Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

US NI LO EXT ART MULTI BILAT

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101098
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI LO EXT ART MULTI UNI LT

Facility

$17,200.00

Service Code	HCPCS 9392352LT
Hospital Charge Code	2101102
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI LO EXT ART MULTI UNI LT

Facility

$17,200.00

Service Code	HCPCS 9392352LT
Hospital Charge Code	2101102
Hospital Revenue Code	921
Min. Negotiated Rate	$414.52
Max. Negotiated Rate	$8,600.00
Rate for Payer: Aetna Commercial	$6,536.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$8,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,160.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$414.52
Rate for Payer: Wellpoint Medicaid Managed Care	$455.80

US NI LO EXT ART MULTI UNI RT

Facility

$17,200.00

Service Code	HCPCS 9392352RT
Hospital Charge Code	2101101
Hospital Revenue Code	921
Min. Negotiated Rate	$414.52
Max. Negotiated Rate	$8,600.00
Rate for Payer: Aetna Commercial	$6,536.00
Rate for Payer: Aetna Medicare Advantage	$5,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,386.00
Rate for Payer: Cigna Commercial	$8,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,160.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$414.52
Rate for Payer: Wellpoint Medicaid Managed Care	$455.80

US NI LO EXT ART MULTI UNI RT

Facility

$17,200.00

Service Code	HCPCS 9392352RT
Hospital Charge Code	2101101
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI LO EXT REST POST TREAD

Facility

$5,100.00

Service Code	HCPCS 93924
Hospital Charge Code	2101094
Hospital Revenue Code	920
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$635.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

US NI LO EXT REST POST TREAD

Facility

$5,100.00

Service Code	HCPCS 93924
Hospital Charge Code	2101094
Hospital Revenue Code	920
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

US NI UP EXT ART MULTI BILAT

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101096
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NI UP EXT ART MULTI BILAT

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101096
Hospital Revenue Code	921
Min. Negotiated Rate	$243.69
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,160.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$414.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$455.80

US NI UP EXT COLD SENSI

Facility

$1,440.90

Service Code	HCPCS 93923
Hospital Charge Code	2101092
Hospital Revenue Code	921
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.27
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$216.13
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$34.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$38.18

US NI UP EXT COLD SENSI

Facility

$1,440.90

Service Code	HCPCS 93923
Hospital Charge Code	2101092
Hospital Revenue Code	921
Min. Negotiated Rate	$216.13
Max. Negotiated Rate	$216.13
Rate for Payer: Qualcare PPO/HMO/WC	$216.13

US NI UP EXT THOR OUTLET

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101090
Hospital Revenue Code	921
Min. Negotiated Rate	$243.69
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,160.00
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$414.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$455.80

US NI UP EXT THOR OUTLET

Facility

$17,200.00

Service Code	HCPCS 93923
Hospital Charge Code	2101090
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

US NONINVAS PHYS VEN EXTM BILA

Facility

$1,079.25

Service Code	HCPCS 93965
Hospital Charge Code	2100758
Hospital Revenue Code	921
Min. Negotiated Rate	$26.01
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$410.12
Rate for Payer: Aetna Medicare Advantage	$323.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.21
Rate for Payer: Cigna Commercial	$539.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$323.77
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$161.89
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$26.01
Rate for Payer: Wellpoint Medicaid Managed Care	$28.60

US NONINVAS PHYS VEN EXTM BILA

Facility

$1,079.25

Service Code	HCPCS 93965
Hospital Charge Code	2100758
Hospital Revenue Code	921
Min. Negotiated Rate	$161.89
Max. Negotiated Rate	$161.89
Rate for Payer: Qualcare PPO/HMO/WC	$161.89

US-OB<14 WEEKS ADDITNL FETUS

Facility

$1,117.00

Service Code	HCPCS 76802
Hospital Charge Code	2008030
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

US-OB<14 WEEKS ADDITNL FETUS

Facility

$1,117.00

Service Code	HCPCS 76802
Hospital Charge Code	2008030
Hospital Revenue Code	402
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$424.46
Rate for Payer: Aetna Medicare Advantage	$335.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.83
Rate for Payer: Cigna Commercial	$558.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.10
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$26.92
Rate for Payer: Wellpoint Medicaid Managed Care	$29.60

US-OB<14 WEEKS SINGLE FETUS-EA

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	2307015
Hospital Revenue Code	402
Min. Negotiated Rate	$37.69
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	$106.48
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	$469.14
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$234.57
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$37.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$41.44

US-OB<14 WEEKS SINGLE FETUS-EA

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	2307015
Hospital Revenue Code	402
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$234.57
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

US OB >/=14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76810
Hospital Charge Code	2101116
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$249.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
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: Wellpoint Medicaid Managed Care	$177.55

US OB >/=14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76810
Hospital Charge Code	2101116
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 OB >/=14 WKS ADDL FETUS

Facility

$555.00

Service Code	HCPCS 76810
Hospital Charge Code	412376810
Hospital Revenue Code	402
Min. Negotiated Rate	$83.25
Max. Negotiated Rate	$83.25
Rate for Payer: Qualcare PPO/HMO/WC	$83.25

US OB >/=14 WKS ADDL FETUS

Facility

$555.00

Service Code	HCPCS 76810
Hospital Charge Code	412376810
Hospital Revenue Code	402
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$210.90
Rate for Payer: Aetna Medicare Advantage	$166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$249.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.53
Rate for Payer: Cigna Commercial	$277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.25
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$13.38
Rate for Payer: Wellpoint Medicaid Managed Care	$14.71

US OB<14 WKS NUCHAL EA ADDTL

Facility

$373.90

Service Code	HCPCS 76814
Hospital Charge Code	83653065
Hospital Revenue Code	402
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$142.08
Rate for Payer: Aetna Medicare Advantage	$112.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.34
Rate for Payer: Cigna Commercial	$186.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.17
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.09
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$9.01
Rate for Payer: Wellpoint Medicaid Managed Care	$9.91

US OB<14 WKS NUCHAL EA ADDTL

Facility

$373.90

Service Code	HCPCS 76814
Hospital Charge Code	83653065
Hospital Revenue Code	402
Min. Negotiated Rate	$56.09
Max. Negotiated Rate	$56.09
Rate for Payer: Qualcare PPO/HMO/WC	$56.09

Know your out-of-pocket cost for care.

All Charges