Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ER-CLAVICLE FRACTURE-BIL

Facility

$612.00

Hospital Charge Code	5790325
Hospital Revenue Code	450
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$91.80
Rate for Payer: Qualcare PPO/HMO/WC	$91.80

ER-CLAVICLE FRACTURE-BIL

Facility

$612.00

Hospital Charge Code	5790325
Hospital Revenue Code	450
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$232.56
Rate for Payer: Aetna Medicare Advantage	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.06
Rate for Payer: Cigna Commercial	$306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.80
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$16.22

ER CLD TX METACARPAL W/O ANES

Facility

$562.50

Service Code	HCPCS 26600
Hospital Charge Code	5700461
Hospital Revenue Code	450
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$1,057.82
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.38
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$14.91

ER CLD TX METACARPAL W/O ANES

Facility

$562.50

Service Code	HCPCS 26600
Hospital Charge Code	5700461
Hospital Revenue Code	450
Min. Negotiated Rate	$84.38
Max. Negotiated Rate	$84.38
Rate for Payer: Qualcare PPO/HMO/WC	$84.38

ER CLD TX PATELLR DIS W/O ANES

Facility

$889.49

Service Code	HCPCS 27560
Hospital Charge Code	5700460
Hospital Revenue Code	450
Min. Negotiated Rate	$133.42
Max. Negotiated Rate	$133.42
Rate for Payer: Qualcare PPO/HMO/WC	$133.42

ER CLD TX PATELLR DIS W/O ANES

Facility

$889.49

Service Code	HCPCS 27560
Hospital Charge Code	5700460
Hospital Revenue Code	450
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$1,057.82
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.42
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$23.57

ER CLECT BLD CNTR PRIPHRL CAT

Facility

$335.40

Service Code	HCPCS 36591
Hospital Charge Code	5700782
Hospital Revenue Code	450
Min. Negotiated Rate	$50.31
Max. Negotiated Rate	$50.31
Rate for Payer: Qualcare PPO/HMO/WC	$50.31

ER CLECT BLD CNTR PRIPHRL CAT

Facility

$335.40

Service Code	HCPCS 36591
Hospital Charge Code	5700782
Hospital Revenue Code	450
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.31
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$8.89

ER-CLOSED BIMAL AKL FX-BI

Facility

$1,827.00

Hospital Charge Code	5790605
Hospital Revenue Code	450
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$913.50
Rate for Payer: Aetna Commercial	$694.26
Rate for Payer: Aetna Medicare Advantage	$548.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.88
Rate for Payer: Cigna Commercial	$913.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$274.05
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$48.42

ER-CLOSED BIMAL AKL FX-BI

Facility

$1,827.00

Hospital Charge Code	5790605
Hospital Revenue Code	450
Min. Negotiated Rate	$274.05
Max. Negotiated Rate	$274.05
Rate for Payer: Qualcare PPO/HMO/WC	$274.05

ER CLOSED TX BENNET FX

Facility

$2,622.50

Service Code	HCPCS 26645
Hospital Charge Code	5700751
Hospital Revenue Code	450
Min. Negotiated Rate	$69.50
Max. Negotiated Rate	$6,895.75
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$302.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.38
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$69.50

ER CLOSED TX BENNET FX

Facility

$2,622.50

Service Code	HCPCS 26645
Hospital Charge Code	5700751
Hospital Revenue Code	450
Min. Negotiated Rate	$393.38
Max. Negotiated Rate	$393.38
Rate for Payer: Qualcare PPO/HMO/WC	$393.38

ER-CLOSED TX DISTAL FX-BI

Facility

$351.00

Hospital Charge Code	5790445
Hospital Revenue Code	450
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$133.38
Rate for Payer: Aetna Medicare Advantage	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.50
Rate for Payer: Cigna Commercial	$175.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.65
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$9.30

ER-CLOSED TX DISTAL FX-BI

Facility

$351.00

Hospital Charge Code	5790445
Hospital Revenue Code	450
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

ER-CLOSED TX FX ANKLE-BIL

Facility

$498.00

Hospital Charge Code	5790590
Hospital Revenue Code	450
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Qualcare PPO/HMO/WC	$74.70

