Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CELIAC GEN INTERPR AND REPORT

Facility

$7.00

Service Code	HCPCS 83912
Hospital Charge Code	3035167
Hospital Revenue Code	301
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CELIAC PLEXUS BLOC (ANALGESIC)

Facility

$3,107.20

Service Code	HCPCS 64530
Hospital Charge Code	84506050
Hospital Revenue Code	361
Min. Negotiated Rate	$466.08
Max. Negotiated Rate	$466.08
Rate for Payer: Qualcare PPO/HMO/WC	$466.08

CELIAC PLEXUS BLOC (ANALGESIC)

Facility

$3,107.20

Service Code	HCPCS 64530
Hospital Charge Code	84506050
Hospital Revenue Code	361
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
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	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$932.16
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$466.08
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$74.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$82.34

CELIAC PLUS

Facility

$799.00

Hospital Charge Code	3035160
Hospital Revenue Code	301
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$119.85
Rate for Payer: Qualcare PPO/HMO/WC	$119.85

CELIAC PLUS

Facility

$799.00

Hospital Charge Code	3035160
Hospital Revenue Code	301
Min. Negotiated Rate	$19.26
Max. Negotiated Rate	$399.50
Rate for Payer: Aetna Commercial	$303.62
Rate for Payer: Aetna Medicare Advantage	$239.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.75
Rate for Payer: Cigna Commercial	$399.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.26
Rate for Payer: Wellpoint Medicaid Managed Care	$21.17

CELL ASSURITY PACEMAKER

Facility

$32,000.00

Service Code	HCPCS C1785
Hospital Charge Code	270676936
Hospital Revenue Code	275
Min. Negotiated Rate	$771.20
Max. Negotiated Rate	$16,000.00
Rate for Payer: Aetna Commercial	$12,160.00
Rate for Payer: Aetna Medicare Advantage	$9,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,160.00
Rate for Payer: Cigna Commercial	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00
Rate for Payer: UnitedHealthcare Community & State	$771.20
Rate for Payer: Wellpoint Medicaid Managed Care	$848.00

CELL ASSURITY PACEMAKER

Facility

$32,000.00

Service Code	HCPCS C1785
Hospital Charge Code	270676936
Hospital Revenue Code	275
Min. Negotiated Rate	$4,800.00
Max. Negotiated Rate	$7,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00

CELLCEPT 500MG TAB

Facility

$114.84

Service Code	HCPCS J7517
Hospital Charge Code	60635225
Hospital Revenue Code	636
Min. Negotiated Rate	$17.23
Max. Negotiated Rate	$27.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.79
Rate for Payer: Qualcare PPO/HMO/WC	$17.23

CELLCEPT 500MG TAB

Facility

$114.84

Service Code	HCPCS J7517
Hospital Charge Code	60635225
Hospital Revenue Code	636
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$43.64
Rate for Payer: Aetna Medicare Advantage	$34.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.28
Rate for Payer: Cigna Commercial	$57.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.79
Rate for Payer: Qualcare PPO/HMO/WC	$17.23
Rate for Payer: UnitedHealthcare Community & State	$2.77
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

CELL COUNT, BODY FLUID

Facility

$91.25

Service Code	HCPCS 89051
Hospital Charge Code	3008703
Hospital Revenue Code	300
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.23
Rate for Payer: Aetna Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.21
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: Cigna Medicare Advantage	$5.60
Rate for Payer: Clover Medicare Advantage	$5.32
Rate for Payer: EmblemHealth Commercial	$16.80
Rate for Payer: Humana Medicare Advantage	$5.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.60
Rate for Payer: Wellcare Medicare Advantage	$5.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

CELL COUNT, BODY FLUID

Facility

$91.25

Service Code	HCPCS 89051
Hospital Charge Code	3008703
Hospital Revenue Code	300
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

CELL COUNT (CSF)

Facility

$390.00

Service Code	HCPCS 89050
Hospital Charge Code	3000676
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CELL COUNT (CSF)

Facility

$390.00

Service Code	HCPCS 89050
Hospital Charge Code	3000676
Hospital Revenue Code	300
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$12.84
Rate for Payer: Aetna Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.04
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.72
Rate for Payer: Clover Medicare Advantage	$4.48
Rate for Payer: EmblemHealth Commercial	$14.16
Rate for Payer: Humana Medicare Advantage	$4.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.72
Rate for Payer: Wellcare Medicare Advantage	$4.72
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CELL COUNT/DIFF PERITONEAL FLD

Facility

$667.59

Service Code	HCPCS 89051
Hospital Charge Code	3008705
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CELL COUNT/DIFF PERITONEAL FLD

