Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EMG-4 EXTREMITIES

Facility

$5,700.00

Hospital Charge Code	9109060
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

EMG-4 EXTREMITIES

Facility

$5,700.00

Hospital Charge Code	9109060
Hospital Revenue Code	922
Min. Negotiated Rate	$137.37
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,710.00
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$137.37
Rate for Payer: Wellpoint Medicaid Managed Care	$151.05

EMG-CRANIAL NERV MSCL-BIL

Facility

$5,700.00

Hospital Charge Code	9109070
Hospital Revenue Code	922
Min. Negotiated Rate	$137.37
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,710.00
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$137.37
Rate for Payer: Wellpoint Medicaid Managed Care	$151.05

EMG-CRANIAL NERV MSCL-BIL

Facility

$5,700.00

Hospital Charge Code	9109070
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

EMG-CRANIAL NERV MSCL-UNI

Facility

$5,700.00

Hospital Charge Code	9109065
Hospital Revenue Code	922
Min. Negotiated Rate	$137.37
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,710.00
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$137.37
Rate for Payer: Wellpoint Medicaid Managed Care	$151.05

EMG-CRANIAL NERV MSCL-UNI

Facility

$5,700.00

Hospital Charge Code	9109065
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

EMG NEEDLE NERVE MODULE

Facility

$7,850.00

Hospital Charge Code	270656582
Hospital Revenue Code	270
Min. Negotiated Rate	$189.19
Max. Negotiated Rate	$3,925.00
Rate for Payer: Aetna Commercial	$2,983.00
Rate for Payer: Aetna Medicare Advantage	$2,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,001.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,001.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,001.75
Rate for Payer: Cigna Commercial	$3,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,355.00
Rate for Payer: Oxford Commercial	$1,570.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.50
Rate for Payer: UnitedHealthcare Commercial	$1,570.00
Rate for Payer: UnitedHealthcare Community & State	$189.19
Rate for Payer: Wellpoint Medicaid Managed Care	$208.03

EMG NEEDLE NERVE MODULE

Facility

$7,850.00

Hospital Charge Code	270656582
Hospital Revenue Code	270
Min. Negotiated Rate	$1,177.50
Max. Negotiated Rate	$1,177.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.50

EMG NIM CONTACT 27FR # 6

Facility

$1,415.00

Hospital Charge Code	270657428
Hospital Revenue Code	278
Min. Negotiated Rate	$212.25
Max. Negotiated Rate	$342.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.30
Rate for Payer: Qualcare PPO/HMO/WC	$212.25

EMG NIM CONTACT 27FR # 6

Facility

$1,415.00

Hospital Charge Code	270657428
Hospital Revenue Code	278
Min. Negotiated Rate	$34.10
Max. Negotiated Rate	$707.50
Rate for Payer: Aetna Commercial	$537.70
Rate for Payer: Aetna Medicare Advantage	$424.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.82
Rate for Payer: Cigna Commercial	$707.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.30
Rate for Payer: Qualcare PPO/HMO/WC	$212.25
Rate for Payer: UnitedHealthcare Community & State	$34.10
Rate for Payer: Wellpoint Medicaid Managed Care	$37.50

EMG-SINGLE FIBER

Facility

$5,700.00

Hospital Charge Code	9109080
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

EMG-SINGLE FIBER

Facility

$5,700.00

Hospital Charge Code	9109080
Hospital Revenue Code	922
Min. Negotiated Rate	$137.37
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,710.00
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$137.37
Rate for Payer: Wellpoint Medicaid Managed Care	$151.05

EMG-THORACIC SPINAL MSCL

Facility

$5,700.00

Hospital Charge Code	9109075
Hospital Revenue Code	922
Min. Negotiated Rate	$137.37
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,710.00
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$137.37
Rate for Payer: Wellpoint Medicaid Managed Care	$151.05

EMG-THORACIC SPINAL MSCL

Facility

$5,700.00

Hospital Charge Code	9109075
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

EMLA CREAM

Facility

$81.00

Hospital Charge Code	60634953
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.30
Rate for Payer: Oxford Commercial	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$16.20
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

EMLA CREAM

Facility

$81.00

Hospital Charge Code	60634953
Hospital Revenue Code	250
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

EMLA CREAM 30 GM

Facility

$269.50

Hospital Charge Code	60628418W
Hospital Revenue Code	250
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$134.75
Rate for Payer: Aetna Commercial	$102.41
Rate for Payer: Aetna Medicare Advantage	$80.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.72
Rate for Payer: Cigna Commercial	$134.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.85
Rate for Payer: Oxford Commercial	$53.90
Rate for Payer: Qualcare PPO/HMO/WC	$40.42
Rate for Payer: UnitedHealthcare Commercial	$53.90
Rate for Payer: UnitedHealthcare Community & State	$6.49
Rate for Payer: Wellpoint Medicaid Managed Care	$7.14

EMLA CREAM 30 GM

Facility

$269.50

Hospital Charge Code	60628418W
Hospital Revenue Code	250
Min. Negotiated Rate	$40.42
Max. Negotiated Rate	$40.42
Rate for Payer: Qualcare PPO/HMO/WC	$40.42

EMLA DIS

Facility

$47.00

Hospital Charge Code	60635262
Hospital Revenue Code	250
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

EMLA DIS

Facility

$47.00

Hospital Charge Code	60635262
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.10
Rate for Payer: Oxford Commercial	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$9.40
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

EMLA WITH TEGADERM

Facility

$42.00

Hospital Charge Code	60635178
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

EMLA WITH TEGADERM

Facility

$42.00

Hospital Charge Code	60635178
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

E&M LEVEL 10 MINS

Facility

$433.40

Service Code	HCPCS 99201
Hospital Charge Code	84518029
Hospital Revenue Code	513
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$164.69
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.02
Rate for Payer: Qualcare PPO/HMO/WC	$65.01
Rate for Payer: UnitedHealthcare Community & State	$10.44
Rate for Payer: Wellpoint Medicaid Managed Care	$11.49

E&M LEVEL 10 MINS

Facility

$433.40

Service Code	HCPCS 99201
Hospital Charge Code	84509029
Hospital Revenue Code	513
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$65.01
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

E&M LEVEL 10 MINS

Facility

$433.40

Service Code	HCPCS 99201
Hospital Charge Code	84509029
Hospital Revenue Code	513
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$164.69
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.02
Rate for Payer: Qualcare PPO/HMO/WC	$65.01
Rate for Payer: UnitedHealthcare Community & State	$10.44
Rate for Payer: Wellpoint Medicaid Managed Care	$11.49

Know your out-of-pocket cost for care.

All Charges