Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TREATMENT RM 0-30 MINUTES

Facility

$97.20

Hospital Charge Code	3401005
Hospital Revenue Code	769
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.60
Rate for Payer: Aetna Commercial	$36.94
Rate for Payer: Aetna Medicare Advantage	$29.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.79
Rate for Payer: Cigna Commercial	$48.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.16
Rate for Payer: Oxford Commercial	$19.44
Rate for Payer: Qualcare PPO/HMO/WC	$14.58
Rate for Payer: UnitedHealthcare Commercial	$19.44
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

TREATMENT RM 0-30 MINUTES

Facility

$97.20

Hospital Charge Code	3401005
Hospital Revenue Code	769
Min. Negotiated Rate	$14.58
Max. Negotiated Rate	$14.58
Rate for Payer: Qualcare PPO/HMO/WC	$14.58

TREATMENT RM 120-180 MIN

Facility

$253.20

Hospital Charge Code	3400062
Hospital Revenue Code	769
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$37.98
Rate for Payer: Qualcare PPO/HMO/WC	$37.98

TREATMENT RM 120-180 MIN

Facility

$253.20

Hospital Charge Code	3400062
Hospital Revenue Code	769
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$126.60
Rate for Payer: Aetna Commercial	$96.22
Rate for Payer: Aetna Medicare Advantage	$75.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.57
Rate for Payer: Cigna Commercial	$126.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.96
Rate for Payer: Oxford Commercial	$50.64
Rate for Payer: Qualcare PPO/HMO/WC	$37.98
Rate for Payer: UnitedHealthcare Commercial	$50.64
Rate for Payer: UnitedHealthcare Community & State	$6.10
Rate for Payer: Wellpoint Medicaid Managed Care	$6.71

TREATMENT RM <1 HOUR****

Facility

$250.00

Hospital Charge Code	1001056
Hospital Revenue Code	761
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$50.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

TREATMENT RM <1 HOUR****

Facility

$250.00

Hospital Charge Code	1001056
Hospital Revenue Code	761
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

TREATMENT RM 2-4 HOURS*****

Facility

$490.00

Hospital Charge Code	1001064
Hospital Revenue Code	761
Min. Negotiated Rate	$11.81
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.95
Rate for Payer: Cigna Commercial	$245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.00
Rate for Payer: Oxford Commercial	$98.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.50
Rate for Payer: UnitedHealthcare Commercial	$98.00
Rate for Payer: UnitedHealthcare Community & State	$11.81
Rate for Payer: Wellpoint Medicaid Managed Care	$12.98

TREATMENT RM 2-4 HOURS*****

Facility

$490.00

Hospital Charge Code	1001064
Hospital Revenue Code	761
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$73.50
Rate for Payer: Qualcare PPO/HMO/WC	$73.50

TREATMENT RM 3-4 HRS***

Facility

$291.60

Hospital Charge Code	3400061
Hospital Revenue Code	769
Min. Negotiated Rate	$7.03
Max. Negotiated Rate	$145.80
Rate for Payer: Aetna Commercial	$110.81
Rate for Payer: Aetna Medicare Advantage	$87.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.36
Rate for Payer: Cigna Commercial	$145.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.48
Rate for Payer: Oxford Commercial	$58.32
Rate for Payer: Qualcare PPO/HMO/WC	$43.74
Rate for Payer: UnitedHealthcare Commercial	$58.32
Rate for Payer: UnitedHealthcare Community & State	$7.03
Rate for Payer: Wellpoint Medicaid Managed Care	$7.73

TREATMENT RM 3-4 HRS***

Facility

$291.60

Hospital Charge Code	3400061
Hospital Revenue Code	769
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$43.74
Rate for Payer: Qualcare PPO/HMO/WC	$43.74

TREATMENT RM/3 60-120 MIN

Facility

$364.80

Service Code	HCPCS 99999
Hospital Charge Code	3400058
Hospital Revenue Code	769
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$182.40
Rate for Payer: Aetna Commercial	$138.62
Rate for Payer: Aetna Medicare Advantage	$109.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.02
Rate for Payer: Cigna Commercial	$182.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.44
Rate for Payer: Oxford Commercial	$72.96
Rate for Payer: Qualcare PPO/HMO/WC	$54.72
Rate for Payer: UnitedHealthcare Commercial	$72.96
Rate for Payer: UnitedHealthcare Community & State	$8.79
Rate for Payer: Wellpoint Medicaid Managed Care	$9.67

TREATMENT RM/3 60-120 MIN

Facility

$364.80

Service Code	HCPCS 99999
Hospital Charge Code	3400058
Hospital Revenue Code	769
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$54.72
Rate for Payer: Qualcare PPO/HMO/WC	$54.72

