Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NON-EXTENSIVE BURNS

Facility

$68,716.69

Service Code	MSDRG 935
Min. Negotiated Rate	$20,923.35
Max. Negotiated Rate	$68,716.69
Rate for Payer: Aetna Commercial	$47,473.52
Rate for Payer: Aetna Medicare Advantage	$68,716.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47,452.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47,452.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,024.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47,452.44
Rate for Payer: Cigna Commercial	$38,550.84
Rate for Payer: Cigna Medicare Advantage	$22,024.58
Rate for Payer: Clover Medicare Advantage	$20,923.35
Rate for Payer: EmblemHealth Commercial	$66,073.74
Rate for Payer: Humana Medicare Advantage	$22,685.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,024.58
Rate for Payer: Oxford Commercial	$27,707.00
Rate for Payer: UnitedHealthcare Commercial	$48,585.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,024.58
Rate for Payer: Wellcare Medicare Advantage	$22,024.58

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$10,497.12

Service Code	APR-DRG 7941
Min. Negotiated Rate	$10,291.29
Max. Negotiated Rate	$10,497.12
Rate for Payer: UnitedHealthcare Community & State	$10,291.29
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,497.12
Rate for Payer: Wellpoint Medicaid Managed Care	$10,291.29

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$38,288.50

Service Code	APR-DRG 7944
Min. Negotiated Rate	$37,537.75
Max. Negotiated Rate	$38,288.50
Rate for Payer: UnitedHealthcare Community & State	$37,537.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$38,288.50
Rate for Payer: Wellpoint Medicaid Managed Care	$37,537.75

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$19,926.91

Service Code	APR-DRG 7943
Min. Negotiated Rate	$19,536.19
Max. Negotiated Rate	$19,926.91
Rate for Payer: UnitedHealthcare Community & State	$19,536.19
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,926.91
Rate for Payer: Wellpoint Medicaid Managed Care	$19,536.19

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$13,531.85

Service Code	APR-DRG 7942
Min. Negotiated Rate	$13,266.52
Max. Negotiated Rate	$13,531.85
Rate for Payer: UnitedHealthcare Community & State	$13,266.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,531.85
Rate for Payer: Wellpoint Medicaid Managed Care	$13,266.52

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$55,257.95

Service Code	MSDRG 988
Min. Negotiated Rate	$16,825.34
Max. Negotiated Rate	$55,257.95
Rate for Payer: Aetna Commercial	$38,225.80
Rate for Payer: Aetna Medicare Advantage	$55,257.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39,543.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39,543.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,710.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39,543.70
Rate for Payer: Cigna Commercial	$30,758.33
Rate for Payer: Cigna Medicare Advantage	$17,710.88
Rate for Payer: Clover Medicare Advantage	$16,825.34
Rate for Payer: EmblemHealth Commercial	$53,132.64
Rate for Payer: Humana Medicare Advantage	$18,242.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,710.88
Rate for Payer: Oxford Commercial	$22,106.42
Rate for Payer: UnitedHealthcare Commercial	$38,764.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,710.88
Rate for Payer: Wellcare Medicare Advantage	$17,710.88

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$112,945.56

Service Code	MSDRG 987
Min. Negotiated Rate	$34,390.47
Max. Negotiated Rate	$112,945.56
Rate for Payer: Aetna Commercial	$77,863.82
Rate for Payer: Aetna Medicare Advantage	$112,945.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,622.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,622.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36,200.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78,622.18
Rate for Payer: Cigna Commercial	$64,159.08
Rate for Payer: Cigna Medicare Advantage	$36,200.50
Rate for Payer: Clover Medicare Advantage	$34,390.47
Rate for Payer: EmblemHealth Commercial	$108,601.50
Rate for Payer: Humana Medicare Advantage	$37,286.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$36,200.50
Rate for Payer: Oxford Commercial	$46,111.98
Rate for Payer: UnitedHealthcare Commercial	$80,858.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$36,200.50
Rate for Payer: Wellcare Medicare Advantage	$36,200.50

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$40,894.21

Service Code	MSDRG 989
Min. Negotiated Rate	$12,451.76
Max. Negotiated Rate	$40,894.21
Rate for Payer: Aetna Commercial	$28,356.33
Rate for Payer: Aetna Medicare Advantage	$40,894.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,121.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,121.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,107.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,121.88
Rate for Payer: Cigna Commercial	$22,441.83
Rate for Payer: Cigna Medicare Advantage	$13,107.12
Rate for Payer: Clover Medicare Advantage	$12,451.76
Rate for Payer: EmblemHealth Commercial	$39,321.36
Rate for Payer: Humana Medicare Advantage	$13,500.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,107.12
Rate for Payer: Oxford Commercial	$16,129.24
Rate for Payer: UnitedHealthcare Commercial	$28,283.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,107.12
Rate for Payer: Wellcare Medicare Advantage	$13,107.12

