Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIPYRIDAMOLE INJ 50MG/10ML

Facility

$1,224.35

Hospital Charge Code	60627647
Hospital Revenue Code	250
Min. Negotiated Rate	$183.65
Max. Negotiated Rate	$183.65
Rate for Payer: Qualcare PPO/HMO/WC	$183.65

DIPYRIDAMOLE INJ 50MG/10ML

Facility

$1,224.35

Hospital Charge Code	60627647
Hospital Revenue Code	250
Min. Negotiated Rate	$29.51
Max. Negotiated Rate	$612.17
Rate for Payer: Aetna Commercial	$465.25
Rate for Payer: Aetna Medicare Advantage	$367.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.21
Rate for Payer: Cigna Commercial	$612.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.31
Rate for Payer: Oxford Commercial	$244.87
Rate for Payer: Qualcare PPO/HMO/WC	$183.65
Rate for Payer: UnitedHealthcare Commercial	$244.87
Rate for Payer: UnitedHealthcare Community & State	$29.51
Rate for Payer: Wellpoint Medicaid Managed Care	$32.45

Dipyridamole Vial 50mg/10ml

Facility

$52.41

Service Code	HCPCS J1245
Hospital Charge Code	4509071
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$26.20
Rate for Payer: Aetna Commercial	$19.92
Rate for Payer: Aetna Medicare Advantage	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.36
Rate for Payer: Cigna Commercial	$26.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.86
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

Dipyridamole Vial 50mg/10ml

Facility

$52.41

Service Code	HCPCS J1245
Hospital Charge Code	4509071
Hospital Revenue Code	636
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$12.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.86

DIR-ARTGRM CAROTID CERV UNIL

Facility

$12,400.74

Service Code	HCPCS 75676
Hospital Charge Code	2680330
Hospital Revenue Code	323
Min. Negotiated Rate	$1,860.11
Max. Negotiated Rate	$1,860.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11

DIR-ARTGRM CAROTID CERV UNIL

Facility

$12,400.74

Service Code	HCPCS 75676
Hospital Charge Code	2680330
Hospital Revenue Code	323
Min. Negotiated Rate	$298.86
Max. Negotiated Rate	$6,200.37
Rate for Payer: Aetna Commercial	$4,712.28
Rate for Payer: Aetna Medicare Advantage	$3,720.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,162.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,162.19
Rate for Payer: Cigna Commercial	$6,200.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,720.22
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,860.11
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$298.86
Rate for Payer: Wellpoint Medicaid Managed Care	$328.62

DIRECT COOMBS

Facility

$60.00

Service Code	HCPCS 86880
Hospital Charge Code	3100641
Hospital Revenue Code	300
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

DIRECT COOMBS

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471013
Hospital Revenue Code	302
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

DIRECT COOMBS

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471013
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIRECT COOMBS

Facility

$60.00

Service Code	HCPCS 86880
Hospital Charge Code	3100641
Hospital Revenue Code	300
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

DIRECT COOMBS, C3D

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471085
Hospital Revenue Code	302
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

DIRECT COOMBS, C3D

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471085
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIRECT COOMBS, IG

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471086
Hospital Revenue Code	302
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$140.48
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

DIRECT COOMBS, IG

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471086
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIRECTED BLOOD, EACH UNIT

Facility

$1,204.00

Service Code	HCPCS P9010
Hospital Charge Code	38471087
Hospital Revenue Code	382
Min. Negotiated Rate	$29.02
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$600.44
Rate for Payer: Aetna Medicare Advantage	$715.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$220.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.84
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: Cigna Medicare Advantage	$220.75
Rate for Payer: Clover Medicare Advantage	$209.71
Rate for Payer: EmblemHealth Commercial	$662.25
Rate for Payer: Humana Medicare Advantage	$227.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$220.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.20
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.60
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$29.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$220.75
Rate for Payer: Wellcare Medicare Advantage	$220.75
Rate for Payer: Wellpoint Medicaid Managed Care	$31.91

DIRECTED BLOOD, EACH UNIT

Facility

$1,204.00

Service Code	HCPCS P9010
Hospital Charge Code	38471087
Hospital Revenue Code	382
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$180.60
Rate for Payer: Qualcare PPO/HMO/WC	$180.60

DIRECTED PACKED CELLS

Facility

$896.00

Hospital Charge Code	3100302
Hospital Revenue Code	381
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$134.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.40

DIRECTED PACKED CELLS

Facility

$896.00

Hospital Charge Code	3100302
Hospital Revenue Code	381
Min. Negotiated Rate	$21.59
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$340.48
Rate for Payer: Aetna Medicare Advantage	$268.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.48
Rate for Payer: Cigna Commercial	$448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.80
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.40
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$21.59
Rate for Payer: Wellpoint Medicaid Managed Care	$23.74

DIRECTED WHOLE BLOOD

Facility

$553.65

Hospital Charge Code	3100294
Hospital Revenue Code	382
Min. Negotiated Rate	$83.05
Max. Negotiated Rate	$83.05
Rate for Payer: Qualcare PPO/HMO/WC	$83.05

DIRECTED WHOLE BLOOD

Facility

$553.65

Hospital Charge Code	3100294
Hospital Revenue Code	382
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$210.39
Rate for Payer: Aetna Medicare Advantage	$166.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.18
Rate for Payer: Cigna Commercial	$276.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.09
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.05
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$13.34
Rate for Payer: Wellpoint Medicaid Managed Care	$14.67

DIRECTIGEN RSV TEST BD

Facility

$1,462.50

Hospital Charge Code	270651994
Hospital Revenue Code	272
Min. Negotiated Rate	$219.38
Max. Negotiated Rate	$219.38
Rate for Payer: Qualcare PPO/HMO/WC	$219.38

DIRECTIGEN RSV TEST BD

Facility

$1,462.50

Hospital Charge Code	270651994
Hospital Revenue Code	272
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$731.25
Rate for Payer: Aetna Commercial	$555.75
Rate for Payer: Aetna Medicare Advantage	$438.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$372.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$372.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$372.94
Rate for Payer: Cigna Commercial	$731.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.75
Rate for Payer: Oxford Commercial	$292.50
Rate for Payer: Qualcare PPO/HMO/WC	$219.38
Rate for Payer: UnitedHealthcare Commercial	$292.50
Rate for Payer: UnitedHealthcare Community & State	$35.25
Rate for Payer: Wellpoint Medicaid Managed Care	$38.76

DIRECT LDL SERUM

Facility

$52.00

Service Code	HCPCS 83721
Hospital Charge Code	401183721
Hospital Revenue Code	300
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

DIRECT LDL SERUM

Facility

$52.00

Service Code	HCPCS 83721
Hospital Charge Code	401183721
Hospital Revenue Code	300
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.56
Rate for Payer: Aetna Medicare Advantage	$34.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.90
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: Cigna Medicare Advantage	$10.50
Rate for Payer: Clover Medicare Advantage	$9.97
Rate for Payer: EmblemHealth Commercial	$31.50
Rate for Payer: Humana Medicare Advantage	$10.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.50
Rate for Payer: Wellcare Medicare Advantage	$10.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

DIR-PERC TRANSHEP CHOLANG

Facility

$3,012.00

Hospital Charge Code	2007035
Hospital Revenue Code	320
Min. Negotiated Rate	$451.80
Max. Negotiated Rate	$451.80
Rate for Payer: Qualcare PPO/HMO/WC	$451.80

Know your out-of-pocket cost for care.

All Charges