Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

REDUCTION FORCEP

Facility

$2,916.95

Hospital Charge Code	270655155
Hospital Revenue Code	272
Min. Negotiated Rate	$437.54
Max. Negotiated Rate	$437.54
Rate for Payer: Qualcare PPO/HMO/WC	$437.54

REDUCTION FORCEP

Facility

$2,685.20

Hospital Charge Code	270655150
Hospital Revenue Code	272
Min. Negotiated Rate	$64.71
Max. Negotiated Rate	$1,342.60
Rate for Payer: Aetna Commercial	$1,020.38
Rate for Payer: Aetna Medicare Advantage	$805.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.73
Rate for Payer: Cigna Commercial	$1,342.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$805.56
Rate for Payer: Oxford Commercial	$537.04
Rate for Payer: Qualcare PPO/HMO/WC	$402.78
Rate for Payer: UnitedHealthcare Commercial	$537.04
Rate for Payer: UnitedHealthcare Community & State	$64.71
Rate for Payer: Wellpoint Medicaid Managed Care	$71.16

REDUCTION FORCEP WITH NARROW

Facility

$2,870.60

Hospital Charge Code	270655153
Hospital Revenue Code	272
Min. Negotiated Rate	$69.18
Max. Negotiated Rate	$1,435.30
Rate for Payer: Aetna Commercial	$1,090.83
Rate for Payer: Aetna Medicare Advantage	$861.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$732.00
Rate for Payer: Cigna Commercial	$1,435.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$861.18
Rate for Payer: Oxford Commercial	$574.12
Rate for Payer: Qualcare PPO/HMO/WC	$430.59
Rate for Payer: UnitedHealthcare Commercial	$574.12
Rate for Payer: UnitedHealthcare Community & State	$69.18
Rate for Payer: Wellpoint Medicaid Managed Care	$76.07

REDUCTION FORCEP WITH NARROW

Facility

$2,870.60

Hospital Charge Code	270655153
Hospital Revenue Code	272
Min. Negotiated Rate	$430.59
Max. Negotiated Rate	$430.59
Rate for Payer: Qualcare PPO/HMO/WC	$430.59

REDUCTION PIN CANCELL THD 5.0M

Facility

$3,335.00

Hospital Charge Code	270701156
Hospital Revenue Code	279
Min. Negotiated Rate	$500.25
Max. Negotiated Rate	$500.25
Rate for Payer: Qualcare PPO/HMO/WC	$500.25

REDUCTION PIN CANCELL THD 5.0M

Facility

$3,335.00

Hospital Charge Code	270701156
Hospital Revenue Code	279
Min. Negotiated Rate	$80.37
Max. Negotiated Rate	$1,667.50
Rate for Payer: Aetna Commercial	$1,267.30
Rate for Payer: Aetna Medicare Advantage	$1,000.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$850.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$850.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$850.42
Rate for Payer: Cigna Commercial	$1,667.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,000.50
Rate for Payer: Oxford Commercial	$667.00
Rate for Payer: Qualcare PPO/HMO/WC	$500.25
Rate for Payer: UnitedHealthcare Commercial	$667.00
Rate for Payer: UnitedHealthcare Community & State	$80.37
Rate for Payer: Wellpoint Medicaid Managed Care	$88.38

REDUCTION TALOTARSAL JOINT

Facility

$713.00

Service Code	HCPCS 28570
Hospital Charge Code	5780115
Hospital Revenue Code	450
Min. Negotiated Rate	$106.95
Max. Negotiated Rate	$106.95
Rate for Payer: Qualcare PPO/HMO/WC	$106.95

REDUCTION TALOTARSAL JOINT

Facility

$713.00

Service Code	HCPCS 28570
Hospital Charge Code	5780115
Hospital Revenue Code	450
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$1,057.82
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$106.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$18.89

REDUCTN OF TORSION TESTIS SURG

Facility

$20,610.70

Service Code	HCPCS 54600
Hospital Charge Code	1600000816
Hospital Revenue Code	360
Min. Negotiated Rate	$3,091.61
Max. Negotiated Rate	$3,091.61
Rate for Payer: Qualcare PPO/HMO/WC	$3,091.61

