Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$50,048.31

Service Code	APR-DRG 3094
Min. Negotiated Rate	$49,066.97
Max. Negotiated Rate	$50,048.31
Rate for Payer: UnitedHealthcare Community & State	$49,066.97
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$50,048.31
Rate for Payer: Wellpoint Medicaid Managed Care	$49,066.97

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$7,118.92

Service Code	APR-DRG 3852
Min. Negotiated Rate	$6,979.33
Max. Negotiated Rate	$7,118.92
Rate for Payer: UnitedHealthcare Community & State	$6,979.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,118.92
Rate for Payer: Wellpoint Medicaid Managed Care	$6,979.33

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$19,967.74

Service Code	APR-DRG 3854
Min. Negotiated Rate	$19,576.22
Max. Negotiated Rate	$19,967.74
Rate for Payer: UnitedHealthcare Community & State	$19,576.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,967.74
Rate for Payer: Wellpoint Medicaid Managed Care	$19,576.22

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$5,387.70

Service Code	APR-DRG 3851
Min. Negotiated Rate	$5,282.06
Max. Negotiated Rate	$5,387.70
Rate for Payer: UnitedHealthcare Community & State	$5,282.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,387.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5,282.06

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$11,079.28

Service Code	APR-DRG 3853
Min. Negotiated Rate	$10,862.04
Max. Negotiated Rate	$11,079.28
Rate for Payer: UnitedHealthcare Community & State	$10,862.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,079.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10,862.04

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$57,985.89

Service Code	MSDRG 580
Min. Negotiated Rate	$17,655.96
Max. Negotiated Rate	$57,985.89
Rate for Payer: Aetna Commercial	$40,100.23
Rate for Payer: Aetna Medicare Advantage	$57,985.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40,706.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40,706.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,585.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40,706.75
Rate for Payer: Cigna Commercial	$32,337.79
Rate for Payer: Cigna Medicare Advantage	$18,585.22
Rate for Payer: Clover Medicare Advantage	$17,655.96
Rate for Payer: EmblemHealth Commercial	$55,755.66
Rate for Payer: Humana Medicare Advantage	$19,142.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,585.22
Rate for Payer: Oxford Commercial	$23,241.60
Rate for Payer: UnitedHealthcare Commercial	$40,754.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,585.22
Rate for Payer: Wellcare Medicare Advantage	$18,585.22

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$106,807.74

Service Code	MSDRG 579
Min. Negotiated Rate	$32,521.59
Max. Negotiated Rate	$106,807.74
Rate for Payer: Aetna Commercial	$73,646.42
Rate for Payer: Aetna Medicare Advantage	$106,807.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77,691.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77,691.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34,233.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77,691.74
Rate for Payer: Cigna Commercial	$60,605.29
Rate for Payer: Cigna Medicare Advantage	$34,233.25
Rate for Payer: Clover Medicare Advantage	$32,521.59
Rate for Payer: EmblemHealth Commercial	$102,699.75
Rate for Payer: Humana Medicare Advantage	$35,260.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34,233.25
Rate for Payer: Oxford Commercial	$43,557.82
Rate for Payer: UnitedHealthcare Commercial	$76,380.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$34,233.25
Rate for Payer: Wellcare Medicare Advantage	$34,233.25

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$48,777.49

Service Code	MSDRG 581
Min. Negotiated Rate	$14,852.12
Max. Negotiated Rate	$48,777.49
Rate for Payer: Aetna Commercial	$33,773.01
Rate for Payer: Aetna Medicare Advantage	$48,777.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,402.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,402.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,633.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,402.35
Rate for Payer: Cigna Commercial	$27,006.17
Rate for Payer: Cigna Medicare Advantage	$15,633.81
Rate for Payer: Clover Medicare Advantage	$14,852.12
Rate for Payer: EmblemHealth Commercial	$46,901.43
Rate for Payer: Humana Medicare Advantage	$16,102.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,633.81
Rate for Payer: Oxford Commercial	$19,409.69
Rate for Payer: UnitedHealthcare Commercial	$34,035.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,633.81
Rate for Payer: Wellcare Medicare Advantage	$15,633.81

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$12,870.53

Service Code	APR-DRG 3642
Min. Negotiated Rate	$12,618.17
Max. Negotiated Rate	$12,870.53
Rate for Payer: UnitedHealthcare Community & State	$12,618.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,870.53
Rate for Payer: Wellpoint Medicaid Managed Care	$12,618.17

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$9,422.12

Service Code	APR-DRG 3641
Min. Negotiated Rate	$9,237.37
Max. Negotiated Rate	$9,422.12
Rate for Payer: UnitedHealthcare Community & State	$9,237.37
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,422.12
Rate for Payer: Wellpoint Medicaid Managed Care	$9,237.37

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$35,823.18

Service Code	APR-DRG 3644
Min. Negotiated Rate	$35,120.76
Max. Negotiated Rate	$35,823.18
Rate for Payer: UnitedHealthcare Community & State	$35,120.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,823.18
Rate for Payer: Wellpoint Medicaid Managed Care	$35,120.76

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$20,338.01

Service Code	APR-DRG 3643
Min. Negotiated Rate	$19,939.23
Max. Negotiated Rate	$20,338.01
Rate for Payer: UnitedHealthcare Community & State	$19,939.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,338.01
Rate for Payer: Wellpoint Medicaid Managed Care	$19,939.23

Other SLP Current Status CH

Facility

$0.01

Service Code	HCPCS G9174GNCH
Hospital Charge Code	74204089CH
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Other SLP Current Status CH

Facility

$0.01

Service Code	HCPCS G9174GNCH
Hospital Charge Code	74204089CH
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

Other SLP Current Status CI

Facility

$0.01

Service Code	HCPCS G9174GNCI
Hospital Charge Code	74204089CI
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

Other SLP Current Status CI

Facility

$0.01

Service Code	HCPCS G9174GNCI
Hospital Charge Code	74204089CI
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Other SLP Current Status CJ

Facility

$0.01

Service Code	HCPCS G9174GNCJ
Hospital Charge Code	74204089CJ
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Other SLP Current Status CJ

Facility

$0.01

Service Code	HCPCS G9174GNCJ
Hospital Charge Code	74204089CJ
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

Other SLP Current Status CK

Facility

$0.01

Service Code	HCPCS G9174GNCK
Hospital Charge Code	74204089CK
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

Other SLP Current Status CK

Facility

$0.01

Service Code	HCPCS G9174GNCK
Hospital Charge Code	74204089CK
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Other SLP Current Status CL

Facility

$0.01

Service Code	HCPCS G9174GNCL
Hospital Charge Code	74204089CL
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

Other SLP Current Status CL

Facility

$0.01

Service Code	HCPCS G9174GNCL
Hospital Charge Code	74204089CL
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Other SLP Current Status CM

Facility

$0.01

Service Code	HCPCS G9174GNCM
Hospital Charge Code	74204089CM
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

Other SLP Current Status CM

Facility

$0.01

Service Code	HCPCS G9174GNCM
Hospital Charge Code	74204089CM
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER SLP CURRENT STATUS CN

Facility

$0.01

Service Code	HCPCS G9174GNCN
Hospital Charge Code	74204089CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges