Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CHAMBER I/C GRAFT 10CC

Facility

$5,648.00

Service Code	HCPCS C1713
Hospital Charge Code	270655438
Hospital Revenue Code	278
Min. Negotiated Rate	$136.12
Max. Negotiated Rate	$2,824.00
Rate for Payer: Aetna Commercial	$2,146.24
Rate for Payer: Aetna Medicare Advantage	$1,694.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,129.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.24
Rate for Payer: Cigna Commercial	$2,824.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,366.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,242.56
Rate for Payer: Qualcare PPO/HMO/WC	$847.20
Rate for Payer: UnitedHealthcare Community & State	$136.12
Rate for Payer: Wellpoint Medicaid Managed Care	$149.67

CHAMBER I/C GRAFT 10CC

Facility

$5,648.00

Service Code	HCPCS C1713
Hospital Charge Code	270655438
Hospital Revenue Code	278
Min. Negotiated Rate	$847.20
Max. Negotiated Rate	$1,366.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,129.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,366.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,242.56
Rate for Payer: Qualcare PPO/HMO/WC	$847.20

CHAMBER I/C GRAFT 15cc

Facility

$7,726.50

Hospital Charge Code	270669951
Hospital Revenue Code	278
Min. Negotiated Rate	$186.21
Max. Negotiated Rate	$3,863.25
Rate for Payer: Aetna Commercial	$2,936.07
Rate for Payer: Aetna Medicare Advantage	$2,317.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,970.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,970.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,970.26
Rate for Payer: Cigna Commercial	$3,863.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.97
Rate for Payer: UnitedHealthcare Community & State	$186.21
Rate for Payer: Wellpoint Medicaid Managed Care	$204.75

CHAMBER I/C GRAFT 15cc

Facility

$7,726.50

Hospital Charge Code	270669951
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.97
Max. Negotiated Rate	$1,869.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.97

CHAMBER MEMBRANE BALANCING

Facility

$550.00

Hospital Charge Code	270676771
Hospital Revenue Code	272
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$110.00
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

CHAMBER MEMBRANE BALANCING

Facility

$550.00

Hospital Charge Code	270676771
Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CHAMBER OPTI IN RECLOSABLE BAG

Facility

$23.01

Hospital Charge Code	270647384
Hospital Revenue Code	270
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.51
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

CHAMBER OPTI IN RECLOSABLE BAG

Facility

$23.01

Hospital Charge Code	270647384
Hospital Revenue Code	270
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

CHAMBER VALUE OPTICHAMBER LARG

Facility

$75.03

Service Code	HCPCS A4627
Hospital Charge Code	270690908
Hospital Revenue Code	272
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.52
Rate for Payer: Aetna Commercial	$28.51
Rate for Payer: Aetna Medicare Advantage	$22.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.13
Rate for Payer: Cigna Commercial	$37.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.51
Rate for Payer: Oxford Commercial	$15.01
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.01
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

CHAMBER VALUE OPTICHAMBER LARG

Facility

$75.03

Service Code	HCPCS A4627
Hospital Charge Code	270690908
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

CHAMBER VALUE OPTICHAMBER MED

Facility

$66.67

Service Code	HCPCS A4627
Hospital Charge Code	270690909
Hospital Revenue Code	272
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.00

CHAMBER VALUE OPTICHAMBER MED

Facility

$66.67

Service Code	HCPCS A4627
Hospital Charge Code	270690909
Hospital Revenue Code	272
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.34
Rate for Payer: Aetna Commercial	$25.33
Rate for Payer: Aetna Medicare Advantage	$20.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.00
Rate for Payer: Cigna Commercial	$33.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.00
Rate for Payer: Oxford Commercial	$13.33
Rate for Payer: Qualcare PPO/HMO/WC	$10.00
Rate for Payer: UnitedHealthcare Commercial	$13.33
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.77

CHAMBER VALUE OPTICHAMBER S

Facility

$26.90

Service Code	HCPCS A4627
Hospital Charge Code	270690907
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$10.22
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Commercial	$5.38
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

CHAMBER VALUE OPTICHAMBER S

Facility

$26.90

Service Code	HCPCS A4627
Hospital Charge Code	270690907
Hospital Revenue Code	272
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

CH AMIKACIN - PEAK

Facility

$177.00

Service Code	HCPCS 80150
Hospital Charge Code	397073140
Hospital Revenue Code	301
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$26.55
Rate for Payer: Qualcare PPO/HMO/WC	$26.55

CH AMIKACIN - PEAK

Facility

$177.00

Service Code	HCPCS 80150
Hospital Charge Code	397073140
Hospital Revenue Code	301
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$88.50
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

CH AMIKACIN-RANDOM

Facility

$24.00

Service Code	HCPCS 80150
Hospital Charge Code	397073182
Hospital Revenue Code	301
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

CH AMIKACIN-RANDOM

Facility

$24.00

Service Code	HCPCS 80150
Hospital Charge Code	397073182
Hospital Revenue Code	301
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

CH AMIKACIN TROUGH

Facility

$128.00

Service Code	HCPCS 80150
Hospital Charge Code	397071240
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CH AMIKACIN TROUGH

Facility

$128.00

Service Code	HCPCS 80150
Hospital Charge Code	397071240
Hospital Revenue Code	301
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

CH AMINO ACID PLASMA

Facility

$225.00

Service Code	HCPCS 82128
Hospital Charge Code	397073051
Hospital Revenue Code	301
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CH AMINO ACID PLASMA

Facility

$225.00

Service Code	HCPCS 82128
Hospital Charge Code	397073051
Hospital Revenue Code	301
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.73
Rate for Payer: Aetna Medicare Advantage	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.07
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: Cigna Medicare Advantage	$13.87
Rate for Payer: Clover Medicare Advantage	$13.18
Rate for Payer: EmblemHealth Commercial	$41.61
Rate for Payer: Humana Medicare Advantage	$14.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.87
Rate for Payer: Wellcare Medicare Advantage	$13.87
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

CH AMINO ACID PLASMA QT

Facility

$180.00

Service Code	HCPCS 82131
Hospital Charge Code	397071236
Hospital Revenue Code	301
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.95
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: Cigna Medicare Advantage	$22.98
Rate for Payer: Clover Medicare Advantage	$21.83
Rate for Payer: EmblemHealth Commercial	$68.94
Rate for Payer: Humana Medicare Advantage	$23.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.98
Rate for Payer: Wellcare Medicare Advantage	$22.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

CH AMINO ACID PLASMA QT

Facility

$180.00

Service Code	HCPCS 82131
Hospital Charge Code	397071236
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

CH AMINO ACIDS

Facility

$105.00

Service Code	HCPCS 82139
Hospital Charge Code	397073251
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

Know your out-of-pocket cost for care.

All Charges