Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OPEN BX/EXC LN; INT MAMM NODE(

Facility

$15,259.20

Service Code	HCPCS 38530
Hospital Charge Code	16000957
Hospital Revenue Code	360
Min. Negotiated Rate	$2,288.88
Max. Negotiated Rate	$2,288.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,288.88

OPEN BX OR EXC LN,SUPERFICIAL

Facility

$24,074.90

Service Code	HCPCS 38500
Hospital Charge Code	16000265
Hospital Revenue Code	360
Min. Negotiated Rate	$580.21
Max. Negotiated Rate	$16,791.02
Rate for Payer: Aetna Commercial	$12,652.46
Rate for Payer: Aetna Medicare Advantage	$15,071.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,791.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,791.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,651.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,791.02
Rate for Payer: Cigna Commercial	$9,324.19
Rate for Payer: Cigna Medicare Advantage	$4,651.64
Rate for Payer: Clover Medicare Advantage	$4,419.06
Rate for Payer: EmblemHealth Commercial	$13,954.92
Rate for Payer: Humana Medicare Advantage	$4,791.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,651.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,222.47
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,611.24
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$580.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,651.64
Rate for Payer: Wellcare Medicare Advantage	$4,651.64
Rate for Payer: Wellpoint Medicaid Managed Care	$637.98

OPEN BX OR EXC LN,SUPERFICIAL

Facility

$24,074.90

Service Code	HCPCS 38500
Hospital Charge Code	16000265
Hospital Revenue Code	360
Min. Negotiated Rate	$3,611.24
Max. Negotiated Rate	$3,611.24
Rate for Payer: Qualcare PPO/HMO/WC	$3,611.24

OPEN CONNECTOR 30MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699333
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

OPEN CONNECTOR 30MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699333
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$30,934.65

Service Code	APR-DRG 0212
Min. Negotiated Rate	$30,328.09
Max. Negotiated Rate	$30,934.65
Rate for Payer: UnitedHealthcare Community & State	$30,328.09
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$30,934.65
Rate for Payer: Wellpoint Medicaid Managed Care	$30,328.09

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$45,855.59

Service Code	APR-DRG 0213
Min. Negotiated Rate	$44,956.46
Max. Negotiated Rate	$45,855.59
Rate for Payer: UnitedHealthcare Community & State	$44,956.46
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$45,855.59
Rate for Payer: Wellpoint Medicaid Managed Care	$44,956.46

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$71,964.26

Service Code	APR-DRG 0214
Min. Negotiated Rate	$70,553.20
Max. Negotiated Rate	$71,964.26
Rate for Payer: UnitedHealthcare Community & State	$70,553.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71,964.26
Rate for Payer: Wellpoint Medicaid Managed Care	$70,553.20

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$24,318.76

Service Code	APR-DRG 0211
Min. Negotiated Rate	$23,841.92
Max. Negotiated Rate	$24,318.76
Rate for Payer: UnitedHealthcare Community & State	$23,841.92
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,318.76
Rate for Payer: Wellpoint Medicaid Managed Care	$23,841.92

OPEN CRANIOTOMY FOR TRAUMA

Facility

$30,315.49

Service Code	APR-DRG 0202
Min. Negotiated Rate	$29,721.07
Max. Negotiated Rate	$30,315.49
Rate for Payer: UnitedHealthcare Community & State	$29,721.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$30,315.49
Rate for Payer: Wellpoint Medicaid Managed Care	$29,721.07

OPEN CRANIOTOMY FOR TRAUMA

Facility

$25,885.26

Service Code	APR-DRG 0201
Min. Negotiated Rate	$25,377.71
Max. Negotiated Rate	$25,885.26
Rate for Payer: UnitedHealthcare Community & State	$25,377.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,885.26
Rate for Payer: Wellpoint Medicaid Managed Care	$25,377.71

OPEN CRANIOTOMY FOR TRAUMA

Facility

$67,596.63

Service Code	APR-DRG 0204
Min. Negotiated Rate	$66,271.21
Max. Negotiated Rate	$67,596.63
Rate for Payer: UnitedHealthcare Community & State	$66,271.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$67,596.63
Rate for Payer: Wellpoint Medicaid Managed Care	$66,271.21

