Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$89,119.44

Service Code	APR-DRG 0093
Min. Negotiated Rate	$87,372.00
Max. Negotiated Rate	$89,119.44
Rate for Payer: UnitedHealthcare Community & State	$87,372.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$89,119.44
Rate for Payer: Wellpoint Medicaid Managed Care	$87,372.00

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$52,032.26

Service Code	APR-DRG 0092
Min. Negotiated Rate	$51,012.02
Max. Negotiated Rate	$52,032.26
Rate for Payer: UnitedHealthcare Community & State	$51,012.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$52,032.26
Rate for Payer: Wellpoint Medicaid Managed Care	$51,012.02

EXTRACRANIAL PROCEDURES WITH CC

Facility

$54,579.22

Service Code	MSDRG 038
Min. Negotiated Rate	$16,618.67
Max. Negotiated Rate	$54,579.22
Rate for Payer: Aetna Medicare Advantage	$54,579.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,217.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,217.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,493.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,217.60
Rate for Payer: Cigna Commercial	$30,365.34
Rate for Payer: Cigna Medicare Advantage	$17,493.34
Rate for Payer: Clover Medicare Advantage	$16,618.67
Rate for Payer: EmblemHealth Commercial	$52,480.02
Rate for Payer: Humana Medicare Advantage	$18,018.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,493.34
Rate for Payer: Oxford Commercial	$21,823.97
Rate for Payer: UnitedHealthcare Commercial	$38,269.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,493.34
Rate for Payer: Wellcare Medicare Advantage	$17,493.34

EXTRACRANIAL PROCEDURES WITH MCC

Facility

$108,540.21

Service Code	MSDRG 037
Min. Negotiated Rate	$33,049.10
Max. Negotiated Rate	$108,540.21
Rate for Payer: Aetna Medicare Advantage	$108,540.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,622.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,622.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34,788.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78,622.18
Rate for Payer: Cigna Commercial	$61,608.36
Rate for Payer: Cigna Medicare Advantage	$34,788.53
Rate for Payer: Clover Medicare Advantage	$33,049.10
Rate for Payer: EmblemHealth Commercial	$104,365.59
Rate for Payer: Humana Medicare Advantage	$35,832.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34,788.53
Rate for Payer: Oxford Commercial	$44,278.75
Rate for Payer: UnitedHealthcare Commercial	$77,644.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$34,788.53
Rate for Payer: Wellcare Medicare Advantage	$34,788.53

EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$40,128.16

Service Code	MSDRG 039
Min. Negotiated Rate	$12,218.51
Max. Negotiated Rate	$40,128.16
Rate for Payer: Aetna Medicare Advantage	$40,128.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,517.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,517.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,861.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,517.54
Rate for Payer: Cigna Commercial	$21,998.31
Rate for Payer: Cigna Medicare Advantage	$12,861.59
Rate for Payer: Clover Medicare Advantage	$12,218.51
Rate for Payer: EmblemHealth Commercial	$38,584.77
Rate for Payer: Humana Medicare Advantage	$13,247.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,861.59
Rate for Payer: Oxford Commercial	$15,810.48
Rate for Payer: UnitedHealthcare Commercial	$27,724.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,861.59
Rate for Payer: Wellcare Medicare Advantage	$12,861.59

EXTRACTABLE NUC ANTIGENS

Facility

$476.00

Service Code	HCPCS 86235
Hospital Charge Code	38476051
Hospital Revenue Code	302
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$238.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$238.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$12.61

EXTRACTABLE NUC ANTIGENS

Facility

$476.00

Service Code	HCPCS 86235
Hospital Charge Code	38476051
Hospital Revenue Code	302
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$71.40

