Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OTHER PT/OT GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8991GPCM
Hospital Charge Code	84202065CM
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER PT/OT GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8991GOCM
Hospital Charge Code	74203113CM
Hospital Revenue Code	430
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) NJ Health	$116.00
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

OTHER PT/OT GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8991GOCM
Hospital Charge Code	74203113CM
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER PT/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8991GOCN
Hospital Charge Code	74203113CN
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER PT/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8991GPCN
Hospital Charge Code	84202065CN
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER PT/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8991GPCN
Hospital Charge Code	84202065CN
Hospital Revenue Code	420
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) NJ Health	$116.00
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

OTHER PT/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8991GOCN
Hospital Charge Code	74203113CN
Hospital Revenue Code	430
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) NJ Health	$116.00
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

OTHER PT/OT STATUS

Facility

$0.01

Service Code	HCPCS G8992GP
Hospital Charge Code	84201134
Hospital Revenue Code	429
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER PT/OT STATUS

Facility

$0.01

Service Code	HCPCS G8992GP
Hospital Charge Code	84201134
Hospital Revenue Code	429
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) NJ Health	$116.00
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

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$56,577.38

Service Code	APR-DRG 1214
Min. Negotiated Rate	$55,468.02
Max. Negotiated Rate	$56,577.38
Rate for Payer: UnitedHealthcare Community & State	$55,468.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$56,577.38
Rate for Payer: Wellpoint Medicaid Managed Care	$55,468.02

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$33,094.85

Service Code	APR-DRG 1213
Min. Negotiated Rate	$32,445.93
Max. Negotiated Rate	$33,094.85
Rate for Payer: UnitedHealthcare Community & State	$32,445.93
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$33,094.85
Rate for Payer: Wellpoint Medicaid Managed Care	$32,445.93

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$21,640.20

Service Code	APR-DRG 1212
Min. Negotiated Rate	$21,215.88
Max. Negotiated Rate	$21,640.20
Rate for Payer: UnitedHealthcare Community & State	$21,215.88
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,640.20
Rate for Payer: Wellpoint Medicaid Managed Care	$21,215.88

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$16,714.69

Service Code	APR-DRG 1211
Min. Negotiated Rate	$16,386.95
Max. Negotiated Rate	$16,714.69
Rate for Payer: UnitedHealthcare Community & State	$16,386.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,714.69
Rate for Payer: Wellpoint Medicaid Managed Care	$16,386.95

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$6,317.17

Service Code	APR-DRG 1431
Min. Negotiated Rate	$6,193.30
Max. Negotiated Rate	$6,317.17
Rate for Payer: UnitedHealthcare Community & State	$6,193.30
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,317.17
Rate for Payer: Wellpoint Medicaid Managed Care	$6,193.30

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$20,959.76

Service Code	APR-DRG 1434
Min. Negotiated Rate	$20,548.78
Max. Negotiated Rate	$20,959.76
Rate for Payer: UnitedHealthcare Community & State	$20,548.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,959.76
Rate for Payer: Wellpoint Medicaid Managed Care	$20,548.78

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$8,827.17

Service Code	APR-DRG 1432
Min. Negotiated Rate	$8,654.09
Max. Negotiated Rate	$8,827.17
Rate for Payer: UnitedHealthcare Community & State	$8,654.09
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,827.17
Rate for Payer: Wellpoint Medicaid Managed Care	$8,654.09

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$13,060.72

Service Code	APR-DRG 1433
Min. Negotiated Rate	$12,804.63
Max. Negotiated Rate	$13,060.72
Rate for Payer: UnitedHealthcare Community & State	$12,804.63
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,060.72
Rate for Payer: Wellpoint Medicaid Managed Care	$12,804.63

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$61,314.99

Service Code	MSDRG 205
Min. Negotiated Rate	$18,669.63
Max. Negotiated Rate	$61,314.99
Rate for Payer: Aetna Commercial	$42,387.74
Rate for Payer: Aetna Medicare Advantage	$61,314.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42,102.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42,102.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,652.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42,102.41
Rate for Payer: Cigna Commercial	$34,265.33
Rate for Payer: Cigna Medicare Advantage	$19,652.24
Rate for Payer: Clover Medicare Advantage	$18,669.63
Rate for Payer: EmblemHealth Commercial	$58,956.72
Rate for Payer: Humana Medicare Advantage	$20,241.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,652.24
Rate for Payer: Oxford Commercial	$24,626.95
Rate for Payer: UnitedHealthcare Commercial	$43,184.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,652.24
Rate for Payer: Wellcare Medicare Advantage	$19,652.24

