Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYPOTHERMIA PER DAY****

Facility

$52.00

Hospital Charge Code	8000879
Hospital Revenue Code	279
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$15,224.75

Service Code	APR-DRG 4224
Min. Negotiated Rate	$14,926.23
Max. Negotiated Rate	$15,224.75
Rate for Payer: UnitedHealthcare Community & State	$14,926.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,224.75
Rate for Payer: Wellpoint Medicaid Managed Care	$14,926.23

HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$9,183.35

Service Code	APR-DRG 4223
Min. Negotiated Rate	$9,003.28
Max. Negotiated Rate	$9,183.35
Rate for Payer: UnitedHealthcare Community & State	$9,003.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,183.35
Rate for Payer: Wellpoint Medicaid Managed Care	$9,003.28

HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$6,303.14

Service Code	APR-DRG 4222
Min. Negotiated Rate	$6,179.55
Max. Negotiated Rate	$6,303.14
Rate for Payer: UnitedHealthcare Community & State	$6,179.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,303.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6,179.55

HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$4,362.53

Service Code	APR-DRG 4221
Min. Negotiated Rate	$4,276.99
Max. Negotiated Rate	$4,362.53
Rate for Payer: UnitedHealthcare Community & State	$4,276.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,362.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4,276.99

HYPROCURE DEVICE SZ 6

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270677410
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

HYPROCURE DEVICE SZ 6

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270677410
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

HYPROCURE DEVICE SZ7

Facility

$9,900.00

Hospital Charge Code	270675464
Hospital Revenue Code	278
Min. Negotiated Rate	$238.59
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$3,762.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00
Rate for Payer: UnitedHealthcare Community & State	$238.59
Rate for Payer: Wellpoint Medicaid Managed Care	$262.35

HYPROCURE DEVICE SZ7

Facility

$9,900.00

Hospital Charge Code	270675464
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

HYPROCURE SIZE 10

Facility

$9,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270679093
Hospital Revenue Code	278
Min. Negotiated Rate	$239.79
Max. Negotiated Rate	$4,975.00
Rate for Payer: Aetna Commercial	$3,781.00
Rate for Payer: Aetna Medicare Advantage	$2,985.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,537.25
Rate for Payer: Cigna Commercial	$4,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,189.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50
Rate for Payer: UnitedHealthcare Community & State	$239.79
Rate for Payer: Wellpoint Medicaid Managed Care	$263.68

HYPROCURE SIZE 10

Facility

$9,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270679093
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,407.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,189.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50

HYSKON

Facility

$158.00

Hospital Charge Code	60634498
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$79.00
Rate for Payer: Aetna Commercial	$60.04
Rate for Payer: Aetna Medicare Advantage	$47.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.29
Rate for Payer: Cigna Commercial	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.40
Rate for Payer: Oxford Commercial	$31.60
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$31.60
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

HYSKON

Facility

$158.00

Hospital Charge Code	60634498
Hospital Revenue Code	250
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

HYSKON 32%/100ML

Facility

$158.00

Hospital Charge Code	60633143
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$79.00
Rate for Payer: Aetna Commercial	$60.04
Rate for Payer: Aetna Medicare Advantage	$47.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.29
Rate for Payer: Cigna Commercial	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.40
Rate for Payer: Oxford Commercial	$31.60
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$31.60
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

HYSKON 32%/100ML

Facility

$158.00

Hospital Charge Code	60633143
Hospital Revenue Code	250
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

HYSTERECTOMY KIT W/T-TUBE 200M

Facility

$136.00

Hospital Charge Code	270332079
Hospital Revenue Code	272
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$51.68
Rate for Payer: Aetna Medicare Advantage	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.68
Rate for Payer: Cigna Commercial	$68.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.80
Rate for Payer: Oxford Commercial	$27.20
Rate for Payer: Qualcare PPO/HMO/WC	$20.40
Rate for Payer: UnitedHealthcare Commercial	$27.20
Rate for Payer: UnitedHealthcare Community & State	$3.28
Rate for Payer: Wellpoint Medicaid Managed Care	$3.60

HYSTERECTOMY KIT W/T-TUBE 200M

Facility

$136.00

Hospital Charge Code	270332079
Hospital Revenue Code	272
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$20.40
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

HYSTERECTOMY,TOTAL ABDOMINAL

Facility

$11,332.50

Service Code	HCPCS 58150
Hospital Charge Code	16001005
Hospital Revenue Code	360
Min. Negotiated Rate	$273.11
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$4,306.35
Rate for Payer: Aetna Medicare Advantage	$3,399.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,889.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,889.79
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	$2,889.79
Rate for Payer: Cigna Commercial	$5,666.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,399.75
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,699.88
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$273.11
Rate for Payer: Wellpoint Medicaid Managed Care	$300.31

HYSTERECTOMY,TOTAL ABDOMINAL

Facility

$11,332.50

Service Code	HCPCS 58150
Hospital Charge Code	16001005
Hospital Revenue Code	360
Min. Negotiated Rate	$1,699.88
Max. Negotiated Rate	$1,699.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,699.88

HYSTEROSALPINGOGRAM

Facility

$5,100.00

Service Code	HCPCS 74740
Hospital Charge Code	5701122
Hospital Revenue Code	320
Min. Negotiated Rate	$54.21
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

HYSTEROSALPINGOGRAM

Facility

$5,100.00

Service Code	HCPCS 74740
Hospital Charge Code	321074740
Hospital Revenue Code	320
Min. Negotiated Rate	$54.21
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

HYSTEROSALPINGOGRAM

Facility

$5,100.00

Service Code	HCPCS 74740
Hospital Charge Code	321074740
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HYSTEROSALPINGOGRAM

Facility

$5,100.00

Service Code	HCPCS 74740
Hospital Charge Code	5701122
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HYSTEROSCOPY DIAGNOSTIC_

Facility

$28,242.08

Service Code	HCPCS 58555
Hospital Charge Code	1600000252
Hospital Revenue Code	360
Min. Negotiated Rate	$680.63
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	$862.00
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	$8,472.62
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,236.31
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$680.63
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	$748.42

HYSTEROSCOPY DIAGNOSTIC_

Facility

$28,242.08

Service Code	HCPCS 58555
Hospital Charge Code	1600000252
Hospital Revenue Code	360
Min. Negotiated Rate	$4,236.31
Max. Negotiated Rate	$4,236.31
Rate for Payer: Qualcare PPO/HMO/WC	$4,236.31

Know your out-of-pocket cost for care.

All Charges