Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DESTROY LUMB/SAC FACET JNT

Facility

$10,782.78

Service Code	HCPCS 64635
Hospital Charge Code	321564635
Hospital Revenue Code	361
Min. Negotiated Rate	$1,617.42
Max. Negotiated Rate	$1,617.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42

DESTROY LUMB/SAC FACET JNT

Facility

$10,093.90

Service Code	HCPCS 64635
Hospital Charge Code	16000524
Hospital Revenue Code	360
Min. Negotiated Rate	$1,514.09
Max. Negotiated Rate	$1,514.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,514.09

DESTROY LUMB/SAC FACET JNT

Facility

$10,782.78

Service Code	HCPCS 64635
Hospital Charge Code	321564635
Hospital Revenue Code	361
Min. Negotiated Rate	$259.86
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,234.83
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$259.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$285.74

DESTROY,VULVA LESIONS,SIM

Facility

$33,410.80

Service Code	HCPCS 56501
Hospital Charge Code	16001003
Hospital Revenue Code	360
Min. Negotiated Rate	$708.84
Max. Negotiated Rate	$10,023.24
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	$1,355.00
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	$10,023.24
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,011.62
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$805.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02
Rate for Payer: Wellpoint Medicaid Managed Care	$708.84

DESTROY,VULVA LESIONS,SIM

Facility

$33,410.80

Service Code	HCPCS 56501
Hospital Charge Code	16001003
Hospital Revenue Code	360
Min. Negotiated Rate	$5,011.62
Max. Negotiated Rate	$5,011.62
Rate for Payer: Qualcare PPO/HMO/WC	$5,011.62

DESTROY VULVA LESIONS SIMPL

Facility

$745.00

Service Code	HCPCS 56501
Hospital Charge Code	83652125
Hospital Revenue Code	514
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$111.75
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

DESTROY VULVA LESIONS SIMPL

Facility

$745.00

Service Code	HCPCS 56501
Hospital Charge Code	83652125
Hospital Revenue Code	514
Min. Negotiated Rate	$17.95
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	$68.90
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	$223.50
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Community & State	$17.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$723.02
Rate for Payer: Wellpoint Medicaid Managed Care	$19.74

DESTR PARAVERTEBRL N ADDON 50

Facility

$3,580.00

Service Code	HCPCS 64636
Hospital Charge Code	1600000432
Hospital Revenue Code	360
Min. Negotiated Rate	$537.00
Max. Negotiated Rate	$537.00
Rate for Payer: Qualcare PPO/HMO/WC	$537.00

DESTR PARAVERTEBRL N ADDON 50

Facility

$3,580.00

Service Code	HCPCS 64636
Hospital Charge Code	1600000432
Hospital Revenue Code	360
Min. Negotiated Rate	$86.28
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,360.40
Rate for Payer: Aetna Medicare Advantage	$1,074.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.90
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	$912.90
Rate for Payer: Cigna Commercial	$1,790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$537.00
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$86.28
Rate for Payer: Wellpoint Medicaid Managed Care	$94.87

DESTR PARAVERTEBRL NERVE C/T-

Facility

$4,344.06

Service Code	HCPCS 64633
Hospital Charge Code	160000249
Hospital Revenue Code	360
Min. Negotiated Rate	$104.69
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,303.22
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$651.61
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$104.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$115.12

DESTR PARAVERTEBRL NERVE C/T-

Facility

$4,344.06

Service Code	HCPCS 64633
Hospital Charge Code	160000249
Hospital Revenue Code	360
Min. Negotiated Rate	$651.61
Max. Negotiated Rate	$651.61
Rate for Payer: Qualcare PPO/HMO/WC	$651.61

DESTRUCT B9 LESION 1-14

Facility

$994.50

Service Code	HCPCS 17110
Hospital Charge Code	16000321
Hospital Revenue Code	360
Min. Negotiated Rate	$23.97
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.35
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.18
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$26.35

DESTRUCT B9 LESION 1-14

Facility

$994.50

Service Code	HCPCS 17110
Hospital Charge Code	16000321
Hospital Revenue Code	360
Min. Negotiated Rate	$149.18
Max. Negotiated Rate	$149.18
Rate for Payer: Qualcare PPO/HMO/WC	$149.18

DESTRUCTION ANAL LESIONS

Facility

$1,330.15

Service Code	HCPCS 46900
Hospital Charge Code	87502935
Hospital Revenue Code	761
Min. Negotiated Rate	$199.52
Max. Negotiated Rate	$199.52
Rate for Payer: Qualcare PPO/HMO/WC	$199.52

DESTRUCTION ANAL LESIONS

Facility

$1,330.15

Service Code	HCPCS 46900
Hospital Charge Code	87502935
Hospital Revenue Code	761
Min. Negotiated Rate	$32.06
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.05
Rate for Payer: Oxford Commercial	$266.03
Rate for Payer: Qualcare PPO/HMO/WC	$199.52
Rate for Payer: UnitedHealthcare Commercial	$266.03
Rate for Payer: UnitedHealthcare Community & State	$32.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$35.25

DESTRUCTION PENIS LESION (S)

Facility

$10,771.05

Service Code	HCPCS 54065
Hospital Charge Code	1600000336
Hospital Revenue Code	360
Min. Negotiated Rate	$1,615.66
Max. Negotiated Rate	$1,615.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66

DESTRUCTION PENIS LESION (S)

Facility

$10,771.05

Service Code	HCPCS 54065
Hospital Charge Code	1600000336
Hospital Revenue Code	360
Min. Negotiated Rate	$259.58
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	$862.00
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	$3,231.32
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$259.58
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	$285.43

DESTR W NEUROLYTIC,OTHER PE

Facility

$7,956.80

Service Code	HCPCS 64640
Hospital Charge Code	16000525
Hospital Revenue Code	360
Min. Negotiated Rate	$1,193.52
Max. Negotiated Rate	$1,193.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52

DESTR W NEUROLYTIC,OTHER PE

Facility

$7,956.80

Service Code	HCPCS 64640
Hospital Charge Code	16000525
Hospital Revenue Code	360
Min. Negotiated Rate	$191.76
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,387.04
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$191.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

DESYREL/100MG/TAB

Facility

$12.00

Hospital Charge Code	60632804
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DESYREL/100MG/TAB

Facility

$12.00

Hospital Charge Code	60632804
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

DESYREL/50MG/TAB

Facility

$7.00

Hospital Charge Code	60632803
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

DESYREL/50MG/TAB

Facility

$7.00

Hospital Charge Code	60632803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

DETACHMENT HANDLE

Facility

$1,250.00

Hospital Charge Code	270673588
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

DETACHMENT HANDLE

Facility

$1,250.00

Hospital Charge Code	270673588
Hospital Revenue Code	272
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

Know your out-of-pocket cost for care.

All Charges