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$24,627.75

Service Code	APR-DRG 9523
Min. Negotiated Rate	$24,144.85
Max. Negotiated Rate	$24,627.75
Rate for Payer: UnitedHealthcare Community & State	$24,144.85
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,627.75
Rate for Payer: Wellpoint Medicaid Managed Care	$24,144.85

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$11,401.05

Service Code	APR-DRG 9521
Min. Negotiated Rate	$11,177.50
Max. Negotiated Rate	$11,401.05
Rate for Payer: UnitedHealthcare Community & State	$11,177.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,401.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11,177.50

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$46,070.06

Service Code	APR-DRG 9524
Min. Negotiated Rate	$45,166.73
Max. Negotiated Rate	$46,070.06
Rate for Payer: UnitedHealthcare Community & State	$45,166.73
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$46,070.06
Rate for Payer: Wellpoint Medicaid Managed Care	$45,166.73

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$15,292.45

Service Code	APR-DRG 9522
Min. Negotiated Rate	$14,992.60
Max. Negotiated Rate	$15,292.45
Rate for Payer: UnitedHealthcare Community & State	$14,992.60
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,292.45
Rate for Payer: Wellpoint Medicaid Managed Care	$14,992.60

NON FORMULARY IVPB

Facility

$62.10

Hospital Charge Code	60628841
Hospital Revenue Code	250
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

NON FORMULARY IVPB

Facility

$62.10

Hospital Charge Code	60628841
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.63
Rate for Payer: Oxford Commercial	$12.42
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$12.42
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

NON-FORMULARY IVPB

Facility

$62.10

Hospital Charge Code	60628537
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.63
Rate for Payer: Oxford Commercial	$12.42
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$12.42
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

NON-FORMULARY IVPB

Facility

$62.10

Hospital Charge Code	60628537
Hospital Revenue Code	250
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

NON FORMULARY LVP

Facility

$122.90

Hospital Charge Code	60628842
Hospital Revenue Code	250
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

NON FORMULARY LVP

Facility

$122.90

Hospital Charge Code	60628842
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Oxford Commercial	$24.58
Rate for Payer: Qualcare PPO/HMO/WC	$18.43
Rate for Payer: UnitedHealthcare Commercial	$24.58
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

NON-FORMULARY LVP

Facility

$122.90

Hospital Charge Code	60628538
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Oxford Commercial	$24.58
Rate for Payer: Qualcare PPO/HMO/WC	$18.43
Rate for Payer: UnitedHealthcare Commercial	$24.58
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

NON-FORMULARY LVP

Facility

$122.90

Hospital Charge Code	60628538
Hospital Revenue Code	250
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

NON-FORMULARY MED

Facility

$31.40

Hospital Charge Code	60628539
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$4.71

NON-FORMULARY MED

Facility

$31.40

Hospital Charge Code	60628843
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$4.71

NON-FORMULARY MED

Facility

$31.40

Hospital Charge Code	60628539
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$15.70
Rate for Payer: Aetna Commercial	$11.93
Rate for Payer: Aetna Medicare Advantage	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.01
Rate for Payer: Cigna Commercial	$15.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.42
Rate for Payer: Oxford Commercial	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.71
Rate for Payer: UnitedHealthcare Commercial	$6.28
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

NON-FORMULARY MED

Facility

$31.40

Hospital Charge Code	60628843
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$15.70
Rate for Payer: Aetna Commercial	$11.93
Rate for Payer: Aetna Medicare Advantage	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.01
Rate for Payer: Cigna Commercial	$15.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.42
Rate for Payer: Oxford Commercial	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.71
Rate for Payer: UnitedHealthcare Commercial	$6.28
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

NON-HODGKIN LYMPHOMA PROFILE(F

Facility

$22.40

Service Code	HCPCS 82271
Hospital Charge Code	3038534H
Hospital Revenue Code	301
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.47
Rate for Payer: Aetna Medicare Advantage	$17.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.20
Rate for Payer: Cigna Commercial	$11.20
Rate for Payer: Cigna Medicare Advantage	$5.32
Rate for Payer: Clover Medicare Advantage	$5.05
Rate for Payer: EmblemHealth Commercial	$15.96
Rate for Payer: Humana Medicare Advantage	$5.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.36
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.32
Rate for Payer: Wellcare Medicare Advantage	$5.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

Know your out-of-pocket cost for care.

All Charges