Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH INTERPRETATION

Facility

$65.00

Service Code	HCPCS 83912
Hospital Charge Code	397073293
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH INTERPRETATION

Facility

$162.00

Service Code	HCPCS 83912
Hospital Charge Code	397073575
Hospital Revenue Code	301
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

CH INTERPRETATION

Facility

$162.00

Service Code	HCPCS 83912
Hospital Charge Code	397073575
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$61.56
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.29

CH INTERPRETATION

Facility

$65.00

Service Code	HCPCS 83912
Hospital Charge Code	397073300
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

CH INTERPRETATION

Facility

$65.00

Service Code	HCPCS 83912
Hospital Charge Code	397073300
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CH INTERPRETATION & REPORT

Facility

$162.00

Service Code	HCPCS 83912
Hospital Charge Code	397073564
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$61.56
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.29

CH INTERPRETATION & REPORT

Facility

$162.00

Service Code	HCPCS 83912
Hospital Charge Code	397073564
Hospital Revenue Code	301
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

CH INTRINS FACTOR BLKING AB

Facility

$222.00

Service Code	HCPCS 86340
Hospital Charge Code	397072101
Hospital Revenue Code	302
Min. Negotiated Rate	$33.30
Max. Negotiated Rate	$33.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.30

CH INTRINS FACTOR BLKING AB

Facility

$222.00

Service Code	HCPCS 86340
Hospital Charge Code	397072101
Hospital Revenue Code	302
Min. Negotiated Rate	$5.88
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	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$111.00
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	$66.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.30
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	$5.88

CHIP CANC 30cc 400150

Facility

$1,974.15

Hospital Charge Code	270635845
Hospital Revenue Code	278
Min. Negotiated Rate	$296.12
Max. Negotiated Rate	$477.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$394.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.31
Rate for Payer: Qualcare PPO/HMO/WC	$296.12

CHIP CANC 30cc 400150

Facility

$1,974.15

Hospital Charge Code	270635845
Hospital Revenue Code	278
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$987.08
Rate for Payer: Aetna Commercial	$750.18
Rate for Payer: Aetna Medicare Advantage	$592.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$394.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.41
Rate for Payer: Cigna Commercial	$987.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.31
Rate for Payer: Qualcare PPO/HMO/WC	$296.12
Rate for Payer: UnitedHealthcare Community & State	$47.58
Rate for Payer: Wellpoint Medicaid Managed Care	$52.31

CHIP CANCEL 3-6m 30c 500154

Facility

$1,974.15

Hospital Charge Code	270636254
Hospital Revenue Code	278
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$987.08
Rate for Payer: Aetna Commercial	$750.18
Rate for Payer: Aetna Medicare Advantage	$592.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$394.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.41
Rate for Payer: Cigna Commercial	$987.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.31
Rate for Payer: Qualcare PPO/HMO/WC	$296.12
Rate for Payer: UnitedHealthcare Community & State	$47.58
Rate for Payer: Wellpoint Medicaid Managed Care	$52.31

CHIP CANCEL 3-6m 30c 500154

Facility

$1,974.15

Hospital Charge Code	270636254
Hospital Revenue Code	278
Min. Negotiated Rate	$296.12
Max. Negotiated Rate	$477.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$394.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.31
Rate for Payer: Qualcare PPO/HMO/WC	$296.12

CHIP CANCEL 6-10m 30c 500153

Facility

$2,130.00

Hospital Charge Code	270636253
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$515.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$468.60
Rate for Payer: Qualcare PPO/HMO/WC	$319.50

CHIP CANCEL 6-10m 30c 500153

Facility

$2,130.00

Hospital Charge Code	270636253
Hospital Revenue Code	278
Min. Negotiated Rate	$51.33
Max. Negotiated Rate	$1,065.00
Rate for Payer: Aetna Commercial	$809.40
Rate for Payer: Aetna Medicare Advantage	$639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.15
Rate for Payer: Cigna Commercial	$1,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$468.60
Rate for Payer: Qualcare PPO/HMO/WC	$319.50
Rate for Payer: UnitedHealthcare Community & State	$51.33
Rate for Payer: Wellpoint Medicaid Managed Care	$56.45

CHIP CANCELLOUS 15cc

Facility

$1,533.00

Service Code	HCPCS C1713
Hospital Charge Code	270675127
Hospital Revenue Code	278
Min. Negotiated Rate	$229.95
Max. Negotiated Rate	$370.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$337.26
Rate for Payer: Qualcare PPO/HMO/WC	$229.95

CHIP CANCELLOUS 15cc

Facility

$1,533.00

Service Code	HCPCS C1713
Hospital Charge Code	270675127
Hospital Revenue Code	278
Min. Negotiated Rate	$36.95
Max. Negotiated Rate	$766.50
Rate for Payer: Aetna Commercial	$582.54
Rate for Payer: Aetna Medicare Advantage	$459.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$390.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$390.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$390.92
Rate for Payer: Cigna Commercial	$766.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$337.26
Rate for Payer: Qualcare PPO/HMO/WC	$229.95
Rate for Payer: UnitedHealthcare Community & State	$36.95
Rate for Payer: Wellpoint Medicaid Managed Care	$40.62

CHIP CANCELLOUS 1.7-10MM 30CC

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270645713
Hospital Revenue Code	278
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$72.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.16

CHIP CANCELLOUS 1.7-10MM 30CC

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270645713
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

CHIP CANCELLOUS 5cc

Facility

$840.00

Service Code	HCPCS C1713
Hospital Charge Code	270675128
Hospital Revenue Code	278
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$420.00
Rate for Payer: Aetna Commercial	$319.20
Rate for Payer: Aetna Medicare Advantage	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.20
Rate for Payer: Cigna Commercial	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.00
Rate for Payer: UnitedHealthcare Community & State	$20.24
Rate for Payer: Wellpoint Medicaid Managed Care	$22.26

CHIP CANCELLOUS 5cc

Facility

$840.00

Service Code	HCPCS C1713
Hospital Charge Code	270675128
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$203.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.00

CHIP CANCELLOUS 5CC

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270682160
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

CHIP CANCELLOUS 5CC

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270682160
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

CHIPS CANC BONE 1.7-10 500150

Facility

$1,807.25

Hospital Charge Code	270614020
Hospital Revenue Code	278
Min. Negotiated Rate	$271.09
Max. Negotiated Rate	$437.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$361.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$397.60
Rate for Payer: Qualcare PPO/HMO/WC	$271.09

CHIPS CANC BONE 1.7-10 500150

Facility

$1,807.25

Hospital Charge Code	270614020
Hospital Revenue Code	278
Min. Negotiated Rate	$43.55
Max. Negotiated Rate	$903.62
Rate for Payer: Aetna Commercial	$686.75
Rate for Payer: Aetna Medicare Advantage	$542.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$460.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$460.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$361.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$460.85
Rate for Payer: Cigna Commercial	$903.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$397.60
Rate for Payer: Qualcare PPO/HMO/WC	$271.09
Rate for Payer: UnitedHealthcare Community & State	$43.55
Rate for Payer: Wellpoint Medicaid Managed Care	$47.89

Know your out-of-pocket cost for care.

All Charges