Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PNEUMOGRAM 24 HR/2 CHAN*****

Facility

$1,020.00

Hospital Charge Code	270606216
Hospital Revenue Code	270
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

PNEUMOGRAM 24 HR/4 CHANNEL

Facility

$3,281.25

Service Code	HCPCS 94772
Hospital Charge Code	110000
Hospital Revenue Code	469
Min. Negotiated Rate	$79.08
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$984.38
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$492.19
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$79.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$86.95

PNEUMOGRAM 24 HR/4 CHANNEL

Facility

$3,281.25

Service Code	HCPCS 94772
Hospital Charge Code	110000
Hospital Revenue Code	469
Min. Negotiated Rate	$492.19
Max. Negotiated Rate	$492.19
Rate for Payer: Qualcare PPO/HMO/WC	$492.19

PNEUMONITIS HEPERSENS

Facility

$336.00

Service Code	HCPCS 86753
Hospital Charge Code	3009636A
Hospital Revenue Code	302
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

PNEUMONITIS HEPERSENS

Facility

$336.00

Service Code	HCPCS 86753
Hospital Charge Code	3009636A
Hospital Revenue Code	302
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.72
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$8.90

PNEUMONOCCOCAL VAC 0.5 ML VIAL

Facility

$541.90

Service Code	HCPCS 90732
Hospital Charge Code	83652335
Hospital Revenue Code	636
Min. Negotiated Rate	$81.28
Max. Negotiated Rate	$131.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.14
Rate for Payer: Qualcare PPO/HMO/WC	$81.28

PNEUMONOCCOCAL VAC 0.5 ML VIAL

Facility

$541.90

Service Code	HCPCS 90732
Hospital Charge Code	83652335
Hospital Revenue Code	636
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$270.95
Rate for Payer: Aetna Commercial	$205.92
Rate for Payer: Aetna Medicare Advantage	$162.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.18
Rate for Payer: Cigna Commercial	$270.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.14
Rate for Payer: Qualcare PPO/HMO/WC	$81.28
Rate for Payer: UnitedHealthcare Community & State	$13.06
Rate for Payer: Wellpoint Medicaid Managed Care	$14.36

PNEUMOTHORAX KIT ARW AK01500**

Facility

$234.00

Hospital Charge Code	8003246
Hospital Revenue Code	279
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$88.92
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$46.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Commercial	$46.80
Rate for Payer: UnitedHealthcare Community & State	$5.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.20

PNEUMOTHORAX KIT ARW AK01500**

Facility

$234.00

Hospital Charge Code	8003246
Hospital Revenue Code	279
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

PNEUMOTHORAX WITH CC

Facility

$37,665.26

Service Code	MSDRG 200
Min. Negotiated Rate	$11,468.59
Max. Negotiated Rate	$37,665.26
Rate for Payer: Aetna Commercial	$26,137.64
Rate for Payer: Aetna Medicare Advantage	$37,665.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,121.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,121.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,072.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,121.88
Rate for Payer: Cigna Commercial	$20,572.30
Rate for Payer: Cigna Medicare Advantage	$12,072.20
Rate for Payer: Clover Medicare Advantage	$11,468.59
Rate for Payer: EmblemHealth Commercial	$36,216.60
Rate for Payer: Humana Medicare Advantage	$12,434.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,072.20
Rate for Payer: Oxford Commercial	$14,785.58
Rate for Payer: UnitedHealthcare Commercial	$25,926.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,072.20
Rate for Payer: Wellcare Medicare Advantage	$12,072.20

PNEUMOTHORAX WITH MCC

Facility

$59,152.70

Service Code	MSDRG 199
Min. Negotiated Rate	$18,011.24
Max. Negotiated Rate	$59,152.70
Rate for Payer: Aetna Commercial	$40,901.97
Rate for Payer: Aetna Medicare Advantage	$59,152.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,171.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,171.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,959.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,171.97
Rate for Payer: Cigna Commercial	$33,013.37
Rate for Payer: Cigna Medicare Advantage	$18,959.20
Rate for Payer: Clover Medicare Advantage	$18,011.24
Rate for Payer: EmblemHealth Commercial	$56,877.60
Rate for Payer: Humana Medicare Advantage	$19,527.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,959.20
Rate for Payer: Oxford Commercial	$23,727.15
Rate for Payer: UnitedHealthcare Commercial	$41,606.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,959.20
Rate for Payer: Wellcare Medicare Advantage	$18,959.20

