Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

US UNLISTED PROCEDURE

Facility

$228.75

Service Code	HCPCS 76999
Hospital Charge Code	2301090
Hospital Revenue Code	402
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$103.39
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.62
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.31
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.06

US UNLISTED PROCEDURE

Facility

$228.75

Service Code	HCPCS 76999
Hospital Charge Code	2301090
Hospital Revenue Code	402
Min. Negotiated Rate	$34.31
Max. Negotiated Rate	$34.31
Rate for Payer: Qualcare PPO/HMO/WC	$34.31

US VL-DUP SCAN LOWER EXT VEIN-

Facility

$1,052.00

Service Code	HCPCS 93971
Hospital Charge Code	2308020
Hospital Revenue Code	921
Min. Negotiated Rate	$25.35
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	$315.60
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.80
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$25.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$27.88

US VL-DUP SCAN LOWER EXT VEIN-

Facility

$1,052.00

Service Code	HCPCS 93971
Hospital Charge Code	2308020
Hospital Revenue Code	921
Min. Negotiated Rate	$157.80
Max. Negotiated Rate	$157.80
Rate for Payer: Qualcare PPO/HMO/WC	$157.80

US VL-DUP.SCAN LOWER EXT.VEIN-

Facility

$1,052.00

Service Code	HCPCS 93971
Hospital Charge Code	2308025
Hospital Revenue Code	921
Min. Negotiated Rate	$25.35
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	$315.60
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.80
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$25.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$27.88

US VL-DUP.SCAN LOWER EXT.VEIN-

Facility

$1,052.00

Service Code	HCPCS 93971
Hospital Charge Code	2308025
Hospital Revenue Code	921
Min. Negotiated Rate	$157.80
Max. Negotiated Rate	$157.80
Rate for Payer: Qualcare PPO/HMO/WC	$157.80

US VL-DUP SCAN-UPPER EXT.VEIN-

Facility

$1,052.00

Service Code	HCPCS 93971
Hospital Charge Code	2308015
Hospital Revenue Code	921
Min. Negotiated Rate	$157.80
Max. Negotiated Rate	$157.80
Rate for Payer: Qualcare PPO/HMO/WC	$157.80

US VL-DUP SCAN-UPPER EXT.VEIN-

Facility

$1,052.00

Service Code	HCPCS 93971
Hospital Charge Code	2308015
Hospital Revenue Code	921
Min. Negotiated Rate	$25.35
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	$315.60
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.80
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$25.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$27.88

US XTR NON-VASC COMPLETE

Facility

$1,170.20

Service Code	HCPCS 76881
Hospital Charge Code	1600000790
Hospital Revenue Code	360
Min. Negotiated Rate	$175.53
Max. Negotiated Rate	$175.53
Rate for Payer: Qualcare PPO/HMO/WC	$175.53

US XTR NON-VASC COMPLETE

Facility

$1,170.20

Service Code	HCPCS 76881
Hospital Charge Code	1600000790
Hospital Revenue Code	360
Min. Negotiated Rate	$28.20
Max. Negotiated Rate	$1,626.00
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	$1,626.00
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	$351.06
Rate for Payer: Qualcare PPO/HMO/WC	$175.53
Rate for Payer: UnitedHealthcare Community & State	$28.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$31.01

US XTR NON-VASC LMTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	2600210
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 XTR NON-VASC LMTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	2600210
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 XTR NON-VASC LMTD

Facility

$534.78

Service Code	HCPCS 76882
Hospital Charge Code	7411751
Hospital Revenue Code	402
Min. Negotiated Rate	$80.22
Max. Negotiated Rate	$80.22
Rate for Payer: Qualcare PPO/HMO/WC	$80.22

US XTR NON-VASC LMTD

Facility

$534.78

Service Code	HCPCS 76882
Hospital Charge Code	7411751
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 XTR NON-VASC LMTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	321076882
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 XTR NON-VASC LMTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	321076882
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

UTAH PRENDEVILLE LOOPS

Facility

$200.00

Hospital Charge Code	270332567
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

UTAH PRENDEVILLE LOOPS

Facility

$200.00

Hospital Charge Code	270332567
Hospital Revenue Code	272
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

UTERIAL BALLOON THERAPY GC-EAC

Facility

$16,250.00

Hospital Charge Code	270657455
Hospital Revenue Code	272
Min. Negotiated Rate	$391.62
Max. Negotiated Rate	$8,125.00
Rate for Payer: Aetna Commercial	$6,175.00
Rate for Payer: Aetna Medicare Advantage	$4,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,143.75
Rate for Payer: Cigna Commercial	$8,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,875.00
Rate for Payer: Oxford Commercial	$3,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50
Rate for Payer: UnitedHealthcare Commercial	$3,250.00
Rate for Payer: UnitedHealthcare Community & State	$391.62
Rate for Payer: Wellpoint Medicaid Managed Care	$430.62

UTERIAL BALLOON THERAPY GC-EAC

Facility

$16,250.00

Hospital Charge Code	270657455
Hospital Revenue Code	272
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$2,437.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$11,449.55

Service Code	APR-DRG 5191
Min. Negotiated Rate	$11,225.05
Max. Negotiated Rate	$11,449.55
Rate for Payer: UnitedHealthcare Community & State	$11,225.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,449.55
Rate for Payer: Wellpoint Medicaid Managed Care	$11,225.05

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$23,361.22

Service Code	APR-DRG 5193
Min. Negotiated Rate	$22,903.16
Max. Negotiated Rate	$23,361.22
Rate for Payer: UnitedHealthcare Community & State	$22,903.16
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,361.22
Rate for Payer: Wellpoint Medicaid Managed Care	$22,903.16

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$47,129.71

Service Code	APR-DRG 5194
Min. Negotiated Rate	$46,205.60
Max. Negotiated Rate	$47,129.71
Rate for Payer: UnitedHealthcare Community & State	$46,205.60
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$47,129.71
Rate for Payer: Wellpoint Medicaid Managed Care	$46,205.60

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$14,637.49

Service Code	APR-DRG 5192
Min. Negotiated Rate	$14,350.48
Max. Negotiated Rate	$14,637.49
Rate for Payer: UnitedHealthcare Community & State	$14,350.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,637.49
Rate for Payer: Wellpoint Medicaid Managed Care	$14,350.48

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$14,560.86

Service Code	APR-DRG 5132
Min. Negotiated Rate	$14,275.35
Max. Negotiated Rate	$14,560.86
Rate for Payer: UnitedHealthcare Community & State	$14,275.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,560.86
Rate for Payer: Wellpoint Medicaid Managed Care	$14,275.35

Know your out-of-pocket cost for care.

All Charges