EXTRACTION ERUPTED TOOTH EXR

Facility

$9,790.05

Service Code	HCPCS D7140
Hospital Charge Code	1600000777
Hospital Revenue Code	360
Min. Negotiated Rate	$235.94
Max. Negotiated Rate	$2,937.01
Rate for Payer: Aetna Commercial	$2,089.07
Rate for Payer: Aetna Medicare Advantage	$2,488.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,772.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,772.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$768.04
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	$2,772.39
Rate for Payer: Cigna Commercial	$1,539.55
Rate for Payer: Cigna Medicare Advantage	$768.04
Rate for Payer: Clover Medicare Advantage	$729.64
Rate for Payer: EmblemHealth Commercial	$2,304.12
Rate for Payer: Humana Medicare Advantage	$791.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$768.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,937.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51
Rate for Payer: UnitedHealthcare Community & State	$235.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$768.04
Rate for Payer: Wellcare Medicare Advantage	$768.04
Rate for Payer: Wellpoint Medicaid Managed Care	$259.44

EXTRACTION ERUPTED TOOTH EXR

Facility

$9,790.05

Service Code	HCPCS D7140
Hospital Charge Code	1600000777
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.51
Max. Negotiated Rate	$1,468.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

EXTRACTION ERUPTED TOOTH/EXR

Facility

$9,790.05

Service Code	HCPCS D7140
Hospital Charge Code	1600000743
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.51
Max. Negotiated Rate	$1,468.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

EXTRACTION ERUPTED TOOTH/EXR

Facility

$9,790.05

Service Code	HCPCS D7140
Hospital Charge Code	1600000743
Hospital Revenue Code	360
Min. Negotiated Rate	$235.94
Max. Negotiated Rate	$2,937.01
Rate for Payer: Aetna Commercial	$2,089.07
Rate for Payer: Aetna Medicare Advantage	$2,488.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,772.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,772.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$768.04
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	$2,772.39
Rate for Payer: Cigna Commercial	$1,539.55
Rate for Payer: Cigna Medicare Advantage	$768.04
Rate for Payer: Clover Medicare Advantage	$729.64
Rate for Payer: EmblemHealth Commercial	$2,304.12
Rate for Payer: Humana Medicare Advantage	$791.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$768.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,937.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51
Rate for Payer: UnitedHealthcare Community & State	$235.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$768.04
Rate for Payer: Wellcare Medicare Advantage	$768.04
Rate for Payer: Wellpoint Medicaid Managed Care	$259.44

EXTRACTOR BROKEN SCREW 7MM

Facility

$1,550.00

Hospital Charge Code	270694536
Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$232.50
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

EXTRACTOR BROKEN SCREW 7MM

Facility

$1,550.00

Hospital Charge Code	270694536
Hospital Revenue Code	272
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.00
Rate for Payer: Oxford Commercial	$310.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Commercial	$310.00
Rate for Payer: UnitedHealthcare Community & State	$37.35
Rate for Payer: Wellpoint Medicaid Managed Care	$41.08

EXTRACTOR CK STNE FLT 4W 3F***

Facility

$444.00

Hospital Charge Code	1604628
Hospital Revenue Code	272
Min. Negotiated Rate	$10.70
Max. Negotiated Rate	$222.00
Rate for Payer: Aetna Commercial	$168.72
Rate for Payer: Aetna Medicare Advantage	$133.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.22
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.20
Rate for Payer: Oxford Commercial	$88.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.60
Rate for Payer: UnitedHealthcare Commercial	$88.80
Rate for Payer: UnitedHealthcare Community & State	$10.70
Rate for Payer: Wellpoint Medicaid Managed Care	$11.77

EXTRACTOR CK STNE FLT 4W 3F***

Facility

$444.00

Hospital Charge Code	1604628
Hospital Revenue Code	272
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$66.60
Rate for Payer: Qualcare PPO/HMO/WC	$66.60

EXTRACTOR CK STONE HEL 3WR****

Facility

$444.00

Hospital Charge Code	1604669
Hospital Revenue Code	272
Min. Negotiated Rate	$10.70
Max. Negotiated Rate	$222.00
Rate for Payer: Aetna Commercial	$168.72
Rate for Payer: Aetna Medicare Advantage	$133.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.22
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.20
Rate for Payer: Oxford Commercial	$88.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.60
Rate for Payer: UnitedHealthcare Commercial	$88.80
Rate for Payer: UnitedHealthcare Community & State	$10.70
Rate for Payer: Wellpoint Medicaid Managed Care	$11.77

