Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERITONEAL ADHESIOLYSIS

Facility

$48,484.31

Service Code	APR-DRG 2244
Min. Negotiated Rate	$47,533.64
Max. Negotiated Rate	$48,484.31
Rate for Payer: UnitedHealthcare Community & State	$47,533.64
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$48,484.31
Rate for Payer: Wellpoint Medicaid Managed Care	$47,533.64

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$70,290.76

Service Code	MSDRG 336
Min. Negotiated Rate	$21,402.64
Max. Negotiated Rate	$70,290.76
Rate for Payer: Aetna Commercial	$48,555.11
Rate for Payer: Aetna Medicare Advantage	$70,290.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,080.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,080.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,529.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,080.71
Rate for Payer: Cigna Commercial	$39,462.21
Rate for Payer: Cigna Medicare Advantage	$22,529.09
Rate for Payer: Clover Medicare Advantage	$21,402.64
Rate for Payer: EmblemHealth Commercial	$67,587.27
Rate for Payer: Humana Medicare Advantage	$23,204.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,529.09
Rate for Payer: Oxford Commercial	$28,362.01
Rate for Payer: UnitedHealthcare Commercial	$49,733.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,529.09
Rate for Payer: Wellcare Medicare Advantage	$22,529.09

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$117,551.43

Service Code	MSDRG 335
Min. Negotiated Rate	$35,792.90
Max. Negotiated Rate	$117,551.43
Rate for Payer: Aetna Commercial	$81,028.56
Rate for Payer: Aetna Medicare Advantage	$117,551.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83,274.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83,274.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37,676.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83,274.38
Rate for Payer: Cigna Commercial	$66,825.82
Rate for Payer: Cigna Medicare Advantage	$37,676.74
Rate for Payer: Clover Medicare Advantage	$35,792.90
Rate for Payer: EmblemHealth Commercial	$113,030.22
Rate for Payer: Humana Medicare Advantage	$38,807.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37,676.74
Rate for Payer: Oxford Commercial	$48,028.61
Rate for Payer: UnitedHealthcare Commercial	$84,219.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$37,676.74
Rate for Payer: Wellcare Medicare Advantage	$37,676.74

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$51,747.76

Service Code	MSDRG 337
Min. Negotiated Rate	$15,756.53
Max. Negotiated Rate	$51,747.76
Rate for Payer: Aetna Commercial	$35,813.94
Rate for Payer: Aetna Medicare Advantage	$51,747.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34,891.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34,891.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,585.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34,891.50
Rate for Payer: Cigna Commercial	$28,725.99
Rate for Payer: Cigna Medicare Advantage	$16,585.82
Rate for Payer: Clover Medicare Advantage	$15,756.53
Rate for Payer: EmblemHealth Commercial	$49,757.46
Rate for Payer: Humana Medicare Advantage	$17,083.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,585.82
Rate for Payer: Oxford Commercial	$20,645.75
Rate for Payer: UnitedHealthcare Commercial	$36,202.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,585.82
Rate for Payer: Wellcare Medicare Advantage	$16,585.82

PERITONEAL LAVAGE W/IMG

Facility

$2,289.68

Service Code	HCPCS 49084
Hospital Charge Code	5780235
Hospital Revenue Code	450
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$3,889.52
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$686.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$343.45
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$60.68

PERITONEAL LAVAGE W/IMG

Facility

$2,289.68

Service Code	HCPCS 49084
Hospital Charge Code	5780235
Hospital Revenue Code	450
Min. Negotiated Rate	$343.45
Max. Negotiated Rate	$343.45
Rate for Payer: Qualcare PPO/HMO/WC	$343.45

PERITONEAL WASHINGS

Facility

$264.85

Service Code	HCPCS 88104
Hospital Charge Code	3005348
Hospital Revenue Code	311
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.73
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$61.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$7.02

PERITONEAL WASHINGS

Facility

$264.85

Service Code	HCPCS 88104
Hospital Charge Code	3005348
Hospital Revenue Code	311
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$39.73
Rate for Payer: Qualcare PPO/HMO/WC	$39.73

PERI TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	74308145
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	74308145
Hospital Revenue Code	402
Min. Negotiated Rate	$117.99
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

PERITRATE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERITRATE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PERITRATE SA/TAB

Facility

$3.00

Hospital Charge Code	60634390
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PERITRATE SA/TAB

Facility

$3.00

Hospital Charge Code	60634390
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PERI ULTRASOUND, TRANSVAGINAL

Facility

$2,298.80

Service Code	HCPCS 76830
Hospital Charge Code	74308190
Hospital Revenue Code	402
Min. Negotiated Rate	$344.82
Max. Negotiated Rate	$344.82
Rate for Payer: Qualcare PPO/HMO/WC	$344.82

PERI ULTRASOUND, TRANSVAGINAL

Facility

$2,298.80

Service Code	HCPCS 76830
Hospital Charge Code	74308190
Hospital Revenue Code	402
Min. Negotiated Rate	$55.40
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$689.64
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$344.82
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$55.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$60.92

PERI US-GUIDE-AMNIOCENTESIS

Facility

$6,700.00

Service Code	HCPCS 76946
Hospital Charge Code	74308195
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI US-GUIDE-AMNIOCENTESIS

Facility

$6,700.00

Service Code	HCPCS 76946
Hospital Charge Code	74308195
Hospital Revenue Code	402
Min. Negotiated Rate	$60.02
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

PERI US-NUCHAL TRANSLUCEN-1ST

Facility

$6,700.00

Service Code	HCPCS 76813
Hospital Charge Code	74308125
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI US-NUCHAL TRANSLUCEN-1ST

Facility

$6,700.00

Service Code	HCPCS 76813
Hospital Charge Code	74308125
Hospital Revenue Code	402
Min. Negotiated Rate	$117.99
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$129.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

PERI US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	74308130
Hospital Revenue Code	402
Min. Negotiated Rate	$37.89
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

PERI US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	74308130
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI UTERINE ART DOPPLER

Facility

$669.00

Service Code	HCPCS 93976
Hospital Charge Code	74308220
Hospital Revenue Code	921
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$551.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.70
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$16.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$17.73

PERI UTERINE ART DOPPLER

Facility

$669.00

Service Code	HCPCS 93976
Hospital Charge Code	74308220
Hospital Revenue Code	921
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

PERI VBAC

Facility

$5,539.00

Service Code	HCPCS 59612
Hospital Charge Code	74308075
Hospital Revenue Code	722
Min. Negotiated Rate	$830.85
Max. Negotiated Rate	$830.85
Rate for Payer: Qualcare PPO/HMO/WC	$830.85

Know your out-of-pocket cost for care.

All Charges