Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ERTHROPOIETIN INJ 20.000U****

Facility

$437.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017321
Hospital Revenue Code	634
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$218.50
Rate for Payer: Aetna Commercial	$166.06
Rate for Payer: Aetna Medicare Advantage	$131.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.44
Rate for Payer: Cigna Commercial	$218.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.10
Rate for Payer: Oxford Commercial	$87.40
Rate for Payer: Qualcare PPO/HMO/WC	$65.55
Rate for Payer: UnitedHealthcare Commercial	$87.40
Rate for Payer: UnitedHealthcare Community & State	$10.53
Rate for Payer: Wellpoint Medicaid Managed Care	$11.58

ERTHROPOIETIN INJ 20.000U****

Facility

$437.00

Service Code	HCPCS Q0136
Hospital Charge Code	6017321
Hospital Revenue Code	634
Min. Negotiated Rate	$65.55
Max. Negotiated Rate	$65.55
Rate for Payer: Qualcare PPO/HMO/WC	$65.55

ER-TMJ - DISLOCATED-BILAT

Facility

$573.00

Hospital Charge Code	5790315
Hospital Revenue Code	450
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$217.74
Rate for Payer: Aetna Medicare Advantage	$171.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.12
Rate for Payer: Cigna Commercial	$286.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$15.18

ER-TMJ - DISLOCATED-BILAT

Facility

$573.00

Hospital Charge Code	5790315
Hospital Revenue Code	450
Min. Negotiated Rate	$85.95
Max. Negotiated Rate	$85.95
Rate for Payer: Qualcare PPO/HMO/WC	$85.95

ER-TONGUE & MOUTH-OTHER

Facility

$323.00

Service Code	HCPCS 41599
Hospital Charge Code	5790135
Hospital Revenue Code	450
Min. Negotiated Rate	$8.56
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) 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	$96.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.45
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	$8.56

ER-TONGUE & MOUTH-OTHER

Facility

$323.00

Service Code	HCPCS 41599
Hospital Charge Code	5790135
Hospital Revenue Code	450
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$48.45
Rate for Payer: Qualcare PPO/HMO/WC	$48.45

ER TOOTH EXTRACTION/ANESTHESIA

Facility

$463.00

Service Code	HCPCS 41899
Hospital Charge Code	5770055
Hospital Revenue Code	450
Min. Negotiated Rate	$12.27
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	$60.35
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	$138.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.45
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	$12.27

ER TOOTH EXTRACTION/ANESTHESIA

Facility

$463.00

Service Code	HCPCS 41899
Hospital Charge Code	5770055
Hospital Revenue Code	450
Min. Negotiated Rate	$69.45
Max. Negotiated Rate	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

ER TRACHEOTOMY TUBE CHANGE

Facility

$431.25

Service Code	HCPCS 31502
Hospital Charge Code	5700620
Hospital Revenue Code	450
Min. Negotiated Rate	$11.43
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	$54.21
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	$129.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.69
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	$11.43

ER TRACHEOTOMY TUBE CHANGE

Facility

$431.25

Service Code	HCPCS 31502
Hospital Charge Code	5700620
Hospital Revenue Code	450
Min. Negotiated Rate	$64.69
Max. Negotiated Rate	$64.69
Rate for Payer: Qualcare PPO/HMO/WC	$64.69

ER TREAT ANKLE DISLOCATION

Facility

$2,792.10

Service Code	HCPCS 27840
Hospital Charge Code	5700325
Hospital Revenue Code	450
Min. Negotiated Rate	$418.81
Max. Negotiated Rate	$418.81
Rate for Payer: Qualcare PPO/HMO/WC	$418.81

ER TREAT ANKLE DISLOCATION

Facility

$2,792.10

Service Code	HCPCS 27840
Hospital Charge Code	5700325
Hospital Revenue Code	450
Min. Negotiated Rate	$73.99
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	$248.00
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	$837.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$418.81
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	$73.99

ER-TREAT BIG TOE FX-BI

Facility

$457.00

Hospital Charge Code	5790650
Hospital Revenue Code	450
Min. Negotiated Rate	$68.55
Max. Negotiated Rate	$68.55
Rate for Payer: Qualcare PPO/HMO/WC	$68.55

ER-TREAT BIG TOE FX-BI

Facility

$457.00

Hospital Charge Code	5790650
Hospital Revenue Code	450
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$173.66
Rate for Payer: Aetna Medicare Advantage	$137.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.53
Rate for Payer: Cigna Commercial	$228.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.55
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$12.11

ER TREAT ELBOW DISLOCATION

Facility

$388.60

Service Code	HCPCS 24600
Hospital Charge Code	5700313
Hospital Revenue Code	450
Min. Negotiated Rate	$58.29
Max. Negotiated Rate	$58.29
Rate for Payer: Qualcare PPO/HMO/WC	$58.29

ER TREAT ELBOW DISLOCATION

Facility

$388.60

Service Code	HCPCS 24600
Hospital Charge Code	5700313
Hospital Revenue Code	450
Min. Negotiated Rate	$10.30
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	$248.00
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	$116.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.29
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	$10.30

ER TREAT FINGER DISLOCATION

Facility

$388.60

Service Code	HCPCS 26700
Hospital Charge Code	5700323
Hospital Revenue Code	450
Min. Negotiated Rate	$58.29
Max. Negotiated Rate	$58.29
Rate for Payer: Qualcare PPO/HMO/WC	$58.29

ER TREAT FINGER DISLOCATION

Facility

$11,949.75

Service Code	HCPCS 26785
Hospital Charge Code	5790900
Hospital Revenue Code	450
Min. Negotiated Rate	$1,792.46
Max. Negotiated Rate	$1,792.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.46

ER TREAT FINGER DISLOCATION

Facility

$11,949.75

Service Code	HCPCS 26785
Hospital Charge Code	5790900
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,584.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.46
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$316.67

ER TREAT FINGER DISLOCATION

Facility

$388.60

Service Code	HCPCS 26700
Hospital Charge Code	5700323
Hospital Revenue Code	450
Min. Negotiated Rate	$10.30
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	$121.97
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	$116.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.29
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	$10.30

ER TREAT HAND DISLOCATION

Facility

$1,175.15

Service Code	HCPCS 26670
Hospital Charge Code	5700580
Hospital Revenue Code	450
Min. Negotiated Rate	$31.14
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	$105.42
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	$352.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$176.27
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	$31.14

ER TREAT HAND DISLOCATION

Facility

$1,175.15

Service Code	HCPCS 26670
Hospital Charge Code	5700580
Hospital Revenue Code	450
Min. Negotiated Rate	$176.27
Max. Negotiated Rate	$176.27
Rate for Payer: Qualcare PPO/HMO/WC	$176.27

ER TREAT HIP DISLOATION W ANES

Facility

$6,125.00

Service Code	HCPCS 27252
Hospital Charge Code	5700688
Hospital Revenue Code	450
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$918.75
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

ER TREAT HIP DISLOATION W ANES

Facility

$6,125.00

Service Code	HCPCS 27252
Hospital Charge Code	5700688
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
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	$609.84
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	$1,837.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$918.75
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	$162.31

ER TREAT KNUCKLE DISLOCATION

Facility

$7,690.80

Service Code	HCPCS 26705
Hospital Charge Code	5792265
Hospital Revenue Code	450
Min. Negotiated Rate	$1,153.62
Max. Negotiated Rate	$1,153.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.62

Know your out-of-pocket cost for care.

All Charges