Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ER COM REP TRUNK >7.6EA ADDL 5

Facility

$2,427.80

Service Code	HCPCS 13102
Hospital Charge Code	5700716
Hospital Revenue Code	450
Min. Negotiated Rate	$364.17
Max. Negotiated Rate	$364.17
Rate for Payer: Qualcare PPO/HMO/WC	$364.17

ER CONTROL NOSEBLD ANT COMPLEX

Facility

$491.25

Service Code	HCPCS 30903
Hospital Charge Code	5700432
Hospital Revenue Code	450
Min. Negotiated Rate	$73.69
Max. Negotiated Rate	$73.69
Rate for Payer: Qualcare PPO/HMO/WC	$73.69

ER CONTROL NOSEBLD ANT COMPLEX

Facility

$491.25

Service Code	HCPCS 30903
Hospital Charge Code	5700432
Hospital Revenue Code	450
Min. Negotiated Rate	$13.02
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) NJ Health	$65.05
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	$147.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.69
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	$13.02

ER CONTROL NOSEBLD ANT SIMPLE

Facility

$442.45

Service Code	HCPCS 30901
Hospital Charge Code	5700430
Hospital Revenue Code	450
Min. Negotiated Rate	$66.37
Max. Negotiated Rate	$66.37
Rate for Payer: Qualcare PPO/HMO/WC	$66.37

ER CONTROL NOSEBLD ANT SIMPLE

Facility

$442.45

Service Code	HCPCS 30901
Hospital Charge Code	5700430
Hospital Revenue Code	450
Min. Negotiated Rate	$11.72
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) NJ Health	$65.05
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	$132.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.37
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	$11.72

ER CONTROL NOSEBLD POST INITAL

Facility

$504.60

Service Code	HCPCS 30905
Hospital Charge Code	5700435
Hospital Revenue Code	450
Min. Negotiated Rate	$75.69
Max. Negotiated Rate	$75.69
Rate for Payer: Qualcare PPO/HMO/WC	$75.69

ER CONTROL NOSEBLD POST INITAL

Facility

$504.60

Service Code	HCPCS 30905
Hospital Charge Code	5700435
Hospital Revenue Code	450
Min. Negotiated Rate	$13.37
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) NJ Health	$100.28
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	$151.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.69
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	$13.37

ER CONTROL NOSEBLD POST SUBSEQ

Facility

$504.60

Service Code	HCPCS 30906
Hospital Charge Code	5700437
Hospital Revenue Code	450
Min. Negotiated Rate	$75.69
Max. Negotiated Rate	$75.69
Rate for Payer: Qualcare PPO/HMO/WC	$75.69

ER CONTROL NOSEBLD POST SUBSEQ

Facility

$504.60

Service Code	HCPCS 30906
Hospital Charge Code	5700437
Hospital Revenue Code	450
Min. Negotiated Rate	$13.37
Max. Negotiated Rate	$1,015.70
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	$65.05
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	$151.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.69
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$13.37

ERCP***

Facility

$531.00

Hospital Charge Code	2300200
Hospital Revenue Code	759
Min. Negotiated Rate	$79.65
Max. Negotiated Rate	$79.65
Rate for Payer: Qualcare PPO/HMO/WC	$79.65

ERCP***

Facility

$531.00

Hospital Charge Code	2300200
Hospital Revenue Code	759
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$265.50
Rate for Payer: Aetna Commercial	$201.78
Rate for Payer: Aetna Medicare Advantage	$159.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.41
Rate for Payer: Cigna Commercial	$265.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.30
Rate for Payer: Qualcare PPO/HMO/WC	$79.65
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.07

ERCP FOR SPHINCT/PAPILLOTOMY

Facility

$9,500.80

Service Code	HCPCS 43262
Hospital Charge Code	16000823
Hospital Revenue Code	360
Min. Negotiated Rate	$1,425.12
Max. Negotiated Rate	$1,425.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.12

ERCP FOR SPHINCT/PAPILLOTOMY

Facility

$9,500.80

Service Code	HCPCS 43262
Hospital Charge Code	16000823
Hospital Revenue Code	360
Min. Negotiated Rate	$228.97
Max. Negotiated Rate	$16,533.87
Rate for Payer: Aetna Commercial	$12,458.69
Rate for Payer: Aetna Medicare Advantage	$14,840.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,533.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,533.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,580.40
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	$16,533.87
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: Cigna Medicare Advantage	$4,580.40
Rate for Payer: Clover Medicare Advantage	$4,351.38
Rate for Payer: EmblemHealth Commercial	$13,741.20
Rate for Payer: Humana Medicare Advantage	$4,717.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,580.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.24
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.12
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$228.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,580.40
Rate for Payer: Wellcare Medicare Advantage	$4,580.40
Rate for Payer: Wellpoint Medicaid Managed Care	$251.77