OPEN CRANIOTOMY FOR TRAUMA

Facility

$42,454.42

Service Code	APR-DRG 0203
Min. Negotiated Rate	$41,621.98
Max. Negotiated Rate	$42,454.42
Rate for Payer: UnitedHealthcare Community & State	$41,621.98
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$42,454.42
Rate for Payer: Wellpoint Medicaid Managed Care	$41,621.98

OPEN END URETERAL CATHETER

Facility

$91.00

Hospital Charge Code	270331895
Hospital Revenue Code	278
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$22.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

OPEN END URETERAL CATHETER

Facility

$91.00

Hospital Charge Code	270331895
Hospital Revenue Code	278
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$45.50
Rate for Payer: Aetna Commercial	$34.58
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$16,255.08

Service Code	APR-DRG 0242
Min. Negotiated Rate	$15,936.35
Max. Negotiated Rate	$16,255.08
Rate for Payer: UnitedHealthcare Community & State	$15,936.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,255.08
Rate for Payer: Wellpoint Medicaid Managed Care	$15,936.35

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$13,083.69

Service Code	APR-DRG 0241
Min. Negotiated Rate	$12,827.15
Max. Negotiated Rate	$13,083.69
Rate for Payer: UnitedHealthcare Community & State	$12,827.15
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,083.69
Rate for Payer: Wellpoint Medicaid Managed Care	$12,827.15

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$50,068.69

Service Code	APR-DRG 0244
Min. Negotiated Rate	$49,086.95
Max. Negotiated Rate	$50,068.69
Rate for Payer: UnitedHealthcare Community & State	$49,086.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$50,068.69
Rate for Payer: Wellpoint Medicaid Managed Care	$49,086.95

OPEN EXTRACRANIAL VASCULAR PROCEDURES

Facility

$28,304.67

Service Code	APR-DRG 0243
Min. Negotiated Rate	$27,749.68
Max. Negotiated Rate	$28,304.67
Rate for Payer: UnitedHealthcare Community & State	$27,749.68
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$28,304.67
Rate for Payer: Wellpoint Medicaid Managed Care	$27,749.68

OPENGASREMOVE&REPLACESUBCUTPO

Facility

$15,874.30

Service Code	HCPCS 43888
Hospital Charge Code	1600188
Hospital Revenue Code	361
Min. Negotiated Rate	$382.57
Max. Negotiated Rate	$15,196.98
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,196.98
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,762.29
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.14
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$382.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$420.67

OPENGASREMOVE&REPLACESUBCUTPO

Facility

$15,874.30

Service Code	HCPCS 43888
Hospital Charge Code	1600188
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.14
Max. Negotiated Rate	$2,381.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.14

OPENGASRESTRICTREMOVALOFSUBCUT

Facility

$13,565.80

Service Code	HCPCS 43887
Hospital Charge Code	1600177
Hospital Revenue Code	361
Min. Negotiated Rate	$2,034.87
Max. Negotiated Rate	$2,034.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,034.87

OPENGASRESTRICTREMOVALOFSUBCUT

Facility

$13,565.80

Service Code	HCPCS 43887
Hospital Charge Code	1600177
Hospital Revenue Code	361
Min. Negotiated Rate	$326.94
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	$1,626.00
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	$4,069.74
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,034.87
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$326.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$359.49

OPENGASRESTRICT REV OFSUBCUTPT

Facility

$15,874.30

Service Code	HCPCS 43886
Hospital Charge Code	1600176
Hospital Revenue Code	361
Min. Negotiated Rate	$382.57
Max. Negotiated Rate	$15,196.98
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,196.98
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,762.29
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.14
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$382.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$420.67

OPENGASRESTRICT REV OFSUBCUTPT

Facility

$15,874.30

Service Code	HCPCS 43886
Hospital Charge Code	1600176
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.14
Max. Negotiated Rate	$2,381.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.14

Know your out-of-pocket cost for care.

All Charges