Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38472806
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479424
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38472806
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.10
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479424
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.10
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479453
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

SEPARATION &ID HIGH RES TECH

Facility

$118.69

Service Code	HCPCS 83909
Hospital Charge Code	38479453
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.10
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

Separator 4

Facility

$44,400.00

Hospital Charge Code	270685894N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,070.04
Max. Negotiated Rate	$22,200.00
Rate for Payer: Aetna Commercial	$16,872.00
Rate for Payer: Aetna Medicare Advantage	$13,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,322.00
Rate for Payer: Cigna Commercial	$22,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,320.00
Rate for Payer: Oxford Commercial	$8,880.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,660.00
Rate for Payer: UnitedHealthcare Commercial	$8,880.00
Rate for Payer: UnitedHealthcare Community & State	$1,070.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,176.60

Separator 4

Facility

$4,400.00

Hospital Charge Code	270685894
Hospital Revenue Code	272
Min. Negotiated Rate	$106.04
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,672.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,320.00
Rate for Payer: Oxford Commercial	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00
Rate for Payer: UnitedHealthcare Commercial	$880.00
Rate for Payer: UnitedHealthcare Community & State	$106.04
Rate for Payer: Wellpoint Medicaid Managed Care	$116.60

Separator 4

Facility

$4,400.00

Hospital Charge Code	270685894
Hospital Revenue Code	272
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

Separator 4

Facility

$44,400.00

Hospital Charge Code	270685894N
Hospital Revenue Code	272
Min. Negotiated Rate	$6,660.00
Max. Negotiated Rate	$6,660.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,660.00

SEPARATOR 4

Facility

$4,400.00

Hospital Charge Code	270685894S
Hospital Revenue Code	272
Min. Negotiated Rate	$106.04
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,672.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,320.00
Rate for Payer: Oxford Commercial	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00
Rate for Payer: UnitedHealthcare Commercial	$880.00
Rate for Payer: UnitedHealthcare Community & State	$106.04
Rate for Payer: Wellpoint Medicaid Managed Care	$116.60

SEPARATOR 4

Facility

$4,400.00

Hospital Charge Code	270685894S
Hospital Revenue Code	272
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

SEPARATOR 8 150CM

Facility

$9,400.00

Hospital Charge Code	270683397
Hospital Revenue Code	272
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$1,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

SEPARATOR 8 150CM

Facility

$9,400.00

Hospital Charge Code	270683397
Hospital Revenue Code	272
Min. Negotiated Rate	$226.54
Max. Negotiated Rate	$4,700.00
Rate for Payer: Aetna Commercial	$3,572.00
Rate for Payer: Aetna Medicare Advantage	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.00
Rate for Payer: Cigna Commercial	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,820.00
Rate for Payer: Oxford Commercial	$1,880.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00
Rate for Payer: UnitedHealthcare Commercial	$1,880.00
Rate for Payer: UnitedHealthcare Community & State	$226.54
Rate for Payer: Wellpoint Medicaid Managed Care	$249.10

SEPARATOR 8 150CM

Facility

$9,400.00

Hospital Charge Code	270683397N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$1,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

SEPARATOR 8 150CM

Facility

$9,400.00

Hospital Charge Code	270683397N
Hospital Revenue Code	272
Min. Negotiated Rate	$226.54
Max. Negotiated Rate	$4,700.00
Rate for Payer: Aetna Commercial	$3,572.00
Rate for Payer: Aetna Medicare Advantage	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.00
Rate for Payer: Cigna Commercial	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,820.00
Rate for Payer: Oxford Commercial	$1,880.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00
Rate for Payer: UnitedHealthcare Commercial	$1,880.00
Rate for Payer: UnitedHealthcare Community & State	$226.54
Rate for Payer: Wellpoint Medicaid Managed Care	$249.10

SEPRA FILM

Facility

$1,345.00

Hospital Charge Code	270627662
Hospital Revenue Code	272
Min. Negotiated Rate	$201.75
Max. Negotiated Rate	$201.75
Rate for Payer: Qualcare PPO/HMO/WC	$201.75

SEPRA FILM

Facility

$1,345.00

Hospital Charge Code	270627662
Hospital Revenue Code	272
Min. Negotiated Rate	$32.41
Max. Negotiated Rate	$672.50
Rate for Payer: Aetna Commercial	$511.10
Rate for Payer: Aetna Medicare Advantage	$403.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.98
Rate for Payer: Cigna Commercial	$672.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.50
Rate for Payer: Oxford Commercial	$269.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.75
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Community & State	$32.41
Rate for Payer: Wellpoint Medicaid Managed Care	$35.64

