Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ER-LIGATION A-V FISTULA

Facility

$8,339.00

Service Code	HCPCS 37607
Hospital Charge Code	5790115
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$677.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,501.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,250.85
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$220.98

ER-LIGATION A-V FISTULA

Facility

$8,339.00

Service Code	HCPCS 37607
Hospital Charge Code	5790115
Hospital Revenue Code	450
Min. Negotiated Rate	$1,250.85
Max. Negotiated Rate	$1,250.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,250.85

ER LIMITED - II

Facility

$6,172.34

Service Code	HCPCS 99282
Hospital Charge Code	5700117
Hospital Revenue Code	450
Min. Negotiated Rate	$925.85
Max. Negotiated Rate	$925.85
Rate for Payer: Qualcare PPO/HMO/WC	$925.85

ER LIMITED - II

Facility

$6,172.34

Service Code	HCPCS 99282
Hospital Charge Code	5700117
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$1,179.00
Rate for Payer: Aetna Commercial	$496.16
Rate for Payer: Aetna Medicare Advantage	$591.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$658.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$658.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$182.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$658.45
Rate for Payer: Cigna Commercial	$365.65
Rate for Payer: Cigna Medicare Advantage	$182.41
Rate for Payer: Clover Medicare Advantage	$173.29
Rate for Payer: EmblemHealth Commercial	$547.23
Rate for Payer: Humana Medicare Advantage	$187.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$182.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Oxford Commercial	$673.00
Rate for Payer: Qualcare PPO/HMO/WC	$925.85
Rate for Payer: UnitedHealthcare Commercial	$1,179.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$182.41
Rate for Payer: Wellcare Medicare Advantage	$182.41
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER LIMITED - II W/O MF

Facility

$6,172.34

Service Code	HCPCS 99282
Hospital Charge Code	5700116
Hospital Revenue Code	450
Min. Negotiated Rate	$925.85
Max. Negotiated Rate	$925.85
Rate for Payer: Qualcare PPO/HMO/WC	$925.85

ER LIMITED - II W/O MF

Facility

$6,172.34

Service Code	HCPCS 99282
Hospital Charge Code	5700116
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$1,179.00
Rate for Payer: Aetna Commercial	$496.16
Rate for Payer: Aetna Medicare Advantage	$591.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$658.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$658.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$182.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$658.45
Rate for Payer: Cigna Commercial	$365.65
Rate for Payer: Cigna Medicare Advantage	$182.41
Rate for Payer: Clover Medicare Advantage	$173.29
Rate for Payer: EmblemHealth Commercial	$547.23
Rate for Payer: Humana Medicare Advantage	$187.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$182.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Oxford Commercial	$673.00
Rate for Payer: Qualcare PPO/HMO/WC	$925.85
Rate for Payer: UnitedHealthcare Commercial	$1,179.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$182.41
Rate for Payer: Wellcare Medicare Advantage	$182.41
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER LIMITED - PP II

Facility

$838.75

Service Code	HCPCS 9928225
Hospital Charge Code	5700216
Hospital Revenue Code	450
Min. Negotiated Rate	$125.81
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$318.73
Rate for Payer: Aetna Medicare Advantage	$251.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.88
Rate for Payer: Cigna Commercial	$419.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$125.81
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER LIMITED - PP II

Facility

$838.75

Service Code	HCPCS 9928225
Hospital Charge Code	5700216
Hospital Revenue Code	450
Min. Negotiated Rate	$125.81
Max. Negotiated Rate	$125.81
Rate for Payer: Qualcare PPO/HMO/WC	$125.81

ER LIMITED - PP II W/O MF

Facility

$838.75

Service Code	HCPCS 99282
Hospital Charge Code	5700215
Hospital Revenue Code	450
Min. Negotiated Rate	$125.81
Max. Negotiated Rate	$125.81
Rate for Payer: Qualcare PPO/HMO/WC	$125.81

