Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RESP ALLERGY PROF REG I XXV

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069Y
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RESP BLOOD GASES-CORD BLOOD

Facility

$175.00

Hospital Charge Code	9509001
Hospital Revenue Code	301
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

RESP BLOOD GASES-CORD BLOOD

Facility

$175.00

Hospital Charge Code	9509001
Hospital Revenue Code	301
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

RESP INDUCED SPUTUM

Facility

$667.59

Service Code	HCPCS 89220
Hospital Charge Code	9508001
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

RESP INDUCED SPUTUM

Facility

$667.59

Service Code	HCPCS 89220
Hospital Charge Code	9508001
Hospital Revenue Code	309
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

RESPIRATORY FAILURE

Facility

$4,688.06

Service Code	APR-DRG 1331
Min. Negotiated Rate	$4,596.14
Max. Negotiated Rate	$4,688.06
Rate for Payer: UnitedHealthcare Community & State	$4,596.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,688.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4,596.14

RESPIRATORY FAILURE

Facility

$8,871.85

Service Code	APR-DRG 1332
Min. Negotiated Rate	$8,697.89
Max. Negotiated Rate	$8,871.85
Rate for Payer: UnitedHealthcare Community & State	$8,697.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,871.85
Rate for Payer: Wellpoint Medicaid Managed Care	$8,697.89

RESPIRATORY FAILURE

Facility

$13,360.78

Service Code	APR-DRG 1333
Min. Negotiated Rate	$13,098.80
Max. Negotiated Rate	$13,360.78
Rate for Payer: UnitedHealthcare Community & State	$13,098.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,360.78
Rate for Payer: Wellpoint Medicaid Managed Care	$13,098.80

RESPIRATORY FAILURE

Facility

$22,098.54

Service Code	APR-DRG 1334
Min. Negotiated Rate	$21,665.24
Max. Negotiated Rate	$22,098.54
Rate for Payer: UnitedHealthcare Community & State	$21,665.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,098.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21,665.24

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$33,679.99

Service Code	MSDRG 178
Min. Negotiated Rate	$10,255.13
Max. Negotiated Rate	$33,679.99
Rate for Payer: Aetna Commercial	$23,399.31
Rate for Payer: Aetna Medicare Advantage	$33,679.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,028.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,028.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,794.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,028.39
Rate for Payer: Cigna Commercial	$18,264.86
Rate for Payer: Cigna Medicare Advantage	$10,794.87
Rate for Payer: Clover Medicare Advantage	$10,255.13
Rate for Payer: EmblemHealth Commercial	$32,384.61
Rate for Payer: Humana Medicare Advantage	$11,118.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,794.87
Rate for Payer: Oxford Commercial	$13,127.20
Rate for Payer: UnitedHealthcare Commercial	$23,018.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,794.87
Rate for Payer: Wellcare Medicare Advantage	$10,794.87

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$52,643.14

Service Code	MSDRG 177
Min. Negotiated Rate	$16,029.16
Max. Negotiated Rate	$52,643.14
Rate for Payer: Aetna Commercial	$36,429.15
Rate for Payer: Aetna Medicare Advantage	$52,643.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39,543.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39,543.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,872.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39,543.70
Rate for Payer: Cigna Commercial	$29,244.37
Rate for Payer: Cigna Medicare Advantage	$16,872.80
Rate for Payer: Clover Medicare Advantage	$16,029.16
Rate for Payer: EmblemHealth Commercial	$50,618.40
Rate for Payer: Humana Medicare Advantage	$17,378.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,872.80
Rate for Payer: Oxford Commercial	$21,018.31
Rate for Payer: UnitedHealthcare Commercial	$36,856.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,872.80
Rate for Payer: Wellcare Medicare Advantage	$16,872.80

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$26,536.88

Service Code	MSDRG 179
Min. Negotiated Rate	$8,080.14
Max. Negotiated Rate	$26,536.88
Rate for Payer: Aetna Commercial	$18,491.18
Rate for Payer: Aetna Medicare Advantage	$26,536.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,678.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,678.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,505.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,678.36
Rate for Payer: Cigna Commercial	$14,129.07
Rate for Payer: Cigna Medicare Advantage	$8,505.41
Rate for Payer: Clover Medicare Advantage	$8,080.14
Rate for Payer: EmblemHealth Commercial	$25,516.23
Rate for Payer: Humana Medicare Advantage	$8,760.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,505.41
Rate for Payer: Oxford Commercial	$10,154.75
Rate for Payer: UnitedHealthcare Commercial	$17,806.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,505.41
Rate for Payer: Wellcare Medicare Advantage	$8,505.41

RESPIRATORY MALIGNANCY

Facility

$22,306.68

Service Code	APR-DRG 1364
Min. Negotiated Rate	$21,869.29
Max. Negotiated Rate	$22,306.68
Rate for Payer: UnitedHealthcare Community & State	$21,869.29
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,306.68
Rate for Payer: Wellpoint Medicaid Managed Care	$21,869.29

RESPIRATORY MALIGNANCY

Facility

$7,681.97

Service Code	APR-DRG 1361
Min. Negotiated Rate	$7,531.34
Max. Negotiated Rate	$7,681.97
Rate for Payer: UnitedHealthcare Community & State	$7,531.34
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,681.97
Rate for Payer: Wellpoint Medicaid Managed Care	$7,531.34

RESPIRATORY MALIGNANCY

Facility

$14,950.24

Service Code	APR-DRG 1363
Min. Negotiated Rate	$14,657.10
Max. Negotiated Rate	$14,950.24
Rate for Payer: UnitedHealthcare Community & State	$14,657.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,950.24
Rate for Payer: Wellpoint Medicaid Managed Care	$14,657.10