Facility

$667.59

Service Code	HCPCS 89051
Hospital Charge Code	3008705
Hospital Revenue Code	309
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$15.23
Rate for Payer: Aetna Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.21
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$5.60
Rate for Payer: Clover Medicare Advantage	$5.32
Rate for Payer: EmblemHealth Commercial	$16.80
Rate for Payer: Humana Medicare Advantage	$5.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.60
Rate for Payer: Wellcare Medicare Advantage	$5.60
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

CELL COUNT/DIFF SYNOVIAL FLUID

Facility

$91.25

Service Code	HCPCS 89051
Hospital Charge Code	3008704
Hospital Revenue Code	309
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.23
Rate for Payer: Aetna Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.21
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: Cigna Medicare Advantage	$5.60
Rate for Payer: Clover Medicare Advantage	$5.32
Rate for Payer: EmblemHealth Commercial	$16.80
Rate for Payer: Humana Medicare Advantage	$5.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.60
Rate for Payer: Wellcare Medicare Advantage	$5.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

CELL COUNT/DIFF SYNOVIAL FLUID

Facility

$91.25

Service Code	HCPCS 89051
Hospital Charge Code	3008704
Hospital Revenue Code	309
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

CELL COUNT/DIF PERICARDIAL FLD

Facility

$91.25

Service Code	HCPCS 89051
Hospital Charge Code	3008706
Hospital Revenue Code	309
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

CELL COUNT/DIF PERICARDIAL FLD

Facility

$91.25

Service Code	HCPCS 89051
Hospital Charge Code	3008706
Hospital Revenue Code	309
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.23
Rate for Payer: Aetna Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.21
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: Cigna Medicare Advantage	$5.60
Rate for Payer: Clover Medicare Advantage	$5.32
Rate for Payer: EmblemHealth Commercial	$16.80
Rate for Payer: Humana Medicare Advantage	$5.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.60
Rate for Payer: Wellcare Medicare Advantage	$5.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

CELL COUNT FLUID

Facility

$307.00

Service Code	HCPCS 89050
Hospital Charge Code	38472208
Hospital Revenue Code	309
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$153.50
Rate for Payer: Aetna Commercial	$12.84
Rate for Payer: Aetna Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.04
Rate for Payer: Cigna Commercial	$153.50
Rate for Payer: Cigna Medicare Advantage	$4.72
Rate for Payer: Clover Medicare Advantage	$4.48
Rate for Payer: EmblemHealth Commercial	$14.16
Rate for Payer: Humana Medicare Advantage	$4.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.72
Rate for Payer: Wellcare Medicare Advantage	$4.72
Rate for Payer: Wellpoint Medicaid Managed Care	$8.14

CELL COUNT FLUID

Facility

$307.00

Service Code	HCPCS 89050
Hospital Charge Code	38472208
Hospital Revenue Code	309
Min. Negotiated Rate	$46.05
Max. Negotiated Rate	$46.05
Rate for Payer: Qualcare PPO/HMO/WC	$46.05

CELL COUNT W/DIFF,FLUID

Facility

$183.00

Service Code	HCPCS 89051
Hospital Charge Code	38473027
Hospital Revenue Code	309
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.23
Rate for Payer: Aetna Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.21
Rate for Payer: Cigna Commercial	$91.50
Rate for Payer: Cigna Medicare Advantage	$5.60
Rate for Payer: Clover Medicare Advantage	$5.32
Rate for Payer: EmblemHealth Commercial	$16.80
Rate for Payer: Humana Medicare Advantage	$5.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.60
Rate for Payer: Wellcare Medicare Advantage	$5.60
Rate for Payer: Wellpoint Medicaid Managed Care	$4.85

CELL COUNT W/DIFF,FLUID

Facility

$183.00

Service Code	HCPCS 89051
Hospital Charge Code	38473027
Hospital Revenue Code	309
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

CELLERATE WND FILL POWDER 5GM

Facility

$13,751.25

Service Code	HCPCS A6010
Hospital Charge Code	270695988
Hospital Revenue Code	272
Min. Negotiated Rate	$2,062.69
Max. Negotiated Rate	$2,062.69
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.69

CELLERATE WND FILL POWDER 5GM

Facility

$13,751.25

Service Code	HCPCS A6010
Hospital Charge Code	270695988
Hospital Revenue Code	272
Min. Negotiated Rate	$331.41
Max. Negotiated Rate	$6,875.62
Rate for Payer: Aetna Commercial	$5,225.48
Rate for Payer: Aetna Medicare Advantage	$4,125.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.57
Rate for Payer: Cigna Commercial	$6,875.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,125.38
Rate for Payer: Oxford Commercial	$2,750.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.69
Rate for Payer: UnitedHealthcare Commercial	$2,750.25
Rate for Payer: UnitedHealthcare Community & State	$331.41
Rate for Payer: Wellpoint Medicaid Managed Care	$364.41

Know your out-of-pocket cost for care.

All Charges