Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

US EXTREMITY NON-VASCULAR COMP

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	2100263M
Hospital Revenue Code	402
Min. Negotiated Rate	$98.81
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US EXTREMITY NON-VASCULAR LEFT

Facility

$659.25

Hospital Charge Code	2301010
Hospital Revenue Code	402
Min. Negotiated Rate	$98.89
Max. Negotiated Rate	$98.89
Rate for Payer: Qualcare PPO/HMO/WC	$98.89

US EXTREMITY NON-VASCULAR LEFT

Facility

$659.25

Hospital Charge Code	2301010
Hospital Revenue Code	402
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$250.51
Rate for Payer: Aetna Medicare Advantage	$197.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.11
Rate for Payer: Cigna Commercial	$329.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.78
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.89
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$15.89
Rate for Payer: Wellpoint Medicaid Managed Care	$17.47

US EXTREMITY NON-VASCULAR LT

Facility

$659.25

Hospital Charge Code	2100261
Hospital Revenue Code	402
Min. Negotiated Rate	$98.89
Max. Negotiated Rate	$98.89
Rate for Payer: Qualcare PPO/HMO/WC	$98.89

US EXTREMITY NON-VASCULAR LT

Facility

$659.25

Hospital Charge Code	2100261
Hospital Revenue Code	402
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$250.51
Rate for Payer: Aetna Medicare Advantage	$197.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.11
Rate for Payer: Cigna Commercial	$329.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.78
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.89
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$15.89
Rate for Payer: Wellpoint Medicaid Managed Care	$17.47

US EXTREMITY NON-VASCULAR LT**

Facility

$234.00

Service Code	HCPCS 76880
Hospital Charge Code	3100262
Hospital Revenue Code	402
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

US EXTREMITY NON-VASCULAR LT**

Facility

$234.00

Service Code	HCPCS 76880
Hospital Charge Code	3100262
Hospital Revenue Code	402
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$88.92
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$5.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.20

US EXTREMITY NON-VASCULAR LTD

Facility

$534.78

Service Code	HCPCS 76882
Hospital Charge Code	2100264M
Hospital Revenue Code	402
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.43
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.22
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$12.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$298.19
Rate for Payer: Wellpoint Medicaid Managed Care	$14.17

US EXTREMITY NON-VASCULAR LTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	2100264
Hospital Revenue Code	402
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$298.19
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US EXTREMITY NON-VASCULAR LTD

Facility

$534.78

Service Code	HCPCS 76882
Hospital Charge Code	2100264M
Hospital Revenue Code	402
Min. Negotiated Rate	$80.22
Max. Negotiated Rate	$80.22
Rate for Payer: Qualcare PPO/HMO/WC	$80.22

US EXTREMITY NON-VASCULAR LTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	2100264
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXTREMITY NON-VASCULAR LTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	94061505
Hospital Revenue Code	402
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$298.19
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US EXTREMITY NON-VASCULAR LTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	94061505
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US EXTREMITY NON-VASCULAR RT

Facility

$659.25

Hospital Charge Code	2100262
Hospital Revenue Code	402
Min. Negotiated Rate	$98.89
Max. Negotiated Rate	$98.89
Rate for Payer: Qualcare PPO/HMO/WC	$98.89

US EXTREMITY NON-VASCULAR RT

Facility

$659.25

Hospital Charge Code	2100262
Hospital Revenue Code	402
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$250.51
Rate for Payer: Aetna Medicare Advantage	$197.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.11
Rate for Payer: Cigna Commercial	$329.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.78
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.89
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$15.89
Rate for Payer: Wellpoint Medicaid Managed Care	$17.47

US-EXTREM NONVASCULAR-BIL

Facility

$517.00

Hospital Charge Code	2309060
Hospital Revenue Code	402
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$196.46
Rate for Payer: Aetna Medicare Advantage	$155.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.84
Rate for Payer: Cigna Commercial	$258.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.10
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.55
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$12.46
Rate for Payer: Wellpoint Medicaid Managed Care	$13.70

US-EXTREM NONVASCULAR-BIL

Facility

$517.00

Hospital Charge Code	2309060
Hospital Revenue Code	402
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$77.55

US FEM- POPLITEAL DUPLEX UNI

Facility

$2,497.57

Service Code	HCPCS 93971
Hospital Charge Code	2100188
Hospital Revenue Code	921
Min. Negotiated Rate	$60.19
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$844.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.27
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$374.64
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$60.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$66.19

US FEM- POPLITEAL DUPLEX UNI

Facility

$2,497.57

Service Code	HCPCS 93971
Hospital Charge Code	2100188
Hospital Revenue Code	921
Min. Negotiated Rate	$374.64
Max. Negotiated Rate	$374.64
Rate for Payer: Qualcare PPO/HMO/WC	$374.64

US FETAL AGE

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	2100030
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US FETAL AGE

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	2100030
Hospital Revenue Code	402
Min. Negotiated Rate	$67.76
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US FETAL BIOPHYSICAL PROFILE

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	94061504B
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US FETAL BIOPHYSICAL PROFILE

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	94061504B
Hospital Revenue Code	402
Min. Negotiated Rate	$117.13
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US FETAL BIOPHYSICAL PROFILE

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	2100287
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US FETAL BIOPHYSICAL PROFILE

Facility

$6,700.00

Service Code	HCPCS 76818
Hospital Charge Code	2100287
Hospital Revenue Code	402
Min. Negotiated Rate	$117.13
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

Know your out-of-pocket cost for care.

All Charges