RESPIRATORY MALIGNANCY

Facility

$10,472.83

Service Code	APR-DRG 1362
Min. Negotiated Rate	$10,267.48
Max. Negotiated Rate	$10,472.83
Rate for Payer: UnitedHealthcare Community & State	$10,267.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,472.83
Rate for Payer: Wellpoint Medicaid Managed Care	$10,267.48

RESPIRATORY NEOPLASMS WITH CC

Facility

$36,750.60

Service Code	MSDRG 181
Min. Negotiated Rate	$11,190.09
Max. Negotiated Rate	$36,750.60
Rate for Payer: Aetna Commercial	$25,509.18
Rate for Payer: Aetna Medicare Advantage	$36,750.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,587.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,587.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,779.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,587.10
Rate for Payer: Cigna Commercial	$20,042.69
Rate for Payer: Cigna Medicare Advantage	$11,779.04
Rate for Payer: Clover Medicare Advantage	$11,190.09
Rate for Payer: EmblemHealth Commercial	$35,337.12
Rate for Payer: Humana Medicare Advantage	$12,132.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,779.04
Rate for Payer: Oxford Commercial	$14,404.95
Rate for Payer: UnitedHealthcare Commercial	$25,259.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,779.04
Rate for Payer: Wellcare Medicare Advantage	$11,779.04

RESPIRATORY NEOPLASMS WITH MCC

Facility

$59,214.11

Service Code	MSDRG 180
Min. Negotiated Rate	$18,029.94
Max. Negotiated Rate	$59,214.11
Rate for Payer: Aetna Commercial	$40,944.15
Rate for Payer: Aetna Medicare Advantage	$59,214.11
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	$18,978.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40,474.14
Rate for Payer: Cigna Commercial	$33,048.92
Rate for Payer: Cigna Medicare Advantage	$18,978.88
Rate for Payer: Clover Medicare Advantage	$18,029.94
Rate for Payer: EmblemHealth Commercial	$56,936.64
Rate for Payer: Humana Medicare Advantage	$19,548.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,978.88
Rate for Payer: Oxford Commercial	$23,752.70
Rate for Payer: UnitedHealthcare Commercial	$41,651.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,978.88
Rate for Payer: Wellcare Medicare Advantage	$18,978.88

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$26,498.13

Service Code	MSDRG 182
Min. Negotiated Rate	$8,068.34
Max. Negotiated Rate	$26,498.13
Rate for Payer: Aetna Commercial	$18,464.57
Rate for Payer: Aetna Medicare Advantage	$26,498.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,608.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,608.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,492.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,608.80
Rate for Payer: Cigna Commercial	$13,923.22
Rate for Payer: Cigna Medicare Advantage	$8,492.99
Rate for Payer: Clover Medicare Advantage	$8,068.34
Rate for Payer: EmblemHealth Commercial	$25,478.97
Rate for Payer: Humana Medicare Advantage	$8,747.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,492.99
Rate for Payer: Oxford Commercial	$10,006.80
Rate for Payer: UnitedHealthcare Commercial	$17,547.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,492.99
Rate for Payer: Wellcare Medicare Advantage	$8,492.99

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$28,230.57

Service Code	MSDRG 204
Min. Negotiated Rate	$8,595.85
Max. Negotiated Rate	$28,230.57
Rate for Payer: Aetna Commercial	$19,654.94
Rate for Payer: Aetna Medicare Advantage	$28,230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,074.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,074.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,048.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,074.02
Rate for Payer: Cigna Commercial	$15,109.68
Rate for Payer: Cigna Medicare Advantage	$9,048.26
Rate for Payer: Clover Medicare Advantage	$8,595.85
Rate for Payer: EmblemHealth Commercial	$27,144.78
Rate for Payer: Humana Medicare Advantage	$9,319.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,048.26
Rate for Payer: Oxford Commercial	$10,859.53
Rate for Payer: UnitedHealthcare Commercial	$19,042.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,048.26
Rate for Payer: Wellcare Medicare Advantage	$9,048.26

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$7,994.79

Service Code	APR-DRG 1442
Min. Negotiated Rate	$7,838.03
Max. Negotiated Rate	$7,994.79
Rate for Payer: UnitedHealthcare Community & State	$7,838.03
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,994.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7,838.03

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$6,126.91

Service Code	APR-DRG 1441
Min. Negotiated Rate	$6,006.77
Max. Negotiated Rate	$6,126.91
Rate for Payer: UnitedHealthcare Community & State	$6,006.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,126.91
Rate for Payer: Wellpoint Medicaid Managed Care	$6,006.77

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$20,200.09

Service Code	APR-DRG 1444
Min. Negotiated Rate	$19,804.01
Max. Negotiated Rate	$20,200.09
Rate for Payer: UnitedHealthcare Community & State	$19,804.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,200.09
Rate for Payer: Wellpoint Medicaid Managed Care	$19,804.01

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$11,942.31

Service Code	APR-DRG 1443
Min. Negotiated Rate	$11,708.15
Max. Negotiated Rate	$11,942.31
Rate for Payer: UnitedHealthcare Community & State	$11,708.15
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,942.31
Rate for Payer: Wellpoint Medicaid Managed Care	$11,708.15

RESPIRATORY SYNCYTIAL VIRUS AN

Facility

$180.00

Service Code	HCPCS 86756
Hospital Charge Code	38476182
Hospital Revenue Code	302
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

Know your out-of-pocket cost for care.

All Charges