Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ATTENTION D/C STATUS CN

Facility

$0.01

Service Code	HCPCS G9167GNCN
Hospital Charge Code	74204075CN
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

ATTENTION D/C STATUS CN

Facility

$0.01

Service Code	HCPCS G9167GNCN
Hospital Charge Code	74204075CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTENTION GOAL STATUS CH

Facility

$0.01

Service Code	HCPCS G9166GNCH
Hospital Charge Code	74204073CH
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

ATTENTION GOAL STATUS CH

Facility

$0.01

Service Code	HCPCS G9166GNCH
Hospital Charge Code	74204073CH
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Attention Goal Status CI

Facility

$0.01

Service Code	HCPCS G9166GNCI
Hospital Charge Code	74204073CI
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Attention Goal Status CI

Facility

$0.01

Service Code	HCPCS G9166GNCI
Hospital Charge Code	74204073CI
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Attention Goal Status CJ

Facility

$0.01

Service Code	HCPCS G9166GNCJ
Hospital Charge Code	74204073CJ
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Attention Goal Status CJ

Facility

$0.01

Service Code	HCPCS G9166GNCJ
Hospital Charge Code	74204073CJ
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

ATTENTION GOAL STATUS CK

Facility

$0.01

Service Code	HCPCS G9166GNCK
Hospital Charge Code	74204073CK
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

ATTENTION GOAL STATUS CK

Facility

$0.01

Service Code	HCPCS G9166GNCK
Hospital Charge Code	74204073CK
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTENTION GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G9166GNCL
Hospital Charge Code	74204073CL
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

ATTENTION GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G9166GNCL
Hospital Charge Code	74204073CL
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTENTION GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G9166GNCM
Hospital Charge Code	74204073CM
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

ATTENTION GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G9166GNCM
Hospital Charge Code	74204073CM
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTENTION GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9166GNCN
Hospital Charge Code	74204073CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTENTION GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9166GNCN
Hospital Charge Code	74204073CN
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

ATTEST SUPER RAPID 5 STEAMPLUS

Facility

$38.10

Hospital Charge Code	270664734
Hospital Revenue Code	272
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.05
Rate for Payer: Aetna Commercial	$14.48
Rate for Payer: Aetna Medicare Advantage	$11.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.72
Rate for Payer: Cigna Commercial	$19.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.43
Rate for Payer: Oxford Commercial	$7.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.71
Rate for Payer: UnitedHealthcare Commercial	$7.62
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

ATTEST SUPER RAPID 5 STEAMPLUS

Facility

$38.10

Hospital Charge Code	270664734
Hospital Revenue Code	272
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$5.71
Rate for Payer: Qualcare PPO/HMO/WC	$5.71

ATT F/C/M/N/A/G/H/F; 10.1-30SQ

Facility

$8,289.16

Service Code	HCPCS 14041
Hospital Charge Code	16000347
Hospital Revenue Code	360
Min. Negotiated Rate	$1,243.37
Max. Negotiated Rate	$1,243.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,243.37

ATT F/C/M/N/A/G/H/F; 10.1-30SQ

Facility

$8,289.16

Service Code	HCPCS 14041
Hospital Charge Code	16000347
Hospital Revenue Code	360
Min. Negotiated Rate	$199.77
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.75
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,243.37
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$199.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,165.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5,064.59

ATT TRUNK,D 10.1-30 SQ

Facility

$16,286.20

Service Code	HCPCS 14001
Hospital Charge Code	16000249
Hospital Revenue Code	360
Min. Negotiated Rate	$2,442.93
Max. Negotiated Rate	$2,442.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93

ATT TRUNK,D 10.1-30 SQ

Facility

$16,286.20

Service Code	HCPCS 14001
Hospital Charge Code	16000249
Hospital Revenue Code	360
Min. Negotiated Rate	$392.50
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,885.86
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$392.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,165.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5,064.59

ATT TRUNK D 10.1-3SQ

Facility

$16,286.20

Service Code	HCPCS 14001
Hospital Charge Code	323014001
Hospital Revenue Code	450
Min. Negotiated Rate	$2,442.93
Max. Negotiated Rate	$2,442.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93

ATT TRUNK D 10.1-3SQ

Facility

$16,286.20

Service Code	HCPCS 14001
Hospital Charge Code	323014001
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,885.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,165.88
Rate for Payer: Wellpoint Medicaid Managed Care	$431.58

ATTUNEFEMPORCRUCRETNAR5NRT

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270690793
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

Know your out-of-pocket cost for care.

All Charges