Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEEP DISSECT FOOT INF; SGL BUR

Facility

$17,164.20

Service Code	HCPCS 28002
Hospital Charge Code	160000248
Hospital Revenue Code	360
Min. Negotiated Rate	$413.66
Max. Negotiated Rate	$8,157.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,149.26
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,574.63
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$413.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$454.85

DEEP I&D ABSC - FARM/WRIST

Facility

$12,289.60

Service Code	HCPCS 25028
Hospital Charge Code	1600000522
Hospital Revenue Code	360
Min. Negotiated Rate	$1,843.44
Max. Negotiated Rate	$1,843.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.44

DEEP I&D ABSC - FARM/WRIST

Facility

$12,289.60

Service Code	HCPCS 25028
Hospital Charge Code	1600000522
Hospital Revenue Code	360
Min. Negotiated Rate	$296.18
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,686.88
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.44
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$296.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$325.67

DEEP I&D THIGH/KNEE

Facility

$16,680.90

Service Code	HCPCS 27301
Hospital Charge Code	16000507
Hospital Revenue Code	360
Min. Negotiated Rate	$2,502.14
Max. Negotiated Rate	$2,502.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.14

DEEP I&D THIGH/KNEE

Facility

$16,680.90

Service Code	HCPCS 27301
Hospital Charge Code	16000507
Hospital Revenue Code	360
Min. Negotiated Rate	$402.01
Max. Negotiated Rate	$12,456.64
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,456.64
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,004.27
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.14
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$402.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$442.04

DEEP I&D - UA/ELBOW

Facility

$14,544.60

Service Code	HCPCS 23930
Hospital Charge Code	16000680
Hospital Revenue Code	360
Min. Negotiated Rate	$350.52
Max. Negotiated Rate	$12,456.64
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,456.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
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	$12,456.64
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,363.38
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,181.69
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$350.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$385.43

DEEP I&D - UA/ELBOW

Facility

$14,544.60

Service Code	HCPCS 23930
Hospital Charge Code	16000680
Hospital Revenue Code	360
Min. Negotiated Rate	$2,181.69
Max. Negotiated Rate	$2,181.69
Rate for Payer: Qualcare PPO/HMO/WC	$2,181.69

DEEP INC FOOT W OP BONE CORTEX

Facility

$19,998.60

Service Code	HCPCS 28005
Hospital Charge Code	16000902
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

DEEP INC FOOT W OP BONE CORTEX

Facility

$19,998.60

Service Code	HCPCS 28005
Hospital Charge Code	16000902
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC

Facility

$25,354.49

Service Code	MSDRG 294
Min. Negotiated Rate	$25,354.49
Max. Negotiated Rate	$25,354.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,354.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,354.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,354.49

DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC

Facility

$18,608.80

Service Code	MSDRG 295
Min. Negotiated Rate	$18,608.80
Max. Negotiated Rate	$18,608.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,608.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,608.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,608.80

DEFEROXAMINE 500 MG INJ

Facility

$147.94

Service Code	HCPCS J0895
Hospital Charge Code	6007744
Hospital Revenue Code	636
Min. Negotiated Rate	$22.19
Max. Negotiated Rate	$35.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.19

DEFEROXAMINE 500 MG INJ

Facility

$147.94

Service Code	HCPCS J0895
Hospital Charge Code	6007744
Hospital Revenue Code	636
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$73.97
Rate for Payer: Aetna Commercial	$56.22
Rate for Payer: Aetna Medicare Advantage	$44.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.72
Rate for Payer: Cigna Commercial	$73.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.19
Rate for Payer: UnitedHealthcare Community & State	$3.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

DEFEROXAMINE INJ 500 MG

Facility

$73.00

Hospital Charge Code	6001630
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.67
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

DEFEROXAMINE INJ 500 MG

Facility

$73.00

Hospital Charge Code	6001630
Hospital Revenue Code	636
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$17.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.67
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

DEFIBRILATOR ICD FORTIFY DR

Facility

$109,010.00

Hospital Charge Code	270CH0001
Hospital Revenue Code	278
Min. Negotiated Rate	$16,351.50
Max. Negotiated Rate	$26,380.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,802.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,380.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,982.20
Rate for Payer: Qualcare PPO/HMO/WC	$16,351.50

