Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

UNSTERILE 8X7 DOZ****

Facility

$20.00

Hospital Charge Code	8000556
Hospital Revenue Code	279
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.00
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

UNSTERILE 8X7 DOZ****

Facility

$20.00

Hospital Charge Code	8000556
Hospital Revenue Code	279
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

UNSUCCSSFL PTCA INTERVENT

Facility

$23,778.00

Hospital Charge Code	7411275
Hospital Revenue Code	481
Min. Negotiated Rate	$3,566.70
Max. Negotiated Rate	$3,566.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.70

UNSUCCSSFL PTCA INTERVENT

Facility

$23,778.00

Service Code	HCPCS 9298074
Hospital Charge Code	7411185
Hospital Revenue Code	481
Min. Negotiated Rate	$573.05
Max. Negotiated Rate	$11,889.00
Rate for Payer: Aetna Commercial	$9,035.64
Rate for Payer: Aetna Medicare Advantage	$7,133.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,063.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,063.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,063.39
Rate for Payer: Cigna Commercial	$11,889.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,133.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.70
Rate for Payer: UnitedHealthcare Community & State	$573.05
Rate for Payer: Wellpoint Medicaid Managed Care	$630.12

UNSUCCSSFL PTCA INTERVENT

Facility

$23,778.00

Hospital Charge Code	7411275
Hospital Revenue Code	481
Min. Negotiated Rate	$573.05
Max. Negotiated Rate	$11,889.00
Rate for Payer: Aetna Commercial	$9,035.64
Rate for Payer: Aetna Medicare Advantage	$7,133.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,063.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,063.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,063.39
Rate for Payer: Cigna Commercial	$11,889.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,133.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.70
Rate for Payer: UnitedHealthcare Community & State	$573.05
Rate for Payer: Wellpoint Medicaid Managed Care	$630.12

UNSUCCSSFL PTCA INTERVENT

Facility

$23,778.00

Service Code	HCPCS 9298074
Hospital Charge Code	7411185
Hospital Revenue Code	481
Min. Negotiated Rate	$3,566.70
Max. Negotiated Rate	$3,566.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.70

UPEPU

Facility

$110.00

Service Code	HCPCS 84166
Hospital Charge Code	3000370C
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

UPEPU

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	3000370A
Hospital Revenue Code	301
Min. Negotiated Rate	$22.90
Max. Negotiated Rate	$22.90
Rate for Payer: Qualcare PPO/HMO/WC	$22.90

UPEPU

Facility

$110.00

Service Code	HCPCS 84166
Hospital Charge Code	3000370C
Hospital Revenue Code	301
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.50
Rate for Payer: Aetna Medicare Advantage	$57.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.36
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: Cigna Medicare Advantage	$17.83
Rate for Payer: Clover Medicare Advantage	$16.94
Rate for Payer: EmblemHealth Commercial	$53.49
Rate for Payer: Humana Medicare Advantage	$18.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.83
Rate for Payer: Wellcare Medicare Advantage	$17.83
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

UPEPU

Facility

$61.70

Service Code	HCPCS 84156
Hospital Charge Code	3000370B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$9.26
Rate for Payer: Qualcare PPO/HMO/WC	$9.26

UPEPU

Facility

$61.70

Service Code	HCPCS 84156
Hospital Charge Code	3000370B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.98
Rate for Payer: Aetna Medicare Advantage	$11.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.25
Rate for Payer: Cigna Commercial	$30.85
Rate for Payer: Cigna Medicare Advantage	$3.67
Rate for Payer: Clover Medicare Advantage	$3.49
Rate for Payer: EmblemHealth Commercial	$11.01
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.26
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.67
Rate for Payer: Wellcare Medicare Advantage	$3.67
Rate for Payer: Wellpoint Medicaid Managed Care	$1.64

UPEPU

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	3000370A
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$76.33
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

UPGRADE PG & LEAD SNGL

Facility

$39,837.00

Service Code	HCPCS 33214
Hospital Charge Code	7411021
Hospital Revenue Code	480
Min. Negotiated Rate	$5,975.55
Max. Negotiated Rate	$5,975.55
Rate for Payer: Qualcare PPO/HMO/WC	$5,975.55

UPGRADE PG & LEAD SNGL

Facility

$39,837.00

Service Code	HCPCS 33214
Hospital Charge Code	7411021
Hospital Revenue Code	480
Min. Negotiated Rate	$450.12
Max. Negotiated Rate	$44,822.55
Rate for Payer: Aetna Commercial	$33,774.92
Rate for Payer: Aetna Medicare Advantage	$40,231.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,822.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,417.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,822.55
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: Cigna Medicare Advantage	$12,417.25
Rate for Payer: Clover Medicare Advantage	$11,796.39
Rate for Payer: EmblemHealth Commercial	$37,251.75
Rate for Payer: Humana Medicare Advantage	$12,789.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,417.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,951.10
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,975.55
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$960.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare Medicare Advantage	$12,417.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,055.68

