Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4527519
Hospital Revenue Code	915
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4511519
Hospital Revenue Code	915
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4518519
Hospital Revenue Code	915
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4517519
Hospital Revenue Code	915
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4546519
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI - FAMILY THERAPY

Facility

$464.00

Service Code	HCPCS 90849
Hospital Charge Code	83246270
Hospital Revenue Code	916
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$69.60
Rate for Payer: Qualcare PPO/HMO/WC	$69.60

MULTI - FAMILY THERAPY

Facility

$464.00

Service Code	HCPCS 90849
Hospital Charge Code	83246270
Hospital Revenue Code	916
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.20
Rate for Payer: Qualcare PPO/HMO/WC	$69.60
Rate for Payer: UnitedHealthcare Community & State	$11.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$12.30

MULTIFIRE ENDO GIA 30V LOADING

Facility

$619.00

Hospital Charge Code	270334729
Hospital Revenue Code	272
Min. Negotiated Rate	$14.92
Max. Negotiated Rate	$309.50
Rate for Payer: Aetna Commercial	$235.22
Rate for Payer: Aetna Medicare Advantage	$185.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.84
Rate for Payer: Cigna Commercial	$309.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.70
Rate for Payer: Oxford Commercial	$123.80
Rate for Payer: Qualcare PPO/HMO/WC	$92.85
Rate for Payer: UnitedHealthcare Commercial	$123.80
Rate for Payer: UnitedHealthcare Community & State	$14.92
Rate for Payer: Wellpoint Medicaid Managed Care	$16.40

MULTIFIRE ENDO GIA 30V LOADING

Facility

$619.00

Hospital Charge Code	270334729
Hospital Revenue Code	272
Min. Negotiated Rate	$92.85
Max. Negotiated Rate	$92.85
Rate for Payer: Qualcare PPO/HMO/WC	$92.85

MULTIFIRE TA30-3.5 LOADING

Facility

$261.00

Hospital Charge Code	270334690
Hospital Revenue Code	272
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna Commercial	$99.18
Rate for Payer: Aetna Medicare Advantage	$78.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.56
Rate for Payer: Cigna Commercial	$130.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.30
Rate for Payer: Oxford Commercial	$52.20
Rate for Payer: Qualcare PPO/HMO/WC	$39.15
Rate for Payer: UnitedHealthcare Commercial	$52.20
Rate for Payer: UnitedHealthcare Community & State	$6.29
Rate for Payer: Wellpoint Medicaid Managed Care	$6.92

MULTIFIRE TA30-3.5 LOADING

Facility

$261.00

Hospital Charge Code	270334690
Hospital Revenue Code	272
Min. Negotiated Rate	$39.15
Max. Negotiated Rate	$39.15
Rate for Payer: Qualcare PPO/HMO/WC	$39.15

MULTIFIRE TA 30-3.5 RELOADABLE

Facility

$555.00

Hospital Charge Code	270334724
Hospital Revenue Code	272
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$277.50
Rate for Payer: Aetna Commercial	$210.90
Rate for Payer: Aetna Medicare Advantage	$166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.53
Rate for Payer: Cigna Commercial	$277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: Oxford Commercial	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.25
Rate for Payer: UnitedHealthcare Commercial	$111.00
Rate for Payer: UnitedHealthcare Community & State	$13.38
Rate for Payer: Wellpoint Medicaid Managed Care	$14.71

MULTIFIRE TA 30-3.5 RELOADABLE

Facility

$555.00

Hospital Charge Code	270334724
Hospital Revenue Code	272
Min. Negotiated Rate	$83.25
Max. Negotiated Rate	$83.25
Rate for Payer: Qualcare PPO/HMO/WC	$83.25

MULTIFIRE TA30-4.8 LOADING

Facility

$283.00

Hospital Charge Code	270334689
Hospital Revenue Code	278
Min. Negotiated Rate	$42.45
Max. Negotiated Rate	$68.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$62.26
Rate for Payer: Qualcare PPO/HMO/WC	$42.45

MULTIFIRE TA30-4.8 LOADING

Facility

$283.00

Hospital Charge Code	270334689
Hospital Revenue Code	278
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$141.50
Rate for Payer: Aetna Commercial	$107.54
Rate for Payer: Aetna Medicare Advantage	$84.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.17
Rate for Payer: Cigna Commercial	$141.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$62.26
Rate for Payer: Qualcare PPO/HMO/WC	$42.45
Rate for Payer: UnitedHealthcare Community & State	$6.82
Rate for Payer: Wellpoint Medicaid Managed Care	$7.50

MULTIFIRE TA 55-3.5 DISPOSABLE

Facility

$293.00

Hospital Charge Code	270334693
Hospital Revenue Code	272
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.90
Rate for Payer: Oxford Commercial	$58.60
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$58.60
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

MULTIFIRE TA 55-3.5 DISPOSABLE

Facility

$293.00

Hospital Charge Code	270334693
Hospital Revenue Code	272
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

MULTIFIRE TA55-4.8 LOADING

Facility

$234.00

Hospital Charge Code	270334694
Hospital Revenue Code	272
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

MULTIFIRE TA55-4.8 LOADING

Facility

$234.00

Hospital Charge Code	270334694
Hospital Revenue Code	272
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$88.92
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$46.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Commercial	$46.80
Rate for Payer: UnitedHealthcare Community & State	$5.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.20

MULTIFIRE TA 55-4.8 STAPLER

Facility

$446.00

Hospital Charge Code	270334726
Hospital Revenue Code	272
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

MULTIFIRE TA 55-4.8 STAPLER

Facility

$446.00

Hospital Charge Code	270334726
Hospital Revenue Code	272
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Oxford Commercial	$89.20
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Commercial	$89.20
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

MULTIGEN RF

Facility

$1,500.00

Hospital Charge Code	270664856
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

MULTIGEN RF

Facility

$1,500.00

Hospital Charge Code	270664856
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

MULTILOC CAP 2MM

Facility

$2,085.00

Hospital Charge Code	270687873
Hospital Revenue Code	272
Min. Negotiated Rate	$312.75
Max. Negotiated Rate	$312.75
Rate for Payer: Qualcare PPO/HMO/WC	$312.75

MULTILOC CAP 2MM

Facility

$2,085.00

Hospital Charge Code	270687873
Hospital Revenue Code	272
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$1,042.50
Rate for Payer: Aetna Commercial	$792.30
Rate for Payer: Aetna Medicare Advantage	$625.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.67
Rate for Payer: Cigna Commercial	$1,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$625.50
Rate for Payer: Oxford Commercial	$417.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.75
Rate for Payer: UnitedHealthcare Commercial	$417.00
Rate for Payer: UnitedHealthcare Community & State	$50.25
Rate for Payer: Wellpoint Medicaid Managed Care	$55.25

Know your out-of-pocket cost for care.

All Charges