Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERI PAPP-A

Facility

$110.00

Service Code	HCPCS 84163
Hospital Charge Code	74308205
Hospital Revenue Code	301
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.33
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$5,904.81

Service Code	APR-DRG 1971
Min. Negotiated Rate	$5,789.03
Max. Negotiated Rate	$5,904.81
Rate for Payer: UnitedHealthcare Community & State	$5,789.03
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,904.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5,789.03

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$19,480.01

Service Code	APR-DRG 1974
Min. Negotiated Rate	$19,098.05
Max. Negotiated Rate	$19,480.01
Rate for Payer: UnitedHealthcare Community & State	$19,098.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,480.01
Rate for Payer: Wellpoint Medicaid Managed Care	$19,098.05

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$7,841.52

Service Code	APR-DRG 1972
Min. Negotiated Rate	$7,687.76
Max. Negotiated Rate	$7,841.52
Rate for Payer: UnitedHealthcare Community & State	$7,687.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,841.52
Rate for Payer: Wellpoint Medicaid Managed Care	$7,687.76

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$11,074.19

Service Code	APR-DRG 1973
Min. Negotiated Rate	$10,857.05
Max. Negotiated Rate	$11,074.19
Rate for Payer: UnitedHealthcare Community & State	$10,857.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,074.19
Rate for Payer: Wellpoint Medicaid Managed Care	$10,857.05

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$23,042.04

Service Code	APR-DRG 0484
Min. Negotiated Rate	$22,590.24
Max. Negotiated Rate	$23,042.04
Rate for Payer: UnitedHealthcare Community & State	$22,590.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,042.04
Rate for Payer: Wellpoint Medicaid Managed Care	$22,590.24

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$7,621.94

Service Code	APR-DRG 0481
Min. Negotiated Rate	$7,472.49
Max. Negotiated Rate	$7,621.94
Rate for Payer: UnitedHealthcare Community & State	$7,472.49
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,621.94
Rate for Payer: Wellpoint Medicaid Managed Care	$7,472.49

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$8,772.24

Service Code	APR-DRG 0482
Min. Negotiated Rate	$8,600.24
Max. Negotiated Rate	$8,772.24
Rate for Payer: UnitedHealthcare Community & State	$8,600.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,772.24
Rate for Payer: Wellpoint Medicaid Managed Care	$8,600.24

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$11,964.02

Service Code	APR-DRG 0483
Min. Negotiated Rate	$11,729.43
Max. Negotiated Rate	$11,964.02
Rate for Payer: UnitedHealthcare Community & State	$11,729.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,964.02
Rate for Payer: Wellpoint Medicaid Managed Care	$11,729.43

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$73,199.69

Service Code	MSDRG 041
Min. Negotiated Rate	$22,288.37
Max. Negotiated Rate	$73,199.69
Rate for Payer: Aetna Medicare Advantage	$73,199.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,872.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,872.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,461.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,872.03
Rate for Payer: Cigna Commercial	$41,146.47
Rate for Payer: Cigna Medicare Advantage	$23,461.44
Rate for Payer: Clover Medicare Advantage	$22,288.37
Rate for Payer: EmblemHealth Commercial	$70,384.32
Rate for Payer: Humana Medicare Advantage	$24,165.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,461.44
Rate for Payer: Oxford Commercial	$29,572.51
Rate for Payer: UnitedHealthcare Commercial	$51,856.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,461.44
Rate for Payer: Wellcare Medicare Advantage	$23,461.44

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$126,934.49

Service Code	MSDRG 040
Min. Negotiated Rate	$38,649.92
Max. Negotiated Rate	$126,934.49
Rate for Payer: Aetna Medicare Advantage	$126,934.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89,554.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89,554.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40,684.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89,554.85
Rate for Payer: Cigna Commercial	$72,258.50
Rate for Payer: Cigna Medicare Advantage	$40,684.13
Rate for Payer: Clover Medicare Advantage	$38,649.92
Rate for Payer: EmblemHealth Commercial	$122,052.39
Rate for Payer: Humana Medicare Advantage	$41,904.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$40,684.13
Rate for Payer: Oxford Commercial	$51,933.14
Rate for Payer: UnitedHealthcare Commercial	$91,066.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$40,684.13
Rate for Payer: Wellcare Medicare Advantage	$40,684.13

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$57,976.21

Service Code	MSDRG 042
Min. Negotiated Rate	$17,653.01
Max. Negotiated Rate	$57,976.21
Rate for Payer: Aetna Medicare Advantage	$57,976.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40,474.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40,474.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,582.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40,474.14
Rate for Payer: Cigna Commercial	$32,332.18
Rate for Payer: Cigna Medicare Advantage	$18,582.12
Rate for Payer: Clover Medicare Advantage	$17,653.01
Rate for Payer: EmblemHealth Commercial	$55,746.36
Rate for Payer: Humana Medicare Advantage	$19,139.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,582.12
Rate for Payer: Oxford Commercial	$23,237.56
Rate for Payer: UnitedHealthcare Commercial	$40,747.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,582.12
Rate for Payer: Wellcare Medicare Advantage	$18,582.12

Peripheral Nerve Stimulator ES

Facility

$4,995.00

Hospital Charge Code	270684936
Hospital Revenue Code	272
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$749.25
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