DEFIBRILATOR ICD FORTIFY DR

Facility

$109,010.00

Hospital Charge Code	270CH0001
Hospital Revenue Code	278
Min. Negotiated Rate	$2,627.14
Max. Negotiated Rate	$54,505.00
Rate for Payer: Aetna Commercial	$41,423.80
Rate for Payer: Aetna Medicare Advantage	$32,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,797.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,797.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,802.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,797.55
Rate for Payer: Cigna Commercial	$54,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,380.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,982.20
Rate for Payer: Qualcare PPO/HMO/WC	$16,351.50
Rate for Payer: UnitedHealthcare Community & State	$2,627.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2,888.76

DEFIBRILATOR ICD FORTIFY DR

Facility

$109,010.00

Hospital Charge Code	2709007369
Hospital Revenue Code	272
Min. Negotiated Rate	$16,351.50
Max. Negotiated Rate	$16,351.50
Rate for Payer: Qualcare PPO/HMO/WC	$16,351.50

DEFIBRILATOR ICD FORTIFY DR

Facility

$114,275.00

Hospital Charge Code	2709007370
Hospital Revenue Code	272
Min. Negotiated Rate	$17,141.25
Max. Negotiated Rate	$17,141.25
Rate for Payer: Qualcare PPO/HMO/WC	$17,141.25

DEFIBRILATOR ICD FORTIFY DR

Facility

$114,275.00

Hospital Charge Code	2709007370
Hospital Revenue Code	272
Min. Negotiated Rate	$2,754.03
Max. Negotiated Rate	$57,137.50
Rate for Payer: Aetna Commercial	$43,424.50
Rate for Payer: Aetna Medicare Advantage	$34,282.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29,140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29,140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29,140.12
Rate for Payer: Cigna Commercial	$57,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34,282.50
Rate for Payer: Oxford Commercial	$22,855.00
Rate for Payer: Qualcare PPO/HMO/WC	$17,141.25
Rate for Payer: UnitedHealthcare Commercial	$22,855.00
Rate for Payer: UnitedHealthcare Community & State	$2,754.03
Rate for Payer: Wellpoint Medicaid Managed Care	$3,028.29

DEFIBRILATOR ICD FORTIFY DR

Facility

$109,010.00

Hospital Charge Code	2709007369
Hospital Revenue Code	272
Min. Negotiated Rate	$2,627.14
Max. Negotiated Rate	$54,505.00
Rate for Payer: Aetna Commercial	$41,423.80
Rate for Payer: Aetna Medicare Advantage	$32,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,797.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,797.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,797.55
Rate for Payer: Cigna Commercial	$54,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32,703.00
Rate for Payer: Oxford Commercial	$21,802.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,351.50
Rate for Payer: UnitedHealthcare Commercial	$21,802.00
Rate for Payer: UnitedHealthcare Community & State	$2,627.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2,888.76

DEFIBRILATOR ICD FORTIFY VR

Facility

$105,475.00

Hospital Charge Code	270CH0002
Hospital Revenue Code	278
Min. Negotiated Rate	$15,821.25
Max. Negotiated Rate	$25,524.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,524.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$15,821.25

DEFIBRILATOR ICD FORTIFY VR

Facility

$105,475.00

Hospital Charge Code	270CH0002
Hospital Revenue Code	278
Min. Negotiated Rate	$2,541.95
Max. Negotiated Rate	$52,737.50
Rate for Payer: Aetna Commercial	$40,080.50
Rate for Payer: Aetna Medicare Advantage	$31,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,896.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,896.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,896.12
Rate for Payer: Cigna Commercial	$52,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25,524.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$15,821.25
Rate for Payer: UnitedHealthcare Community & State	$2,541.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2,795.09

DEFIBRILATOR ICD FORTIFY VR

Facility

$105,475.00

Hospital Charge Code	2709007368
Hospital Revenue Code	272
Min. Negotiated Rate	$2,541.95
Max. Negotiated Rate	$52,737.50
Rate for Payer: Aetna Commercial	$40,080.50
Rate for Payer: Aetna Medicare Advantage	$31,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,896.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,896.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,896.12
Rate for Payer: Cigna Commercial	$52,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31,642.50
Rate for Payer: Oxford Commercial	$21,095.00
Rate for Payer: Qualcare PPO/HMO/WC	$15,821.25
Rate for Payer: UnitedHealthcare Commercial	$21,095.00
Rate for Payer: UnitedHealthcare Community & State	$2,541.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2,795.09

DEFIBRILATOR ICD FORTIFY VR

Facility

$105,475.00

Hospital Charge Code	2709007368
Hospital Revenue Code	272
Min. Negotiated Rate	$15,821.25
Max. Negotiated Rate	$15,821.25
Rate for Payer: Qualcare PPO/HMO/WC	$15,821.25

Know your out-of-pocket cost for care.

All Charges