Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$7,127.85

Service Code	APR-DRG 7201
Min. Negotiated Rate	$6,988.09
Max. Negotiated Rate	$7,127.85
Rate for Payer: UnitedHealthcare Community & State	$6,988.09
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,127.85
Rate for Payer: Wellpoint Medicaid Managed Care	$6,988.09

SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$9,125.90

Service Code	APR-DRG 7202
Min. Negotiated Rate	$8,946.96
Max. Negotiated Rate	$9,125.90
Rate for Payer: UnitedHealthcare Community & State	$8,946.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,125.90
Rate for Payer: Wellpoint Medicaid Managed Care	$8,946.96

SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$13,633.96

Service Code	APR-DRG 7203
Min. Negotiated Rate	$13,366.63
Max. Negotiated Rate	$13,633.96
Rate for Payer: UnitedHealthcare Community & State	$13,366.63
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,633.96
Rate for Payer: Wellpoint Medicaid Managed Care	$13,366.63

SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$24,976.24

Service Code	APR-DRG 7204
Min. Negotiated Rate	$24,486.51
Max. Negotiated Rate	$24,976.24
Rate for Payer: UnitedHealthcare Community & State	$24,486.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,976.24
Rate for Payer: Wellpoint Medicaid Managed Care	$24,486.51

SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$225,534.85

Service Code	MSDRG 870
Min. Negotiated Rate	$68,672.47
Max. Negotiated Rate	$225,534.85
Rate for Payer: Aetna Commercial	$155,225.47
Rate for Payer: Aetna Medicare Advantage	$225,534.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161,896.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161,896.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$72,286.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161,896.56
Rate for Payer: Cigna Commercial	$129,347.43
Rate for Payer: Cigna Medicare Advantage	$72,286.81
Rate for Payer: Clover Medicare Advantage	$68,672.47
Rate for Payer: EmblemHealth Commercial	$216,860.43
Rate for Payer: Humana Medicare Advantage	$74,455.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$72,286.81
Rate for Payer: Oxford Commercial	$92,963.71
Rate for Payer: UnitedHealthcare Commercial	$163,014.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$72,286.81
Rate for Payer: Wellcare Medicare Advantage	$72,286.81

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$64,918.90

Service Code	MSDRG 871
Min. Negotiated Rate	$19,766.97
Max. Negotiated Rate	$64,918.90
Rate for Payer: Aetna Commercial	$44,864.01
Rate for Payer: Aetna Medicare Advantage	$64,918.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,056.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,056.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,807.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,056.78
Rate for Payer: Cigna Commercial	$36,351.94
Rate for Payer: Cigna Medicare Advantage	$20,807.34
Rate for Payer: Clover Medicare Advantage	$19,766.97
Rate for Payer: EmblemHealth Commercial	$62,422.02
Rate for Payer: Humana Medicare Advantage	$21,431.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,807.34
Rate for Payer: Oxford Commercial	$26,126.62
Rate for Payer: UnitedHealthcare Commercial	$45,813.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,807.34
Rate for Payer: Wellcare Medicare Advantage	$20,807.34

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility

$35,208.83

Service Code	MSDRG 872
Min. Negotiated Rate	$10,720.64
Max. Negotiated Rate	$35,208.83
Rate for Payer: Aetna Commercial	$24,449.82
Rate for Payer: Aetna Medicare Advantage	$35,208.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,958.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,958.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,284.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,958.83
Rate for Payer: Cigna Commercial	$19,150.04
Rate for Payer: Cigna Medicare Advantage	$11,284.88
Rate for Payer: Clover Medicare Advantage	$10,720.64
Rate for Payer: EmblemHealth Commercial	$33,854.64
Rate for Payer: Humana Medicare Advantage	$11,623.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,284.88
Rate for Payer: Oxford Commercial	$13,763.39
Rate for Payer: UnitedHealthcare Commercial	$24,134.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,284.88
Rate for Payer: Wellcare Medicare Advantage	$11,284.88

SEPTOPLASTY/SMR

Facility

$22,083.40

Service Code	HCPCS 30520
Hospital Charge Code	1600000330
Hospital Revenue Code	360
Min. Negotiated Rate	$3,312.51
Max. Negotiated Rate	$3,312.51
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51

SEPTOPLASTY/SMR

Facility

$22,083.40

Service Code	HCPCS 30520
Hospital Charge Code	1600000330
Hospital Revenue Code	360
Min. Negotiated Rate	$532.21
Max. Negotiated Rate	$14,218.07
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
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	$14,218.07
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,625.02
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$532.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$585.21

SEPTRA/473ML

Facility

$15.00

Hospital Charge Code	60633871
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

SEPTRA/473ML

Facility

$15.00

Hospital Charge Code	60633871
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

SEPTRA/5ML/ADDVANT

Facility

$18.00

Hospital Charge Code	60634678
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

SEPTRA/5ML/ADDVANT

Facility

$18.00

Hospital Charge Code	60634678
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

SEPTRA ADDVANTAGE

Facility

$27.00

Hospital Charge Code	60634462
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

SEPTRA ADDVANTAGE

Facility

$27.00

Hospital Charge Code	60634462
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SEPTRA I.V./10ML

Facility

$42.00

Hospital Charge Code	60633873
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

SEPTRA I.V./10ML

Facility

$42.00

Hospital Charge Code	60633873
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

SEPTRA I.V./5ML

Facility

$13.00

Hospital Charge Code	60633874
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

SEPTRA I.V./5ML

Facility

$13.00

Hospital Charge Code	60633874
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

SEPTRA I.V./5ML

Facility

$18.00

Hospital Charge Code	60633872
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

SEPTRA I.V./5ML

Facility

$18.00

Hospital Charge Code	60633872
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

SER-AP-ES

Facility

$3.00

Hospital Charge Code	60634437
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

SER-AP-ES

Facility

$3.00

Hospital Charge Code	60634437
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SERENTIL/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633875
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

SERENTIL/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633875
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges