Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ADD-A-VIAL BINARY CONNECT INJ

Facility

$5.00

Hospital Charge Code	60629211
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

ADD-A-VIAL BINARY CONNECT INJ

Facility

$5.00

Hospital Charge Code	60629211
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

ADDITIONAL BLOOD UNITS X MATCH

Facility

$170.45

Service Code	HCPCS 86922
Hospital Charge Code	3100914
Hospital Revenue Code	300
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.57

ADDITIONAL BLOOD UNITS X MATCH

Facility

$170.45

Service Code	HCPCS 86922
Hospital Charge Code	3100914
Hospital Revenue Code	300
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

ADDITIONAL SPINAL- FUSION

Facility

$22,894.84

Service Code	HCPCS 22585
Hospital Charge Code	16000498
Hospital Revenue Code	360
Min. Negotiated Rate	$3,434.23
Max. Negotiated Rate	$3,434.23
Rate for Payer: Qualcare PPO/HMO/WC	$3,434.23

ADDITIONAL SPINAL- FUSION

Facility

$22,894.84

Service Code	HCPCS 22585
Hospital Charge Code	16000498
Hospital Revenue Code	360
Min. Negotiated Rate	$551.77
Max. Negotiated Rate	$14,834.00
Rate for Payer: Aetna Commercial	$8,700.04
Rate for Payer: Aetna Medicare Advantage	$6,868.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,838.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,838.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,838.18
Rate for Payer: Cigna Commercial	$11,447.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,868.45
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,434.23
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$551.77
Rate for Payer: Wellpoint Medicaid Managed Care	$606.71

ADD SET IN OR

Facility

$840.00

Hospital Charge Code	2009035
Hospital Revenue Code	320
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$1,975.00
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) PPO	$214.20
Rate for Payer: Cigna Commercial	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$20.24
Rate for Payer: Wellpoint Medicaid Managed Care	$22.26

ADD SET IN OR

Facility

$840.00

Hospital Charge Code	2009035
Hospital Revenue Code	320
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.00

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	7411125
Hospital Revenue Code	361
Min. Negotiated Rate	$283.03
Max. Negotiated Rate	$5,872.00
Rate for Payer: Aetna Commercial	$4,462.72
Rate for Payer: Aetna Medicare Advantage	$3,523.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,994.72
Rate for Payer: Cigna Commercial	$5,872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,523.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$283.03
Rate for Payer: Wellpoint Medicaid Managed Care	$311.22

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	366837185
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	411037185
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	366837185
Hospital Revenue Code	361
Min. Negotiated Rate	$283.03
Max. Negotiated Rate	$5,872.00
Rate for Payer: Aetna Commercial	$4,462.72
Rate for Payer: Aetna Medicare Advantage	$3,523.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,994.72
Rate for Payer: Cigna Commercial	$5,872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,523.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$283.03
Rate for Payer: Wellpoint Medicaid Managed Care	$311.22

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	411037185
Hospital Revenue Code	361
Min. Negotiated Rate	$283.03
Max. Negotiated Rate	$5,872.00
Rate for Payer: Aetna Commercial	$4,462.72
Rate for Payer: Aetna Medicare Advantage	$3,523.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,994.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,994.72
Rate for Payer: Cigna Commercial	$5,872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,523.20
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$283.03
Rate for Payer: Wellpoint Medicaid Managed Care	$311.22

ADDTL THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37185
Hospital Charge Code	7411125
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

ADD WALKER CAST

Facility

$468.75

Service Code	HCPCS 29440
Hospital Charge Code	5780150
Hospital Revenue Code	450
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$696.85
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$12.42

ADD WALKER CAST

Facility

$468.75

Service Code	HCPCS 29440
Hospital Charge Code	5780150
Hospital Revenue Code	450
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

ADEFOVIR DIPIVOXIL 10 MG Tab

Facility

$162.60

Hospital Charge Code	60630051
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$81.30
Rate for Payer: Aetna Commercial	$61.79
Rate for Payer: Aetna Medicare Advantage	$48.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.46
Rate for Payer: Cigna Commercial	$81.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.78
Rate for Payer: Oxford Commercial	$32.52
Rate for Payer: Qualcare PPO/HMO/WC	$24.39
Rate for Payer: UnitedHealthcare Commercial	$32.52
Rate for Payer: UnitedHealthcare Community & State	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$4.31

ADEFOVIR DIPIVOXIL 10 MG Tab

Facility

$162.60

Hospital Charge Code	60630051
Hospital Revenue Code	250
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$24.39
Rate for Payer: Qualcare PPO/HMO/WC	$24.39

ADENOCARD 12MG/4ML SYRING

Facility

$82.00

Hospital Charge Code	60635491
Hospital Revenue Code	636
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$19.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.84
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

ADENOCARD 12MG/4ML SYRING

Facility

$82.00

Hospital Charge Code	60635491
Hospital Revenue Code	636
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$31.16
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.84
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

ADENOCARD 12MG/4ML VIAL

Facility

$183.45

Service Code	HCPCS J0153
Hospital Charge Code	60635637
Hospital Revenue Code	636
Min. Negotiated Rate	$27.52
Max. Negotiated Rate	$44.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.39
Rate for Payer: Qualcare PPO/HMO/WC	$27.52

ADENOCARD 12MG/4ML VIAL

Facility

$183.45

Service Code	HCPCS J0153
Hospital Charge Code	60635637
Hospital Revenue Code	636
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$91.72
Rate for Payer: Aetna Commercial	$69.71
Rate for Payer: Aetna Medicare Advantage	$55.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.78
Rate for Payer: Cigna Commercial	$91.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.39
Rate for Payer: Qualcare PPO/HMO/WC	$27.52
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: Wellpoint Medicaid Managed Care	$4.86

ADENOIDECTOMY,AGE 12 OR OVER

Facility

$22,083.40

Service Code	HCPCS 42831
Hospital Charge Code	1600000635
Hospital Revenue Code	360
Min. Negotiated Rate	$3,312.51
Max. Negotiated Rate	$3,312.51
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51

ADENOIDECTOMY,AGE 12 OR OVER

Facility

$22,083.40

Service Code	HCPCS 42831
Hospital Charge Code	1600000635
Hospital Revenue Code	360
Min. Negotiated Rate	$532.21
Max. Negotiated Rate	$14,218.07
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,218.07
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,625.02
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$532.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$585.21

ADENOSINE 6 MG/2 ML INJ

Facility

$42.61

Service Code	HCPCS J0153
Hospital Charge Code	60627544
Hospital Revenue Code	636
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$10.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.31
Rate for Payer: Qualcare PPO/HMO/WC	$6.39

Know your out-of-pocket cost for care.

All Charges