ER LIMITED - PP II W/O MF

Facility

$838.75

Service Code	HCPCS 99282
Hospital Charge Code	5700215
Hospital Revenue Code	450
Min. Negotiated Rate	$125.81
Max. Negotiated Rate	$1,179.00
Rate for Payer: Aetna Commercial	$496.16
Rate for Payer: Aetna Medicare Advantage	$591.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$658.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$658.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$182.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$658.45
Rate for Payer: Cigna Commercial	$365.65
Rate for Payer: Cigna Medicare Advantage	$182.41
Rate for Payer: Clover Medicare Advantage	$173.29
Rate for Payer: EmblemHealth Commercial	$547.23
Rate for Payer: Humana Medicare Advantage	$187.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$182.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Oxford Commercial	$673.00
Rate for Payer: Qualcare PPO/HMO/WC	$125.81
Rate for Payer: UnitedHealthcare Commercial	$1,179.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$182.41
Rate for Payer: Wellcare Medicare Advantage	$182.41
Rate for Payer: Wellpoint Medicaid Managed Care	$450.00

ER LUMBAR PUNCTURE DIAGNOSTIC

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	5700803
Hospital Revenue Code	450
Min. Negotiated Rate	$477.86
Max. Negotiated Rate	$477.86
Rate for Payer: Qualcare PPO/HMO/WC	$477.86

ER LUMBAR PUNCTURE DIAGNOSTIC

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	5700803
Hospital Revenue Code	450
Min. Negotiated Rate	$84.42
Max. Negotiated Rate	$3,027.13
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$477.86
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$84.42

ER LWBS WITH DOLLAR CHARGE

Facility

$1.00

Service Code	HCPCS LWBS1
Hospital Charge Code	5700001
Hospital Revenue Code	450
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

ER LWBS WITH DOLLAR CHARGE

Facility

$1.00

Service Code	HCPCS LWBS1
Hospital Charge Code	5700001
Hospital Revenue Code	450
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

ER-MAJOR JNT SH, KNEE-BIL

Facility

$697.00

Hospital Charge Code	5790305
Hospital Revenue Code	450
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna Medicare Advantage	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.74
Rate for Payer: Cigna Commercial	$348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.55
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$18.47

ER-MAJOR JNT SH, KNEE-BIL

Facility

$697.00

Hospital Charge Code	5790305
Hospital Revenue Code	450
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$104.55

ER-MATERNITY CARE OTHER

Facility

$500.00

Service Code	HCPCS 59899
Hospital Charge Code	5790210
Hospital Revenue Code	450
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

ER-MATERNITY CARE OTHER

Facility

$500.00

Service Code	HCPCS 59899
Hospital Charge Code	5790210
Hospital Revenue Code	450
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$866.98
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$866.98
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

ER MD VENIPNCTR<AGE 3 FEM/JUG

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	5700631
Hospital Revenue Code	450
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$114.47
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.82
Rate for Payer: Cigna Commercial	$150.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.19
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.98

ER MD VENIPNCTR<AGE 3 FEM/JUG

Facility

$301.25

Service Code	HCPCS 36405
Hospital Charge Code	5700631
Hospital Revenue Code	450
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$45.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

ER MD VENIPUNCTR <3Y NOT ROUTI

Facility

$301.25

Service Code	HCPCS 36406
Hospital Charge Code	5700778
Hospital Revenue Code	450
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$114.47
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.82
Rate for Payer: Cigna Commercial	$150.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.19
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.98

ER MD VENIPUNCTR <3Y NOT ROUTI

Facility

$301.25

Service Code	HCPCS 36406
Hospital Charge Code	5700778
Hospital Revenue Code	450
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$45.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

ER MD VENIPUNCTR > AGE 3

Facility

$285.00

Service Code	HCPCS 36410
Hospital Charge Code	5700633
Hospital Revenue Code	450
Min. Negotiated Rate	$42.75
Max. Negotiated Rate	$42.75
Rate for Payer: Qualcare PPO/HMO/WC	$42.75

ER MD VENIPUNCTR > AGE 3

Facility

$285.00

Service Code	HCPCS 36410
Hospital Charge Code	5700633
Hospital Revenue Code	450
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$108.30
Rate for Payer: Aetna Medicare Advantage	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.67
Rate for Payer: Cigna Commercial	$142.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.75
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.55

ER MD VENIPUNCTR FEM/JUG <3YRS

Facility

$301.25

Service Code	HCPCS 36400
Hospital Charge Code	5700777
Hospital Revenue Code	450
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$114.47
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.82
Rate for Payer: Cigna Commercial	$150.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.19
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.98

Know your out-of-pocket cost for care.

All Charges