Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NJX AA&/STRD GNCLR NRV BRNCH

Facility

$3,865.20

Service Code	HCPCS 64454
Hospital Charge Code	321564454
Hospital Revenue Code	361
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,159.56
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$579.78
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$93.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$102.43

NJX AA&/STRD GNCLR NRV BRNCH

Facility

$3,865.20

Service Code	HCPCS 64454
Hospital Charge Code	321564454
Hospital Revenue Code	361
Min. Negotiated Rate	$579.78
Max. Negotiated Rate	$579.78
Rate for Payer: Qualcare PPO/HMO/WC	$579.78

NJX AA&/STRD GNCLR NRV BRNCH

Facility

$2,930.12

Service Code	HCPCS 64454
Hospital Charge Code	1600000661
Hospital Revenue Code	360
Min. Negotiated Rate	$439.52
Max. Negotiated Rate	$439.52
Rate for Payer: Qualcare PPO/HMO/WC	$439.52

NJX AA&/STRD GNCLR NRV BRNCH

Facility

$3,865.20

Service Code	HCPCS 64454
Hospital Charge Code	411064454
Hospital Revenue Code	361
Min. Negotiated Rate	$579.78
Max. Negotiated Rate	$579.78
Rate for Payer: Qualcare PPO/HMO/WC	$579.78

NJX AA&/STRD GR OCPL NRV

Facility

$1,630.99

Service Code	HCPCS 64405
Hospital Charge Code	321564405
Hospital Revenue Code	361
Min. Negotiated Rate	$244.65
Max. Negotiated Rate	$244.65
Rate for Payer: Qualcare PPO/HMO/WC	$244.65

NJX AA&/STRD GR OCPL NRV

Facility

$1,630.99

Service Code	HCPCS 64405
Hospital Charge Code	321564405
Hospital Revenue Code	361
Min. Negotiated Rate	$39.31
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$489.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$39.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$43.22

NJX AA&/STRD NRV NRVTG SI JT

Facility

$2,930.12

Service Code	HCPCS 64451
Hospital Charge Code	16000653
Hospital Revenue Code	360
Min. Negotiated Rate	$70.62
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$879.04
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$439.52
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$70.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$77.65

NJX AA&/STRD NRV NRVTG SI JT

Facility

$2,930.12

Service Code	HCPCS 64451
Hospital Charge Code	16000653
Hospital Revenue Code	360
Min. Negotiated Rate	$439.52
Max. Negotiated Rate	$439.52
Rate for Payer: Qualcare PPO/HMO/WC	$439.52

NJX AA&/STRD SCIATIC NRV IMG

Facility

$3,865.20

Service Code	HCPCS 64445
Hospital Charge Code	321564445
Hospital Revenue Code	361
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,159.56
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$579.78
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$93.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$102.43

NJX AA&/STRD SCIATIC NRV IMG

Facility

$3,865.20

Service Code	HCPCS 64445
Hospital Charge Code	321564445
Hospital Revenue Code	361
Min. Negotiated Rate	$579.78
Max. Negotiated Rate	$579.78
Rate for Payer: Qualcare PPO/HMO/WC	$579.78

NJX AA& STRD TFRM EPI C/T EA

Facility

$5,068.00

Service Code	HCPCS 64480
Hospital Charge Code	411064480
Hospital Revenue Code	361
Min. Negotiated Rate	$122.14
Max. Negotiated Rate	$2,534.00
Rate for Payer: Aetna Commercial	$1,925.84
Rate for Payer: Aetna Medicare Advantage	$1,520.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,292.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,292.34
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	$1,292.34
Rate for Payer: Cigna Commercial	$2,534.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,520.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$760.20
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$122.14

NJX AA& STRD TFRM EPI C/T EA

Facility

$5,068.00

Service Code	HCPCS 64480
Hospital Charge Code	411064480
Hospital Revenue Code	361
Min. Negotiated Rate	$760.20
Max. Negotiated Rate	$760.20
Rate for Payer: Qualcare PPO/HMO/WC	$760.20

NJX AA&/STRD TFRM EPI L/S 1

Facility

$5,111.97

Service Code	HCPCS 64483
Hospital Charge Code	321564483
Hospital Revenue Code	361
Min. Negotiated Rate	$766.80
Max. Negotiated Rate	$766.80
Rate for Payer: Qualcare PPO/HMO/WC	$766.80

NJX AA&/STRD TFRM EPI L/S 1

Facility

$5,111.97

Service Code	HCPCS 64483
Hospital Charge Code	321564483
Hospital Revenue Code	361
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
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	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,533.59
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$123.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

