Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AFB IDENTIFICATION

Facility

$96.85

Service Code	HCPCS 87118
Hospital Charge Code	3006798
Hospital Revenue Code	309
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.74
Rate for Payer: Aetna Medicare Advantage	$47.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.74
Rate for Payer: Cigna Commercial	$48.42
Rate for Payer: Cigna Medicare Advantage	$14.61
Rate for Payer: Clover Medicare Advantage	$13.88
Rate for Payer: EmblemHealth Commercial	$43.83
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.53
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.61
Rate for Payer: Wellcare Medicare Advantage	$14.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

AFB ID HPLC-FL and CONVENT

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39990164A
Hospital Revenue Code	309
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$34.05
Rate for Payer: Aetna Medicare Advantage	$40.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.19
Rate for Payer: Cigna Commercial	$43.05
Rate for Payer: Cigna Medicare Advantage	$12.52
Rate for Payer: Clover Medicare Advantage	$11.89
Rate for Payer: EmblemHealth Commercial	$37.56
Rate for Payer: Humana Medicare Advantage	$12.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.91
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.52
Rate for Payer: Wellcare Medicare Advantage	$12.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

AFB ID HPLC-FL and CONVENT

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39990164B
Hospital Revenue Code	309
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$34.05
Rate for Payer: Aetna Medicare Advantage	$40.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.19
Rate for Payer: Cigna Commercial	$43.05
Rate for Payer: Cigna Medicare Advantage	$12.52
Rate for Payer: Clover Medicare Advantage	$11.89
Rate for Payer: EmblemHealth Commercial	$37.56
Rate for Payer: Humana Medicare Advantage	$12.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.91
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.52
Rate for Payer: Wellcare Medicare Advantage	$12.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

AFB ID HPLC-FL and CONVENT

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39990164B
Hospital Revenue Code	309
Min. Negotiated Rate	$12.91
Max. Negotiated Rate	$12.91
Rate for Payer: Qualcare PPO/HMO/WC	$12.91

AFB ID HPLC-FL and CONVENT

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39990164A
Hospital Revenue Code	309
Min. Negotiated Rate	$12.91
Max. Negotiated Rate	$12.91
Rate for Payer: Qualcare PPO/HMO/WC	$12.91

AFB ID HPLC-FL & CONVENTI

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39900272
Hospital Revenue Code	309
Min. Negotiated Rate	$12.91
Max. Negotiated Rate	$12.91
Rate for Payer: Qualcare PPO/HMO/WC	$12.91

AFB ID HPLC-FL & CONVENTI

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39900272
Hospital Revenue Code	309
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$34.05
Rate for Payer: Aetna Medicare Advantage	$40.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.19
Rate for Payer: Cigna Commercial	$43.05
Rate for Payer: Cigna Medicare Advantage	$12.52
Rate for Payer: Clover Medicare Advantage	$11.89
Rate for Payer: EmblemHealth Commercial	$37.56
Rate for Payer: Humana Medicare Advantage	$12.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.83
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.91
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.52
Rate for Payer: Wellcare Medicare Advantage	$12.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

AFB SENS

Facility

$40.85

Service Code	HCPCS 87190
Hospital Charge Code	3006516A
Hospital Revenue Code	309
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

AFB SENS

Facility

$40.85

Service Code	HCPCS 87190
Hospital Charge Code	3006516C
Hospital Revenue Code	309
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

AFB SENS

Facility

$40.85

Service Code	HCPCS 87190
Hospital Charge Code	3006516C
Hospital Revenue Code	309
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare Advantage	$23.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.39
Rate for Payer: Cigna Commercial	$20.43
Rate for Payer: Cigna Medicare Advantage	$7.31
Rate for Payer: Clover Medicare Advantage	$6.94
Rate for Payer: EmblemHealth Commercial	$21.93
Rate for Payer: Humana Medicare Advantage	$7.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.31
Rate for Payer: Wellcare Medicare Advantage	$7.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

AFB SENS

Facility

$40.85

Service Code	HCPCS 87190
Hospital Charge Code	3006516D
Hospital Revenue Code	309
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare Advantage	$23.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.39
Rate for Payer: Cigna Commercial	$20.43
Rate for Payer: Cigna Medicare Advantage	$7.31
Rate for Payer: Clover Medicare Advantage	$6.94
Rate for Payer: EmblemHealth Commercial	$21.93
Rate for Payer: Humana Medicare Advantage	$7.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.31
Rate for Payer: Wellcare Medicare Advantage	$7.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

AFB SENS

Facility

$40.85

Service Code	HCPCS 87190
Hospital Charge Code	3006516B
Hospital Revenue Code	309
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare Advantage	$23.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.39
Rate for Payer: Cigna Commercial	$20.43
Rate for Payer: Cigna Medicare Advantage	$7.31
Rate for Payer: Clover Medicare Advantage	$6.94
Rate for Payer: EmblemHealth Commercial	$21.93
Rate for Payer: Humana Medicare Advantage	$7.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.31
Rate for Payer: Wellcare Medicare Advantage	$7.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

AFB SENS

Facility

$40.85

Service Code	HCPCS 87190
Hospital Charge Code	3006516D
Hospital Revenue Code	309
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

AFB SENS

Facility

$40.85

Service Code	HCPCS 87190
Hospital Charge Code	3006516B
Hospital Revenue Code	309
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

AFB SENS

Facility

$40.85

Service Code	HCPCS 87190
Hospital Charge Code	3006516A
Hospital Revenue Code	309
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare Advantage	$23.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.39
Rate for Payer: Cigna Commercial	$20.43
Rate for Payer: Cigna Medicare Advantage	$7.31
Rate for Payer: Clover Medicare Advantage	$6.94
Rate for Payer: EmblemHealth Commercial	$21.93
Rate for Payer: Humana Medicare Advantage	$7.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.31
Rate for Payer: Wellcare Medicare Advantage	$7.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

AFB SENSITIVITIES, I

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053A
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

AFB SENSITIVITIES, I

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053A
Hospital Revenue Code	309
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

AFB SENSITIVITIES, II

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053B
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

AFB SENSITIVITIES, II

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053B
Hospital Revenue Code	309
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

AFB SENSITIVITIES, III

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053C
Hospital Revenue Code	309
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

AFB SENSITIVITIES, III

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053C
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

AFB SENSITIVITIES, IV

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053D
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

AFB SENSITIVITIES, IV

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053D
Hospital Revenue Code	309
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

AFB SENSITIVITIES, V

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053E
Hospital Revenue Code	309
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

AFB SENSITIVITIES, V

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053E
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

Know your out-of-pocket cost for care.

All Charges