Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CNS URINE DRUG SCREEN

Facility

$34.00

Service Code	HCPCS H0003HF
Hospital Charge Code	94810105
Hospital Revenue Code	300
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

CNS URINE DRUG SCREEN

Facility

$34.00

Service Code	HCPCS H0003HF
Hospital Charge Code	94810105
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

CNTRL NASL HEMORRH ANT SIMPLE

Facility

$1,049.06

Service Code	HCPCS 30901
Hospital Charge Code	1600000348
Hospital Revenue Code	360
Min. Negotiated Rate	$157.36
Max. Negotiated Rate	$157.36
Rate for Payer: Qualcare PPO/HMO/WC	$157.36

CNTRL NASL HEMORRH ANT SIMPLE

Facility

$1,049.06

Service Code	HCPCS 30901
Hospital Charge Code	1600000348
Hospital Revenue Code	360
Min. Negotiated Rate	$25.28
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.72
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.36
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$25.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$27.80

CNTRL OROPHAR HEMORRH,REQ SURG

Facility

$40,491.68

Service Code	HCPCS 42962
Hospital Charge Code	1600000501
Hospital Revenue Code	360
Min. Negotiated Rate	$975.85
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	$1,016.00
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	$12,147.50
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,073.75
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$975.85
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	$1,073.03

CNTRL OROPHAR HEMORRH,REQ SURG

Facility

$40,491.68

Service Code	HCPCS 42962
Hospital Charge Code	1600000501
Hospital Revenue Code	360
Min. Negotiated Rate	$6,073.75
Max. Negotiated Rate	$6,073.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,073.75

CNTRL ORPHARYNG HEMORRAH,COMPL

Facility

$9,263.26

Service Code	HCPCS 42961
Hospital Charge Code	16000584
Hospital Revenue Code	360
Min. Negotiated Rate	$223.24
Max. Negotiated Rate	$8,157.00
Rate for Payer: Aetna Commercial	$3,520.04
Rate for Payer: Aetna Medicare Advantage	$2,778.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.13
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	$2,362.13
Rate for Payer: Cigna Commercial	$4,631.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,778.98
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.49
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$223.24
Rate for Payer: Wellpoint Medicaid Managed Care	$245.48

CNTRL ORPHARYNG HEMORRAH,COMPL

Facility

$9,263.26

Service Code	HCPCS 42961
Hospital Charge Code	16000584
Hospital Revenue Code	360
Min. Negotiated Rate	$1,389.49
Max. Negotiated Rate	$1,389.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.49

CNTRL VENOUS CATHTER STRPNG

Facility

$5,100.00

Service Code	HCPCS 75901
Hospital Charge Code	2600057
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

CNTRL VENOUS CATHTER STRPNG

Facility

$5,100.00

Service Code	HCPCS 75901
Hospital Charge Code	2600057
Hospital Revenue Code	320
Min. Negotiated Rate	$79.38
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

CNTRL VENOUS CATHTER STRPNG

Facility

$5,100.00

Service Code	HCPCS 75901
Hospital Charge Code	321075901
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

CNTRL VENOUS CATHTER STRPNG

Facility

$5,100.00

Service Code	HCPCS 75901
Hospital Charge Code	321075901
Hospital Revenue Code	320
Min. Negotiated Rate	$79.38
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

CNTRLZR DSTL VRSYS 9mm 7859-00

Facility

$401.20

Hospital Charge Code	270635650
Hospital Revenue Code	278
Min. Negotiated Rate	$9.67
Max. Negotiated Rate	$200.60
Rate for Payer: Aetna Commercial	$152.46
Rate for Payer: Aetna Medicare Advantage	$120.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.31
Rate for Payer: Cigna Commercial	$200.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$88.26
Rate for Payer: Qualcare PPO/HMO/WC	$60.18
Rate for Payer: UnitedHealthcare Community & State	$9.67
Rate for Payer: Wellpoint Medicaid Managed Care	$10.63

CNTRLZR DSTL VRSYS 9mm 7859-00

Facility

$401.20

Hospital Charge Code	270635650
Hospital Revenue Code	278
Min. Negotiated Rate	$60.18
Max. Negotiated Rate	$97.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$88.26
Rate for Payer: Qualcare PPO/HMO/WC	$60.18

CNTRSNK 1.7STRYKR END 60-80117

Facility

$1,000.00

Hospital Charge Code	270655380
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CNTRSNK 1.7STRYKR END 60-80117

Facility

$1,000.00

Hospital Charge Code	270655380
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CO02 HE02 N2 E CYLINDER

Facility

$60.50

Hospital Charge Code	270658106
Hospital Revenue Code	270
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$30.25
Rate for Payer: Aetna Commercial	$22.99
Rate for Payer: Aetna Medicare Advantage	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.43
Rate for Payer: Cigna Commercial	$30.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Oxford Commercial	$12.10
Rate for Payer: Qualcare PPO/HMO/WC	$9.07
Rate for Payer: UnitedHealthcare Commercial	$12.10
Rate for Payer: UnitedHealthcare Community & State	$1.46
Rate for Payer: Wellpoint Medicaid Managed Care	$1.60

CO02 HE02 N2 E CYLINDER

Facility

$60.50

Hospital Charge Code	270658106
Hospital Revenue Code	270
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$9.07
Rate for Payer: Qualcare PPO/HMO/WC	$9.07

CO2 CANISTER

Facility

$55.00

Hospital Charge Code	270665361
Hospital Revenue Code	270
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

CO2 CANISTER

Facility

$55.00

Hospital Charge Code	270665361
Hospital Revenue Code	270
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$11.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

CO2 SMART CAPNOLINE ADULT CO2

Facility

$70.40

Hospital Charge Code	270676818
Hospital Revenue Code	272
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

CO2 SMART CAPNOLINE ADULT CO2

Facility

$70.40

Hospital Charge Code	270676818
Hospital Revenue Code	272
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

COAG FACTOR VIII ACTIVITY

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	39900347
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COAG FACTOR VIII ACTIVITY

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	39900347
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.61
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
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	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COAG/FRIBINOLYSIS FUNCT ACT EA

Facility

$162.50

Service Code	HCPCS 85397
Hospital Charge Code	38477173
Hospital Revenue Code	305
Min. Negotiated Rate	$24.38
Max. Negotiated Rate	$24.38
Rate for Payer: Qualcare PPO/HMO/WC	$24.38

Know your out-of-pocket cost for care.

All Charges