Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

E1 VNGD PS+ TIB BRG 63/67X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682023
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS+ TIB BRG 63/67X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682023
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

E1 VNGD PS+ TIB BRG 63/67X16

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683822
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

E1 VNGD PS+ TIB BRG 63/67X16

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683822
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS+ TIB BRG 71/75X12

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676504
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS+ TIB BRG 71/75X12

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676504
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

E1 VNGD PS TIB BRG 71/75X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687301
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E1 VNGD PS TIB BRG 71/75X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687301
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

E 1 VNGD PS+TIB BRG 71/75X18

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685250
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

E 1 VNGD PS+TIB BRG 71/75X18

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685250
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

E7M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Hospital Charge Code	84310165
Hospital Revenue Code	513
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E7M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Hospital Charge Code	84310165
Hospital Revenue Code	513
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$107.69
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.02
Rate for Payer: Qualcare PPO/HMO/WC	$42.51
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

EACH ADDN'L IMMUNIZTION ADMNT

Facility

$45.00

Service Code	HCPCS 90461
Hospital Charge Code	5780275
Hospital Revenue Code	771
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

EACH ADDN'L IMMUNIZTION ADMNT

Facility

$45.00

Service Code	HCPCS 90461
Hospital Charge Code	5780275
Hospital Revenue Code	771
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.50
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

EAR CARTILAGE GRAFT

Facility

$34,833.20

Service Code	HCPCS 21235
Hospital Charge Code	1600000717
Hospital Revenue Code	360
Min. Negotiated Rate	$5,224.98
Max. Negotiated Rate	$5,224.98
Rate for Payer: Qualcare PPO/HMO/WC	$5,224.98

EAR CARTILAGE GRAFT

Facility

$34,833.20

Service Code	HCPCS 21235
Hospital Charge Code	1600000717
Hospital Revenue Code	360
Min. Negotiated Rate	$839.48
Max. Negotiated Rate	$25,386.70
Rate for Payer: Aetna Commercial	$19,129.52
Rate for Payer: Aetna Medicare Advantage	$22,786.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,032.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,386.70
Rate for Payer: Cigna Commercial	$14,097.46
Rate for Payer: Cigna Medicare Advantage	$7,032.91
Rate for Payer: Clover Medicare Advantage	$6,681.26
Rate for Payer: EmblemHealth Commercial	$21,098.73
Rate for Payer: Humana Medicare Advantage	$7,243.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,032.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,449.96
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,224.98
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$839.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,032.91
Rate for Payer: Wellcare Medicare Advantage	$7,032.91
Rate for Payer: Wellpoint Medicaid Managed Care	$923.08

EAR DRILL RENTAL

Facility

$750.00

Hospital Charge Code	270339437
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

EAR DRILL RENTAL

Facility

$750.00

Hospital Charge Code	270339437
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

EAR DRILL RENTAL

Facility

$867.00

Hospital Charge Code	270338804
Hospital Revenue Code	272
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.10
Rate for Payer: Oxford Commercial	$173.40
Rate for Payer: Qualcare PPO/HMO/WC	$130.05
Rate for Payer: UnitedHealthcare Commercial	$173.40
Rate for Payer: UnitedHealthcare Community & State	$20.89
Rate for Payer: Wellpoint Medicaid Managed Care	$22.98

EAR DRILL RENTAL

Facility

$867.00

Hospital Charge Code	270338804
Hospital Revenue Code	272
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

EARLY INTERVENTION

Facility

$1,262.80

Service Code	HCPCS 90853
Hospital Charge Code	87506096
Hospital Revenue Code	915
Min. Negotiated Rate	$189.42
Max. Negotiated Rate	$189.42
Rate for Payer: Qualcare PPO/HMO/WC	$189.42

EARLY INTERVENTION

Facility

$1,262.80

Service Code	HCPCS 90785
Hospital Charge Code	84504001
Hospital Revenue Code	900
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$479.86
Rate for Payer: Aetna Medicare Advantage	$378.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.01
Rate for Payer: Cigna Commercial	$631.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.84
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.42
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$30.43
Rate for Payer: Wellpoint Medicaid Managed Care	$33.46

EARLY INTERVENTION

Facility

$1,262.80

Service Code	HCPCS 90785
Hospital Charge Code	84504001
Hospital Revenue Code	900
Min. Negotiated Rate	$189.42
Max. Negotiated Rate	$189.42
Rate for Payer: Qualcare PPO/HMO/WC	$189.42

EARLY INTERVENTION

Facility

$1,262.80

Service Code	HCPCS 90853
Hospital Charge Code	87506096
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.84
Rate for Payer: Qualcare PPO/HMO/WC	$189.42
Rate for Payer: UnitedHealthcare Community & State	$30.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$33.46

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$43,231.09

Service Code	MSDRG 147
Min. Negotiated Rate	$13,163.31
Max. Negotiated Rate	$43,231.09
Rate for Payer: Aetna Commercial	$29,961.99
Rate for Payer: Aetna Medicare Advantage	$43,231.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,843.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,843.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,856.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,843.64
Rate for Payer: Cigna Commercial	$23,794.85
Rate for Payer: Cigna Medicare Advantage	$13,856.12
Rate for Payer: Clover Medicare Advantage	$13,163.31
Rate for Payer: EmblemHealth Commercial	$41,568.36
Rate for Payer: Humana Medicare Advantage	$14,271.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,856.12
Rate for Payer: Oxford Commercial	$17,101.67
Rate for Payer: UnitedHealthcare Commercial	$29,988.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,856.12
Rate for Payer: Wellcare Medicare Advantage	$13,856.12

Know your out-of-pocket cost for care.

All Charges