Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

US PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	94061503
Hospital Revenue Code	402
Min. Negotiated Rate	$85.18
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	$85.18
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	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US PELV NON OB B SCAN LIMIT/FU

Facility

$6,700.00

Service Code	HCPCS 76857
Hospital Charge Code	94061503
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 PERC RENAL CYST ASP

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2100543
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

US PERC RENAL CYST ASP

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2100543
Hospital Revenue Code	361
Min. Negotiated Rate	$113.51
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.97
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$113.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$124.81

US PERC RENAL CYST ASP RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2101197
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

US PERC RENAL CYST ASP RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2101197
Hospital Revenue Code	361
Min. Negotiated Rate	$113.51
Max. Negotiated Rate	$2,354.95
Rate for Payer: Aetna Commercial	$1,789.76
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.97
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Community & State	$113.51
Rate for Payer: Wellpoint Medicaid Managed Care	$124.81

US PERICARDIOCENTESIS INITIAL

Facility

$3,036.85

Service Code	HCPCS 33010
Hospital Charge Code	2100527
Hospital Revenue Code	361
Min. Negotiated Rate	$73.19
Max. Negotiated Rate	$1,518.42
Rate for Payer: Aetna Commercial	$1,154.00
Rate for Payer: Aetna Medicare Advantage	$911.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$774.40
Rate for Payer: Cigna Commercial	$1,518.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$911.05
Rate for Payer: Qualcare PPO/HMO/WC	$455.53
Rate for Payer: UnitedHealthcare Community & State	$73.19
Rate for Payer: Wellpoint Medicaid Managed Care	$80.48

US PERICARDIOCENTESIS INITIAL

Facility

$3,036.85

Service Code	HCPCS 33010
Hospital Charge Code	2100527
Hospital Revenue Code	361
Min. Negotiated Rate	$455.53
Max. Negotiated Rate	$455.53
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

US PERICARDIOCENTESIS SUBSEQUE

Facility

$3,036.85

Service Code	HCPCS 33011
Hospital Charge Code	2100535
Hospital Revenue Code	361
Min. Negotiated Rate	$455.53
Max. Negotiated Rate	$455.53
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

US PERICARDIOCENTESIS SUBSEQUE

Facility

$3,036.85

Service Code	HCPCS 33011
Hospital Charge Code	2100535
Hospital Revenue Code	361
Min. Negotiated Rate	$73.19
Max. Negotiated Rate	$1,518.42
Rate for Payer: Aetna Commercial	$1,154.00
Rate for Payer: Aetna Medicare Advantage	$911.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$774.40
Rate for Payer: Cigna Commercial	$1,518.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$911.05
Rate for Payer: Qualcare PPO/HMO/WC	$455.53
Rate for Payer: UnitedHealthcare Community & State	$73.19
Rate for Payer: Wellpoint Medicaid Managed Care	$80.48

US PERICARDIOCENTESIS WITH SI

Facility

$859.25

Service Code	HCPCS 76930
Hospital Charge Code	74110027
Hospital Revenue Code	402
Min. Negotiated Rate	$128.89
Max. Negotiated Rate	$128.89
Rate for Payer: Qualcare PPO/HMO/WC	$128.89

US PERICARDIOCENTESIS WITH SI

Facility

$859.25

Service Code	HCPCS 76930
Hospital Charge Code	5100227
Hospital Revenue Code	402
Min. Negotiated Rate	$20.71
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$326.51
Rate for Payer: Aetna Medicare Advantage	$257.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.11
Rate for Payer: Cigna Commercial	$429.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.77
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.89
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$20.71
Rate for Payer: Wellpoint Medicaid Managed Care	$22.77

US PERICARDIOCENTESIS WITH SI

Facility

$859.25

Service Code	HCPCS 76930
Hospital Charge Code	5100227
Hospital Revenue Code	402
Min. Negotiated Rate	$128.89
Max. Negotiated Rate	$128.89
Rate for Payer: Qualcare PPO/HMO/WC	$128.89

US PERICARDIOCENTESIS WITH SI

Facility

$859.25

Service Code	HCPCS 76930
Hospital Charge Code	74110027
Hospital Revenue Code	402
Min. Negotiated Rate	$20.71
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$326.51
Rate for Payer: Aetna Medicare Advantage	$257.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.11
Rate for Payer: Cigna Commercial	$429.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.77
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.89
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$20.71
Rate for Payer: Wellpoint Medicaid Managed Care	$22.77

US PLACENTA LOCALIZ

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	2100089
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 PLACENTA LOCALIZ

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	2100089
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 PLEURAL EFFUSION

Facility

$6,700.00

Service Code	HCPCS 76604
Hospital Charge Code	2100097
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 PLEURAL EFFUSION

Facility

$6,700.00

Service Code	HCPCS 76604
Hospital Charge Code	2100097
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 - POPLITEAL-BIL

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	94061183
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 - POPLITEAL-BIL

Facility

$6,700.00

Service Code	HCPCS 76881
Hospital Charge Code	94061183
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 PREGNANCY < 14 WEEKS

Facility

$6,700.00

Service Code	HCPCS 76801
Hospital Charge Code	64061508
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 PREGNANCY < 14 WEEKS

Facility

$6,700.00

Service Code	HCPCS 76801
Hospital Charge Code	2301052
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 PREGNANCY < 14 WEEKS

Facility

$6,700.00

Service Code	HCPCS 76801
Hospital Charge Code	64061508
Hospital Revenue Code	402
Min. Negotiated Rate	$106.48
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	$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	$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 PREGNANCY < 14 WEEKS

Facility

$6,700.00

Service Code	HCPCS 76801
Hospital Charge Code	2301052
Hospital Revenue Code	402
Min. Negotiated Rate	$106.48
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	$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	$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 PREGNANCY > 14 WEEKS

Facility

$563.15

Service Code	HCPCS 76805
Hospital Charge Code	2301053
Hospital Revenue Code	402
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$84.47
Rate for Payer: Qualcare PPO/HMO/WC	$84.47

Know your out-of-pocket cost for care.

All Charges