Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MAIN BODY AFX2 28 16 X 40 MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270684793
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

MAIN BODY AFX2 28 16 X 40 MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270684793
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

MAIN BODY TFB 28x74 Lg 279453

Facility

$36,704.00

Hospital Charge Code	270632725
Hospital Revenue Code	278
Min. Negotiated Rate	$5,505.60
Max. Negotiated Rate	$8,882.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,074.88
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60

MAIN BODY TFB 28x74 Lg 279453

Facility

$36,704.00

Hospital Charge Code	270632725
Hospital Revenue Code	278
Min. Negotiated Rate	$884.57
Max. Negotiated Rate	$18,352.00
Rate for Payer: Aetna Commercial	$13,947.52
Rate for Payer: Aetna Medicare Advantage	$11,011.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,359.52
Rate for Payer: Cigna Commercial	$18,352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,074.88
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60
Rate for Payer: UnitedHealthcare Community & State	$884.57
Rate for Payer: Wellpoint Medicaid Managed Care	$972.66

MAIN PUMP TUBING

Facility

$305.00

Hospital Charge Code	270688454
Hospital Revenue Code	272
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$152.50
Rate for Payer: Aetna Commercial	$115.90
Rate for Payer: Aetna Medicare Advantage	$91.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.78
Rate for Payer: Cigna Commercial	$152.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.50
Rate for Payer: Oxford Commercial	$61.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.75
Rate for Payer: UnitedHealthcare Commercial	$61.00
Rate for Payer: UnitedHealthcare Community & State	$7.35
Rate for Payer: Wellpoint Medicaid Managed Care	$8.08

MAIN PUMP TUBING

Facility

$305.00

Hospital Charge Code	270688454
Hospital Revenue Code	272
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$45.75
Rate for Payer: Qualcare PPO/HMO/WC	$45.75

MAJOR (3-10 BLOCKS)

Facility

$500.00

Service Code	HCPCS 88309
Hospital Charge Code	3004983
Hospital Revenue Code	312
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$3,455.10
Rate for Payer: Aetna Commercial	$2,603.50
Rate for Payer: Aetna Medicare Advantage	$3,101.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$957.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,455.10
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$957.17
Rate for Payer: Clover Medicare Advantage	$909.31
Rate for Payer: EmblemHealth Commercial	$2,871.51
Rate for Payer: Humana Medicare Advantage	$985.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$352.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$957.17
Rate for Payer: Wellcare Medicare Advantage	$957.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

MAJOR (3-10 BLOCKS)

Facility

$500.00

Service Code	HCPCS 88309
Hospital Charge Code	3004983
Hospital Revenue Code	312
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$73,512.90

Service Code	APR-DRG 1694
Min. Negotiated Rate	$72,071.47
Max. Negotiated Rate	$73,512.90
Rate for Payer: UnitedHealthcare Community & State	$72,071.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73,512.90
Rate for Payer: Wellpoint Medicaid Managed Care	$72,071.47

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$35,686.58

Service Code	APR-DRG 1691
Min. Negotiated Rate	$34,986.84
Max. Negotiated Rate	$35,686.58
Rate for Payer: UnitedHealthcare Community & State	$34,986.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,686.58
Rate for Payer: Wellpoint Medicaid Managed Care	$34,986.84

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$36,354.32

Service Code	APR-DRG 1692
Min. Negotiated Rate	$35,641.49
Max. Negotiated Rate	$36,354.32
Rate for Payer: UnitedHealthcare Community & State	$35,641.49
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$36,354.32
Rate for Payer: Wellpoint Medicaid Managed Care	$35,641.49

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$46,824.57

Service Code	APR-DRG 1693
Min. Negotiated Rate	$45,906.44
Max. Negotiated Rate	$46,824.57
Rate for Payer: UnitedHealthcare Community & State	$45,906.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$46,824.57
Rate for Payer: Wellpoint Medicaid Managed Care	$45,906.44

MAJOR BILIARY TRACT PROCEDURES

Facility

$23,333.17

Service Code	APR-DRG 2612
Min. Negotiated Rate	$22,875.66
Max. Negotiated Rate	$23,333.17
Rate for Payer: UnitedHealthcare Community & State	$22,875.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,333.17
Rate for Payer: Wellpoint Medicaid Managed Care	$22,875.66

MAJOR BILIARY TRACT PROCEDURES

Facility

$32,136.06

Service Code	APR-DRG 2613
Min. Negotiated Rate	$31,505.94
Max. Negotiated Rate	$32,136.06
Rate for Payer: UnitedHealthcare Community & State	$31,505.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$32,136.06
Rate for Payer: Wellpoint Medicaid Managed Care	$31,505.94

MAJOR BILIARY TRACT PROCEDURES

Facility

$62,591.98

Service Code	APR-DRG 2614
Min. Negotiated Rate	$61,364.69
Max. Negotiated Rate	$62,591.98
Rate for Payer: UnitedHealthcare Community & State	$61,364.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$62,591.98
Rate for Payer: Wellpoint Medicaid Managed Care	$61,364.69

