Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH RBC DIRECTED

Facility

$820.00

Service Code	HCPCS P9010
Hospital Charge Code	397031033
Hospital Revenue Code	390
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$600.44
Rate for Payer: Aetna Medicare Advantage	$715.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$220.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.84
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: Cigna Medicare Advantage	$220.75
Rate for Payer: Clover Medicare Advantage	$209.71
Rate for Payer: EmblemHealth Commercial	$662.25
Rate for Payer: Humana Medicare Advantage	$227.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$220.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.00
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$19.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$220.75
Rate for Payer: Wellcare Medicare Advantage	$220.75
Rate for Payer: Wellpoint Medicaid Managed Care	$21.73

CH RBC DIRECTED

Facility

$820.00

Service Code	HCPCS P9010
Hospital Charge Code	397031033
Hospital Revenue Code	390
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

CH RBC, IRRADIATED X1

Facility

$1,302.59

Service Code	HCPCS P9038
Hospital Charge Code	397031121
Hospital Revenue Code	390
Min. Negotiated Rate	$31.39
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$459.33
Rate for Payer: Aetna Medicare Advantage	$547.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$609.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$609.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$168.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$609.57
Rate for Payer: Cigna Commercial	$338.50
Rate for Payer: Cigna Medicare Advantage	$168.87
Rate for Payer: Clover Medicare Advantage	$160.43
Rate for Payer: EmblemHealth Commercial	$506.61
Rate for Payer: Humana Medicare Advantage	$173.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$168.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.78
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.39
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$31.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$168.87
Rate for Payer: Wellcare Medicare Advantage	$168.87
Rate for Payer: Wellpoint Medicaid Managed Care	$34.52

CH RBC, IRRADIATED X1

Facility

$1,302.59

Service Code	HCPCS P9038
Hospital Charge Code	397031121
Hospital Revenue Code	390
Min. Negotiated Rate	$195.39
Max. Negotiated Rate	$195.39
Rate for Payer: Qualcare PPO/HMO/WC	$195.39

CH RBC LEUKOCYTE-POOR X1

Facility

$765.00

Service Code	HCPCS P9016
Hospital Charge Code	397031125
Hospital Revenue Code	390
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$114.75
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

CH RBC LEUKOCYTE-POOR X1

Facility

$765.00

Service Code	HCPCS P9016
Hospital Charge Code	397031125
Hospital Revenue Code	390
Min. Negotiated Rate	$18.44
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$584.85
Rate for Payer: Aetna Medicare Advantage	$696.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$776.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$776.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$215.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$776.16
Rate for Payer: Cigna Commercial	$431.02
Rate for Payer: Cigna Medicare Advantage	$215.02
Rate for Payer: Clover Medicare Advantage	$204.27
Rate for Payer: EmblemHealth Commercial	$645.06
Rate for Payer: Humana Medicare Advantage	$221.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$215.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.50
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$18.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$215.02
Rate for Payer: Wellcare Medicare Advantage	$215.02
Rate for Payer: Wellpoint Medicaid Managed Care	$20.27

CH RBC LEUKO IRRAD CMV NEG

Facility

$1,430.80

Service Code	HCPCS P9058
Hospital Charge Code	397031173
Hospital Revenue Code	390
Min. Negotiated Rate	$214.62
Max. Negotiated Rate	$214.62
Rate for Payer: Qualcare PPO/HMO/WC	$214.62

CH RBC LEUKO IRRAD CMV NEG

Facility

$1,430.80

Service Code	HCPCS P9058
Hospital Charge Code	397031173
Hospital Revenue Code	390
Min. Negotiated Rate	$34.48
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$788.83
Rate for Payer: Aetna Medicare Advantage	$939.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,046.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,046.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$290.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,046.85
Rate for Payer: Cigna Commercial	$581.32
Rate for Payer: Cigna Medicare Advantage	$290.01
Rate for Payer: Clover Medicare Advantage	$275.51
Rate for Payer: EmblemHealth Commercial	$870.03
Rate for Payer: Humana Medicare Advantage	$298.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$290.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.24
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.62
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$34.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$290.01
Rate for Payer: Wellcare Medicare Advantage	$290.01
Rate for Payer: Wellpoint Medicaid Managed Care	$37.92

CH RBC WASHED X1

Facility

$944.00

Hospital Charge Code	397031001
Hospital Revenue Code	390
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$358.72
Rate for Payer: Aetna Medicare Advantage	$283.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.72
Rate for Payer: Cigna Commercial	$472.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.20
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.60
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$22.75
Rate for Payer: Wellpoint Medicaid Managed Care	$25.02

CH RBC WASHED X1

Facility

$944.00

Hospital Charge Code	397031001
Hospital Revenue Code	390
Min. Negotiated Rate	$141.60
Max. Negotiated Rate	$141.60
Rate for Payer: Qualcare PPO/HMO/WC	$141.60

CH RBC X1

Facility

$899.65

Hospital Charge Code	397031007
Hospital Revenue Code	390
Min. Negotiated Rate	$21.68
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$341.87
Rate for Payer: Aetna Medicare Advantage	$269.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.41
Rate for Payer: Cigna Commercial	$449.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.89
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.95
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$21.68
Rate for Payer: Wellpoint Medicaid Managed Care	$23.84

CH RBC X1

Facility

$899.65

Hospital Charge Code	397031007
Hospital Revenue Code	390
Min. Negotiated Rate	$134.95
Max. Negotiated Rate	$134.95
Rate for Payer: Qualcare PPO/HMO/WC	$134.95

