Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

COAG TIME***

Facility

$8.00

Hospital Charge Code	3010832
Hospital Revenue Code	309
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

COAG TIME***

Facility

$8.00

Hospital Charge Code	3010832
Hospital Revenue Code	309
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

COAGULATION AND PLATELET DISORDERS

Facility

$29,066.85

Service Code	APR-DRG 6614
Min. Negotiated Rate	$28,496.91
Max. Negotiated Rate	$29,066.85
Rate for Payer: UnitedHealthcare Community & State	$28,496.91
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$29,066.85
Rate for Payer: Wellpoint Medicaid Managed Care	$28,496.91

COAGULATION AND PLATELET DISORDERS

Facility

$11,615.53

Service Code	APR-DRG 6612
Min. Negotiated Rate	$11,387.77
Max. Negotiated Rate	$11,615.53
Rate for Payer: UnitedHealthcare Community & State	$11,387.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,615.53
Rate for Payer: Wellpoint Medicaid Managed Care	$11,387.77

COAGULATION AND PLATELET DISORDERS

Facility

$8,820.76

Service Code	APR-DRG 6611
Min. Negotiated Rate	$8,647.80
Max. Negotiated Rate	$8,820.76
Rate for Payer: UnitedHealthcare Community & State	$8,647.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,820.76
Rate for Payer: Wellpoint Medicaid Managed Care	$8,647.80

COAGULATION AND PLATELET DISORDERS

Facility

$14,779.18

Service Code	APR-DRG 6613
Min. Negotiated Rate	$14,489.39
Max. Negotiated Rate	$14,779.18
Rate for Payer: UnitedHealthcare Community & State	$14,489.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,779.18
Rate for Payer: Wellpoint Medicaid Managed Care	$14,489.39

COAGULATION DISORDERS

Facility

$51,434.32

Service Code	MSDRG 813
Min. Negotiated Rate	$15,661.09
Max. Negotiated Rate	$51,434.32
Rate for Payer: Aetna Commercial	$35,598.55
Rate for Payer: Aetna Medicare Advantage	$51,434.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,287.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,287.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,485.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,287.16
Rate for Payer: Cigna Commercial	$28,544.46
Rate for Payer: Cigna Medicare Advantage	$16,485.36
Rate for Payer: Clover Medicare Advantage	$15,661.09
Rate for Payer: EmblemHealth Commercial	$49,456.08
Rate for Payer: Humana Medicare Advantage	$16,979.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,485.36
Rate for Payer: Oxford Commercial	$20,515.28
Rate for Payer: UnitedHealthcare Commercial	$35,974.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,485.36
Rate for Payer: Wellcare Medicare Advantage	$16,485.36

COAGULATION FACTOR II

Facility

$283.40

Service Code	HCPCS 85210
Hospital Charge Code	3004200
Hospital Revenue Code	305
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$35.31
Rate for Payer: Aetna Medicare Advantage	$42.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.85
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: Cigna Medicare Advantage	$12.98
Rate for Payer: Clover Medicare Advantage	$12.33
Rate for Payer: EmblemHealth Commercial	$38.94
Rate for Payer: Humana Medicare Advantage	$13.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.51
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.98
Rate for Payer: Wellcare Medicare Advantage	$12.98
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

COAGULATION FACTOR II

Facility

$283.40

Service Code	HCPCS 85210
Hospital Charge Code	3004200
Hospital Revenue Code	305
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

COAGULATION FACTOR IX

Facility

$290.45

Service Code	HCPCS 85250
Hospital Charge Code	3004199
Hospital Revenue Code	305
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$145.22
Rate for Payer: Aetna Commercial	$51.79
Rate for Payer: Aetna Medicare Advantage	$61.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.73
Rate for Payer: Cigna Commercial	$145.22
Rate for Payer: Cigna Medicare Advantage	$19.04
Rate for Payer: Clover Medicare Advantage	$18.09
Rate for Payer: EmblemHealth Commercial	$57.12
Rate for Payer: Humana Medicare Advantage	$19.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.04
Rate for Payer: Wellcare Medicare Advantage	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$7.70

COAGULATION FACTOR IX

Facility

$290.45

Service Code	HCPCS 85250
Hospital Charge Code	3004199
Hospital Revenue Code	305
Min. Negotiated Rate	$43.57
Max. Negotiated Rate	$43.57
Rate for Payer: Qualcare PPO/HMO/WC	$43.57

COAGULATOR SUCT 10F E2506-10

Facility

$110.45

Hospital Charge Code	270600323
Hospital Revenue Code	272
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$16.57
Rate for Payer: Qualcare PPO/HMO/WC	$16.57

