Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.90
Rate for Payer: Oxford Commercial	$20.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$20.60
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.90
Rate for Payer: Oxford Commercial	$20.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$20.60
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$100.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349N
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Hospital Charge Code	270658349R
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.90
Rate for Payer: Oxford Commercial	$20.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$20.60
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$103.00

Hospital Charge Code	270658349R
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAINAGE BAG W/JACKSON-PRATT10

Facility

$100.00

Service Code	HCPCS A4357
Hospital Charge Code	270658349N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

DRAINAGEBAGW/JACKSONPRATT10/BX

Facility

$100.00

Hospital Charge Code	2709001456
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

DRAINAGEBAGW/JACKSONPRATT10/BX

Facility

$100.00

Hospital Charge Code	2709001456
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

DRAINAGEBAGWJACKSONPRATT10/BX

Facility

$100.00

Hospital Charge Code	2709001459
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

DRAINAGEBAGWJACKSONPRATT10/BX

Facility

$100.00

Hospital Charge Code	2709001459
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

DRAINAGE DEPOT LEG BAG 20/BX

Facility

$48.75

Hospital Charge Code	2709001460
Hospital Revenue Code	272
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$7.31
Rate for Payer: Qualcare PPO/HMO/WC	$7.31

DRAINAGE DEPOT LEG BAG 20/BX

Facility

$48.75

Hospital Charge Code	2709001460
Hospital Revenue Code	272
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$24.38
Rate for Payer: Aetna Commercial	$18.52
Rate for Payer: Aetna Medicare Advantage	$14.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.43
Rate for Payer: Cigna Commercial	$24.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.62
Rate for Payer: Oxford Commercial	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.31
Rate for Payer: UnitedHealthcare Commercial	$9.75
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

DRAINAGE LYMPH NODE LESION

Facility

$16,852.60

Service Code	HCPCS 38305
Hospital Charge Code	1600000650
Hospital Revenue Code	360
Min. Negotiated Rate	$406.15
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	$1,016.00
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	$5,055.78
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,527.89
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$406.15
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	$446.59

DRAINAGE LYMPH NODE LESION

Facility

$16,852.60

Service Code	HCPCS 38305
Hospital Charge Code	1600000650
Hospital Revenue Code	360
Min. Negotiated Rate	$2,527.89
Max. Negotiated Rate	$2,527.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,527.89

DRAINAGE OF HIP AND JOINT

Facility

$11,558.00

Service Code	HCPCS 27030
Hospital Charge Code	1600000332
Hospital Revenue Code	360
Min. Negotiated Rate	$1,733.70
Max. Negotiated Rate	$1,733.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,733.70

DRAINAGE OF HIP AND JOINT

Facility

$11,558.00

Service Code	HCPCS 27030
Hospital Charge Code	1600000332
Hospital Revenue Code	360
Min. Negotiated Rate	$278.55
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,467.40
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,733.70
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$278.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$306.29

DRAINAGE OF NOSE LESION

Facility

$714.00

Service Code	HCPCS 30000
Hospital Charge Code	16000923
Hospital Revenue Code	360
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$107.10
Rate for Payer: Qualcare PPO/HMO/WC	$107.10

DRAINAGE OF NOSE LESION

Facility

$714.00

Service Code	HCPCS 30000
Hospital Charge Code	16000923
Hospital Revenue Code	360
Min. Negotiated Rate	$17.21
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
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	$1,015.70
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$107.10
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$17.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$18.92

DRAINAGE OF SCROTAL WALL ABSCE

Facility

$6,799.08

Service Code	HCPCS 55100
Hospital Charge Code	160000233
Hospital Revenue Code	360
Min. Negotiated Rate	$1,019.86
Max. Negotiated Rate	$1,019.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.86

DRAINAGE OF SCROTAL WALL ABSCE

Facility

$6,799.08

Service Code	HCPCS 55100
Hospital Charge Code	160000233
Hospital Revenue Code	360
Min. Negotiated Rate	$163.86
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,039.72
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.86
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$163.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$180.18

DRAINAGE OF SCROTUM

Facility

$6,782.72

Service Code	HCPCS 54700
Hospital Charge Code	16000650
Hospital Revenue Code	360
Min. Negotiated Rate	$1,017.41
Max. Negotiated Rate	$1,017.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.41

DRAINAGE OF SCROTUM

Facility

$6,782.72

Service Code	HCPCS 54700
Hospital Charge Code	16000650
Hospital Revenue Code	360
Min. Negotiated Rate	$163.46
Max. Negotiated Rate	$8,964.44
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,964.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
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	$8,964.44
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,034.82
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,017.41
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$163.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$179.74

DRAINAGE PAROTID ABSCESS COMPL

Facility

$7,090.00

Service Code	HCPCS 42305
Hospital Charge Code	5780220
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$14,218.07
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,218.07
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,127.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.50
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$187.88

DRAINAGE PAROTID ABSCESS COMPL

Facility

$7,090.00

Service Code	HCPCS 42305
Hospital Charge Code	5780220
Hospital Revenue Code	450
Min. Negotiated Rate	$1,063.50
Max. Negotiated Rate	$1,063.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.50

Know your out-of-pocket cost for care.

All Charges