REDUCTN OF TORSION TESTIS SURG

Facility

$20,610.70

Service Code	HCPCS 54600
Hospital Charge Code	1600000816
Hospital Revenue Code	360
Min. Negotiated Rate	$496.72
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,183.21
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,091.61
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$496.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$546.18

REDUCTN TARSOMETATARSAL JOINT

Facility

$645.00

Service Code	HCPCS 28600
Hospital Charge Code	5780120
Hospital Revenue Code	450
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$1,057.82
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$17.09

REDUCTN TARSOMETATARSAL JOINT

Facility

$645.00

Service Code	HCPCS 28600
Hospital Charge Code	5780120
Hospital Revenue Code	450
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

RE-EVALUATION OT

Facility

$286.00

Service Code	HCPCS 97004GO
Hospital Charge Code	74203023
Hospital Revenue Code	434
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$108.68
Rate for Payer: Aetna Medicare Advantage	$85.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.93
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	$72.93
Rate for Payer: Cigna Commercial	$143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

RE-EVALUATION OT

Facility

$286.00

Service Code	HCPCS 97004GO
Hospital Charge Code	74203023
Hospital Revenue Code	434
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

RE EVALUATION PT

Facility

$394.00

Service Code	HCPCS 97164
Hospital Charge Code	409297164
Hospital Revenue Code	424
Min. Negotiated Rate	$59.10
Max. Negotiated Rate	$59.10
Rate for Payer: Qualcare PPO/HMO/WC	$59.10

RE EVALUATION PT

Facility

$394.00

Service Code	HCPCS 97164
Hospital Charge Code	409297164
Hospital Revenue Code	424
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$149.72
Rate for Payer: Aetna Medicare Advantage	$118.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.47
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	$100.47
Rate for Payer: Cigna Commercial	$197.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10.44

REFECOXIB 12.5MG TAB

Facility

$12.20

Hospital Charge Code	60629184
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.83

REFECOXIB 12.5MG TAB

Facility

$12.20

Hospital Charge Code	60629184
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.10
Rate for Payer: Aetna Commercial	$4.64
Rate for Payer: Aetna Medicare Advantage	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.11
Rate for Payer: Cigna Commercial	$6.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Oxford Commercial	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.83
Rate for Payer: UnitedHealthcare Commercial	$2.44
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

REFERRED AB ID, COMPLEX

Facility

$149.00

Service Code	HCPCS 86870
Hospital Charge Code	38471152
Hospital Revenue Code	302
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

REFERRED AB ID, COMPLEX

Facility

$149.00

Service Code	HCPCS 86870
Hospital Charge Code	38471152
Hospital Revenue Code	302
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$1,537.15
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,537.15
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

REFILL/MAINT IMPL PUMP SYSTEMI

Facility

$884.30

Service Code	HCPCS 96522
Hospital Charge Code	3401152
Hospital Revenue Code	335
Min. Negotiated Rate	$132.65
Max. Negotiated Rate	$132.65
Rate for Payer: Qualcare PPO/HMO/WC	$132.65

REFILL/MAINT IMPL PUMP SYSTEMI

Facility

$884.30

Service Code	HCPCS 96522
Hospital Charge Code	3401152
Hospital Revenue Code	335
Min. Negotiated Rate	$21.31
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$176.89
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.29
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.65
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$21.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$23.43

REFILL/MAINT PORTABLE PUMP

Facility

$1,292.25

Service Code	HCPCS 96521
Hospital Charge Code	3401151
Hospital Revenue Code	335
Min. Negotiated Rate	$193.84
Max. Negotiated Rate	$193.84
Rate for Payer: Qualcare PPO/HMO/WC	$193.84

REFILL/MAINT PORTABLE PUMP

Facility

$1,292.25

Service Code	HCPCS 96521
Hospital Charge Code	3401151
Hospital Revenue Code	335
Min. Negotiated Rate	$31.14
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$176.89
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.68
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.84
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$31.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$34.24

REFIT MULTIPLE DROP & LOCATION

Facility

$3,076.25

Hospital Charge Code	270659148
Hospital Revenue Code	278
Min. Negotiated Rate	$461.44
Max. Negotiated Rate	$744.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.77
Rate for Payer: Qualcare PPO/HMO/WC	$461.44

Know your out-of-pocket cost for care.

All Charges