CH RED BLOOD CELL IRAD LEUKO

Facility

$1,078.00

Service Code	HCPCS P9040
Hospital Charge Code	397031166
Hospital Revenue Code	390
Min. Negotiated Rate	$25.98
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$839.47
Rate for Payer: Aetna Medicare Advantage	$999.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,114.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,114.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$308.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,114.06
Rate for Payer: Cigna Commercial	$618.64
Rate for Payer: Cigna Medicare Advantage	$308.63
Rate for Payer: Clover Medicare Advantage	$293.20
Rate for Payer: EmblemHealth Commercial	$925.89
Rate for Payer: Humana Medicare Advantage	$317.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$308.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$323.40
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$161.70
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$25.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$308.63
Rate for Payer: Wellcare Medicare Advantage	$308.63
Rate for Payer: Wellpoint Medicaid Managed Care	$28.57

CH RED BLOOD CELL IRAD LEUKO

Facility

$1,078.00

Service Code	HCPCS P9040
Hospital Charge Code	397031166
Hospital Revenue Code	390
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$161.70
Rate for Payer: Qualcare PPO/HMO/WC	$161.70

CH RED CELL WASHING

Facility

$944.00

Service Code	HCPCS P9022
Hospital Charge Code	397031027
Hospital Revenue Code	390
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$1,547.12
Rate for Payer: Aetna Commercial	$1,165.79
Rate for Payer: Aetna Medicare Advantage	$1,388.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$428.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.12
Rate for Payer: Cigna Commercial	$859.12
Rate for Payer: Cigna Medicare Advantage	$428.60
Rate for Payer: Clover Medicare Advantage	$407.17
Rate for Payer: EmblemHealth Commercial	$1,285.80
Rate for Payer: Humana Medicare Advantage	$441.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$428.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.20
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.60
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$22.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$428.60
Rate for Payer: Wellcare Medicare Advantage	$428.60
Rate for Payer: Wellpoint Medicaid Managed Care	$25.02

CH RED CELL WASHING

Facility

$944.00

Service Code	HCPCS P9022
Hospital Charge Code	397031027
Hospital Revenue Code	390
Min. Negotiated Rate	$141.60
Max. Negotiated Rate	$141.60
Rate for Payer: Qualcare PPO/HMO/WC	$141.60

CH REDUCING SUBSTANCE FECAL

Facility

$16.00

Service Code	HCPCS 81005
Hospital Charge Code	397071257
Hospital Revenue Code	307
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$5.90
Rate for Payer: Aetna Medicare Advantage	$7.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.83
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: Cigna Medicare Advantage	$2.17
Rate for Payer: Clover Medicare Advantage	$2.06
Rate for Payer: EmblemHealth Commercial	$6.51
Rate for Payer: Humana Medicare Advantage	$2.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.17
Rate for Payer: Wellcare Medicare Advantage	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

CH REDUCING SUBSTANCE FECAL

Facility

$16.00

Service Code	HCPCS 81005
Hospital Charge Code	397071257
Hospital Revenue Code	307
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

CH REDUCING SUGARS

Facility

$22.45

Service Code	HCPCS 81005
Hospital Charge Code	397073022
Hospital Revenue Code	307
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

CH REDUCING SUGARS

Facility

$22.45

Service Code	HCPCS 81005
Hospital Charge Code	397073022
Hospital Revenue Code	307
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$5.90
Rate for Payer: Aetna Medicare Advantage	$7.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.83
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: Cigna Medicare Advantage	$2.17
Rate for Payer: Clover Medicare Advantage	$2.06
Rate for Payer: EmblemHealth Commercial	$6.51
Rate for Payer: Humana Medicare Advantage	$2.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.17
Rate for Payer: Wellcare Medicare Advantage	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

CH REFERRED ANTIGEN TESTING

Facility

$260.00

Service Code	HCPCS 86902
Hospital Charge Code	397031132
Hospital Revenue Code	300
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.92
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$6.35
Rate for Payer: Clover Medicare Advantage	$6.03
Rate for Payer: EmblemHealth Commercial	$19.05
Rate for Payer: Humana Medicare Advantage	$6.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.35
Rate for Payer: Wellcare Medicare Advantage	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

CH REFERRED ANTIGEN TESTING

Facility

$260.00

Service Code	HCPCS 86902
Hospital Charge Code	397031132
Hospital Revenue Code	300
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

CH REFRRD ANTIBODY ID -BASIC

Facility

$1,004.00

Service Code	HCPCS 86870
Hospital Charge Code	397031130
Hospital Revenue Code	300
Min. Negotiated Rate	$150.60
Max. Negotiated Rate	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$150.60

CH REFRRD ANTIBODY ID -BASIC

Facility

$1,004.00

Service Code	HCPCS 86870
Hospital Charge Code	397031130
Hospital Revenue Code	300
Min. Negotiated Rate	$9.00
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) NJ Health	$17.42
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	$301.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$26.61

CH REFRRD ANTIBODY ID-COMPLX

Facility

$1,594.00

Service Code	HCPCS 86870
Hospital Charge Code	397031131
Hospital Revenue Code	300
Min. Negotiated Rate	$239.10
Max. Negotiated Rate	$239.10
Rate for Payer: Qualcare PPO/HMO/WC	$239.10

Know your out-of-pocket cost for care.

All Charges