Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EXC/TRANSPOS PTERYGIUM,W GRAFT

Facility

$20,773.00

Service Code	HCPCS 65426
Hospital Charge Code	16000773
Hospital Revenue Code	360
Min. Negotiated Rate	$3,115.95
Max. Negotiated Rate	$3,115.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,115.95

EXC TR--EXT B9+MARG 0.5CM/<

Facility

$3,786.40

Service Code	HCPCS 11400
Hospital Charge Code	16000216
Hospital Revenue Code	360
Min. Negotiated Rate	$567.96
Max. Negotiated Rate	$567.96
Rate for Payer: Qualcare PPO/HMO/WC	$567.96

EXC TR--EXT B9+MARG 0.5CM/<

Facility

$3,786.40

Service Code	HCPCS 11400
Hospital Charge Code	16000216
Hospital Revenue Code	360
Min. Negotiated Rate	$91.25
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,135.92
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$567.96
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$91.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$100.34

EXC TR-EXT MAL+MARG 2.1-3 CM

Facility

$7,917.64

Service Code	HCPCS 11603
Hospital Charge Code	16000492
Hospital Revenue Code	360
Min. Negotiated Rate	$1,187.65
Max. Negotiated Rate	$1,187.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.65

EXC TR-EXT MAL+MARG 2.1-3 CM

Facility

$7,917.64

Service Code	HCPCS 11603
Hospital Charge Code	16000492
Hospital Revenue Code	360
Min. Negotiated Rate	$190.82
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,375.29
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.65
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$190.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$209.82

EXC TR-EXT MAL+MARG 3.1-4 CM

Facility

$7,612.30

Service Code	HCPCS 11604
Hospital Charge Code	16000436
Hospital Revenue Code	360
Min. Negotiated Rate	$1,141.85
Max. Negotiated Rate	$1,141.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85

EXC TR-EXT MAL+MARG 3.1-4 CM

Facility

$7,612.30

Service Code	HCPCS 11604
Hospital Charge Code	16000436
Hospital Revenue Code	360
Min. Negotiated Rate	$183.46
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,283.69
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$183.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$201.73

EXC TR-EXT MAL+MARG >4 CM

Facility

$6,929.84

Service Code	HCPCS 11606
Hospital Charge Code	16000419
Hospital Revenue Code	360
Min. Negotiated Rate	$167.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,078.95
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.48
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$167.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$183.64

EXC TR-EXT MAL+MARG >4 CM

Facility

$6,929.84

Service Code	HCPCS 11606
Hospital Charge Code	16000419
Hospital Revenue Code	360
Min. Negotiated Rate	$1,039.48
Max. Negotiated Rate	$1,039.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.48

EXC TROCHANTEC BURSA/CAL RT

Facility

$21,422.50

Service Code	HCPCS 27062
Hospital Charge Code	16000705
Hospital Revenue Code	360
Min. Negotiated Rate	$3,213.38
Max. Negotiated Rate	$3,213.38
Rate for Payer: Qualcare PPO/HMO/WC	$3,213.38

EXC TROCHANTEC BURSA/CAL RT

Facility

$21,422.50

Service Code	HCPCS 27062
Hospital Charge Code	16000705
Hospital Revenue Code	360
Min. Negotiated Rate	$516.28
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	$1,742.00
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	$6,426.75
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,213.38
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$516.28
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	$567.70

EXERCISE BAND RESISTANCE 1

Facility

$8.20

Hospital Charge Code	270667803
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna Commercial	$3.12
Rate for Payer: Aetna Medicare Advantage	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.09
Rate for Payer: Cigna Commercial	$4.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.46
Rate for Payer: Oxford Commercial	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.23
Rate for Payer: UnitedHealthcare Commercial	$1.64
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

EXERCISE BAND RESISTANCE 1

Facility

$8.20

Hospital Charge Code	270667803
Hospital Revenue Code	270
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$1.23

EXERCISE BAND RESISTANCE 2

Facility

$9.30

Hospital Charge Code	270667802
Hospital Revenue Code	270
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.65
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna Medicare Advantage	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.37
Rate for Payer: Cigna Commercial	$4.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.79
Rate for Payer: Oxford Commercial	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.40
Rate for Payer: UnitedHealthcare Commercial	$1.86
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

EXERCISE BAND RESISTANCE 2

Facility

$9.30

Hospital Charge Code	270667802
Hospital Revenue Code	270
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.40

EXERCISE BAND RESISTANCE 3

Facility

$11.50

Hospital Charge Code	270667801
Hospital Revenue Code	270
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.73

EXERCISE BAND RESISTANCE 3

Facility

$11.50

Hospital Charge Code	270667801
Hospital Revenue Code	270
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.75
Rate for Payer: Aetna Commercial	$4.37
Rate for Payer: Aetna Medicare Advantage	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.93
Rate for Payer: Cigna Commercial	$5.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.45
Rate for Payer: Oxford Commercial	$2.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.73
Rate for Payer: UnitedHealthcare Commercial	$2.30
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

EXERCISE BAND RESISTANCE 4

Facility

$13.50

Hospital Charge Code	270667800
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.75
Rate for Payer: Aetna Commercial	$5.13
Rate for Payer: Aetna Medicare Advantage	$4.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.44
Rate for Payer: Cigna Commercial	$6.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.05
Rate for Payer: Oxford Commercial	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$2.70
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

EXERCISE BAND RESISTANCE 4

Facility

$13.50

Hospital Charge Code	270667800
Hospital Revenue Code	270
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

EXERCISE BAND RESISTANCE 5

Facility

$17.00

Hospital Charge Code	270667799
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$6.46
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.10
Rate for Payer: Oxford Commercial	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$3.40
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

EXERCISE BAND RESISTANCE 5

Facility

$17.00

Hospital Charge Code	270667799
Hospital Revenue Code	270
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

EXERCISE GROUP PSYCHOTHERAPY

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246290
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

EXERCISE GROUP PSYCHOTHERAPY

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246290
Hospital Revenue Code	915
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

EXERCISE MONITORED PHASE II

Facility

$3,900.00

Service Code	HCPCS 93798
Hospital Charge Code	5200027
Hospital Revenue Code	943
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

EXERCISE MONITORED PHASE II

Facility

$3,900.00

Service Code	HCPCS 93798
Hospital Charge Code	5200027
Hospital Revenue Code	943
Min. Negotiated Rate	$93.99
Max. Negotiated Rate	$1,749.00
Rate for Payer: Aetna Commercial	$416.57
Rate for Payer: Aetna Medicare Advantage	$496.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$552.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$552.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$153.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$552.83
Rate for Payer: Cigna Commercial	$306.98
Rate for Payer: Cigna Medicare Advantage	$153.15
Rate for Payer: Clover Medicare Advantage	$145.49
Rate for Payer: EmblemHealth Commercial	$459.45
Rate for Payer: Humana Medicare Advantage	$157.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$153.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$997.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Commercial	$1,749.00
Rate for Payer: UnitedHealthcare Community & State	$93.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$153.15
Rate for Payer: Wellcare Medicare Advantage	$153.15
Rate for Payer: Wellpoint Medicaid Managed Care	$103.35

Know your out-of-pocket cost for care.

All Charges