE 4OZ

Facility

$207.40

Hospital Charge Code	6012181
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$103.70
Rate for Payer: Aetna Commercial	$78.81
Rate for Payer: Aetna Medicare Advantage	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.89
Rate for Payer: Cigna Commercial	$103.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.22
Rate for Payer: Oxford Commercial	$41.48
Rate for Payer: Qualcare PPO/HMO/WC	$31.11
Rate for Payer: UnitedHealthcare Commercial	$41.48
Rate for Payer: UnitedHealthcare Community & State	$5.00
Rate for Payer: Wellpoint Medicaid Managed Care	$5.50

ADHESIVE OCTYLSEAL 0.7GM M076Z

Facility

$37.00

Hospital Charge Code	270646077
Hospital Revenue Code	272
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.50
Rate for Payer: Aetna Commercial	$14.06
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.10
Rate for Payer: Oxford Commercial	$7.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$7.40
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

ADHESIVE OCTYLSEAL 0.7GM M076Z

Facility

$37.00

Hospital Charge Code	270646077
Hospital Revenue Code	272
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.55

ADHESIVE SURGISEAL STYLUS

Facility

$75.00

Hospital Charge Code	270677308
Hospital Revenue Code	272
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

ADHESIVE SURGISEAL STYLUS

Facility

$75.00

Hospital Charge Code	270677308
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

ADHSVE SRGISL SKIN 35ML SS035T

Facility

$118.18

Hospital Charge Code	270659973
Hospital Revenue Code	272
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$59.09
Rate for Payer: Aetna Commercial	$44.91
Rate for Payer: Aetna Medicare Advantage	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.14
Rate for Payer: Cigna Commercial	$59.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.45
Rate for Payer: Oxford Commercial	$23.64
Rate for Payer: Qualcare PPO/HMO/WC	$17.73
Rate for Payer: UnitedHealthcare Commercial	$23.64
Rate for Payer: UnitedHealthcare Community & State	$2.85
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

ADHSVE SRGISL SKIN 35ML SS035T

Facility

$118.18

Hospital Charge Code	270659973
Hospital Revenue Code	272
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$17.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.73

ADJECTABLE DRILL BIT

Facility

$986.85

Hospital Charge Code	270663788
Hospital Revenue Code	272
Min. Negotiated Rate	$148.03
Max. Negotiated Rate	$148.03
Rate for Payer: Qualcare PPO/HMO/WC	$148.03

ADJECTABLE DRILL BIT

Facility

$986.85

Hospital Charge Code	270663788
Hospital Revenue Code	272
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$493.43
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$296.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.65
Rate for Payer: Cigna Commercial	$493.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.06
Rate for Payer: Oxford Commercial	$197.37
Rate for Payer: Qualcare PPO/HMO/WC	$148.03
Rate for Payer: UnitedHealthcare Commercial	$197.37
Rate for Payer: UnitedHealthcare Community & State	$23.78
Rate for Payer: Wellpoint Medicaid Managed Care	$26.15

ADJ GASTRIC BAND

Facility

$1,543.70

Service Code	HCPCS S2083
Hospital Charge Code	1600191
Hospital Revenue Code	361
Min. Negotiated Rate	$231.56
Max. Negotiated Rate	$231.56
Rate for Payer: Qualcare PPO/HMO/WC	$231.56

ADJ GASTRIC BAND

Facility

$1,543.70

Service Code	HCPCS S2083
Hospital Charge Code	1600191
Hospital Revenue Code	361
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$586.61
Rate for Payer: Aetna Medicare Advantage	$463.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.64
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	$393.64
Rate for Payer: Cigna Commercial	$771.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.11
Rate for Payer: Qualcare PPO/HMO/WC	$231.56
Rate for Payer: UnitedHealthcare Community & State	$37.20
Rate for Payer: Wellpoint Medicaid Managed Care	$40.91

ADJ TXFR LID NOSEEARSLIPS10CM

Facility

$9,508.95

Service Code	HCPCS 14060
Hospital Charge Code	5792295
Hospital Revenue Code	450
Min. Negotiated Rate	$1,426.34
Max. Negotiated Rate	$1,426.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,426.34

ADJ TXFR LID NOSEEARSLIPS10CM

Facility

$9,508.95

Service Code	HCPCS 14060
Hospital Charge Code	5792295
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$583.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,852.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,426.34
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$251.99

ADJUST BONE FIXATION DEVICE

Facility

$30,894.64

Service Code	HCPCS 30894.64
Hospital Charge Code	1600000408
Hospital Revenue Code	360
Min. Negotiated Rate	$4,634.20
Max. Negotiated Rate	$4,634.20
Rate for Payer: Qualcare PPO/HMO/WC	$4,634.20

ADJUST BONE FIXATION DEVICE

Facility

$30,894.64

Service Code	HCPCS 30894.64
Hospital Charge Code	1600000408
Hospital Revenue Code	360
Min. Negotiated Rate	$744.56
Max. Negotiated Rate	$15,447.32
Rate for Payer: Aetna Commercial	$11,739.96
Rate for Payer: Aetna Medicare Advantage	$9,268.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,878.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,878.13
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	$7,878.13
Rate for Payer: Cigna Commercial	$15,447.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,268.39
Rate for Payer: Qualcare PPO/HMO/WC	$4,634.20
Rate for Payer: UnitedHealthcare Community & State	$744.56
Rate for Payer: Wellpoint Medicaid Managed Care	$818.71

ADJUSTMENT DISORDERS

Facility

$14,429.36

Service Code	APR-DRG 7554
Min. Negotiated Rate	$14,146.43
Max. Negotiated Rate	$14,429.36
Rate for Payer: UnitedHealthcare Community & State	$14,146.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,429.36
Rate for Payer: Wellpoint Medicaid Managed Care	$14,146.43

ADJUSTMENT DISORDERS

Facility

$5,284.32

Service Code	APR-DRG 7552
Min. Negotiated Rate	$5,180.71
Max. Negotiated Rate	$5,284.32
Rate for Payer: UnitedHealthcare Community & State	$5,180.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,284.32
Rate for Payer: Wellpoint Medicaid Managed Care	$5,180.71

ADJUSTMENT DISORDERS

Facility

$3,642.45

Service Code	APR-DRG 7551
Min. Negotiated Rate	$3,571.03
Max. Negotiated Rate	$3,642.45
Rate for Payer: UnitedHealthcare Community & State	$3,571.03
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$3,642.45
Rate for Payer: Wellpoint Medicaid Managed Care	$3,571.03

Know your out-of-pocket cost for care.

All Charges