Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ER TX CARPOMET DIS THB W/MAN

Facility

$1,259.90

Service Code	HCPCS 26641
Hospital Charge Code	5700579
Hospital Revenue Code	450
Min. Negotiated Rate	$188.99
Max. Negotiated Rate	$188.99
Rate for Payer: Qualcare PPO/HMO/WC	$188.99

ER TX CARPOMET DIS THB W/MAN

Facility

$1,259.90

Service Code	HCPCS 26641
Hospital Charge Code	5700579
Hospital Revenue Code	450
Min. Negotiated Rate	$33.39
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	$377.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$188.99
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	$33.39

ER-TX CLAV DISL W/MAN-BI

Facility

$1,426.00

Hospital Charge Code	5790335
Hospital Revenue Code	450
Min. Negotiated Rate	$37.79
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$541.88
Rate for Payer: Aetna Medicare Advantage	$427.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.63
Rate for Payer: Cigna Commercial	$713.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$213.90
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$37.79

ER-TX CLAV DISL W/MAN-BI

Facility

$1,426.00

Hospital Charge Code	5790335
Hospital Revenue Code	450
Min. Negotiated Rate	$213.90
Max. Negotiated Rate	$213.90
Rate for Payer: Qualcare PPO/HMO/WC	$213.90

ER TX CLAVICULAR FX W/O ANES

Facility

$563.75

Service Code	HCPCS 23500
Hospital Charge Code	5700554
Hospital Revenue Code	450
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER TX CLAVICULAR FX W/O ANES

Facility

$563.75

Service Code	HCPCS 23500
Hospital Charge Code	5700554
Hospital Revenue Code	450
Min. Negotiated Rate	$14.94
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	$164.83
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	$169.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.56
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	$14.94

ER TX CL METATAR FX W/O MAN EA

Facility

$563.75

Service Code	HCPCS 28470
Hospital Charge Code	5700608
Hospital Revenue Code	450
Min. Negotiated Rate	$84.56
Max. Negotiated Rate	$84.56
Rate for Payer: Qualcare PPO/HMO/WC	$84.56

ER TX CL METATAR FX W/O MAN EA

Facility

$563.75

Service Code	HCPCS 28470
Hospital Charge Code	5700608
Hospital Revenue Code	450
Min. Negotiated Rate	$14.94
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	$78.41
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	$169.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.56
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	$14.94

ER-TX CLOSE ELBOW DISL-BI

Facility

$466.00

Hospital Charge Code	5790400
Hospital Revenue Code	450
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$177.08
Rate for Payer: Aetna Medicare Advantage	$139.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.83
Rate for Payer: Cigna Commercial	$233.00
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: Wellpoint Medicaid Managed Care	$12.35

ER-TX CLOSE ELBOW DISL-BI

Facility

$466.00

Hospital Charge Code	5790400
Hospital Revenue Code	450
Min. Negotiated Rate	$69.90
Max. Negotiated Rate	$69.90
Rate for Payer: Qualcare PPO/HMO/WC	$69.90

ER-TX DISLSHOULD W/ANE-BI

Facility

$3,571.00

Hospital Charge Code	5790355
Hospital Revenue Code	450
Min. Negotiated Rate	$94.63
Max. Negotiated Rate	$1,785.50
Rate for Payer: Aetna Commercial	$1,356.98
Rate for Payer: Aetna Medicare Advantage	$1,071.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$910.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$910.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$910.61
Rate for Payer: Cigna Commercial	$1,785.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,071.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$535.65
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$94.63

ER-TX DISLSHOULD W/ANE-BI

Facility

$3,571.00

Hospital Charge Code	5790355
Hospital Revenue Code	450
Min. Negotiated Rate	$535.65
Max. Negotiated Rate	$535.65
Rate for Payer: Qualcare PPO/HMO/WC	$535.65

ER-TX DIST RADIAL FX-BI

Facility

$466.00

Hospital Charge Code	5790450
Hospital Revenue Code	450
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$177.08
Rate for Payer: Aetna Medicare Advantage	$139.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.83
Rate for Payer: Cigna Commercial	$233.00
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: Wellpoint Medicaid Managed Care	$12.35

ER-TX DIST RADIAL FX-BI

Facility

$466.00

Hospital Charge Code	5790450
Hospital Revenue Code	450
Min. Negotiated Rate	$69.90
Max. Negotiated Rate	$69.90
Rate for Payer: Qualcare PPO/HMO/WC	$69.90

ER-TX ELBOW DIS-W/ANES-BI

Facility

$4,148.00

Hospital Charge Code	5790405
Hospital Revenue Code	450
Min. Negotiated Rate	$622.20
Max. Negotiated Rate	$622.20
Rate for Payer: Qualcare PPO/HMO/WC	$622.20

ER-TX ELBOW DIS-W/ANES-BI

Facility

$4,148.00

Hospital Charge Code	5790405
Hospital Revenue Code	450
Min. Negotiated Rate	$109.92
Max. Negotiated Rate	$2,074.00
Rate for Payer: Aetna Commercial	$1,576.24
Rate for Payer: Aetna Medicare Advantage	$1,244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.74
Rate for Payer: Cigna Commercial	$2,074.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,244.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$622.20
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$109.92

ER-TX ELBOW DIS-W/ANES-RT

Facility

$4,148.00

Hospital Charge Code	5791190
Hospital Revenue Code	450
Min. Negotiated Rate	$109.92
Max. Negotiated Rate	$2,074.00
Rate for Payer: Aetna Commercial	$1,576.24
Rate for Payer: Aetna Medicare Advantage	$1,244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.74
Rate for Payer: Cigna Commercial	$2,074.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,244.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$622.20
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$109.92

ER-TX ELBOW DIS-W/ANES-RT

Facility

$4,148.00

Hospital Charge Code	5791190
Hospital Revenue Code	450
Min. Negotiated Rate	$622.20
Max. Negotiated Rate	$622.20
Rate for Payer: Qualcare PPO/HMO/WC	$622.20

ER-TX HUMERAL EPI FX-BI

Facility

$453.00

Hospital Charge Code	5790380
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-TX HUMERAL EPI FX-BI

Facility

$453.00

Hospital Charge Code	5790380
Hospital Revenue Code	450
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

ER-TX HUMERAL FX W/MAN-BI

Facility

$453.00

Hospital Charge Code	5790365
Hospital Revenue Code	450
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

ER-TX HUMERAL FX W/MAN-BI

Facility

$453.00

Hospital Charge Code	5790365
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-TX INTER JT DISLOC-BI

Facility

$3,764.00

Hospital Charge Code	5790545
Hospital Revenue Code	450
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$1,882.00
Rate for Payer: Aetna Commercial	$1,430.32
Rate for Payer: Aetna Medicare Advantage	$1,129.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$959.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$959.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$959.82
Rate for Payer: Cigna Commercial	$1,882.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,129.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$564.60
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$99.75

ER-TX INTER JT DISLOC-BI

Facility

$3,764.00

Hospital Charge Code	5790545
Hospital Revenue Code	450
Min. Negotiated Rate	$564.60
Max. Negotiated Rate	$564.60
Rate for Payer: Qualcare PPO/HMO/WC	$564.60

ER-TX INTERPHA DISLOC-BI

Facility

$4,148.00

Hospital Charge Code	5790680
Hospital Revenue Code	450
Min. Negotiated Rate	$622.20
Max. Negotiated Rate	$622.20
Rate for Payer: Qualcare PPO/HMO/WC	$622.20

Know your out-of-pocket cost for care.

All Charges