Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ER-TX ULNAR FX W/MAN-BI

Facility

$466.00

Hospital Charge Code	5790425
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 ULNAR FX W/MAN-BI

Facility

$466.00

Hospital Charge Code	5790425
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 ULNAR STYLOID FX

Facility

$1,050.00

Service Code	HCPCS 25650
Hospital Charge Code	5700573
Hospital Revenue Code	450
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

ER TX ULNAR STYLOID FX

Facility

$1,050.00

Service Code	HCPCS 25650
Hospital Charge Code	5700573
Hospital Revenue Code	450
Min. Negotiated Rate	$27.82
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	$338.80
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	$315.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
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	$27.82

ER-TX ULNAR STYLOID FX-BI

Facility

$453.00

Hospital Charge Code	5790465
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 ULNAR STYLOID FX-BI

Facility

$453.00

Hospital Charge Code	5790465
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 WRST BNE FX-EACH-BI

Facility

$1,355.00

Hospital Charge Code	5790460
Hospital Revenue Code	450
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

ER-TX WRST BNE FX-EACH-BI

Facility

$1,355.00

Hospital Charge Code	5790460
Hospital Revenue Code	450
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$514.90
Rate for Payer: Aetna Medicare Advantage	$406.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.52
Rate for Payer: Cigna Commercial	$677.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

ER-ULNAR SHAFT FX WMAN-BI

Facility

$453.00

Hospital Charge Code	5790435
Hospital Revenue Code	450
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

ER-ULNAR SHAFT FX WMAN-BI

Facility

$453.00

Hospital Charge Code	5790435
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 UNLISTED MUSCULOSKELE GEN

Facility

$11,652.95

Service Code	HCPCS 20999
Hospital Charge Code	5700671
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$3,495.89
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	$3,495.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,747.94
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	$308.80

ER UNLISTED MUSCULOSKELE GEN

Facility

$11,652.95

Service Code	HCPCS 20999
Hospital Charge Code	5700671
Hospital Revenue Code	450
Min. Negotiated Rate	$1,747.94
Max. Negotiated Rate	$1,747.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,747.94

ER UNLISTED PROCEDURE, NOSE

Facility

$442.00

Service Code	HCPCS 30999
Hospital Charge Code	5700826
Hospital Revenue Code	450
Min. Negotiated Rate	$11.71
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	$132.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.30
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	$11.71

ER UNLISTED PROCEDURE, NOSE

Facility

$442.00

Service Code	HCPCS 30999
Hospital Charge Code	5700826
Hospital Revenue Code	450
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$66.30
Rate for Payer: Qualcare PPO/HMO/WC	$66.30

ER UNLISTED THROAT SURGERY

Facility

$442.00

Service Code	HCPCS 42999
Hospital Charge Code	5700827
Hospital Revenue Code	450
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$66.30
Rate for Payer: Qualcare PPO/HMO/WC	$66.30

ER UNLISTED THROAT SURGERY

Facility

$442.00

Service Code	HCPCS 42999
Hospital Charge Code	5700827
Hospital Revenue Code	450
Min. Negotiated Rate	$11.71
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	$132.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.30
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	$11.71

ER URETHRAL REPAIR PROC

Facility

$16,607.90

Service Code	HCPCS 53502
Hospital Charge Code	93500201
Hospital Revenue Code	450
Min. Negotiated Rate	$2,491.18
Max. Negotiated Rate	$2,491.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,491.18

ER URETHRAL REPAIR PROC

Facility

$16,607.90

Service Code	HCPCS 53502
Hospital Charge Code	93500201
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,982.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,491.18
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$440.11

ER VACCINE TETANUS ,IM

Facility

$12.50

Hospital Charge Code	5700295
Hospital Revenue Code	636
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

ER VACCINE TETANUS ,IM

Facility

$12.50

Hospital Charge Code	5700295
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.25
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Aetna Medicare Advantage	$3.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.19
Rate for Payer: Cigna Commercial	$6.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

ER VAGINAL DELIVERY ANY METHOD

Facility

$10,964.20

Service Code	HCPCS 59409
Hospital Charge Code	5700801
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$809.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,289.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.63
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$290.55

ER VAGINAL DELIVERY ANY METHOD

Facility

$10,964.20

Service Code	HCPCS 59409
Hospital Charge Code	5700801
Hospital Revenue Code	450
Min. Negotiated Rate	$1,644.63
Max. Negotiated Rate	$1,644.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.63

ER VENIPUNCTURE

Facility

$667.59

Service Code	HCPCS 36415
Hospital Charge Code	5700634
Hospital Revenue Code	300
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.71
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

ER VENIPUNCTURE

Facility

$667.59

Service Code	HCPCS 36415
Hospital Charge Code	5700634
Hospital Revenue Code	300
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ER-VENT MGMT INIT DAY

Facility

$903.00

Service Code	HCPCS 94002
Hospital Charge Code	5790240
Hospital Revenue Code	410
Min. Negotiated Rate	$135.45
Max. Negotiated Rate	$135.45
Rate for Payer: Qualcare PPO/HMO/WC	$135.45

Know your out-of-pocket cost for care.

All Charges