EXTRACTOR CK STONE HEL 3WR****

Facility

$389.00

Hospital Charge Code	1604644
Hospital Revenue Code	272
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$58.35
Rate for Payer: Qualcare PPO/HMO/WC	$58.35

EXTRACTOR CK STONE HEL 3WR****

Facility

$389.00

Hospital Charge Code	1604644
Hospital Revenue Code	272
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$194.50
Rate for Payer: Aetna Commercial	$147.82
Rate for Payer: Aetna Medicare Advantage	$116.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.19
Rate for Payer: Cigna Commercial	$194.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.70
Rate for Payer: Oxford Commercial	$77.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.35
Rate for Payer: UnitedHealthcare Commercial	$77.80
Rate for Payer: UnitedHealthcare Community & State	$9.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.31

EXTRACTOR CK STONE HEL 3WR****

Facility

$444.00

Hospital Charge Code	1604669
Hospital Revenue Code	272
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$66.60
Rate for Payer: Qualcare PPO/HMO/WC	$66.60

EXTRACTOR CK STONE HEL 4WR****

Facility

$369.00

Hospital Charge Code	1604677
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna Commercial	$140.22
Rate for Payer: Aetna Medicare Advantage	$110.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.09
Rate for Payer: Cigna Commercial	$184.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.70
Rate for Payer: Oxford Commercial	$73.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.35
Rate for Payer: UnitedHealthcare Commercial	$73.80
Rate for Payer: UnitedHealthcare Community & State	$8.89
Rate for Payer: Wellpoint Medicaid Managed Care	$9.78

EXTRACTOR CK STONE HEL 4WR****

Facility

$369.00

Hospital Charge Code	1604677
Hospital Revenue Code	272
Min. Negotiated Rate	$55.35
Max. Negotiated Rate	$55.35
Rate for Payer: Qualcare PPO/HMO/WC	$55.35

EXTRACTOR CK STONE HEL 5WR****

Facility

$389.00

Hospital Charge Code	1604651
Hospital Revenue Code	272
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$58.35
Rate for Payer: Qualcare PPO/HMO/WC	$58.35

EXTRACTOR CK STONE HEL 5WR****

Facility

$389.00

Hospital Charge Code	1604651
Hospital Revenue Code	272
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$194.50
Rate for Payer: Aetna Commercial	$147.82
Rate for Payer: Aetna Medicare Advantage	$116.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.19
Rate for Payer: Cigna Commercial	$194.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.70
Rate for Payer: Oxford Commercial	$77.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.35
Rate for Payer: UnitedHealthcare Commercial	$77.80
Rate for Payer: UnitedHealthcare Community & State	$9.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.31

EXTRACTOR CK STONE HEL RTR 7F*

Facility

$778.00

Hospital Charge Code	1604636
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$389.00
Rate for Payer: Aetna Commercial	$295.64
Rate for Payer: Aetna Medicare Advantage	$233.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.39
Rate for Payer: Cigna Commercial	$389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.40
Rate for Payer: Oxford Commercial	$155.60
Rate for Payer: Qualcare PPO/HMO/WC	$116.70
Rate for Payer: UnitedHealthcare Commercial	$155.60
Rate for Payer: UnitedHealthcare Community & State	$18.75
Rate for Payer: Wellpoint Medicaid Managed Care	$20.62

EXTRACTOR CK STONE HEL RTR 7F*

Facility

$778.00

Hospital Charge Code	1604636
Hospital Revenue Code	272
Min. Negotiated Rate	$116.70
Max. Negotiated Rate	$116.70
Rate for Payer: Qualcare PPO/HMO/WC	$116.70

Know your out-of-pocket cost for care.

All Charges