Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH PHIL CHROM & DNA

Facility

$2,862.00

Service Code	HCPCS 81240
Hospital Charge Code	397073030
Hospital Revenue Code	310
Min. Negotiated Rate	$429.30
Max. Negotiated Rate	$429.30
Rate for Payer: Qualcare PPO/HMO/WC	$429.30

CH PHIL CHROM DNA PROBE

Facility

$1,181.00

Service Code	HCPCS 83912
Hospital Charge Code	397073100
Hospital Revenue Code	301
Min. Negotiated Rate	$177.15
Max. Negotiated Rate	$177.15
Rate for Payer: Qualcare PPO/HMO/WC	$177.15

CH PHIL CHROM DNA PROBE

Facility

$1,181.00

Service Code	HCPCS 83912
Hospital Charge Code	397073100
Hospital Revenue Code	301
Min. Negotiated Rate	$28.46
Max. Negotiated Rate	$590.50
Rate for Payer: Aetna Commercial	$448.78
Rate for Payer: Aetna Medicare Advantage	$354.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.15
Rate for Payer: Cigna Commercial	$590.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$177.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.46
Rate for Payer: Wellpoint Medicaid Managed Care	$31.30

CH PHOSPHATIDYSERINE (G,A,M)

Facility

$1,248.00

Service Code	HCPCS 86148
Hospital Charge Code	397071415
Hospital Revenue Code	302
Min. Negotiated Rate	$12.86
Max. Negotiated Rate	$624.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$624.00
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$374.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$33.07

CH PHOSPHATIDYSERINE (G,A,M)

Facility

$1,248.00

Service Code	HCPCS 86148
Hospital Charge Code	397071415
Hospital Revenue Code	302
Min. Negotiated Rate	$187.20
Max. Negotiated Rate	$187.20
Rate for Payer: Qualcare PPO/HMO/WC	$187.20

CH PHOSPHOLIPIDS

Facility

$299.00

Service Code	HCPCS 84311
Hospital Charge Code	397073098
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$149.50
Rate for Payer: Aetna Commercial	$22.03
Rate for Payer: Aetna Medicare Advantage	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.24
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: Cigna Medicare Advantage	$8.10
Rate for Payer: Clover Medicare Advantage	$7.70
Rate for Payer: EmblemHealth Commercial	$24.30
Rate for Payer: Humana Medicare Advantage	$8.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.10
Rate for Payer: Wellcare Medicare Advantage	$8.10
Rate for Payer: Wellpoint Medicaid Managed Care	$7.92

CH PHOSPHOLIPIDS

Facility

$299.00

Service Code	HCPCS 84311
Hospital Charge Code	397073098
Hospital Revenue Code	301
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

CH PHOSPHORUS

Facility

$141.80

Service Code	HCPCS 84100
Hospital Charge Code	397071267
Hospital Revenue Code	301
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.89
Rate for Payer: Aetna Medicare Advantage	$15.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.74
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	$17.11
Rate for Payer: Cigna Commercial	$70.90
Rate for Payer: Cigna Medicare Advantage	$4.74
Rate for Payer: Clover Medicare Advantage	$4.50
Rate for Payer: EmblemHealth Commercial	$14.22
Rate for Payer: Humana Medicare Advantage	$4.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.27
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.74
Rate for Payer: Wellcare Medicare Advantage	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

CH PHOSPHORUS

Facility

$141.80

Service Code	HCPCS 84100
Hospital Charge Code	397071267
Hospital Revenue Code	301
Min. Negotiated Rate	$21.27
Max. Negotiated Rate	$21.27
Rate for Payer: Qualcare PPO/HMO/WC	$21.27

CH PHOSPHORUS URINE 24 HR

Facility

$390.00

Service Code	HCPCS 84105
Hospital Charge Code	397071311
Hospital Revenue Code	301
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
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	$20.86
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
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	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CH PHOSPHORUS URINE 24 HR

Facility

$390.00

Service Code	HCPCS 84105
Hospital Charge Code	397071311
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH PH URINE

Facility

$22.00

Service Code	HCPCS 83986
Hospital Charge Code	397071321
Hospital Revenue Code	301
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.92
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

CH PH URINE

Facility

$22.00

Service Code	HCPCS 83986
Hospital Charge Code	397071321
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