PNEUMOTHORAX WITHOUT CC/MCC

Facility

$25,247.29

Service Code	MSDRG 201
Min. Negotiated Rate	$7,687.48
Max. Negotiated Rate	$25,247.29
Rate for Payer: Aetna Commercial	$17,605.10
Rate for Payer: Aetna Medicare Advantage	$25,247.29
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	$8,092.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,515.31
Rate for Payer: Cigna Commercial	$13,382.38
Rate for Payer: Cigna Medicare Advantage	$8,092.08
Rate for Payer: Clover Medicare Advantage	$7,687.48
Rate for Payer: EmblemHealth Commercial	$24,276.24
Rate for Payer: Humana Medicare Advantage	$8,334.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,092.08
Rate for Payer: Oxford Commercial	$9,618.09
Rate for Payer: UnitedHealthcare Commercial	$16,865.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,092.08
Rate for Payer: Wellcare Medicare Advantage	$8,092.08

POBA 2X ADDITION

Facility

$34,486.68

Hospital Charge Code	74110058
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA 2X ADDITION

Facility

$34,486.68

Hospital Charge Code	74110058
Hospital Revenue Code	481
Min. Negotiated Rate	$831.13
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$13,104.94
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,346.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00
Rate for Payer: UnitedHealthcare Community & State	$831.13
Rate for Payer: Wellpoint Medicaid Managed Care	$913.90

POBA 2X ADDITION

Facility

$34,486.68

Hospital Charge Code	5100629
Hospital Revenue Code	481
Min. Negotiated Rate	$831.13
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$13,104.94
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,346.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00
Rate for Payer: UnitedHealthcare Community & State	$831.13
Rate for Payer: Wellpoint Medicaid Managed Care	$913.90

POBA 2X ADDITION

Facility

$34,486.68

Hospital Charge Code	5100629
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA ADDITION

Facility

$34,486.68

Hospital Charge Code	74110057
Hospital Revenue Code	481
Min. Negotiated Rate	$831.13
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$13,104.94
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,346.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00
Rate for Payer: UnitedHealthcare Community & State	$831.13
Rate for Payer: Wellpoint Medicaid Managed Care	$913.90

POBA ADDITION

Facility

$34,486.68

Hospital Charge Code	5100625
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA ADDITION

Facility

$34,486.68

Hospital Charge Code	5100625
Hospital Revenue Code	481
Min. Negotiated Rate	$831.13
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$13,104.94
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,346.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00
Rate for Payer: UnitedHealthcare Community & State	$831.13
Rate for Payer: Wellpoint Medicaid Managed Care	$913.90

POBA ADDITION

Facility

$34,486.68

Hospital Charge Code	74110057
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA SINGLE

Facility

$34,486.68

Hospital Charge Code	74110056
Hospital Revenue Code	481
Min. Negotiated Rate	$831.13
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$13,104.94
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,346.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00
Rate for Payer: UnitedHealthcare Community & State	$831.13
Rate for Payer: Wellpoint Medicaid Managed Care	$913.90

POBA SINGLE

Facility

$34,486.68

Hospital Charge Code	74110056
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POBA SINGLE

Facility

$34,486.68

Hospital Charge Code	5100621
Hospital Revenue Code	481
Min. Negotiated Rate	$831.13
Max. Negotiated Rate	$17,243.34
Rate for Payer: Aetna Commercial	$13,104.94
Rate for Payer: Aetna Medicare Advantage	$10,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,794.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,794.10
Rate for Payer: Cigna Commercial	$17,243.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,346.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00
Rate for Payer: UnitedHealthcare Community & State	$831.13
Rate for Payer: Wellpoint Medicaid Managed Care	$913.90

POBA SINGLE

Facility

$34,486.68

Hospital Charge Code	5100621
Hospital Revenue Code	481
Min. Negotiated Rate	$5,173.00
Max. Negotiated Rate	$5,173.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,173.00

POC GLUCOSE

Facility

$639.70

Service Code	HCPCS 82948
Hospital Charge Code	3100140
Hospital Revenue Code	301
Min. Negotiated Rate	$95.95
Max. Negotiated Rate	$95.95
Rate for Payer: Qualcare PPO/HMO/WC	$95.95

Know your out-of-pocket cost for care.

All Charges