COAGULATOR SUCT 10F E2506-10

Facility

$110.45

Hospital Charge Code	270600323
Hospital Revenue Code	272
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$55.23
Rate for Payer: Aetna Commercial	$41.97
Rate for Payer: Aetna Medicare Advantage	$33.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.16
Rate for Payer: Cigna Commercial	$55.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.13
Rate for Payer: Oxford Commercial	$22.09
Rate for Payer: Qualcare PPO/HMO/WC	$16.57
Rate for Payer: UnitedHealthcare Commercial	$22.09
Rate for Payer: UnitedHealthcare Community & State	$2.66
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

COALESCE STRAIGHT 10X10X28MM8D

Facility

$24,200.00

Service Code	HCPCS L8699
Hospital Charge Code	270692908
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$5,856.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

COALESCE STRAIGHT 10X10X28MM8D

Facility

$24,200.00

Service Code	HCPCS L8699
Hospital Charge Code	270692908
Hospital Revenue Code	278
Min. Negotiated Rate	$583.22
Max. Negotiated Rate	$12,100.00
Rate for Payer: Aetna Commercial	$9,196.00
Rate for Payer: Aetna Medicare Advantage	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,171.00
Rate for Payer: Cigna Commercial	$12,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00
Rate for Payer: UnitedHealthcare Community & State	$583.22
Rate for Payer: Wellpoint Medicaid Managed Care	$641.30

COALESCE STRAIGHT 12X10X28MM8D

Facility

$24,200.00

Service Code	HCPCS L8699
Hospital Charge Code	270693048
Hospital Revenue Code	278
Min. Negotiated Rate	$3,630.00
Max. Negotiated Rate	$5,856.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00

COALESCE STRAIGHT 12X10X28MM8D

Facility

$24,200.00

Service Code	HCPCS L8699
Hospital Charge Code	270693048
Hospital Revenue Code	278
Min. Negotiated Rate	$583.22
Max. Negotiated Rate	$12,100.00
Rate for Payer: Aetna Commercial	$9,196.00
Rate for Payer: Aetna Medicare Advantage	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,171.00
Rate for Payer: Cigna Commercial	$12,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,856.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,630.00
Rate for Payer: UnitedHealthcare Community & State	$583.22
Rate for Payer: Wellpoint Medicaid Managed Care	$641.30

COAL TAR 30% TOP SOLN

Facility

$274.45

Hospital Charge Code	60628438
Hospital Revenue Code	250
Min. Negotiated Rate	$41.17
Max. Negotiated Rate	$41.17
Rate for Payer: Qualcare PPO/HMO/WC	$41.17

COAL TAR 30% TOP SOLN

Facility

$274.45

Hospital Charge Code	60628438
Hospital Revenue Code	250
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$137.22
Rate for Payer: Aetna Commercial	$104.29
Rate for Payer: Aetna Medicare Advantage	$82.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.98
Rate for Payer: Cigna Commercial	$137.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.33
Rate for Payer: Oxford Commercial	$54.89
Rate for Payer: Qualcare PPO/HMO/WC	$41.17
Rate for Payer: UnitedHealthcare Commercial	$54.89
Rate for Payer: UnitedHealthcare Community & State	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$7.27

COAL TAR SHAMPOO

Facility

$72.85

Hospital Charge Code	60628440
Hospital Revenue Code	250
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

COAL TAR SHAMPOO

Facility

$72.85

Hospital Charge Code	60628440
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

COAL TAR SOL 2.5%

Facility

$148.00

Hospital Charge Code	60628439
Hospital Revenue Code	250
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$74.00
Rate for Payer: Aetna Commercial	$56.24
Rate for Payer: Aetna Medicare Advantage	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.74
Rate for Payer: Cigna Commercial	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.40
Rate for Payer: Oxford Commercial	$29.60
Rate for Payer: Qualcare PPO/HMO/WC	$22.20
Rate for Payer: UnitedHealthcare Commercial	$29.60
Rate for Payer: UnitedHealthcare Community & State	$3.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

COAL TAR SOL 2.5%

Facility

$148.00

Hospital Charge Code	60628439
Hospital Revenue Code	250
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

COAPTITE INJECTABLE IMPLANT

Facility

$1,675.00

Service Code	HCPCS L8606
Hospital Charge Code	270662270
Hospital Revenue Code	278
Min. Negotiated Rate	$251.25
Max. Negotiated Rate	$405.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$368.50
Rate for Payer: Qualcare PPO/HMO/WC	$251.25

Know your out-of-pocket cost for care.

All Charges