Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ADALIMUMAB LEVEL FOR IBD

Facility

$250.00

Service Code	HCPCS 80145
Hospital Charge Code	401180145
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$139.23
Rate for Payer: Aetna Commercial	$104.91
Rate for Payer: Aetna Medicare Advantage	$124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.23
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: Cigna Medicare Advantage	$38.57
Rate for Payer: Clover Medicare Advantage	$36.64
Rate for Payer: EmblemHealth Commercial	$115.71
Rate for Payer: Humana Medicare Advantage	$39.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.57
Rate for Payer: Wellcare Medicare Advantage	$38.57
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

ADALIMUMAB LEVEL FOR IBD

Facility

$250.00

Service Code	HCPCS 80145
Hospital Charge Code	401180145
Hospital Revenue Code	301
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ADALIMUMAB LEVEL FOR IBD SERUM

Facility

$250.00

Service Code	HCPCS 80145
Hospital Charge Code	401380145
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$139.23
Rate for Payer: Aetna Commercial	$104.91
Rate for Payer: Aetna Medicare Advantage	$124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.23
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: Cigna Medicare Advantage	$38.57
Rate for Payer: Clover Medicare Advantage	$36.64
Rate for Payer: EmblemHealth Commercial	$115.71
Rate for Payer: Humana Medicare Advantage	$39.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.57
Rate for Payer: Wellcare Medicare Advantage	$38.57
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

ADALIMUMAB LEVEL FOR IBD SERUM

Facility

$250.00

Service Code	HCPCS 80145
Hospital Charge Code	401380145
Hospital Revenue Code	301
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ADAMS TS13 ACT W REFLEX INHIB

Facility

$390.00

Service Code	HCPCS 85397
Hospital Charge Code	39900520
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$83.94
Rate for Payer: Aetna Medicare Advantage	$99.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.40
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$30.86
Rate for Payer: Clover Medicare Advantage	$29.32
Rate for Payer: EmblemHealth Commercial	$92.58
Rate for Payer: Humana Medicare Advantage	$31.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.86
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	$24.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.86
Rate for Payer: Wellcare Medicare Advantage	$30.86
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ADAMS TS13 ACT W REFLEX INHIB

Facility

$390.00

Service Code	HCPCS 85397
Hospital Charge Code	39900520
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ADAPER GATEWAY Y 0448310

Facility

$111.65

Hospital Charge Code	270636398
Hospital Revenue Code	272
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$16.75
Rate for Payer: Qualcare PPO/HMO/WC	$16.75

ADAPER GATEWAY Y 0448310

Facility

$111.65

Hospital Charge Code	270636398
Hospital Revenue Code	272
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$55.83
Rate for Payer: Aetna Commercial	$42.43
Rate for Payer: Aetna Medicare Advantage	$33.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.47
Rate for Payer: Cigna Commercial	$55.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.49
Rate for Payer: Oxford Commercial	$22.33
Rate for Payer: Qualcare PPO/HMO/WC	$16.75
Rate for Payer: UnitedHealthcare Commercial	$22.33
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.96

ADAPTER 3WAY FOR CHOLANGIOGRAM

Facility

$135.00

Hospital Charge Code	270642008
Hospital Revenue Code	272
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$27.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

ADAPTER 3WAY FOR CHOLANGIOGRAM

Facility

$135.00

Hospital Charge Code	270642008
Hospital Revenue Code	272
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

ADAPTER 45 DEGREE AS B/F

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683031
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

ADAPTER 45 DEGREE AS B/F

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683031
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

ADAPTER 6mm HIP NECK LENGTH

Facility

$1,700.00

Hospital Charge Code	270646451
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

ADAPTER 6mm HIP NECK LENGTH

Facility

$1,700.00

Hospital Charge Code	270646451
Hospital Revenue Code	278
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Community & State	$40.97
Rate for Payer: Wellpoint Medicaid Managed Care	$45.05

ADAPTER AIRWAY ST 151D 1100

Facility

$29.65

Hospital Charge Code	270600611
Hospital Revenue Code	270
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

ADAPTER AIRWAY ST 151D 1100

Facility

$29.65

Hospital Charge Code	270600611
Hospital Revenue Code	270
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.89
Rate for Payer: Oxford Commercial	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$5.93
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

ADAPTER BD FEEDING TUBE 000333

Facility

$36.00

Hospital Charge Code	270600921
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

ADAPTER BD FEEDING TUBE 000333

Facility

$36.00

Hospital Charge Code	270600921
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

ADAPTER BIOLOX +0MM 12/14

Facility

$935.00

Service Code	HCPCS C1776
Hospital Charge Code	270678673
Hospital Revenue Code	278
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$226.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

ADAPTER BIOLOX +0MM 12/14

Facility

$935.00

Service Code	HCPCS C1776
Hospital Charge Code	270678673
Hospital Revenue Code	278
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$467.50
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare Advantage	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.43
Rate for Payer: Cigna Commercial	$467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$140.25
Rate for Payer: UnitedHealthcare Community & State	$22.53
Rate for Payer: Wellpoint Medicaid Managed Care	$24.78

ADAPTER BIOPSY VALVE

Facility

$48.85

Hospital Charge Code	270677982
Hospital Revenue Code	272
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$7.33
Rate for Payer: Qualcare PPO/HMO/WC	$7.33

ADAPTER BIOPSY VALVE

Facility

$48.85

Hospital Charge Code	270677982
Hospital Revenue Code	272
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.43
Rate for Payer: Aetna Commercial	$18.56
Rate for Payer: Aetna Medicare Advantage	$14.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.46
Rate for Payer: Cigna Commercial	$24.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.65
Rate for Payer: Oxford Commercial	$9.77
Rate for Payer: Qualcare PPO/HMO/WC	$7.33
Rate for Payer: UnitedHealthcare Commercial	$9.77
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

ADAPTER BIPOLAR 3.5MM

Facility

$935.00

Service Code	HCPCS C1776
Hospital Charge Code	270689638
Hospital Revenue Code	278
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$467.50
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare Advantage	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.43
Rate for Payer: Cigna Commercial	$467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$140.25
Rate for Payer: UnitedHealthcare Community & State	$22.53
Rate for Payer: Wellpoint Medicaid Managed Care	$24.78

ADAPTER BIPOLAR 3.5MM

Facility

$935.00

Service Code	HCPCS C1776
Hospital Charge Code	270689638
Hospital Revenue Code	278
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$226.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

ADAPTER BMT DRLL 4.3 471843

Facility

$930.00

Hospital Charge Code	270617541
Hospital Revenue Code	272
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Qualcare PPO/HMO/WC	$139.50

Know your out-of-pocket cost for care.

All Charges