Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CONTROL OROPHARYNGEAL HEMORRHC

Facility

$2,070.48

Service Code	HCPCS 42960
Hospital Charge Code	16000287
Hospital Revenue Code	360
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$2,312.88
Rate for Payer: Aetna Commercial	$1,742.81
Rate for Payer: Aetna Medicare Advantage	$2,076.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$640.74
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	$2,312.88
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: Cigna Medicare Advantage	$640.74
Rate for Payer: Clover Medicare Advantage	$608.70
Rate for Payer: EmblemHealth Commercial	$1,922.22
Rate for Payer: Humana Medicare Advantage	$659.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$640.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.14
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.57
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$49.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$640.74
Rate for Payer: Wellcare Medicare Advantage	$640.74
Rate for Payer: Wellpoint Medicaid Managed Care	$54.87

CONTROL SYRINGE 5CC W/STOP

Facility

$54.00

Hospital Charge Code	270332030
Hospital Revenue Code	272
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.20
Rate for Payer: Oxford Commercial	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

CONTROL SYRINGE 5CC W/STOP

Facility

$54.00

Hospital Charge Code	270332030
Hospital Revenue Code	272
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$8,684.17

Service Code	APR-DRG 3842
Min. Negotiated Rate	$8,513.89
Max. Negotiated Rate	$8,684.17
Rate for Payer: UnitedHealthcare Community & State	$8,513.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,684.17
Rate for Payer: Wellpoint Medicaid Managed Care	$8,513.89

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$12,770.93

Service Code	APR-DRG 3843
Min. Negotiated Rate	$12,520.52
Max. Negotiated Rate	$12,770.93
Rate for Payer: UnitedHealthcare Community & State	$12,520.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,770.93
Rate for Payer: Wellpoint Medicaid Managed Care	$12,520.52

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$21,211.23

Service Code	APR-DRG 3844
Min. Negotiated Rate	$20,795.32
Max. Negotiated Rate	$21,211.23
Rate for Payer: UnitedHealthcare Community & State	$20,795.32
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,211.23
Rate for Payer: Wellpoint Medicaid Managed Care	$20,795.32

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$6,984.91

Service Code	APR-DRG 3841
Min. Negotiated Rate	$6,847.95
Max. Negotiated Rate	$6,984.91
Rate for Payer: UnitedHealthcare Community & State	$6,847.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,984.91
Rate for Payer: Wellpoint Medicaid Managed Care	$6,847.95

CONT VISIPAQUE 320 PER 100 ML

Facility

$288.75

Hospital Charge Code	600715
Hospital Revenue Code	636
Min. Negotiated Rate	$43.31
Max. Negotiated Rate	$69.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.31

CONT VISIPAQUE 320 PER 100 ML

Facility

$288.75

Hospital Charge Code	600715
Hospital Revenue Code	636
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$144.38
Rate for Payer: Aetna Commercial	$109.72
Rate for Payer: Aetna Medicare Advantage	$86.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.63
Rate for Payer: Cigna Commercial	$144.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.31
Rate for Payer: UnitedHealthcare Community & State	$6.96
Rate for Payer: Wellpoint Medicaid Managed Care	$7.65

CONT VISIPAQUE 320 PER 150 ML

Facility

$410.65

Hospital Charge Code	600716
Hospital Revenue Code	636
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$205.32
Rate for Payer: Aetna Commercial	$156.05
Rate for Payer: Aetna Medicare Advantage	$123.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.72
Rate for Payer: Cigna Commercial	$205.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.38
Rate for Payer: Qualcare PPO/HMO/WC	$61.60
Rate for Payer: UnitedHealthcare Community & State	$9.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.88

CONT VISIPAQUE 320 PER 150 ML

Facility

$410.65

Hospital Charge Code	600716
Hospital Revenue Code	636
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$99.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.38
Rate for Payer: Qualcare PPO/HMO/WC	$61.60

CONT VISIPAQUE 320 PER ML (100

Facility

$281.65

Hospital Charge Code	270626139
Hospital Revenue Code	255
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$107.03
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$56.33
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$56.33
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

CONT VISIPAQUE 320 PER ML (100

Facility

$281.65

Hospital Charge Code	270626139
Hospital Revenue Code	255
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

CONVALESCENT PLASMA [EUA]

Facility

$0.01

Service Code	HCPCS P9017
Hospital Charge Code	4025P9017
Hospital Revenue Code	390
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

CONVALESCENT PLASMA [EUA]

Facility

$0.01

Service Code	HCPCS P9017
Hospital Charge Code	4025P9017
Hospital Revenue Code	390
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$271.95
Rate for Payer: Aetna Medicare Advantage	$323.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$99.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.90
Rate for Payer: Cigna Commercial	$200.40
Rate for Payer: Cigna Medicare Advantage	$99.98
Rate for Payer: Clover Medicare Advantage	$94.98
Rate for Payer: EmblemHealth Commercial	$299.94
Rate for Payer: Humana Medicare Advantage	$102.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$99.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$99.98
Rate for Payer: Wellcare Medicare Advantage	$99.98
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

CONVENTIONAL INSTRUMENT SET

Facility

$625.00

Hospital Charge Code	270684549
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CONVENTIONAL INSTRUMENT SET

Facility

$625.00

Hospital Charge Code	270684549
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

CONVERSION EXT BIL DRG CATH

Facility

$12,827.31

Service Code	HCPCS 47535
Hospital Charge Code	7411564
Hospital Revenue Code	361
Min. Negotiated Rate	$309.14
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,848.19
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$309.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$339.92

CONVERSION EXT BIL DRG CATH

Facility

$12,827.31

Service Code	HCPCS 47535
Hospital Charge Code	7411564
Hospital Revenue Code	361
Min. Negotiated Rate	$1,924.10
Max. Negotiated Rate	$1,924.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10

CONVERSION EXT BIL DRG CATH

Facility

$12,827.31

Service Code	HCPCS 47535
Hospital Charge Code	2600235
Hospital Revenue Code	361
Min. Negotiated Rate	$1,924.10
Max. Negotiated Rate	$1,924.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,924.10

CONVERSION EXT BIL DRG CATH

Facility

$17,259.20

Service Code	HCPCS 47535
Hospital Charge Code	321047535
Hospital Revenue Code	361
Min. Negotiated Rate	$2,588.88
Max. Negotiated Rate	$2,588.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88

CONVERSION EXT BIL DRG CATH

Facility

$17,259.20

Service Code	HCPCS 47535
Hospital Charge Code	321047535
Hospital Revenue Code	361
Min. Negotiated Rate	$415.95
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,177.76
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,588.88
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$415.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$457.37

CONVERSION EXT BIL DRG CATH

Facility

$14,554.80

Service Code	HCPCS 47535
Hospital Charge Code	411047535
Hospital Revenue Code	361
Min. Negotiated Rate	$350.77
Max. Negotiated Rate	$15,354.26
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,354.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,354.26
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,366.44
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,183.22
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$350.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$385.70

CONVERSION EXT BIL DRG CATH

Facility

$14,554.80

Service Code	HCPCS 47535
Hospital Charge Code	411047535
Hospital Revenue Code	361
Min. Negotiated Rate	$2,183.22
Max. Negotiated Rate	$2,183.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,183.22

CONVERSION EXT BIL DRG CATH

Facility

$14,554.80

Service Code	HCPCS 47535
Hospital Charge Code	366847535
Hospital Revenue Code	361
Min. Negotiated Rate	$2,183.22
Max. Negotiated Rate	$2,183.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,183.22

Know your out-of-pocket cost for care.

All Charges