Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACTISHIELD BARRIER GRAFT 2X4CM

Facility

$15,000.00

Service Code	HCPCS V2790
Hospital Charge Code	270700803
Hospital Revenue Code	278
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

ACTISHIELD BARRIER GRAFT 2X4CM

Facility

$15,000.00

Service Code	HCPCS V2790
Hospital Charge Code	270700803
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

ACTIVASE 100MG

Facility

$15,916.00

Hospital Charge Code	60635012
Hospital Revenue Code	636
Min. Negotiated Rate	$383.58
Max. Negotiated Rate	$7,958.00
Rate for Payer: Aetna Commercial	$6,048.08
Rate for Payer: Aetna Medicare Advantage	$4,774.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,058.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,058.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,058.58
Rate for Payer: Cigna Commercial	$7,958.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,851.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,387.40
Rate for Payer: UnitedHealthcare Community & State	$383.58
Rate for Payer: Wellpoint Medicaid Managed Care	$421.77

ACTIVASE 100MG

Facility

$15,916.00

Hospital Charge Code	60635012
Hospital Revenue Code	636
Min. Negotiated Rate	$2,387.40
Max. Negotiated Rate	$3,851.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,851.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,387.40

ACTIVASE 100MG (TRANSPORT

Facility

$17,133.00

Hospital Charge Code	60635393
Hospital Revenue Code	636
Min. Negotiated Rate	$2,569.95
Max. Negotiated Rate	$4,146.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,146.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,569.95

ACTIVASE 100MG (TRANSPORT

Facility

$17,133.00

Hospital Charge Code	60635393
Hospital Revenue Code	636
Min. Negotiated Rate	$412.91
Max. Negotiated Rate	$8,566.50
Rate for Payer: Aetna Commercial	$6,510.54
Rate for Payer: Aetna Medicare Advantage	$5,139.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,368.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,368.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,368.91
Rate for Payer: Cigna Commercial	$8,566.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,146.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,569.95
Rate for Payer: UnitedHealthcare Community & State	$412.91
Rate for Payer: Wellpoint Medicaid Managed Care	$454.02

ACTIVASE 50MG VIAL

Facility

$9,211.00

Hospital Charge Code	60635661
Hospital Revenue Code	636
Min. Negotiated Rate	$221.99
Max. Negotiated Rate	$4,605.50
Rate for Payer: Aetna Commercial	$3,500.18
Rate for Payer: Aetna Medicare Advantage	$2,763.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,348.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,348.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,348.80
Rate for Payer: Cigna Commercial	$4,605.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,229.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,381.65
Rate for Payer: UnitedHealthcare Community & State	$221.99
Rate for Payer: Wellpoint Medicaid Managed Care	$244.09

ACTIVASE 50MG VIAL

Facility

$9,211.00

Hospital Charge Code	60635661
Hospital Revenue Code	636
Min. Negotiated Rate	$1,381.65
Max. Negotiated Rate	$2,229.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,229.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,381.65

ACTIVASE INJ/20MG

Facility

$3,122.00

Hospital Charge Code	60634538
Hospital Revenue Code	636
Min. Negotiated Rate	$468.30
Max. Negotiated Rate	$755.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.52
Rate for Payer: Qualcare PPO/HMO/WC	$468.30

ACTIVASE INJ/20MG

Facility

$3,122.00

Hospital Charge Code	60634538
Hospital Revenue Code	636
Min. Negotiated Rate	$75.24
Max. Negotiated Rate	$1,561.00
Rate for Payer: Aetna Commercial	$1,186.36
Rate for Payer: Aetna Medicare Advantage	$936.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.11
Rate for Payer: Cigna Commercial	$1,561.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$755.52
Rate for Payer: Qualcare PPO/HMO/WC	$468.30
Rate for Payer: UnitedHealthcare Community & State	$75.24
Rate for Payer: Wellpoint Medicaid Managed Care	$82.73

ACTIVASE INJ/50MG

Facility

$7,805.00

Hospital Charge Code	60634537
Hospital Revenue Code	636
Min. Negotiated Rate	$188.10
Max. Negotiated Rate	$3,902.50
Rate for Payer: Aetna Commercial	$2,965.90
Rate for Payer: Aetna Medicare Advantage	$2,341.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,990.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,990.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,990.28
Rate for Payer: Cigna Commercial	$3,902.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.75
Rate for Payer: UnitedHealthcare Community & State	$188.10
Rate for Payer: Wellpoint Medicaid Managed Care	$206.83

ACTIVASE INJ/50MG

Facility

$7,805.00

Hospital Charge Code	60634537
Hospital Revenue Code	636
Min. Negotiated Rate	$1,170.75
Max. Negotiated Rate	$1,888.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.75

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	74110071
Hospital Revenue Code	300
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	1500100
Hospital Revenue Code	300
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	74110071
Hospital Revenue Code	300
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$55.41
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.53
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: Cigna Medicare Advantage	$20.37
Rate for Payer: Clover Medicare Advantage	$19.35
Rate for Payer: EmblemHealth Commercial	$61.11
Rate for Payer: Humana Medicare Advantage	$20.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.37
Rate for Payer: Wellcare Medicare Advantage	$20.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	1600501
Hospital Revenue Code	300
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$55.41
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.53
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: Cigna Medicare Advantage	$20.37
Rate for Payer: Clover Medicare Advantage	$19.35
Rate for Payer: EmblemHealth Commercial	$61.11
Rate for Payer: Humana Medicare Advantage	$20.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.37
Rate for Payer: Wellcare Medicare Advantage	$20.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

ACTIVATED CLOTTING TIME

Facility

$390.00

Service Code	HCPCS 85175
Hospital Charge Code	5100770
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	1600501
Hospital Revenue Code	300
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

ACTIVATED CLOTTING TIME

Facility

$390.00

Service Code	HCPCS 85175
Hospital Charge Code	5100770
Hospital Revenue Code	300
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$55.41
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.37
Rate for Payer: Clover Medicare Advantage	$19.35
Rate for Payer: EmblemHealth Commercial	$61.11
Rate for Payer: Humana Medicare Advantage	$20.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.37
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	$16.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.37
Rate for Payer: Wellcare Medicare Advantage	$20.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ACTIVATED CLOTTING TIME

Facility

$32.00

Service Code	HCPCS 85175
Hospital Charge Code	1500100
Hospital Revenue Code	300
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$55.41
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.53
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: Cigna Medicare Advantage	$20.37
Rate for Payer: Clover Medicare Advantage	$19.35
Rate for Payer: EmblemHealth Commercial	$61.11
Rate for Payer: Humana Medicare Advantage	$20.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.37
Rate for Payer: Wellcare Medicare Advantage	$20.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

ACTIVATED COAGULATION TIME

Facility

$29.25

Service Code	HCPCS 85347
Hospital Charge Code	3038108
Hospital Revenue Code	305
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$4.39
Rate for Payer: Qualcare PPO/HMO/WC	$4.39

ACTIVATED COAGULATION TIME

Facility

$29.25

Service Code	HCPCS 85347
Hospital Charge Code	3038108
Hospital Revenue Code	305
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.45
Rate for Payer: Cigna Commercial	$14.62
Rate for Payer: Cigna Medicare Advantage	$4.28
Rate for Payer: Clover Medicare Advantage	$4.07
Rate for Payer: EmblemHealth Commercial	$12.84
Rate for Payer: Humana Medicare Advantage	$4.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.39
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.28
Rate for Payer: Wellcare Medicare Advantage	$4.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

ACTIVATOR NV CLIPS DSC

Facility

$2,835.00

Hospital Charge Code	270691828
Hospital Revenue Code	270
Min. Negotiated Rate	$425.25
Max. Negotiated Rate	$425.25
Rate for Payer: Qualcare PPO/HMO/WC	$425.25

ACTIVATOR NV CLIPS DSC

Facility

$2,835.00

Hospital Charge Code	270691828
Hospital Revenue Code	270
Min. Negotiated Rate	$68.32
Max. Negotiated Rate	$1,417.50
Rate for Payer: Aetna Commercial	$1,077.30
Rate for Payer: Aetna Medicare Advantage	$850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$722.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$722.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$722.92
Rate for Payer: Cigna Commercial	$1,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$850.50
Rate for Payer: Oxford Commercial	$567.00
Rate for Payer: Qualcare PPO/HMO/WC	$425.25
Rate for Payer: UnitedHealthcare Commercial	$567.00
Rate for Payer: UnitedHealthcare Community & State	$68.32
Rate for Payer: Wellpoint Medicaid Managed Care	$75.13

ACTIVE WOUND 20 CM OR LES

Facility

$411.00

Service Code	HCPCS 97597
Hospital Charge Code	94186085
Hospital Revenue Code	361
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.89

Know your out-of-pocket cost for care.

All Charges