Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$25,034.01

Service Code	MSDRG 159
Min. Negotiated Rate	$7,622.53
Max. Negotiated Rate	$25,034.01
Rate for Payer: Aetna Commercial	$17,458.53
Rate for Payer: Aetna Medicare Advantage	$25,034.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,817.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,817.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,023.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,817.48
Rate for Payer: Cigna Commercial	$13,258.87
Rate for Payer: Cigna Medicare Advantage	$8,023.72
Rate for Payer: Clover Medicare Advantage	$7,622.53
Rate for Payer: EmblemHealth Commercial	$24,071.16
Rate for Payer: Humana Medicare Advantage	$8,264.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,023.72
Rate for Payer: Oxford Commercial	$9,529.33
Rate for Payer: UnitedHealthcare Commercial	$16,709.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,023.72
Rate for Payer: Wellcare Medicare Advantage	$8,023.72

DENTAL DISEASES AND DISORDERS

Facility

$6,804.84

Service Code	APR-DRG 1142
Min. Negotiated Rate	$6,671.41
Max. Negotiated Rate	$6,804.84
Rate for Payer: UnitedHealthcare Community & State	$6,671.41
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,804.84
Rate for Payer: Wellpoint Medicaid Managed Care	$6,671.41

DENTAL DISEASES AND DISORDERS

Facility

$4,848.94

Service Code	APR-DRG 1141
Min. Negotiated Rate	$4,753.86
Max. Negotiated Rate	$4,848.94
Rate for Payer: UnitedHealthcare Community & State	$4,753.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,848.94
Rate for Payer: Wellpoint Medicaid Managed Care	$4,753.86

DENTAL DISEASES AND DISORDERS

Facility

$19,372.80

Service Code	APR-DRG 1144
Min. Negotiated Rate	$18,992.94
Max. Negotiated Rate	$19,372.80
Rate for Payer: UnitedHealthcare Community & State	$18,992.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,372.80
Rate for Payer: Wellpoint Medicaid Managed Care	$18,992.94

DENTAL DISEASES AND DISORDERS

Facility

$10,020.90

Service Code	APR-DRG 1143
Min. Negotiated Rate	$9,824.41
Max. Negotiated Rate	$10,020.90
Rate for Payer: UnitedHealthcare Community & State	$9,824.41
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,020.90
Rate for Payer: Wellpoint Medicaid Managed Care	$9,824.41

DENTAL PASTE

Facility

$21.15

Hospital Charge Code	60628444
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

DENTAL PASTE

Facility

$21.15

Hospital Charge Code	60628444
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

DENTAL SEALANT PER TOOTH

Facility

$5,110.00

Service Code	HCPCS D1351
Hospital Charge Code	1600000797
Hospital Revenue Code	360
Min. Negotiated Rate	$766.50
Max. Negotiated Rate	$766.50
Rate for Payer: Qualcare PPO/HMO/WC	$766.50

DENTAL SEALANT PER TOOTH

Facility

$5,110.00

Service Code	HCPCS D1351
Hospital Charge Code	1600000797
Hospital Revenue Code	360
Min. Negotiated Rate	$123.15
Max. Negotiated Rate	$2,555.00
Rate for Payer: Aetna Commercial	$1,941.80
Rate for Payer: Aetna Medicare Advantage	$1,533.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.05
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	$1,303.05
Rate for Payer: Cigna Commercial	$2,555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,533.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.50
Rate for Payer: UnitedHealthcare Community & State	$123.15
Rate for Payer: Wellpoint Medicaid Managed Care	$135.41

DENTAL TRAUMA UPG LORENZ******

Facility

$22,304.00

Hospital Charge Code	270610974
Hospital Revenue Code	259
Min. Negotiated Rate	$3,345.60
Max. Negotiated Rate	$3,345.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,345.60

DENTAL TRAUMA UPG LORENZ******

Facility

$22,304.00

Hospital Charge Code	270610974
Hospital Revenue Code	259
Min. Negotiated Rate	$537.53
Max. Negotiated Rate	$11,152.00
Rate for Payer: Aetna Commercial	$8,475.52
Rate for Payer: Aetna Medicare Advantage	$6,691.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,687.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,687.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,687.52
Rate for Payer: Cigna Commercial	$11,152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,691.20
Rate for Payer: Oxford Commercial	$4,460.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,345.60
Rate for Payer: UnitedHealthcare Commercial	$4,460.80
Rate for Payer: UnitedHealthcare Community & State	$537.53
Rate for Payer: Wellpoint Medicaid Managed Care	$591.06

