Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CONRAY 60% 50ML

Facility

$65.00

Hospital Charge Code	270332270
Hospital Revenue Code	255
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CONRAY 60% 50 ML BOTTLES

Facility

$39.50

Hospital Charge Code	270654537
Hospital Revenue Code	270
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.75
Rate for Payer: Aetna Commercial	$15.01
Rate for Payer: Aetna Medicare Advantage	$11.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.07
Rate for Payer: Cigna Commercial	$19.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.85
Rate for Payer: Oxford Commercial	$7.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.92
Rate for Payer: UnitedHealthcare Commercial	$7.90
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

CONRAY 60% 50 ML BOTTLES

Facility

$39.50

Hospital Charge Code	270654537
Hospital Revenue Code	270
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$5.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.92

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	83653150
Hospital Revenue Code	370
Min. Negotiated Rate	$15.33
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.80
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$15.33
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	74308265
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	74308265
Hospital Revenue Code	370
Min. Negotiated Rate	$15.33
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.80
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$15.33
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	83653150
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

CONSTRAINED 70 RIGHT

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270662792
Hospital Revenue Code	278
Min. Negotiated Rate	$5,445.00
Max. Negotiated Rate	$8,784.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,986.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00

CONSTRAINED 70 RIGHT

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270662792
Hospital Revenue Code	278
Min. Negotiated Rate	$874.83
Max. Negotiated Rate	$18,150.00
Rate for Payer: Aetna Commercial	$13,794.00
Rate for Payer: Aetna Medicare Advantage	$10,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,256.50
Rate for Payer: Cigna Commercial	$18,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,986.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00
Rate for Payer: UnitedHealthcare Community & State	$874.83
Rate for Payer: Wellpoint Medicaid Managed Care	$961.95

CONSTRAINED LINER 65x36MM

Facility

$17,943.50

Service Code	HCPCS C1776
Hospital Charge Code	270675299
Hospital Revenue Code	278
Min. Negotiated Rate	$432.44
Max. Negotiated Rate	$8,971.75
Rate for Payer: Aetna Commercial	$6,818.53
Rate for Payer: Aetna Medicare Advantage	$5,383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,575.59
Rate for Payer: Cigna Commercial	$8,971.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,947.57
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53
Rate for Payer: UnitedHealthcare Community & State	$432.44
Rate for Payer: Wellpoint Medicaid Managed Care	$475.50

CONSTRAINED LINER 65x36MM

Facility

$17,943.50

Service Code	HCPCS C1776
Hospital Charge Code	270675299
Hospital Revenue Code	278
Min. Negotiated Rate	$2,691.53
Max. Negotiated Rate	$4,342.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,947.57
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53

CONSTRUCT BOWEL BLADDER

Facility

$27,828.20

Service Code	HCPCS 27828.2
Hospital Charge Code	1600000524
Hospital Revenue Code	360
Min. Negotiated Rate	$670.66
Max. Negotiated Rate	$13,914.10
Rate for Payer: Aetna Commercial	$10,574.72
Rate for Payer: Aetna Medicare Advantage	$8,348.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,096.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,096.19
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	$7,096.19
Rate for Payer: Cigna Commercial	$13,914.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,348.46
Rate for Payer: Qualcare PPO/HMO/WC	$4,174.23
Rate for Payer: UnitedHealthcare Community & State	$670.66
Rate for Payer: Wellpoint Medicaid Managed Care	$737.45

CONSTRUCT BOWEL BLADDER

Facility

$27,828.20

Service Code	HCPCS 27828.2
Hospital Charge Code	1600000524
Hospital Revenue Code	360
Min. Negotiated Rate	$4,174.23
Max. Negotiated Rate	$4,174.23
Rate for Payer: Qualcare PPO/HMO/WC	$4,174.23

CONSULTATION COMPREHENSIVE

Facility

$342.65

Service Code	HCPCS 88325
Hospital Charge Code	38477205
Hospital Revenue Code	312
Min. Negotiated Rate	$9.08
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) 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	$102.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.40
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$122.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9.08

CONSULTATION COMPREHENSIVE

Facility

$342.65

Service Code	HCPCS 88325
Hospital Charge Code	38477205
Hospital Revenue Code	312
Min. Negotiated Rate	$51.40
Max. Negotiated Rate	$51.40
Rate for Payer: Qualcare PPO/HMO/WC	$51.40

CONSULTATION EXAPANDED 30 MIN

Facility

$405.00

Service Code	HCPCS 99242
Hospital Charge Code	75190240
Hospital Revenue Code	510
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.50
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

CONSULTATION EXAPANDED 30 MIN

Facility

$405.00

Service Code	HCPCS 99242
Hospital Charge Code	75190240
Hospital Revenue Code	510
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

CONSULTATION HIGH COMPLEXITY

Facility

$867.00

Service Code	HCPCS 99245
Hospital Charge Code	75190245
Hospital Revenue Code	510
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

CONSULTATION HIGH COMPLEXITY

Facility

$867.00

Service Code	HCPCS 99245
Hospital Charge Code	75190245
Hospital Revenue Code	510
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.10
Rate for Payer: Qualcare PPO/HMO/WC	$130.05
Rate for Payer: UnitedHealthcare Community & State	$20.89
Rate for Payer: Wellpoint Medicaid Managed Care	$22.98

CONTAINER CHEMOTHERAPY 2GAL

Facility

$18.47

Hospital Charge Code	270649381
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

CONTAINER CHEMOTHERAPY 2GAL

Facility

$18.47

Hospital Charge Code	270649381
Hospital Revenue Code	272
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.23
Rate for Payer: Aetna Commercial	$7.02
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.71
Rate for Payer: Cigna Commercial	$9.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.54
Rate for Payer: Oxford Commercial	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

CONTAINER IMPLANT 2.7 NEURO

Facility

$2,108.00

Hospital Charge Code	270610954
Hospital Revenue Code	272
Min. Negotiated Rate	$50.80
Max. Negotiated Rate	$1,054.00
Rate for Payer: Aetna Commercial	$801.04
Rate for Payer: Aetna Medicare Advantage	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$537.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$537.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$537.54
Rate for Payer: Cigna Commercial	$1,054.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.40
Rate for Payer: Oxford Commercial	$421.60
Rate for Payer: Qualcare PPO/HMO/WC	$316.20
Rate for Payer: UnitedHealthcare Commercial	$421.60
Rate for Payer: UnitedHealthcare Community & State	$50.80
Rate for Payer: Wellpoint Medicaid Managed Care	$55.86

CONTAINER IMPLANT 2.7 NEURO

Facility

$2,108.00

Hospital Charge Code	270610954
Hospital Revenue Code	272
Min. Negotiated Rate	$316.20
Max. Negotiated Rate	$316.20
Rate for Payer: Qualcare PPO/HMO/WC	$316.20

CONTAINER PLASTIC MONOJECT 4QT

Facility

$21.00

Hospital Charge Code	270665393
Hospital Revenue Code	270
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

CONTAINER PLASTIC MONOJECT 4QT

Facility

$21.00

Hospital Charge Code	270665393
Hospital Revenue Code	270
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

Know your out-of-pocket cost for care.

All Charges