Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

US-OB DETAILED ADDL FETUS

Facility

$517.00

Hospital Charge Code	2309015
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-OB DETAILED ADDL FETUS

Facility

$517.00

Hospital Charge Code	2309015
Hospital Revenue Code	402
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$77.55

US-OB DETAILED SNGL FETUS

Facility

$1,754.00

Hospital Charge Code	2309010
Hospital Revenue Code	402
Min. Negotiated Rate	$263.10
Max. Negotiated Rate	$263.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.10

US-OB DETAILED SNGL FETUS

Facility

$1,754.00

Hospital Charge Code	2309010
Hospital Revenue Code	402
Min. Negotiated Rate	$42.27
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$666.52
Rate for Payer: Aetna Medicare Advantage	$526.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.27
Rate for Payer: Cigna Commercial	$877.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.20
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$263.10
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$42.27
Rate for Payer: Wellpoint Medicaid Managed Care	$46.48

US OB NUCHAL TRANSLUCENCY MEAS

Facility

$518.00

Service Code	HCPCS 76813
Hospital Charge Code	83653060
Hospital Revenue Code	402
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$77.70
Rate for Payer: Qualcare PPO/HMO/WC	$77.70

US OB NUCHAL TRANSLUCENCY MEAS

Facility

$518.00

Service Code	HCPCS 76813
Hospital Charge Code	83653060
Hospital Revenue Code	402
Min. Negotiated Rate	$12.48
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	$129.23
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	$155.40
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.70
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$12.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$13.73

US OPHTHALMIC A-SCAN BILATERAL

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301036
Hospital Revenue Code	402
Min. Negotiated Rate	$8.48
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	$77.44
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	$105.61
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.81
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$8.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$9.33

US OPHTHALMIC A-SCAN BILATERAL

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301036
Hospital Revenue Code	402
Min. Negotiated Rate	$52.81
Max. Negotiated Rate	$52.81
Rate for Payer: Qualcare PPO/HMO/WC	$52.81

US OPHTHALMIC A-SCAN LEFT

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301040
Hospital Revenue Code	402
Min. Negotiated Rate	$8.48
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	$77.44
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	$105.61
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.81
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$8.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$9.33

US OPHTHALMIC A-SCAN LEFT

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301040
Hospital Revenue Code	402
Min. Negotiated Rate	$52.81
Max. Negotiated Rate	$52.81
Rate for Payer: Qualcare PPO/HMO/WC	$52.81

US OPHTHALMIC A-SCAN RIGHT

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301041
Hospital Revenue Code	402
Min. Negotiated Rate	$8.48
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	$77.44
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	$105.61
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.81
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$8.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$9.33

US OPHTHALMIC A-SCAN RIGHT

Facility

$352.05

Service Code	HCPCS 76516
Hospital Charge Code	2301041
Hospital Revenue Code	402
Min. Negotiated Rate	$52.81
Max. Negotiated Rate	$52.81
Rate for Payer: Qualcare PPO/HMO/WC	$52.81

US OPHTHALMIC B-SCAN BILATERAL

Facility

$563.15

Service Code	HCPCS 76512
Hospital Charge Code	2301045
Hospital Revenue Code	402
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

US OPHTHALMIC B-SCAN BILATERAL

Facility

$563.15

Service Code	HCPCS 76512
Hospital Charge Code	2301045
Hospital Revenue Code	402
Min. Negotiated Rate	$13.57
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	$116.16
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	$168.94
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.47
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

US OPHTHALMIC B-SCAN LEFT

Facility

$563.15

Service Code	HCPCS 76512LT
Hospital Charge Code	2301049
Hospital Revenue Code	402
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

US OPHTHALMIC B-SCAN LEFT

Facility

$563.15

Service Code	HCPCS 76512LT
Hospital Charge Code	2301049
Hospital Revenue Code	402
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$214.00
Rate for Payer: Aetna Medicare Advantage	$168.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.60
Rate for Payer: Cigna Commercial	$281.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.94
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.47
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

US OPHTHALMIC B-SCAN RIGHT

Facility

$563.15

Service Code	HCPCS 76512RT
Hospital Charge Code	2301050
Hospital Revenue Code	402
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$214.00
Rate for Payer: Aetna Medicare Advantage	$168.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.60
Rate for Payer: Cigna Commercial	$281.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.94
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.47
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

US OPHTHALMIC B-SCAN RIGHT

Facility

$563.15

Service Code	HCPCS 76512RT
Hospital Charge Code	2301050
Hospital Revenue Code	402
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

US OPHTHLMC A-SCAN INTCLR BLTL

Facility

$1,126.30

Service Code	HCPCS 7651950
Hospital Charge Code	2301037
Hospital Revenue Code	402
Min. Negotiated Rate	$27.14
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$427.99
Rate for Payer: Aetna Medicare Advantage	$337.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.21
Rate for Payer: Cigna Commercial	$563.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.89
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.94
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$27.14
Rate for Payer: Wellpoint Medicaid Managed Care	$29.85

US OPHTHLMC A-SCAN INTCLR BLTL

Facility

$1,126.30

Service Code	HCPCS 7651950
Hospital Charge Code	2301037
Hospital Revenue Code	402
Min. Negotiated Rate	$168.94
Max. Negotiated Rate	$168.94
Rate for Payer: Qualcare PPO/HMO/WC	$168.94

US OPHTHLMC A-SCAN INTCLR LEFT

Facility

$563.15

Service Code	HCPCS 76519LT
Hospital Charge Code	2301038
Hospital Revenue Code	402
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

US OPHTHLMC A-SCAN INTCLR LEFT

Facility

$563.15

Service Code	HCPCS 76519LT
Hospital Charge Code	2301038
Hospital Revenue Code	402
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$214.00
Rate for Payer: Aetna Medicare Advantage	$168.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.60
Rate for Payer: Cigna Commercial	$281.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.94
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.47
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

US OPHTHLMC A-SCAN INTCLR RGHT

Facility

$563.15

Service Code	HCPCS 76519RT
Hospital Charge Code	2301039
Hospital Revenue Code	402
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$214.00
Rate for Payer: Aetna Medicare Advantage	$168.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.60
Rate for Payer: Cigna Commercial	$281.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.94
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.47
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

US OPHTHLMC A-SCAN INTCLR RGHT

Facility

$563.15

Service Code	HCPCS 76519RT
Hospital Charge Code	2301039
Hospital Revenue Code	402
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

US OPHTHLMC BIMTRY A-SCAN BLTL

Facility

$1,126.30

Service Code	HCPCS 7651150
Hospital Charge Code	2301042
Hospital Revenue Code	402
Min. Negotiated Rate	$27.14
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$427.99
Rate for Payer: Aetna Medicare Advantage	$337.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.21
Rate for Payer: Cigna Commercial	$563.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.89
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.94
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$27.14
Rate for Payer: Wellpoint Medicaid Managed Care	$29.85

Know your out-of-pocket cost for care.

All Charges