DENVAIR 1% CREAM 1.5GM

Facility

$156.00

Hospital Charge Code	60635658
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

DENVAIR 1% CREAM 1.5GM

Facility

$156.00

Hospital Charge Code	60635658
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$59.28
Rate for Payer: Aetna Medicare Advantage	$46.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.78
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$31.20
Rate for Payer: UnitedHealthcare Community & State	$3.76
Rate for Payer: Wellpoint Medicaid Managed Care	$4.13

DENVER ASCITES

Facility

$4,925.00

Hospital Charge Code	270621194
Hospital Revenue Code	272
Min. Negotiated Rate	$118.69
Max. Negotiated Rate	$2,462.50
Rate for Payer: Aetna Commercial	$1,871.50
Rate for Payer: Aetna Medicare Advantage	$1,477.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,255.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,255.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,255.88
Rate for Payer: Cigna Commercial	$2,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,477.50
Rate for Payer: Oxford Commercial	$985.00
Rate for Payer: Qualcare PPO/HMO/WC	$738.75
Rate for Payer: UnitedHealthcare Commercial	$985.00
Rate for Payer: UnitedHealthcare Community & State	$118.69
Rate for Payer: Wellpoint Medicaid Managed Care	$130.51

DENVER ASCITES

Facility

$4,925.00

Hospital Charge Code	270621194
Hospital Revenue Code	272
Min. Negotiated Rate	$738.75
Max. Negotiated Rate	$738.75
Rate for Payer: Qualcare PPO/HMO/WC	$738.75

DENVER NASAL SPLINT

Facility

$242.00

Hospital Charge Code	270331761
Hospital Revenue Code	272
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$121.00
Rate for Payer: Aetna Commercial	$91.96
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.71
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Oxford Commercial	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$48.40
Rate for Payer: UnitedHealthcare Community & State	$5.83
Rate for Payer: Wellpoint Medicaid Managed Care	$6.41

DENVER NASAL SPLINT

Facility

$242.00

Hospital Charge Code	270331761
Hospital Revenue Code	272
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

DENVER SHUNT PERC

Facility

$11,250.00

Hospital Charge Code	270686042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

DENVER SHUNT PERC

Facility

$11,250.00

Hospital Charge Code	270686042
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

DEODERANT ROLL ON 1.5OZ

Facility

$1.93

Hospital Charge Code	270655587
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.97
Rate for Payer: Aetna Commercial	$0.73
Rate for Payer: Aetna Medicare Advantage	$0.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.49
Rate for Payer: Cigna Commercial	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.58
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

DEODERANT ROLL ON 1.5OZ

Facility

$1.93

Hospital Charge Code	270655587
Hospital Revenue Code	270
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

DEOXYCORTICOSTERONE

Facility

$211.30

Service Code	HCPCS 82633
Hospital Charge Code	39900502
Hospital Revenue Code	301
Min. Negotiated Rate	$31.70
Max. Negotiated Rate	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$31.70

DEOXYCORTICOSTERONE

Facility

$211.30

Service Code	HCPCS 82633
Hospital Charge Code	39900502
Hospital Revenue Code	301
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$84.27
Rate for Payer: Aetna Medicare Advantage	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.83
Rate for Payer: Cigna Commercial	$105.65
Rate for Payer: Cigna Medicare Advantage	$30.98
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Medicare Advantage	$30.98
Rate for Payer: Wellpoint Medicaid Managed Care	$5.60

DEOXYCORTICOSTERONE, SERUM

Facility

$212.90

Service Code	HCPCS 82633
Hospital Charge Code	3038106
Hospital Revenue Code	300
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$84.27
Rate for Payer: Aetna Medicare Advantage	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.83
Rate for Payer: Cigna Commercial	$106.45
Rate for Payer: Cigna Medicare Advantage	$30.98
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.93
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Medicare Advantage	$30.98
Rate for Payer: Wellpoint Medicaid Managed Care	$5.64

DEOXYCORTICOSTERONE, SERUM

Facility

$212.90

Service Code	HCPCS 82633
Hospital Charge Code	3038106
Hospital Revenue Code	300
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$31.93
Rate for Payer: Qualcare PPO/HMO/WC	$31.93

Know your out-of-pocket cost for care.

All Charges