Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH FETAL MAT HEM TEST

Facility

$153.00

Service Code	HCPCS 85460
Hospital Charge Code	397031061
Hospital Revenue Code	305
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

CH FFP SERIES 1

Facility

$688.00

Service Code	HCPCS P9017
Hospital Charge Code	397031041
Hospital Revenue Code	390
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$103.20
Rate for Payer: Qualcare PPO/HMO/WC	$103.20

CH FFP SERIES 1

Facility

$688.00

Service Code	HCPCS P9017
Hospital Charge Code	397031041
Hospital Revenue Code	390
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$271.95
Rate for Payer: Aetna Medicare Advantage	$323.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$99.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.90
Rate for Payer: Cigna Commercial	$200.40
Rate for Payer: Cigna Medicare Advantage	$99.98
Rate for Payer: Clover Medicare Advantage	$94.98
Rate for Payer: EmblemHealth Commercial	$299.94
Rate for Payer: Humana Medicare Advantage	$102.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$99.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.40
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.20
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$16.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$99.98
Rate for Payer: Wellcare Medicare Advantage	$99.98
Rate for Payer: Wellpoint Medicaid Managed Care	$18.23

CH FFP SERIES 3

Facility

$352.35

Service Code	HCPCS P9017
Hospital Charge Code	397031042
Hospital Revenue Code	390
Min. Negotiated Rate	$52.85
Max. Negotiated Rate	$52.85
Rate for Payer: Qualcare PPO/HMO/WC	$52.85

CH FFP SERIES 3

Facility

$352.35

Service Code	HCPCS P9017
Hospital Charge Code	397031042
Hospital Revenue Code	390
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$271.95
Rate for Payer: Aetna Medicare Advantage	$323.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$99.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.90
Rate for Payer: Cigna Commercial	$200.40
Rate for Payer: Cigna Medicare Advantage	$99.98
Rate for Payer: Clover Medicare Advantage	$94.98
Rate for Payer: EmblemHealth Commercial	$299.94
Rate for Payer: Humana Medicare Advantage	$102.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$99.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.70
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.85
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$8.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$99.98
Rate for Payer: Wellcare Medicare Advantage	$99.98
Rate for Payer: Wellpoint Medicaid Managed Care	$9.34

CH FFP X1

Facility

$352.35

Service Code	HCPCS P9017
Hospital Charge Code	397031006
Hospital Revenue Code	390
Min. Negotiated Rate	$52.85
Max. Negotiated Rate	$52.85
Rate for Payer: Qualcare PPO/HMO/WC	$52.85

CH FFP X1

Facility

$352.35

Service Code	HCPCS P9017
Hospital Charge Code	397031006
Hospital Revenue Code	390
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$271.95
Rate for Payer: Aetna Medicare Advantage	$323.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$99.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.90
Rate for Payer: Cigna Commercial	$200.40
Rate for Payer: Cigna Medicare Advantage	$99.98
Rate for Payer: Clover Medicare Advantage	$94.98
Rate for Payer: EmblemHealth Commercial	$299.94
Rate for Payer: Humana Medicare Advantage	$102.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$99.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.70
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.85
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$8.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$99.98
Rate for Payer: Wellcare Medicare Advantage	$99.98
Rate for Payer: Wellpoint Medicaid Managed Care	$9.34

CH FIBRIN DEG PROD

Facility

$390.00

Service Code	HCPCS 85362
Hospital Charge Code	397021006
Hospital Revenue Code	305
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare Advantage	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.87
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.89
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.89
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	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Medicare Advantage	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH FIBRIN DEG PROD

Facility

$390.00

Service Code	HCPCS 85362
Hospital Charge Code	397021006
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH FIBRINOGEN

Facility

$53.00

Service Code	HCPCS 85384
Hospital Charge Code	397021071
Hospital Revenue Code	305
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.44
Rate for Payer: Aetna Medicare Advantage	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.09
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: Cigna Medicare Advantage	$9.72
Rate for Payer: Clover Medicare Advantage	$9.23
Rate for Payer: EmblemHealth Commercial	$29.16
Rate for Payer: Humana Medicare Advantage	$10.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72
Rate for Payer: Wellcare Medicare Advantage	$9.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