CH PILL/POWDER ID QL

Facility

$578.00

Service Code	HCPCS 80100
Hospital Charge Code	397073099
Hospital Revenue Code	301
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$289.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

CH PILL/POWDER ID QL

Facility

$578.00

Service Code	HCPCS 80100
Hospital Charge Code	397073099
Hospital Revenue Code	301
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

CH PLACEMENT IVC FILTER PERCU

Facility

$1,370.00

Service Code	HCPCS 75940
Hospital Charge Code	7411329
Hospital Revenue Code	320
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$520.60
Rate for Payer: Aetna Medicare Advantage	$411.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.35
Rate for Payer: Cigna Commercial	$685.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$205.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$33.02
Rate for Payer: Wellpoint Medicaid Managed Care	$36.30

CH PLACEMENT IVC FILTER PERCU

Facility

$1,370.00

Service Code	HCPCS 75940
Hospital Charge Code	7411329
Hospital Revenue Code	320
Min. Negotiated Rate	$205.50
Max. Negotiated Rate	$205.50
Rate for Payer: Qualcare PPO/HMO/WC	$205.50

CH PLASMINOGEN ACTIV INHIB

Facility

$441.00

Service Code	HCPCS 85415
Hospital Charge Code	397021097
Hospital Revenue Code	305
Min. Negotiated Rate	$66.15
Max. Negotiated Rate	$66.15
Rate for Payer: Qualcare PPO/HMO/WC	$66.15

CH PLASMINOGEN ACTIV INHIB

Facility

$441.00

Service Code	HCPCS 85415
Hospital Charge Code	397021097
Hospital Revenue Code	305
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna Commercial	$46.76
Rate for Payer: Aetna Medicare Advantage	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.05
Rate for Payer: Cigna Commercial	$220.50
Rate for Payer: Cigna Medicare Advantage	$17.19
Rate for Payer: Clover Medicare Advantage	$16.33
Rate for Payer: EmblemHealth Commercial	$51.57
Rate for Payer: Humana Medicare Advantage	$17.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.19
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	$13.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.19
Rate for Payer: Wellcare Medicare Advantage	$17.19
Rate for Payer: Wellpoint Medicaid Managed Care	$11.69

CH PLASMINOGEN ACTIVITY

Facility

$116.00

Service Code	HCPCS 85420
Hospital Charge Code	397073688
Hospital Revenue Code	305
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

CH PLASMINOGEN ACTIVITY

Facility

$116.00

Service Code	HCPCS 85420
Hospital Charge Code	397073688
Hospital Revenue Code	305
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.76
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.57
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: Cigna Medicare Advantage	$6.53
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Medicare Advantage	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

CH PLAT CONC IRRADIATED

Facility

$440.00

Service Code	HCPCS P9032
Hospital Charge Code	397031044
Hospital Revenue Code	390
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$1,649.49
Rate for Payer: Aetna Commercial	$1,242.93
Rate for Payer: Aetna Medicare Advantage	$1,480.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,649.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,649.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$456.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,649.49
Rate for Payer: Cigna Commercial	$915.99
Rate for Payer: Cigna Medicare Advantage	$456.96
Rate for Payer: Clover Medicare Advantage	$434.11
Rate for Payer: EmblemHealth Commercial	$1,370.88
Rate for Payer: Humana Medicare Advantage	$470.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$456.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.00
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$456.96
Rate for Payer: Wellcare Medicare Advantage	$456.96
Rate for Payer: Wellpoint Medicaid Managed Care	$11.66

CH PLAT CONC IRRADIATED

Facility

$440.00

Service Code	HCPCS P9032
Hospital Charge Code	397031044
Hospital Revenue Code	390
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

CH PLATELET AB, CIRCULATING

Facility

$662.00

Service Code	HCPCS 86022
Hospital Charge Code	397020002
Hospital Revenue Code	302
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$99.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.30

CH PLATELET AB, CIRCULATING

Facility

$662.00

Service Code	HCPCS 86022
Hospital Charge Code	397020002
Hospital Revenue Code	302
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$331.00
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$59.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.31
Rate for Payer: Cigna Commercial	$331.00
Rate for Payer: Cigna Medicare Advantage	$18.37
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Medicare Advantage	$18.37
Rate for Payer: Wellpoint Medicaid Managed Care	$17.54

Know your out-of-pocket cost for care.

All Charges