ER CPLX REP LIP - 1/2 VERT HT

Facility

$4,167.70

Service Code	HCPCS 40652
Hospital Charge Code	5700786
Hospital Revenue Code	450
Min. Negotiated Rate	$625.15
Max. Negotiated Rate	$625.15
Rate for Payer: Qualcare PPO/HMO/WC	$625.15

ER CPLX REP LIP - 1/2 VERT HT

Facility

$4,167.70

Service Code	HCPCS 40652
Hospital Charge Code	5700786
Hospital Revenue Code	450
Min. Negotiated Rate	$110.44
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	$441.41
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	$1,250.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$625.15
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	$110.44

ER CPLX REP LIP > 1/2 VERT HT

Facility

$4,167.70

Service Code	HCPCS 40654
Hospital Charge Code	5700787
Hospital Revenue Code	450
Min. Negotiated Rate	$625.15
Max. Negotiated Rate	$625.15
Rate for Payer: Qualcare PPO/HMO/WC	$625.15

ER CPLX REP LIP > 1/2 VERT HT

Facility

$4,167.70

Service Code	HCPCS 40654
Hospital Charge Code	5700787
Hospital Revenue Code	450
Min. Negotiated Rate	$110.44
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	$534.34
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	$1,250.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$625.15
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	$110.44

ER CPR

Facility

$1,120.00

Service Code	HCPCS 92950
Hospital Charge Code	5700255
Hospital Revenue Code	480
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$2,770.00
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) NJ Health	$100.28
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	$336.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$26.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

ER CPR

Facility

$1,120.00

Service Code	HCPCS 92950
Hospital Charge Code	5700255
Hospital Revenue Code	480
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

ERCP REMOVE DUCT CALCULI

Facility

$22,967.20

Service Code	HCPCS 43264
Hospital Charge Code	16000965
Hospital Revenue Code	360
Min. Negotiated Rate	$3,445.08
Max. Negotiated Rate	$3,445.08
Rate for Payer: Qualcare PPO/HMO/WC	$3,445.08

ERCP REMOVE DUCT CALCULI

Facility

$22,967.20

Service Code	HCPCS 43264
Hospital Charge Code	16000965
Hospital Revenue Code	360
Min. Negotiated Rate	$553.51
Max. Negotiated Rate	$16,533.87
Rate for Payer: Aetna Commercial	$12,458.69
Rate for Payer: Aetna Medicare Advantage	$14,840.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,533.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,533.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,580.40
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	$16,533.87
Rate for Payer: Cigna Commercial	$9,181.40
Rate for Payer: Cigna Medicare Advantage	$4,580.40
Rate for Payer: Clover Medicare Advantage	$4,351.38
Rate for Payer: EmblemHealth Commercial	$13,741.20
Rate for Payer: Humana Medicare Advantage	$4,717.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,580.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,890.16
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,445.08
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$553.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,580.40
Rate for Payer: Wellcare Medicare Advantage	$4,580.40
Rate for Payer: Wellpoint Medicaid Managed Care	$608.63

ERCP W/BIOPSY****

Facility

$1,289.00

Hospital Charge Code	2300014
Hospital Revenue Code	759
Min. Negotiated Rate	$31.06
Max. Negotiated Rate	$644.50
Rate for Payer: Aetna Commercial	$489.82
Rate for Payer: Aetna Medicare Advantage	$386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.69
Rate for Payer: Cigna Commercial	$644.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.70
Rate for Payer: Qualcare PPO/HMO/WC	$193.35
Rate for Payer: UnitedHealthcare Community & State	$31.06
Rate for Payer: Wellpoint Medicaid Managed Care	$34.16

ERCP W/BIOPSY****

Facility

$1,289.00

Hospital Charge Code	2300014
Hospital Revenue Code	759
Min. Negotiated Rate	$193.35
Max. Negotiated Rate	$193.35
Rate for Payer: Qualcare PPO/HMO/WC	$193.35

ERCP W/DILATION****

Facility

$1,289.00

Hospital Charge Code	2300015
Hospital Revenue Code	759
Min. Negotiated Rate	$193.35
Max. Negotiated Rate	$193.35
Rate for Payer: Qualcare PPO/HMO/WC	$193.35

ERCP W/DILATION****

Facility

$1,289.00

Hospital Charge Code	2300015
Hospital Revenue Code	759
Min. Negotiated Rate	$31.06
Max. Negotiated Rate	$644.50
Rate for Payer: Aetna Commercial	$489.82
Rate for Payer: Aetna Medicare Advantage	$386.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.69
Rate for Payer: Cigna Commercial	$644.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.70
Rate for Payer: Qualcare PPO/HMO/WC	$193.35
Rate for Payer: UnitedHealthcare Community & State	$31.06
Rate for Payer: Wellpoint Medicaid Managed Care	$34.16

Know your out-of-pocket cost for care.

All Charges