Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEL L & D NURSE LOC W/NO PROC

Facility

$10,100.00

Service Code	HCPCS 99211
Hospital Charge Code	73190115
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEL NON STRESS TEST 1+ HRS

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	73190019
Hospital Revenue Code	920
Min. Negotiated Rate	$284.76
Max. Negotiated Rate	$284.76
Rate for Payer: Qualcare PPO/HMO/WC	$284.76

DEL NON STRESS TEST 1+ HRS

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	73190019
Hospital Revenue Code	920
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$503.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$866.98
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$569.52
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.76
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$45.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$50.31

DEL OBSTETRICAL CARE

Facility

$216.00

Service Code	HCPCS 59400
Hospital Charge Code	73190031
Hospital Revenue Code	720
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$82.08
Rate for Payer: Aetna Medicare Advantage	$64.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.08
Rate for Payer: Cigna Commercial	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.80
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.40
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$5.21
Rate for Payer: Wellpoint Medicaid Managed Care	$5.72

DEL OBSTETRICAL CARE

Facility

$216.00

Service Code	HCPCS 59400
Hospital Charge Code	73190031
Hospital Revenue Code	720
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

DEL OB/US<14 WKS ADD'L FETUS

Facility

$349.00

Service Code	HCPCS 76802
Hospital Charge Code	73190055
Hospital Revenue Code	402
Min. Negotiated Rate	$8.41
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$132.62
Rate for Payer: Aetna Medicare Advantage	$104.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.00
Rate for Payer: Cigna Commercial	$174.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.70
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.35
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$9.25

DEL OB/US<14 WKS ADD'L FETUS

Facility

$349.00

Service Code	HCPCS 76802
Hospital Charge Code	73190055
Hospital Revenue Code	402
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

DEL OB/US>/= 14WKS ADDL FETUS

Facility

$555.00

Service Code	HCPCS 76810
Hospital Charge Code	73190059
Hospital Revenue Code	402
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$210.90
Rate for Payer: Aetna Medicare Advantage	$166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$249.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.53
Rate for Payer: Cigna Commercial	$277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.25
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$13.38
Rate for Payer: Wellpoint Medicaid Managed Care	$14.71

DEL OB/US>/= 14WKS ADDL FETUS

Facility

$555.00

Service Code	HCPCS 76810
Hospital Charge Code	73190059
Hospital Revenue Code	402
Min. Negotiated Rate	$83.25
Max. Negotiated Rate	$83.25
Rate for Payer: Qualcare PPO/HMO/WC	$83.25

DEL OB/US<14 WKS SINGLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76801
Hospital Charge Code	73190053
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

DEL OB/US<14 WKS SINGLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76801
Hospital Charge Code	73190053
Hospital Revenue Code	402
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.10
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$26.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.60

DEL OB/US>/= 14WKS SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	73190057
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

DEL OB/US>/= 14WKS SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	73190057
Hospital Revenue Code	402
Min. Negotiated Rate	$117.99
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

DEL OB/US DETAILED ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76812
Hospital Charge Code	73190063
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

DEL OB/US DETAILED ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76812
Hospital Charge Code	73190063
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

DEL OB/US DETAILED SNGL FETUS

Facility

$1,754.00

Service Code	HCPCS 76811
Hospital Charge Code	73190061
Hospital Revenue Code	402
Min. Negotiated Rate	$263.10
Max. Negotiated Rate	$263.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.10

DEL OB/US DETAILED SNGL FETUS

Facility

$1,754.00

Service Code	HCPCS 76811
Hospital Charge Code	73190061
Hospital Revenue Code	402
Min. Negotiated Rate	$42.27
Max. Negotiated Rate	$2,517.00
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	$394.94
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	$283.47
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	$526.20
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$263.10
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$42.27
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$46.48

DEL OB/US FOLLOW UP PER FETUS

Facility

$913.00

Service Code	HCPCS 76816
Hospital Charge Code	73190071
Hospital Revenue Code	402
Min. Negotiated Rate	$136.95
Max. Negotiated Rate	$136.95
Rate for Payer: Qualcare PPO/HMO/WC	$136.95

DEL OB/US FOLLOW UP PER FETUS

Facility

$913.00

Service Code	HCPCS 76816
Hospital Charge Code	73190071
Hospital Revenue Code	402
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.90
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.95
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$22.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.67
Rate for Payer: Wellpoint Medicaid Managed Care	$24.19

DEL OB US-LIMITED

Facility

$331.00

Service Code	HCPCS 76815
Hospital Charge Code	73190069
Hospital Revenue Code	402
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.30
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.65
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$7.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$8.77

DEL OB US-LIMITED

Facility

$331.00

Service Code	HCPCS 76815
Hospital Charge Code	73190069
Hospital Revenue Code	402
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$49.65
Rate for Payer: Qualcare PPO/HMO/WC	$49.65

DEL OXYTOXIN TEST

Facility

$10,100.00

Service Code	HCPCS 59020
Hospital Charge Code	73190017
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEL OXYTOXIN TEST

Facility

$10,100.00

Service Code	HCPCS 59020
Hospital Charge Code	73190017
Hospital Revenue Code	720
Min. Negotiated Rate	$76.84
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$866.98
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,030.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$243.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$267.65

DEL ROUTINE VAG DEL 1ST HR

Facility

$10,100.00

Service Code	HCPCS 59409
Hospital Charge Code	73190033
Hospital Revenue Code	720
Min. Negotiated Rate	$243.41
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$809.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,030.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$243.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$267.65

DEL ROUTINE VAG DEL 1ST HR

Facility

$10,100.00

Service Code	HCPCS 59409
Hospital Charge Code	73190033
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

Know your out-of-pocket cost for care.

All Charges