Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CHEMO IM/SQ NON HORM

Facility

$210.90

Service Code	HCPCS 96401
Hospital Charge Code	93500079
Hospital Revenue Code	331
Min. Negotiated Rate	$31.64
Max. Negotiated Rate	$31.64
Rate for Payer: Qualcare PPO/HMO/WC	$31.64

CHEMO,INF METHOD PORT/IMP PUMP

Facility

$355.76

Service Code	HCPCS 96425
Hospital Charge Code	93500182
Hospital Revenue Code	335
Min. Negotiated Rate	$53.36
Max. Negotiated Rate	$53.36
Rate for Payer: Qualcare PPO/HMO/WC	$53.36

CHEMO,INF METHOD PORT/IMP PUMP

Facility

$355.76

Service Code	HCPCS 96425
Hospital Charge Code	93500182
Hospital Revenue Code	335
Min. Negotiated Rate	$8.57
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.73
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.36
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$8.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$9.43

CHEMO,INF METHOD PORT/IMP PUMP

Facility

$917.00

Service Code	HCPCS 96425
Hospital Charge Code	3401155
Hospital Revenue Code	335
Min. Negotiated Rate	$137.55
Max. Negotiated Rate	$137.55
Rate for Payer: Qualcare PPO/HMO/WC	$137.55

CHEMO,INF METHOD PORT/IMP PUMP

Facility

$917.00

Service Code	HCPCS 96425
Hospital Charge Code	3401155
Hospital Revenue Code	335
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.10
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$137.55
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$22.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$24.30

CHEMO INFUSE W/PUMP >8 HRS

Facility

$1,778.80

Service Code	HCPCS 96416
Hospital Charge Code	93500092
Hospital Revenue Code	335
Min. Negotiated Rate	$266.82
Max. Negotiated Rate	$266.82
Rate for Payer: Qualcare PPO/HMO/WC	$266.82

CHEMO INFUSE W/PUMP >8 HRS

Facility

$1,778.80

Service Code	HCPCS 96416
Hospital Charge Code	93500092
Hospital Revenue Code	335
Min. Negotiated Rate	$42.87
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.64
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.82
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$42.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$47.14

CHEMO INFUSION ADD'L 1 HR***

Facility

$111.00

Service Code	HCPCS Q0085
Hospital Charge Code	3400181
Hospital Revenue Code	289
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

CHEMO INFUSION ADD'L 1 HR***

Facility

$111.00

Service Code	HCPCS Q0085
Hospital Charge Code	3400181
Hospital Revenue Code	289
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

CHEMO INFUSION ADDL LEVEL HR 2

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401001
Hospital Revenue Code	335
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$59.88
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.93
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7.77

CHEMO INFUSION ADDL LEVEL HR 2

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401001
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION ADDL LEVEL HR 3

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401002
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION ADDL LEVEL HR 3

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401002
Hospital Revenue Code	335
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$59.88
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.93
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7.77

CHEMO INFUSION ADDL LEVEL HR 4

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401017
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION ADDL LEVEL HR 4

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401017
Hospital Revenue Code	335
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$59.88
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.93
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7.77

CHEMO INFUSION ADDL LEVEL HR 5

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401018
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION ADDL LEVEL HR 5

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401018
Hospital Revenue Code	335
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$59.88
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.93
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7.77

CHEMO INFUSION ADDL LEVEL HR 6

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401019
Hospital Revenue Code	335
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

CHEMO INFUSION ADDL LEVEL HR 6

Facility

$293.10

Service Code	HCPCS 96415
Hospital Charge Code	3401019
Hospital Revenue Code	335
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.77
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$59.88
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.93
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7.77

CHEMO INFUSION COMPLEX****

Facility

$216.00

Service Code	HCPCS Q0084
Hospital Charge Code	3400173
Hospital Revenue Code	289
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

CHEMO INFUSION COMPLEX****

Facility

$216.00

Service Code	HCPCS Q0084
Hospital Charge Code	3400173
Hospital Revenue Code	289
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$82.08
Rate for Payer: Aetna Medicare Advantage	$64.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.08
Rate for Payer: Cigna Commercial	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.80
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.40
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$5.21
Rate for Payer: Wellpoint Medicaid Managed Care	$5.72

CHEMO INFUSION LEVEL HR 1

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	3401000
Hospital Revenue Code	335
Min. Negotiated Rate	$186.36
Max. Negotiated Rate	$186.36
Rate for Payer: Qualcare PPO/HMO/WC	$186.36

CHEMO INFUSION LEVEL HR 1

Facility

$1,242.40

Service Code	HCPCS 96413
Hospital Charge Code	3401000
Hospital Revenue Code	335
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,416.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,416.48
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$274.69
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.72
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.36
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$29.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$32.92

CHEMO INFUSN INTERIM MLTI IV**

Facility

$154.00

Service Code	HCPCS Q0084
Hospital Charge Code	3400165
Hospital Revenue Code	289
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

CHEMO INFUSN INTERIM MLTI IV**

Facility

$154.00

Service Code	HCPCS Q0084
Hospital Charge Code	3400165
Hospital Revenue Code	289
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

Know your out-of-pocket cost for care.

All Charges