NJX AA&STRD TFRM EPI L/S 1

Facility

$5,068.00

Service Code	HCPCS 64483
Hospital Charge Code	411064483
Hospital Revenue Code	361
Min. Negotiated Rate	$122.14
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
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	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,520.40
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$760.20
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$122.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

NJX AA&STRD TFRM EPI L/S 1

Facility

$5,068.00

Service Code	HCPCS 64483
Hospital Charge Code	411064483
Hospital Revenue Code	361
Min. Negotiated Rate	$760.20
Max. Negotiated Rate	$760.20
Rate for Payer: Qualcare PPO/HMO/WC	$760.20

NJX AA&/STRD TFRM EPI L/S 1 BI

Facility

$10,223.94

Service Code	HCPCS 6448350
Hospital Charge Code	3215644832
Hospital Revenue Code	361
Min. Negotiated Rate	$1,533.59
Max. Negotiated Rate	$1,533.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.59

NJX AA&/STRD TFRM EPI L/S 1 BI

Facility

$10,223.94

Service Code	HCPCS 6448350
Hospital Charge Code	3215644832
Hospital Revenue Code	361
Min. Negotiated Rate	$246.40
Max. Negotiated Rate	$5,111.97
Rate for Payer: Aetna Commercial	$3,885.10
Rate for Payer: Aetna Medicare Advantage	$3,067.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,607.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,607.10
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	$2,607.10
Rate for Payer: Cigna Commercial	$5,111.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.59
Rate for Payer: UnitedHealthcare Community & State	$246.40
Rate for Payer: Wellpoint Medicaid Managed Care	$270.93

NJX AA&/STRDTFRMEPILSADDLBIL

Facility

$10,223.94

Service Code	HCPCS 6448450
Hospital Charge Code	3215644842
Hospital Revenue Code	361
Min. Negotiated Rate	$1,533.59
Max. Negotiated Rate	$1,533.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.59

NJX AA&/STRDTFRMEPILSADDLBIL

Facility

$10,223.94

Service Code	HCPCS 6448450
Hospital Charge Code	3215644842
Hospital Revenue Code	361
Min. Negotiated Rate	$246.40
Max. Negotiated Rate	$5,111.97
Rate for Payer: Aetna Commercial	$3,885.10
Rate for Payer: Aetna Medicare Advantage	$3,067.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,607.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,607.10
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	$2,607.10
Rate for Payer: Cigna Commercial	$5,111.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.59
Rate for Payer: UnitedHealthcare Community & State	$246.40
Rate for Payer: Wellpoint Medicaid Managed Care	$270.93

NJX AA&/STRD TFRM EPI L/S EA

Facility

$5,111.97

Service Code	HCPCS 64484
Hospital Charge Code	321564484
Hospital Revenue Code	361
Min. Negotiated Rate	$766.80
Max. Negotiated Rate	$766.80
Rate for Payer: Qualcare PPO/HMO/WC	$766.80

NJX AA&/STRD TFRM EPI L/S EA

Facility

$5,111.97

Service Code	HCPCS 64484
Hospital Charge Code	321564484
Hospital Revenue Code	361
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$2,555.99
Rate for Payer: Aetna Commercial	$1,942.55
Rate for Payer: Aetna Medicare Advantage	$1,533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.55
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	$1,303.55
Rate for Payer: Cigna Commercial	$2,555.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,533.59
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$123.20

NJX AA&STRD TFRM EPI L/S EA

Facility

$5,068.00

Service Code	HCPCS 64484
Hospital Charge Code	411064484
Hospital Revenue Code	361
Min. Negotiated Rate	$122.14
Max. Negotiated Rate	$2,534.00
Rate for Payer: Aetna Commercial	$1,925.84
Rate for Payer: Aetna Medicare Advantage	$1,520.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,292.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,292.34
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	$1,292.34
Rate for Payer: Cigna Commercial	$2,534.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,520.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$760.20
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$122.14

NJX AA&STRD TFRM EPI L/S EA

Facility

$5,068.00

Service Code	HCPCS 64484
Hospital Charge Code	411064484
Hospital Revenue Code	361
Min. Negotiated Rate	$760.20
Max. Negotiated Rate	$760.20
Rate for Payer: Qualcare PPO/HMO/WC	$760.20

NJX B1 SUB MTRL SBCHDRL DFCT

Facility

$14,284.88

Service Code	HCPCS 0707T
Hospital Charge Code	1600000696
Hospital Revenue Code	360
Min. Negotiated Rate	$2,142.73
Max. Negotiated Rate	$2,142.73
Rate for Payer: Qualcare PPO/HMO/WC	$2,142.73

Know your out-of-pocket cost for care.

All Charges