Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ER-HUMERAL EPICONDY FX-BI

Facility

$453.00

Hospital Charge Code	5790385
Hospital Revenue Code	450
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

ER-HUMERAL EPICONDY FX-BI

Facility

$453.00

Hospital Charge Code	5790385
Hospital Revenue Code	450
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$172.14
Rate for Payer: Aetna Medicare Advantage	$135.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.52
Rate for Payer: Cigna Commercial	$226.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$12.00

ER-HUMERAL FX-BI

Facility

$453.00

Hospital Charge Code	5790375
Hospital Revenue Code	450
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

ER-HUMERAL FX-BI

Facility

$453.00

Hospital Charge Code	5790375
Hospital Revenue Code	450
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$172.14
Rate for Payer: Aetna Medicare Advantage	$135.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.52
Rate for Payer: Cigna Commercial	$226.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$12.00

ER-HUMERUS FX W/MANIP-BI

Facility

$458.00

Hospital Charge Code	5790345
Hospital Revenue Code	450
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

ER-HUMERUS FX W/MANIP-BI

Facility

$458.00

Hospital Charge Code	5790345
Hospital Revenue Code	450
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: Aetna Medicare Advantage	$137.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.79
Rate for Payer: Cigna Commercial	$229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

ER-HUMERUS OR ELBOW OTHER

Facility

$466.00

Service Code	HCPCS 24999
Hospital Charge Code	5790065
Hospital Revenue Code	450
Min. Negotiated Rate	$69.90
Max. Negotiated Rate	$69.90
Rate for Payer: Qualcare PPO/HMO/WC	$69.90

ER-HUMERUS OR ELBOW OTHER

Facility

$466.00

Service Code	HCPCS 24999
Hospital Charge Code	5790065
Hospital Revenue Code	450
Min. Negotiated Rate	$12.35
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) 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	$139.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.90
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	$12.35

ER HYDRATION IV INFUSIN ADD H2

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700390
Hospital Revenue Code	450
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

ER HYDRATION IV INFUSIN ADD H2

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700390
Hospital Revenue Code	450
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

ER HYDRATION IV INFUSIN ADD H3

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700392
Hospital Revenue Code	450
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

ER HYDRATION IV INFUSIN ADD H3

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700392
Hospital Revenue Code	450
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

ER HYDRATION IV INFUSIN ADD H4

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700394
Hospital Revenue Code	450
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

ER HYDRATION IV INFUSIN ADD H4

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700394
Hospital Revenue Code	450
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

ER HYDRATION IV INFUSIN ADD H5

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700396
Hospital Revenue Code	450
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

ER HYDRATION IV INFUSIN ADD H5

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700396
Hospital Revenue Code	450
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

ER HYDRATION IV INFUSIN ADD H6

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700398
Hospital Revenue Code	450
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

ER HYDRATION IV INFUSIN ADD H6

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700398
Hospital Revenue Code	450
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

ER HYDRATION IV INFUSIN ADD H7

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700400
Hospital Revenue Code	450
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

ER HYDRATION IV INFUSIN ADD H7

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700400
Hospital Revenue Code	450
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

ER HYDRATION IV INFUSIN ADD H8

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700402
Hospital Revenue Code	450
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

ER HYDRATION IV INFUSIN ADD H8

Facility

$116.48

Service Code	HCPCS 96361
Hospital Charge Code	5700402
Hospital Revenue Code	450
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

ERIBULIN 0.5 MG/ML INJ

Facility

$6,529.33

Hospital Charge Code	6063943198
Hospital Revenue Code	636
Min. Negotiated Rate	$157.36
Max. Negotiated Rate	$3,264.66
Rate for Payer: Aetna Commercial	$2,481.15
Rate for Payer: Aetna Medicare Advantage	$1,958.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,664.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,664.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,664.98
Rate for Payer: Cigna Commercial	$3,264.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.10
Rate for Payer: Qualcare PPO/HMO/WC	$979.40
Rate for Payer: UnitedHealthcare Community & State	$157.36
Rate for Payer: Wellpoint Medicaid Managed Care	$173.03

ERIBULIN 0.5 MG/ML INJ

Facility

$6,529.33

Hospital Charge Code	6063943198
Hospital Revenue Code	636
Min. Negotiated Rate	$979.40
Max. Negotiated Rate	$1,580.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.10
Rate for Payer: Qualcare PPO/HMO/WC	$979.40

ERIBULIN MESYLATE 0.5MG/ML INJ

Facility

$7,863.12

Service Code	HCPCS J9179
Hospital Charge Code	60630227
Hospital Revenue Code	636
Min. Negotiated Rate	$72.92
Max. Negotiated Rate	$1,902.88
Rate for Payer: Aetna Commercial	$208.79
Rate for Payer: Aetna Medicare Advantage	$248.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$277.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$277.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$76.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$277.08
Rate for Payer: Cigna Medicare Advantage	$76.76
Rate for Payer: Clover Medicare Advantage	$72.92
Rate for Payer: EmblemHealth Commercial	$230.28
Rate for Payer: Humana Medicare Advantage	$79.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$76.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,902.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,179.47
Rate for Payer: UnitedHealthcare Community & State	$189.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$76.76
Rate for Payer: Wellcare Medicare Advantage	$76.76
Rate for Payer: Wellpoint Medicaid Managed Care	$208.37

Know your out-of-pocket cost for care.

All Charges