Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EEG/VIDEO MON/RECORD PER 24 HR

Facility

$5,294.00

Service Code	HCPCS 95951
Hospital Charge Code	403395951
Hospital Revenue Code	740
Min. Negotiated Rate	$794.10
Max. Negotiated Rate	$794.10
Rate for Payer: Qualcare PPO/HMO/WC	$794.10

EEG/VIDEO MON/RECORD PER 24 HR

Facility

$5,294.00

Service Code	HCPCS 95951
Hospital Charge Code	403395951
Hospital Revenue Code	740
Min. Negotiated Rate	$127.59
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$2,011.72
Rate for Payer: Aetna Medicare Advantage	$1,588.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,349.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,349.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,349.97
Rate for Payer: Cigna Commercial	$2,647.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,588.20
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$794.10
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$127.59
Rate for Payer: Wellpoint Medicaid Managed Care	$140.29

EEG WO VID 12-26HRS CONT MON

Facility

$2,843.33

Service Code	HCPCS 95710
Hospital Charge Code	403395710
Hospital Revenue Code	740
Min. Negotiated Rate	$68.52
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.00
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.50
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$68.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$75.35

EEG WO VID 12-26HRS CONT MON

Facility

$2,843.33

Service Code	HCPCS 95710
Hospital Charge Code	403395710
Hospital Revenue Code	740
Min. Negotiated Rate	$426.50
Max. Negotiated Rate	$426.50
Rate for Payer: Qualcare PPO/HMO/WC	$426.50

EEG WO VID 12-26HRS INT MON

Facility

$2,843.33

Service Code	HCPCS 95709
Hospital Charge Code	403395709
Hospital Revenue Code	740
Min. Negotiated Rate	$426.50
Max. Negotiated Rate	$426.50
Rate for Payer: Qualcare PPO/HMO/WC	$426.50

EEG WO VID 12-26HRS INT MON

Facility

$2,843.33

Service Code	HCPCS 95709
Hospital Charge Code	403395709
Hospital Revenue Code	740
Min. Negotiated Rate	$68.52
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.00
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.50
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$68.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$75.35

EEG WO VID 12-26HRS UNMON

Facility

$2,843.33

Service Code	HCPCS 95708
Hospital Charge Code	403395708
Hospital Revenue Code	740
Min. Negotiated Rate	$68.52
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.00
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$426.50
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$68.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$75.35

EEG WO VID 12-26HRS UNMON

Facility

$2,843.33

Service Code	HCPCS 95708
Hospital Charge Code	403395708
Hospital Revenue Code	740
Min. Negotiated Rate	$426.50
Max. Negotiated Rate	$426.50
Rate for Payer: Qualcare PPO/HMO/WC	$426.50

EEG WO VID 2-12HRS CONT MON

Facility

$1,481.95

Service Code	HCPCS 95707
Hospital Charge Code	403395707
Hospital Revenue Code	740
Min. Negotiated Rate	$35.71
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.58
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.29
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$35.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$39.27

EEG WO VID 2-12HRS CONT MON

Facility

$1,481.95

Service Code	HCPCS 95707
Hospital Charge Code	403395707
Hospital Revenue Code	740
Min. Negotiated Rate	$222.29
Max. Negotiated Rate	$222.29
Rate for Payer: Qualcare PPO/HMO/WC	$222.29

EEG WO VID 2-12HRS INT MON

Facility

$1,481.95

Service Code	HCPCS 95706
Hospital Charge Code	403395706
Hospital Revenue Code	740
Min. Negotiated Rate	$35.71
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.58
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.29
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$35.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$39.27

EEG WO VID 2-12HRS INT MON

Facility

$1,481.95

Service Code	HCPCS 95706
Hospital Charge Code	403395706
Hospital Revenue Code	740
Min. Negotiated Rate	$222.29
Max. Negotiated Rate	$222.29
Rate for Payer: Qualcare PPO/HMO/WC	$222.29

EEG WO VID 2-12HRS UNMON

Facility

$1,481.95

Service Code	HCPCS 95705
Hospital Charge Code	403395705
Hospital Revenue Code	740
Min. Negotiated Rate	$35.71
Max. Negotiated Rate	$5,944.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.58
Rate for Payer: Oxford Commercial	$3,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.29
Rate for Payer: UnitedHealthcare Commercial	$5,944.00
Rate for Payer: UnitedHealthcare Community & State	$35.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$39.27

EEG WO VID 2-12HRS UNMON

Facility

$1,481.95

Service Code	HCPCS 95705
Hospital Charge Code	403395705
Hospital Revenue Code	740
Min. Negotiated Rate	$222.29
Max. Negotiated Rate	$222.29
Rate for Payer: Qualcare PPO/HMO/WC	$222.29

EENT KIT

Facility

$163.00

Hospital Charge Code	270338739
Hospital Revenue Code	272
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$81.50
Rate for Payer: Aetna Commercial	$61.94
Rate for Payer: Aetna Medicare Advantage	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.56
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.90
Rate for Payer: Oxford Commercial	$32.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$32.60
Rate for Payer: UnitedHealthcare Community & State	$3.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

EENT KIT

Facility

$163.00

Hospital Charge Code	270338739
Hospital Revenue Code	272
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

E.E.S. 200/200MG/5ML

Facility

$71.00

Hospital Charge Code	60632922
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

E.E.S. 200/200MG/5ML

Facility

$71.00

Hospital Charge Code	60632922
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

E.E.S. 400/400MG/5ML

Facility

$135.00

Hospital Charge Code	60632923
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$27.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

E.E.S. 400/400MG/5ML

Facility

$135.00

Hospital Charge Code	60632923
Hospital Revenue Code	250
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

EES SULFISOX SU 200/600MG 5ML

Facility

$63.80

Hospital Charge Code	60627349
Hospital Revenue Code	251
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$31.90
Rate for Payer: Aetna Commercial	$24.24
Rate for Payer: Aetna Medicare Advantage	$19.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.27
Rate for Payer: Cigna Commercial	$31.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.14
Rate for Payer: Oxford Commercial	$12.76
Rate for Payer: Qualcare PPO/HMO/WC	$9.57
Rate for Payer: UnitedHealthcare Commercial	$12.76
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.69

EES SULFISOX SU 200/600MG 5ML

Facility

$63.80

Hospital Charge Code	60627349
Hospital Revenue Code	251
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$9.57
Rate for Payer: Qualcare PPO/HMO/WC	$9.57

E,F 10MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656989
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

E,F 10MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656989
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

EF 10MM 7-10 POLY INSERT

Facility

$5,862.40

Hospital Charge Code	270657006
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.20
Rate for Payer: Aetna Commercial	$2,227.71
Rate for Payer: Aetna Medicare Advantage	$1,758.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.91
Rate for Payer: Cigna Commercial	$2,931.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.73
Rate for Payer: Qualcare PPO/HMO/WC	$879.36
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

Know your out-of-pocket cost for care.

All Charges