ER-CLOSED TX FX ANKLE-BIL

Facility

$498.00

Hospital Charge Code	5790590
Hospital Revenue Code	450
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$189.24
Rate for Payer: Aetna Medicare Advantage	$149.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.99
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.70
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$13.20

ER CLOSED TX MANDIBLE W/O MANI

Facility

$1,873.45

Service Code	HCPCS 21450
Hospital Charge Code	5700727
Hospital Revenue Code	450
Min. Negotiated Rate	$281.02
Max. Negotiated Rate	$281.02
Rate for Payer: Qualcare PPO/HMO/WC	$281.02

ER CLOSED TX MANDIBLE W/O MANI

Facility

$1,873.45

Service Code	HCPCS 21450
Hospital Charge Code	5700727
Hospital Revenue Code	450
Min. Negotiated Rate	$49.65
Max. Negotiated Rate	$2,312.88
Rate for Payer: Aetna Commercial	$1,742.81
Rate for Payer: Aetna Medicare Advantage	$2,076.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$640.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,312.88
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: Cigna Medicare Advantage	$640.74
Rate for Payer: Clover Medicare Advantage	$608.70
Rate for Payer: EmblemHealth Commercial	$1,922.22
Rate for Payer: Humana Medicare Advantage	$659.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$640.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$281.02
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$640.74
Rate for Payer: Wellcare Medicare Advantage	$640.74
Rate for Payer: Wellpoint Medicaid Managed Care	$49.65

ER CLOSED TX NASAL FX W/O ANE

Facility

$796.25

Service Code	HCPCS 21310
Hospital Charge Code	5700551
Hospital Revenue Code	450
Min. Negotiated Rate	$21.10
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$302.57
Rate for Payer: Aetna Medicare Advantage	$238.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.04
Rate for Payer: Cigna Commercial	$398.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.44
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$21.10

ER CLOSED TX NASAL FX W/O ANE

Facility

$796.25

Service Code	HCPCS 21310
Hospital Charge Code	5700551
Hospital Revenue Code	450
Min. Negotiated Rate	$119.44
Max. Negotiated Rate	$119.44
Rate for Payer: Qualcare PPO/HMO/WC	$119.44

ER CLOSED TX NASAL FX W/O STAB

Facility

$7,901.60

Service Code	HCPCS 21315
Hospital Charge Code	5700724
Hospital Revenue Code	450
Min. Negotiated Rate	$1,185.24
Max. Negotiated Rate	$1,185.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.24

ER CLOSED TX NASAL FX W/O STAB

Facility

$7,901.60

Service Code	HCPCS 21315
Hospital Charge Code	5700724
Hospital Revenue Code	450
Min. Negotiated Rate	$121.97
Max. Negotiated Rate	$6,653.83
Rate for Payer: Aetna Commercial	$5,013.83
Rate for Payer: Aetna Medicare Advantage	$5,972.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,653.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,653.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,843.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,653.83
Rate for Payer: Cigna Commercial	$3,694.94
Rate for Payer: Cigna Medicare Advantage	$1,843.32
Rate for Payer: Clover Medicare Advantage	$1,751.15
Rate for Payer: EmblemHealth Commercial	$5,529.96
Rate for Payer: Humana Medicare Advantage	$1,898.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,843.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,370.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.24
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,843.32
Rate for Payer: Wellcare Medicare Advantage	$1,843.32
Rate for Payer: Wellpoint Medicaid Managed Care	$209.39

ER CLOSED TX NASAL FX W STAB

Facility

$12,892.65

Service Code	HCPCS 21320
Hospital Charge Code	5700725
Hospital Revenue Code	450
Min. Negotiated Rate	$1,933.90
Max. Negotiated Rate	$1,933.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,933.90

ER CLOSED TX NASAL FX W STAB

Facility

$12,892.65

Service Code	HCPCS 21320
Hospital Charge Code	5700725
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	$196.72
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	$3,867.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,933.90
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	$341.66

ER CLOSED TX POST ANTH DISWOAN

Facility

$2,006.25

Service Code	HCPCS 27265
Hospital Charge Code	5700485
Hospital Revenue Code	450
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$1,057.82
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$338.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$601.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.94
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$53.17

Know your out-of-pocket cost for care.

All Charges