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$32,551.96

Service Code	MSDRG 206
Min. Negotiated Rate	$9,911.65
Max. Negotiated Rate	$32,551.96
Rate for Payer: Aetna Commercial	$22,624.23
Rate for Payer: Aetna Medicare Advantage	$32,551.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,433.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,167.51
Rate for Payer: Cigna Commercial	$17,611.75
Rate for Payer: Cigna Medicare Advantage	$10,433.32
Rate for Payer: Clover Medicare Advantage	$9,911.65
Rate for Payer: EmblemHealth Commercial	$31,299.96
Rate for Payer: Humana Medicare Advantage	$10,746.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,433.32
Rate for Payer: Oxford Commercial	$12,657.80
Rate for Payer: UnitedHealthcare Commercial	$22,195.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,433.32
Rate for Payer: Wellcare Medicare Advantage	$10,433.32

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$60,422.98

Service Code	MSDRG 167
Min. Negotiated Rate	$18,398.02
Max. Negotiated Rate	$60,422.98
Rate for Payer: Aetna Commercial	$41,774.80
Rate for Payer: Aetna Medicare Advantage	$60,422.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42,335.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42,335.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,366.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42,335.02
Rate for Payer: Cigna Commercial	$33,748.83
Rate for Payer: Cigna Medicare Advantage	$19,366.34
Rate for Payer: Clover Medicare Advantage	$18,398.02
Rate for Payer: EmblemHealth Commercial	$58,099.02
Rate for Payer: Humana Medicare Advantage	$19,947.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,366.34
Rate for Payer: Oxford Commercial	$24,255.73
Rate for Payer: UnitedHealthcare Commercial	$42,533.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,366.34
Rate for Payer: Wellcare Medicare Advantage	$19,366.34

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$122,942.70

Service Code	MSDRG 166
Min. Negotiated Rate	$37,434.47
Max. Negotiated Rate	$122,942.70
Rate for Payer: Aetna Commercial	$84,732.98
Rate for Payer: Aetna Medicare Advantage	$122,942.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94,439.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94,439.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$39,404.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94,439.66
Rate for Payer: Cigna Commercial	$69,947.32
Rate for Payer: Cigna Medicare Advantage	$39,404.71
Rate for Payer: Clover Medicare Advantage	$37,434.47
Rate for Payer: EmblemHealth Commercial	$118,214.13
Rate for Payer: Humana Medicare Advantage	$40,586.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$39,404.71
Rate for Payer: Oxford Commercial	$50,272.07
Rate for Payer: UnitedHealthcare Commercial	$88,153.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$39,404.71
Rate for Payer: Wellcare Medicare Advantage	$39,404.71

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$46,298.37

Service Code	MSDRG 168
Min. Negotiated Rate	$14,097.26
Max. Negotiated Rate	$46,298.37
Rate for Payer: Aetna Commercial	$32,069.57
Rate for Payer: Aetna Medicare Advantage	$46,298.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,634.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,634.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,839.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,634.96
Rate for Payer: Cigna Commercial	$25,570.81
Rate for Payer: Cigna Medicare Advantage	$14,839.22
Rate for Payer: Clover Medicare Advantage	$14,097.26
Rate for Payer: EmblemHealth Commercial	$44,517.66
Rate for Payer: Humana Medicare Advantage	$15,284.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,839.22
Rate for Payer: Oxford Commercial	$18,378.08
Rate for Payer: UnitedHealthcare Commercial	$32,226.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,839.22
Rate for Payer: Wellcare Medicare Advantage	$14,839.22

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$22,690.97

Service Code	APR-DRG 3092
Min. Negotiated Rate	$22,246.05
Max. Negotiated Rate	$22,690.97
Rate for Payer: UnitedHealthcare Community & State	$22,246.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,690.97
Rate for Payer: Wellpoint Medicaid Managed Care	$22,246.05

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$17,480.70

Service Code	APR-DRG 3091
Min. Negotiated Rate	$17,137.94
Max. Negotiated Rate	$17,480.70
Rate for Payer: UnitedHealthcare Community & State	$17,137.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,480.70
Rate for Payer: Wellpoint Medicaid Managed Care	$17,137.94

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$31,921.57

Service Code	APR-DRG 3093
Min. Negotiated Rate	$31,295.66
Max. Negotiated Rate	$31,921.57
Rate for Payer: UnitedHealthcare Community & State	$31,295.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$31,921.57
Rate for Payer: Wellpoint Medicaid Managed Care	$31,295.66

Know your out-of-pocket cost for care.

All Charges