SEPRAPA UNILAT APPLI 7089-0810

Facility

$345.05

Hospital Charge Code	270639838
Hospital Revenue Code	272
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$51.76
Rate for Payer: Qualcare PPO/HMO/WC	$51.76

SEPRAPA UNILAT APPLI 7089-0810

Facility

$345.05

Hospital Charge Code	270639838
Hospital Revenue Code	272
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$172.53
Rate for Payer: Aetna Commercial	$131.12
Rate for Payer: Aetna Medicare Advantage	$103.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.99
Rate for Payer: Cigna Commercial	$172.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.52
Rate for Payer: Oxford Commercial	$69.01
Rate for Payer: Qualcare PPO/HMO/WC	$51.76
Rate for Payer: UnitedHealthcare Commercial	$69.01
Rate for Payer: UnitedHealthcare Community & State	$8.32
Rate for Payer: Wellpoint Medicaid Managed Care	$9.14

SEPT9 METHYLATED DNA DETECTION

Facility

$200.00

Service Code	HCPCS 81401
Hospital Charge Code	3038132
Hospital Revenue Code	310
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

SEPT9 METHYLATED DNA DETECTION

Facility

$200.00

Service Code	HCPCS 81401
Hospital Charge Code	3038132
Hospital Revenue Code	310
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$494.53
Rate for Payer: Aetna Commercial	$372.64
Rate for Payer: Aetna Medicare Advantage	$443.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$494.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$494.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$494.53
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: Cigna Medicare Advantage	$137.00
Rate for Payer: Clover Medicare Advantage	$130.15
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Humana Medicare Advantage	$141.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$109.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.00
Rate for Payer: Wellcare Medicare Advantage	$137.00
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

SEPTIC ARTHRITIS WITH CC

Facility

$41,152.80

Service Code	MSDRG 549
Min. Negotiated Rate	$12,530.50
Max. Negotiated Rate	$41,152.80
Rate for Payer: Aetna Commercial	$28,533.99
Rate for Payer: Aetna Medicare Advantage	$41,152.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,145.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,145.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,145.81
Rate for Payer: Cigna Commercial	$22,591.54
Rate for Payer: Cigna Medicare Advantage	$13,190.00
Rate for Payer: Clover Medicare Advantage	$12,530.50
Rate for Payer: EmblemHealth Commercial	$39,570.00
Rate for Payer: Humana Medicare Advantage	$13,585.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,190.00
Rate for Payer: Oxford Commercial	$16,236.84
Rate for Payer: UnitedHealthcare Commercial	$28,471.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,190.00
Rate for Payer: Wellcare Medicare Advantage	$13,190.00

SEPTIC ARTHRITIS WITH MCC

Facility

$64,543.94

Service Code	MSDRG 548
Min. Negotiated Rate	$19,652.80
Max. Negotiated Rate	$64,543.94
Rate for Payer: Aetna Commercial	$44,606.37
Rate for Payer: Aetna Medicare Advantage	$64,543.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,358.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,358.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,687.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,358.95
Rate for Payer: Cigna Commercial	$36,134.86
Rate for Payer: Cigna Medicare Advantage	$20,687.16
Rate for Payer: Clover Medicare Advantage	$19,652.80
Rate for Payer: EmblemHealth Commercial	$62,061.48
Rate for Payer: Humana Medicare Advantage	$21,307.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,687.16
Rate for Payer: Oxford Commercial	$25,970.60
Rate for Payer: UnitedHealthcare Commercial	$45,540.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,687.16
Rate for Payer: Wellcare Medicare Advantage	$20,687.16

SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$30,386.46

Service Code	MSDRG 550
Min. Negotiated Rate	$9,252.29
Max. Negotiated Rate	$30,386.46
Rate for Payer: Aetna Commercial	$21,136.30
Rate for Payer: Aetna Medicare Advantage	$30,386.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,865.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,865.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,739.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,865.34
Rate for Payer: Cigna Commercial	$16,357.91
Rate for Payer: Cigna Medicare Advantage	$9,739.25
Rate for Payer: Clover Medicare Advantage	$9,252.29
Rate for Payer: EmblemHealth Commercial	$29,217.75
Rate for Payer: Humana Medicare Advantage	$10,031.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,739.25
Rate for Payer: Oxford Commercial	$11,756.65
Rate for Payer: UnitedHealthcare Commercial	$20,615.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,739.25
Rate for Payer: Wellcare Medicare Advantage	$9,739.25

Know your out-of-pocket cost for care.

All Charges