Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FRACTIONATED PORPHYRINS III

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538C
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

FRACTIONATED PORPHYRINS IV

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538D
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

FRACTIONATED PORPHYRINS IV

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538D
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

FRACTIONATED PORPHYRINS V

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538E
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

FRACTIONATED PORPHYRINS V

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3038538E
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

FRACTIONATION

Facility

$215.20

Service Code	HCPCS 83704
Hospital Charge Code	39900525
Hospital Revenue Code	301
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$93.00
Rate for Payer: Aetna Medicare Advantage	$110.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.42
Rate for Payer: Cigna Commercial	$107.60
Rate for Payer: Cigna Medicare Advantage	$34.19
Rate for Payer: Clover Medicare Advantage	$32.48
Rate for Payer: EmblemHealth Commercial	$102.57
Rate for Payer: Humana Medicare Advantage	$35.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.28
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$27.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.19
Rate for Payer: Wellcare Medicare Advantage	$34.19
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

FRACTIONATION

Facility

$215.20

Service Code	HCPCS 83704
Hospital Charge Code	39900525
Hospital Revenue Code	301
Min. Negotiated Rate	$32.28
Max. Negotiated Rate	$32.28
Rate for Payer: Qualcare PPO/HMO/WC	$32.28

FRACTURE ASSESSMENT VIA DXA

Facility

$352.40

Service Code	HCPCS 77086
Hospital Charge Code	85000890
Hospital Revenue Code	409
Min. Negotiated Rate	$52.86
Max. Negotiated Rate	$52.86
Rate for Payer: Qualcare PPO/HMO/WC	$52.86

FRACTURE ASSESSMENT VIA DXA

Facility

$352.40

Service Code	HCPCS 77086
Hospital Charge Code	85000890
Hospital Revenue Code	409
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$1,296.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$103.39
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.72
Rate for Payer: Oxford Commercial	$739.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.86
Rate for Payer: UnitedHealthcare Commercial	$1,296.00
Rate for Payer: UnitedHealthcare Community & State	$8.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$9.34

FRACTURE OF FEMUR

Facility

$16,846.19

Service Code	APR-DRG 3404
Min. Negotiated Rate	$16,515.87
Max. Negotiated Rate	$16,846.19
Rate for Payer: UnitedHealthcare Community & State	$16,515.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,846.19
Rate for Payer: Wellpoint Medicaid Managed Care	$16,515.87

FRACTURE OF FEMUR

Facility

$10,480.50

Service Code	APR-DRG 3403
Min. Negotiated Rate	$10,275.00
Max. Negotiated Rate	$10,480.50
Rate for Payer: UnitedHealthcare Community & State	$10,275.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,480.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10,275.00

FRACTURE OF FEMUR

Facility

$7,392.16

Service Code	APR-DRG 3402
Min. Negotiated Rate	$7,247.22
Max. Negotiated Rate	$7,392.16
Rate for Payer: UnitedHealthcare Community & State	$7,247.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,392.16
Rate for Payer: Wellpoint Medicaid Managed Care	$7,247.22

FRACTURE OF FEMUR

Facility

$5,862.65

Service Code	APR-DRG 3401
Min. Negotiated Rate	$5,747.70
Max. Negotiated Rate	$5,862.65
Rate for Payer: UnitedHealthcare Community & State	$5,747.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,862.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5,747.70

FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$10,074.50

Service Code	APR-DRG 3413
Min. Negotiated Rate	$9,876.96
Max. Negotiated Rate	$10,074.50
Rate for Payer: UnitedHealthcare Community & State	$9,876.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,074.50
Rate for Payer: Wellpoint Medicaid Managed Care	$9,876.96

FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$6,359.26

Service Code	APR-DRG 3411
Min. Negotiated Rate	$6,234.57
Max. Negotiated Rate	$6,359.26
Rate for Payer: UnitedHealthcare Community & State	$6,234.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,359.26
Rate for Payer: Wellpoint Medicaid Managed Care	$6,234.57

FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$18,465.03

Service Code	APR-DRG 3414
Min. Negotiated Rate	$18,102.97
Max. Negotiated Rate	$18,465.03
Rate for Payer: UnitedHealthcare Community & State	$18,102.97
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,465.03
Rate for Payer: Wellpoint Medicaid Managed Care	$18,102.97

FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$7,674.29

Service Code	APR-DRG 3412
Min. Negotiated Rate	$7,523.81
Max. Negotiated Rate	$7,674.29
Rate for Payer: UnitedHealthcare Community & State	$7,523.81
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,674.29
Rate for Payer: Wellpoint Medicaid Managed Care	$7,523.81

FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK

Facility

$6,368.20

Service Code	APR-DRG 3421
Min. Negotiated Rate	$6,243.33
Max. Negotiated Rate	$6,368.20
Rate for Payer: UnitedHealthcare Community & State	$6,243.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,368.20
Rate for Payer: Wellpoint Medicaid Managed Care	$6,243.33

FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK

Facility

$8,408.40

Service Code	APR-DRG 3422
Min. Negotiated Rate	$8,243.53
Max. Negotiated Rate	$8,408.40
Rate for Payer: UnitedHealthcare Community & State	$8,243.53
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,408.40
Rate for Payer: Wellpoint Medicaid Managed Care	$8,243.53

FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK

Facility

$20,692.92

Service Code	APR-DRG 3424
Min. Negotiated Rate	$20,287.18
Max. Negotiated Rate	$20,692.92
Rate for Payer: UnitedHealthcare Community & State	$20,287.18
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,692.92
Rate for Payer: Wellpoint Medicaid Managed Care	$20,287.18

FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK

Facility

$11,975.53

Service Code	APR-DRG 3423
Min. Negotiated Rate	$11,740.72
Max. Negotiated Rate	$11,975.53
Rate for Payer: UnitedHealthcare Community & State	$11,740.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,975.53
Rate for Payer: Wellpoint Medicaid Managed Care	$11,740.72

FRACTURES OF FEMUR WITH MCC

Facility

$52,804.75

Service Code	MSDRG 533
Min. Negotiated Rate	$16,078.37
Max. Negotiated Rate	$52,804.75
Rate for Payer: Aetna Commercial	$36,540.20
Rate for Payer: Aetna Medicare Advantage	$52,804.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,915.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,915.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,924.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,915.43
Rate for Payer: Cigna Commercial	$29,337.94
Rate for Payer: Cigna Medicare Advantage	$16,924.60
Rate for Payer: Clover Medicare Advantage	$16,078.37
Rate for Payer: EmblemHealth Commercial	$50,773.80
Rate for Payer: Humana Medicare Advantage	$17,432.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,924.60
Rate for Payer: Oxford Commercial	$21,085.56
Rate for Payer: UnitedHealthcare Commercial	$36,974.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,924.60
Rate for Payer: Wellcare Medicare Advantage	$16,924.60

FRACTURES OF FEMUR WITHOUT MCC

Facility

$28,188.54

Service Code	MSDRG 534
Min. Negotiated Rate	$8,583.05
Max. Negotiated Rate	$28,188.54
Rate for Payer: Aetna Commercial	$19,626.09
Rate for Payer: Aetna Medicare Advantage	$28,188.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,841.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,841.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,034.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,841.41
Rate for Payer: Cigna Commercial	$15,085.36
Rate for Payer: Cigna Medicare Advantage	$9,034.79
Rate for Payer: Clover Medicare Advantage	$8,583.05
Rate for Payer: EmblemHealth Commercial	$27,104.37
Rate for Payer: Humana Medicare Advantage	$9,305.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,034.79
Rate for Payer: Oxford Commercial	$10,842.05
Rate for Payer: UnitedHealthcare Commercial	$19,011.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,034.79
Rate for Payer: Wellcare Medicare Advantage	$9,034.79

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$43,570.46

Service Code	MSDRG 535
Min. Negotiated Rate	$13,266.65
Max. Negotiated Rate	$43,570.46
Rate for Payer: Aetna Commercial	$30,195.22
Rate for Payer: Aetna Medicare Advantage	$43,570.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,239.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,239.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,964.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,239.30
Rate for Payer: Cigna Commercial	$23,991.35
Rate for Payer: Cigna Medicare Advantage	$13,964.89
Rate for Payer: Clover Medicare Advantage	$13,266.65
Rate for Payer: EmblemHealth Commercial	$41,894.67
Rate for Payer: Humana Medicare Advantage	$14,383.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,964.89
Rate for Payer: Oxford Commercial	$17,242.90
Rate for Payer: UnitedHealthcare Commercial	$30,235.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,964.89
Rate for Payer: Wellcare Medicare Advantage	$13,964.89

FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$28,237.09

Service Code	MSDRG 536
Min. Negotiated Rate	$8,597.83
Max. Negotiated Rate	$28,237.09
Rate for Payer: Aetna Commercial	$19,659.43
Rate for Payer: Aetna Medicare Advantage	$28,237.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,376.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,376.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,050.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,376.19
Rate for Payer: Cigna Commercial	$15,113.43
Rate for Payer: Cigna Medicare Advantage	$9,050.35
Rate for Payer: Clover Medicare Advantage	$8,597.83
Rate for Payer: EmblemHealth Commercial	$27,151.05
Rate for Payer: Humana Medicare Advantage	$9,321.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,050.35
Rate for Payer: Oxford Commercial	$10,862.22
Rate for Payer: UnitedHealthcare Commercial	$19,047.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,050.35
Rate for Payer: Wellcare Medicare Advantage	$9,050.35

Know your out-of-pocket cost for care.

All Charges