TREATMENT RM 4-8 HRS

Facility

$453.60

Hospital Charge Code	3400060
Hospital Revenue Code	769
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna Commercial	$172.37
Rate for Payer: Aetna Medicare Advantage	$136.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.67
Rate for Payer: Cigna Commercial	$226.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.08
Rate for Payer: Oxford Commercial	$90.72
Rate for Payer: Qualcare PPO/HMO/WC	$68.04
Rate for Payer: UnitedHealthcare Commercial	$90.72
Rate for Payer: UnitedHealthcare Community & State	$10.93
Rate for Payer: Wellpoint Medicaid Managed Care	$12.02

TREATMENT RM 4-8 HRS

Facility

$453.60

Hospital Charge Code	3400060
Hospital Revenue Code	769
Min. Negotiated Rate	$68.04
Max. Negotiated Rate	$68.04
Rate for Payer: Qualcare PPO/HMO/WC	$68.04

TREATMENT RM > 4 HOURS***

Facility

$1,642.00

Hospital Charge Code	1001098
Hospital Revenue Code	761
Min. Negotiated Rate	$39.57
Max. Negotiated Rate	$821.00
Rate for Payer: Aetna Commercial	$623.96
Rate for Payer: Aetna Medicare Advantage	$492.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$418.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$418.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$418.71
Rate for Payer: Cigna Commercial	$821.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$492.60
Rate for Payer: Oxford Commercial	$328.40
Rate for Payer: Qualcare PPO/HMO/WC	$246.30
Rate for Payer: UnitedHealthcare Commercial	$328.40
Rate for Payer: UnitedHealthcare Community & State	$39.57
Rate for Payer: Wellpoint Medicaid Managed Care	$43.51

TREATMENT RM > 4 HOURS***

Facility

$1,642.00

Hospital Charge Code	1001098
Hospital Revenue Code	761
Min. Negotiated Rate	$246.30
Max. Negotiated Rate	$246.30
Rate for Payer: Qualcare PPO/HMO/WC	$246.30

TREATMENT RM - OV-4

Facility

$831.25

Hospital Charge Code	6900021
Hospital Revenue Code	361
Min. Negotiated Rate	$20.03
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$315.88
Rate for Payer: Aetna Medicare Advantage	$249.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.97
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	$211.97
Rate for Payer: Cigna Commercial	$415.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.38
Rate for Payer: Qualcare PPO/HMO/WC	$124.69
Rate for Payer: UnitedHealthcare Community & State	$20.03
Rate for Payer: Wellpoint Medicaid Managed Care	$22.03

TREATMENT RM - OV-4

Facility

$831.25

Hospital Charge Code	6900021
Hospital Revenue Code	361
Min. Negotiated Rate	$124.69
Max. Negotiated Rate	$124.69
Rate for Payer: Qualcare PPO/HMO/WC	$124.69

TREATMENT RM/P 30-60 MIN/A DNR

Facility

$175.20

Hospital Charge Code	3400041
Hospital Revenue Code	769
Min. Negotiated Rate	$26.28
Max. Negotiated Rate	$26.28
Rate for Payer: Qualcare PPO/HMO/WC	$26.28

TREATMENT RM/P 30-60 MIN/A DNR

Facility

$175.20

Hospital Charge Code	3400041
Hospital Revenue Code	769
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.60
Rate for Payer: Aetna Commercial	$66.58
Rate for Payer: Aetna Medicare Advantage	$52.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.68
Rate for Payer: Cigna Commercial	$87.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.56
Rate for Payer: Oxford Commercial	$35.04
Rate for Payer: Qualcare PPO/HMO/WC	$26.28
Rate for Payer: UnitedHealthcare Commercial	$35.04
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

TREATMENT RM - U4

Facility

$638.45

Hospital Charge Code	6900013
Hospital Revenue Code	361
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$242.61
Rate for Payer: Aetna Medicare Advantage	$191.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.80
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	$162.80
Rate for Payer: Cigna Commercial	$319.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$95.77
Rate for Payer: UnitedHealthcare Community & State	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$16.92

TREATMENT RM - U4

Facility

$638.45

Hospital Charge Code	6900013
Hospital Revenue Code	361
Min. Negotiated Rate	$95.77
Max. Negotiated Rate	$95.77
Rate for Payer: Qualcare PPO/HMO/WC	$95.77

TREATMENT ROOM 30 MI*******

Facility

$75.00

Hospital Charge Code	34010005
Hospital Revenue Code	769
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

TREATMENT ROOM 30 MI*******

Facility

$75.00

Hospital Charge Code	34010005
Hospital Revenue Code	769
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

TREATMENT TIBIAL FX

Facility

$645.00

Service Code	HCPCS 27760
Hospital Charge Code	9808210
Hospital Revenue Code	361
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

Know your out-of-pocket cost for care.

All Charges