CH FIBRINOGEN

Facility

$53.00

Service Code	HCPCS 85384
Hospital Charge Code	397021071
Hospital Revenue Code	305
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$7.95
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

CH FLEXERIL

Facility

$441.00

Service Code	HCPCS 80299
Hospital Charge Code	397072070
Hospital Revenue Code	301
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$220.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.69

CH FLEXERIL

Facility

$441.00

Service Code	HCPCS 80299
Hospital Charge Code	397072070
Hospital Revenue Code	301
Min. Negotiated Rate	$66.15
Max. Negotiated Rate	$66.15
Rate for Payer: Qualcare PPO/HMO/WC	$66.15

CH FLOWCTOMETRY/TC ADD-ON

Facility

$115.00

Service Code	HCPCS 88185
Hospital Charge Code	397071458
Hospital Revenue Code	311
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$43.70
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$19.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

CH FLOWCTOMETRY/TC ADD-ON

Facility

$115.00

Service Code	HCPCS 88185
Hospital Charge Code	397071458
Hospital Revenue Code	311
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

CH FLOWCYTOMETRY/TC 1 MARKER

Facility

$115.00

Service Code	HCPCS 88184
Hospital Charge Code	397071457
Hospital Revenue Code	311
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$1,537.15
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,537.15
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$64.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

CH FLOWCYTOMETRY/TC 1 MARKER

Facility

$115.00

Service Code	HCPCS 88184
Hospital Charge Code	397071457
Hospital Revenue Code	311
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

CH FLOW CYTOMETRY X19

Facility

$147.00

Service Code	HCPCS 88182
Hospital Charge Code	397073305
Hospital Revenue Code	311
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$22.05
Rate for Payer: Qualcare PPO/HMO/WC	$22.05

CH FLOW CYTOMETRY X19

Facility

$147.00

Service Code	HCPCS 88182
Hospital Charge Code	397073305
Hospital Revenue Code	311
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.05
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

CH FLOW CYTOMETRY X23

Facility

$149.00

Service Code	HCPCS 88182
Hospital Charge Code	397073311
Hospital Revenue Code	311
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

CH FLOW CYTOMETRY X23

Facility

$149.00

Service Code	HCPCS 88182
Hospital Charge Code	397073311
Hospital Revenue Code	311
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

CH FLUAB

Facility

$125.00

Service Code	HCPCS 87804
Hospital Charge Code	397040095
Hospital Revenue Code	306
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CH FLUAB

Facility

$125.00

Service Code	HCPCS 87804
Hospital Charge Code	397040095
Hospital Revenue Code	306
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.02
Rate for Payer: Aetna Medicare Advantage	$53.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.74
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: Cigna Medicare Advantage	$16.55
Rate for Payer: Clover Medicare Advantage	$15.72
Rate for Payer: EmblemHealth Commercial	$49.65
Rate for Payer: Humana Medicare Advantage	$17.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.55
Rate for Payer: Wellcare Medicare Advantage	$16.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

CH FLUNITRAZEPAM/MET CONF(S)

Facility

$832.00

Service Code	HCPCS 80300
Hospital Charge Code	397071435
Hospital Revenue Code	301
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$416.00
Rate for Payer: Aetna Commercial	$316.16
Rate for Payer: Aetna Medicare Advantage	$249.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.16
Rate for Payer: Cigna Commercial	$416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$22.05

CH FLUNITRAZEPAM/MET CONF(S)

Facility

$832.00

Service Code	HCPCS 80300
Hospital Charge Code	397071435
Hospital Revenue Code	301
Min. Negotiated Rate	$124.80
Max. Negotiated Rate	$124.80
Rate for Payer: Qualcare PPO/HMO/WC	$124.80

Know your out-of-pocket cost for care.

All Charges