UPPER GI W/SMALL BOWEL

Facility

$825.00

Service Code	HCPCS 74245
Hospital Charge Code	94061141
Hospital Revenue Code	320
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$19.88
Rate for Payer: Wellpoint Medicaid Managed Care	$21.86

UPPER GI W/SMALL BOWEL

Facility

$825.00

Service Code	HCPCS 74245
Hospital Charge Code	94061141
Hospital Revenue Code	320
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$57,013.01

Service Code	MSDRG 256
Min. Negotiated Rate	$17,359.73
Max. Negotiated Rate	$57,013.01
Rate for Payer: Aetna Commercial	$39,431.78
Rate for Payer: Aetna Medicare Advantage	$57,013.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38,148.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38,148.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,273.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38,148.04
Rate for Payer: Cigna Commercial	$31,774.50
Rate for Payer: Cigna Medicare Advantage	$18,273.40
Rate for Payer: Clover Medicare Advantage	$17,359.73
Rate for Payer: EmblemHealth Commercial	$54,820.20
Rate for Payer: Humana Medicare Advantage	$18,821.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,273.40
Rate for Payer: Oxford Commercial	$22,836.76
Rate for Payer: UnitedHealthcare Commercial	$40,044.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,273.40
Rate for Payer: Wellcare Medicare Advantage	$18,273.40

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$89,318.55

Service Code	MSDRG 255
Min. Negotiated Rate	$27,196.35
Max. Negotiated Rate	$89,318.55
Rate for Payer: Aetna Commercial	$61,629.37
Rate for Payer: Aetna Medicare Advantage	$89,318.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63,967.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63,967.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28,627.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63,967.75
Rate for Payer: Cigna Commercial	$50,479.14
Rate for Payer: Cigna Medicare Advantage	$28,627.74
Rate for Payer: Clover Medicare Advantage	$27,196.35
Rate for Payer: EmblemHealth Commercial	$85,883.22
Rate for Payer: Humana Medicare Advantage	$29,486.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28,627.74
Rate for Payer: Oxford Commercial	$36,280.03
Rate for Payer: UnitedHealthcare Commercial	$63,618.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$28,627.74
Rate for Payer: Wellcare Medicare Advantage	$28,627.74

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$37,435.79

Service Code	MSDRG 257
Min. Negotiated Rate	$11,398.72
Max. Negotiated Rate	$37,435.79
Rate for Payer: Aetna Commercial	$25,979.97
Rate for Payer: Aetna Medicare Advantage	$37,435.79
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	$11,998.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,028.39
Rate for Payer: Cigna Commercial	$20,439.43
Rate for Payer: Cigna Medicare Advantage	$11,998.65
Rate for Payer: Clover Medicare Advantage	$11,398.72
Rate for Payer: EmblemHealth Commercial	$35,995.95
Rate for Payer: Humana Medicare Advantage	$12,358.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,998.65
Rate for Payer: Oxford Commercial	$14,690.09
Rate for Payer: UnitedHealthcare Commercial	$25,759.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,998.65
Rate for Payer: Wellcare Medicare Advantage	$11,998.65

UPPER MINOR KIT

Facility

$145.00

Hospital Charge Code	270338758
Hospital Revenue Code	272
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

UPPER MINOR KIT

Facility

$145.00

Hospital Charge Code	270338758
Hospital Revenue Code	272
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.50
Rate for Payer: Oxford Commercial	$29.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$29.00
Rate for Payer: UnitedHealthcare Community & State	$3.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

UP TO 2 YRS OLD, SPIROMETRY

Facility

$464.65

Service Code	HCPCS 94011
Hospital Charge Code	9501291
Hospital Revenue Code	460
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$415.81
Rate for Payer: Aetna Medicare Advantage	$495.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$551.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$551.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$152.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$551.81
Rate for Payer: Cigna Commercial	$306.43
Rate for Payer: Cigna Medicare Advantage	$152.87
Rate for Payer: Clover Medicare Advantage	$145.23
Rate for Payer: EmblemHealth Commercial	$458.61
Rate for Payer: Humana Medicare Advantage	$157.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$152.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.70
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$11.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$152.87
Rate for Payer: Wellcare Medicare Advantage	$152.87
Rate for Payer: Wellpoint Medicaid Managed Care	$12.31

UP TO 2 YRS OLD, SPIROMETRY

Facility

$464.65

Service Code	HCPCS 94011
Hospital Charge Code	9501291
Hospital Revenue Code	460
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$69.70
Rate for Payer: Qualcare PPO/HMO/WC	$69.70

UREA 10% LOTION

Facility

$120.00

Hospital Charge Code	60628462
Hospital Revenue Code	250
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

UREA 10% LOTION

Facility

$120.00

Hospital Charge Code	60628462
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.00
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$24.00
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

Know your out-of-pocket cost for care.

All Charges