Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

ADENOSINE 6/MG INJ

Facility

$131.00

Hospital Charge Code	60632401
Hospital Revenue Code	636
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$31.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

ADENOSINE 6/MG INJ

Facility

$131.00

Hospital Charge Code	60632401
Hospital Revenue Code	636
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

ADENOSINE (ADENOSCAN) 90MG/30M

Facility

$2,125.91

Service Code	HCPCS J0153
Hospital Charge Code	60630194
Hospital Revenue Code	636
Min. Negotiated Rate	$51.23
Max. Negotiated Rate	$1,062.95
Rate for Payer: Aetna Commercial	$807.85
Rate for Payer: Aetna Medicare Advantage	$637.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$542.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$542.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$542.11
Rate for Payer: Cigna Commercial	$1,062.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.47
Rate for Payer: Qualcare PPO/HMO/WC	$318.89
Rate for Payer: UnitedHealthcare Community & State	$51.23
Rate for Payer: Wellpoint Medicaid Managed Care	$56.34

ADENOSINE (ADENOSCAN) 90MG/30M

Facility

$2,125.91

Service Code	HCPCS J0153
Hospital Charge Code	60630194
Hospital Revenue Code	636
Min. Negotiated Rate	$318.89
Max. Negotiated Rate	$514.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.47
Rate for Payer: Qualcare PPO/HMO/WC	$318.89

ADENOSINE DEAMINASE

Facility

$390.00

Service Code	HCPCS 84311
Hospital Charge Code	39900343
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

ADENOSINE DEAMINASE

Facility

$390.00

Service Code	HCPCS 84311
Hospital Charge Code	39900343
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ADENOSINE VL 6MG/2ML

Facility

$199.05

Hospital Charge Code	6006191
Hospital Revenue Code	636
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$99.53
Rate for Payer: Aetna Commercial	$75.64
Rate for Payer: Aetna Medicare Advantage	$59.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.76
Rate for Payer: Cigna Commercial	$99.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.17
Rate for Payer: Qualcare PPO/HMO/WC	$29.86
Rate for Payer: UnitedHealthcare Community & State	$4.80
Rate for Payer: Wellpoint Medicaid Managed Care	$5.27

ADENOSINE VL 6MG/2ML

Facility

$199.05

Hospital Charge Code	6006191
Hospital Revenue Code	636
Min. Negotiated Rate	$29.86
Max. Negotiated Rate	$48.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.17
Rate for Payer: Qualcare PPO/HMO/WC	$29.86

ADENOVIRUS AB

Facility

$156.00

Service Code	HCPCS 86603
Hospital Charge Code	38476007
Hospital Revenue Code	302
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

ADENOVIRUS AB

Facility

$88.45

Service Code	HCPCS 86603
Hospital Charge Code	39900226
Hospital Revenue Code	302
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
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	$46.46
Rate for Payer: Cigna Commercial	$44.23
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.27
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

ADENOVIRUS AB

Facility

$156.00

Service Code	HCPCS 86603
Hospital Charge Code	38476007
Hospital Revenue Code	302
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
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	$46.46
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$4.13

ADENOVIRUS AB

Facility

$88.45

Service Code	HCPCS 86603
Hospital Charge Code	39900226
Hospital Revenue Code	302
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$13.27
Rate for Payer: Qualcare PPO/HMO/WC	$13.27

ADENOVIRUS AG,EIA

Facility

$390.00

Service Code	HCPCS 87301
Hospital Charge Code	39900282
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ADENOVIRUS AG,EIA

Facility

$390.00

Service Code	HCPCS 87301
Hospital Charge Code	39900282
Hospital Revenue Code	309
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
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	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ADENOVIRUS DNA,QL,RT-PCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39900403
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ADENOVIRUS DNA,QL,RT-PCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39900403
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ADENOVIRUS DNA,QN,RT-PCR

Facility

$390.00

Service Code	HCPCS 87799
Hospital Charge Code	39900405
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.64
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
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	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ADENOVIRUS DNA,QN,RT-PCR

Facility

$390.00

Service Code	HCPCS 87799
Hospital Charge Code	39900405
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ADENOVIRUS ENTERIC 40/41

Facility

$103.25

Service Code	HCPCS 87301
Hospital Charge Code	3006708
Hospital Revenue Code	309
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

ADENOVIRUS ENTERIC 40/41

Facility

$103.25

Service Code	HCPCS 87301
Hospital Charge Code	3006708
Hospital Revenue Code	309
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

ADENOVIRUS GROUP AB, QN

Facility

$116.85

Service Code	HCPCS 86603
Hospital Charge Code	3006509
Hospital Revenue Code	302
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

ADENOVIRUS GROUP AB, QN

Facility

$116.85

Service Code	HCPCS 86603
Hospital Charge Code	3006509
Hospital Revenue Code	302
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
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	$46.46
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

ADEPT ADHES REDUC SOL 0600041

Facility

$876.75

Hospital Charge Code	270638251
Hospital Revenue Code	272
Min. Negotiated Rate	$131.51
Max. Negotiated Rate	$131.51
Rate for Payer: Qualcare PPO/HMO/WC	$131.51

ADEPT ADHES REDUC SOL 0600041

Facility

$876.75

Hospital Charge Code	270638251
Hospital Revenue Code	272
Min. Negotiated Rate	$21.13
Max. Negotiated Rate	$438.38
Rate for Payer: Aetna Commercial	$333.17
Rate for Payer: Aetna Medicare Advantage	$263.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.57
Rate for Payer: Cigna Commercial	$438.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.02
Rate for Payer: Oxford Commercial	$175.35
Rate for Payer: Qualcare PPO/HMO/WC	$131.51
Rate for Payer: UnitedHealthcare Commercial	$175.35
Rate for Payer: UnitedHealthcare Community & State	$21.13
Rate for Payer: Wellpoint Medicaid Managed Care	$23.23

Know your out-of-pocket cost for care.

All Charges