Peripheral Nerve Stimulator ES

Facility

$4,995.00

Hospital Charge Code	270684936
Hospital Revenue Code	272
Min. Negotiated Rate	$120.38
Max. Negotiated Rate	$2,497.50
Rate for Payer: Aetna Commercial	$1,898.10
Rate for Payer: Aetna Medicare Advantage	$1,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.72
Rate for Payer: Cigna Commercial	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,498.50
Rate for Payer: Oxford Commercial	$999.00
Rate for Payer: Qualcare PPO/HMO/WC	$749.25
Rate for Payer: UnitedHealthcare Commercial	$999.00
Rate for Payer: UnitedHealthcare Community & State	$120.38
Rate for Payer: Wellpoint Medicaid Managed Care	$132.37

PERIPHERAL PARENTERL NUTRITION

Facility

$500.00

Hospital Charge Code	6007117
Hospital Revenue Code	250
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

PERIPHERAL PARENTERL NUTRITION

Facility

$500.00

Hospital Charge Code	6007117
Hospital Revenue Code	250
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

Peripheral Shield, absorbent

Facility

$135.00

Hospital Charge Code	270667573
Hospital Revenue Code	270
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

Peripheral Shield, absorbent

Facility

$135.00

Hospital Charge Code	270667573
Hospital Revenue Code	270
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$27.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

PERIPHERAL STENT

Facility

$7,350.00

Hospital Charge Code	270664603
Hospital Revenue Code	278
Min. Negotiated Rate	$177.13
Max. Negotiated Rate	$3,675.00
Rate for Payer: Aetna Commercial	$2,793.00
Rate for Payer: Aetna Medicare Advantage	$2,205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,874.25
Rate for Payer: Cigna Commercial	$3,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,617.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50
Rate for Payer: UnitedHealthcare Community & State	$177.13
Rate for Payer: Wellpoint Medicaid Managed Care	$194.78

PERIPHERAL STENT

Facility

$7,350.00

Hospital Charge Code	270664603
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$1,778.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,617.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$36,637.44

Service Code	MSDRG 300
Min. Negotiated Rate	$11,155.63
Max. Negotiated Rate	$36,637.44
Rate for Payer: Aetna Commercial	$25,431.44
Rate for Payer: Aetna Medicare Advantage	$36,637.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,889.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,889.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,742.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,889.27
Rate for Payer: Cigna Commercial	$19,977.19
Rate for Payer: Cigna Medicare Advantage	$11,742.77
Rate for Payer: Clover Medicare Advantage	$11,155.63
Rate for Payer: EmblemHealth Commercial	$35,228.31
Rate for Payer: Humana Medicare Advantage	$12,095.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,742.77
Rate for Payer: Oxford Commercial	$14,357.88
Rate for Payer: UnitedHealthcare Commercial	$25,176.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,742.77
Rate for Payer: Wellcare Medicare Advantage	$11,742.77

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$54,905.64

Service Code	MSDRG 299
Min. Negotiated Rate	$16,718.06
Max. Negotiated Rate	$54,905.64
Rate for Payer: Aetna Commercial	$37,983.73
Rate for Payer: Aetna Medicare Advantage	$54,905.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,752.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,752.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,597.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,752.38
Rate for Payer: Cigna Commercial	$30,554.35
Rate for Payer: Cigna Medicare Advantage	$17,597.96
Rate for Payer: Clover Medicare Advantage	$16,718.06
Rate for Payer: EmblemHealth Commercial	$52,793.88
Rate for Payer: Humana Medicare Advantage	$18,125.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,597.96
Rate for Payer: Oxford Commercial	$21,959.81
Rate for Payer: UnitedHealthcare Commercial	$38,507.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,597.96
Rate for Payer: Wellcare Medicare Advantage	$17,597.96

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$25,395.99

Service Code	MSDRG 301
Min. Negotiated Rate	$7,732.75
Max. Negotiated Rate	$25,395.99
Rate for Payer: Aetna Commercial	$17,707.28
Rate for Payer: Aetna Medicare Advantage	$25,395.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,515.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,515.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,139.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,515.31
Rate for Payer: Cigna Commercial	$13,468.47
Rate for Payer: Cigna Medicare Advantage	$8,139.74
Rate for Payer: Clover Medicare Advantage	$7,732.75
Rate for Payer: EmblemHealth Commercial	$24,419.22
Rate for Payer: Humana Medicare Advantage	$8,383.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,139.74
Rate for Payer: Oxford Commercial	$9,679.97
Rate for Payer: UnitedHealthcare Commercial	$16,974.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,139.74
Rate for Payer: Wellcare Medicare Advantage	$8,139.74

PERIPROSTH CAPSULECT BREAST

Facility

$31,541.30

Service Code	HCPCS 19371
Hospital Charge Code	16000358
Hospital Revenue Code	360
Min. Negotiated Rate	$760.15
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	$1,626.00
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	$9,462.39
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.19
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$760.15
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	$835.84

PERIPROSTH CAPSULECT BREAST

Facility

$31,541.30

Service Code	HCPCS 19371
Hospital Charge Code	16000358
Hospital Revenue Code	360
Min. Negotiated Rate	$4,731.19
Max. Negotiated Rate	$4,731.19
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.19

Know your out-of-pocket cost for care.

All Charges