MAJOR BILIARY TRACT PROCEDURES

Facility

$18,256.97

Service Code	APR-DRG 2611
Min. Negotiated Rate	$17,898.99
Max. Negotiated Rate	$18,256.97
Rate for Payer: UnitedHealthcare Community & State	$17,898.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,256.97
Rate for Payer: Wellpoint Medicaid Managed Care	$17,898.99

MAJOR BLADDER PROCEDURES

Facility

$66,568.89

Service Code	APR-DRG 4414
Min. Negotiated Rate	$65,263.62
Max. Negotiated Rate	$66,568.89
Rate for Payer: UnitedHealthcare Community & State	$65,263.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$66,568.89
Rate for Payer: Wellpoint Medicaid Managed Care	$65,263.62

MAJOR BLADDER PROCEDURES

Facility

$36,863.69

Service Code	APR-DRG 4413
Min. Negotiated Rate	$36,140.87
Max. Negotiated Rate	$36,863.69
Rate for Payer: UnitedHealthcare Community & State	$36,140.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$36,863.69
Rate for Payer: Wellpoint Medicaid Managed Care	$36,140.87

MAJOR BLADDER PROCEDURES

Facility

$17,627.55

Service Code	APR-DRG 4411
Min. Negotiated Rate	$17,281.91
Max. Negotiated Rate	$17,627.55
Rate for Payer: UnitedHealthcare Community & State	$17,281.91
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,627.55
Rate for Payer: Wellpoint Medicaid Managed Care	$17,281.91

MAJOR BLADDER PROCEDURES

Facility

$28,318.70

Service Code	APR-DRG 4412
Min. Negotiated Rate	$27,763.43
Max. Negotiated Rate	$28,318.70
Rate for Payer: UnitedHealthcare Community & State	$27,763.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$28,318.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27,763.43

MAJOR BLADDER PROCEDURES WITH CC

Facility

$92,612.05

Service Code	MSDRG 654
Min. Negotiated Rate	$28,199.18
Max. Negotiated Rate	$92,612.05
Rate for Payer: Aetna Commercial	$63,892.36
Rate for Payer: Aetna Medicare Advantage	$92,612.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29,683.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63,735.14
Rate for Payer: Cigna Commercial	$52,386.10
Rate for Payer: Cigna Medicare Advantage	$29,683.35
Rate for Payer: Clover Medicare Advantage	$28,199.18
Rate for Payer: EmblemHealth Commercial	$89,050.05
Rate for Payer: Humana Medicare Advantage	$30,573.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29,683.35
Rate for Payer: Oxford Commercial	$37,650.58
Rate for Payer: UnitedHealthcare Commercial	$66,021.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$29,683.35
Rate for Payer: Wellcare Medicare Advantage	$29,683.35

MAJOR BLADDER PROCEDURES WITH MCC

Facility

$170,090.29

Service Code	MSDRG 653
Min. Negotiated Rate	$51,790.31
Max. Negotiated Rate	$170,090.29
Rate for Payer: Aetna Commercial	$117,128.74
Rate for Payer: Aetna Medicare Advantage	$170,090.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125,842.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125,842.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$54,516.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125,842.01
Rate for Payer: Cigna Commercial	$97,245.43
Rate for Payer: Cigna Medicare Advantage	$54,516.12
Rate for Payer: Clover Medicare Advantage	$51,790.31
Rate for Payer: EmblemHealth Commercial	$163,548.36
Rate for Payer: Humana Medicare Advantage	$56,151.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$54,516.12
Rate for Payer: Oxford Commercial	$69,891.58
Rate for Payer: UnitedHealthcare Commercial	$122,557.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$54,516.12
Rate for Payer: Wellcare Medicare Advantage	$54,516.12

MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$70,546.10

Service Code	MSDRG 655
Min. Negotiated Rate	$21,480.38
Max. Negotiated Rate	$70,546.10
Rate for Payer: Aetna Commercial	$48,730.53
Rate for Payer: Aetna Medicare Advantage	$70,546.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,080.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,080.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,610.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,080.71
Rate for Payer: Cigna Commercial	$39,610.05
Rate for Payer: Cigna Medicare Advantage	$22,610.93
Rate for Payer: Clover Medicare Advantage	$21,480.38
Rate for Payer: EmblemHealth Commercial	$67,832.79
Rate for Payer: Humana Medicare Advantage	$23,289.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,610.93
Rate for Payer: Oxford Commercial	$28,468.27
Rate for Payer: UnitedHealthcare Commercial	$49,920.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,610.93
Rate for Payer: Wellcare Medicare Advantage	$22,610.93

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$65,663.70

Service Code	APR-DRG 1603
Min. Negotiated Rate	$64,376.18
Max. Negotiated Rate	$65,663.70
Rate for Payer: UnitedHealthcare Community & State	$64,376.18
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$65,663.70
Rate for Payer: Wellpoint Medicaid Managed Care	$64,376.18

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$35,788.69

Service Code	APR-DRG 1601
Min. Negotiated Rate	$35,086.95
Max. Negotiated Rate	$35,788.69
Rate for Payer: UnitedHealthcare Community & State	$35,086.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,788.69
Rate for Payer: Wellpoint Medicaid Managed Care	$35,086.95

Know your out-of-pocket cost for care.

All Charges