Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALIGN RADIAL HEAD AND LOCK SCR

Facility

$11,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270679706
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

ALIGN RADIAL HEAD AND LOCK SCR

Facility

$11,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270679706
Hospital Revenue Code	278
Min. Negotiated Rate	$283.18
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$4,465.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50
Rate for Payer: UnitedHealthcare Community & State	$283.18
Rate for Payer: Wellpoint Medicaid Managed Care	$311.38

ALIGN RADIAL STEM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679705
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

ALIGN RADIAL STEM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679705
Hospital Revenue Code	278
Min. Negotiated Rate	$277.15
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$277.15
Rate for Payer: Wellpoint Medicaid Managed Care	$304.75

ALIQUOTING CHARGE

Facility

$88.75

Service Code	HCPCS 86985
Hospital Charge Code	3100524
Hospital Revenue Code	309
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.31

ALIQUOTING CHARGE

Facility

$88.75

Service Code	HCPCS 86985
Hospital Charge Code	3100524
Hospital Revenue Code	309
Min. Negotiated Rate	$2.35
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) NJ Health	$15.14
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	$26.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$25.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

ALISKIREN 150MG TABLET

Facility

$30.62

Service Code	NDC 70839015030
Hospital Charge Code	60630024
Hospital Revenue Code	250
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

ALISKIREN 150MG TABLET

Facility

$30.62

Service Code	NDC 70839015030
Hospital Charge Code	60630024
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.31
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$9.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.81
Rate for Payer: Cigna Commercial	$15.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.19
Rate for Payer: Oxford Commercial	$6.12
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Commercial	$6.12
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

ALISKIREN 300MG TABLET

Facility

$20.50

Hospital Charge Code	60630025
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.08

ALISKIREN 300MG TABLET

Facility

$20.50

Hospital Charge Code	60630025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.25
Rate for Payer: Aetna Commercial	$7.79
Rate for Payer: Aetna Medicare Advantage	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.23
Rate for Payer: Cigna Commercial	$10.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.15
Rate for Payer: Oxford Commercial	$4.10
Rate for Payer: Qualcare PPO/HMO/WC	$3.08
Rate for Payer: UnitedHealthcare Commercial	$4.10
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

ALISKIREN (TEKTURNA) 300MG TAB

Facility

$26.80

Service Code	NDC 70839030030
Hospital Charge Code	60630149
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

ALISKIREN (TEKTURNA) 300MG TAB

Facility

$26.80

Service Code	NDC 70839030030
Hospital Charge Code	60630149
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.04
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

ALKALI, BASE 55 GAL

Facility

$195.00

Hospital Charge Code	270654255
Hospital Revenue Code	272
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

ALKALI, BASE 55 GAL

Facility

$195.00

Hospital Charge Code	270654255
Hospital Revenue Code	272
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$39.00
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

ALKALINE PHOS PANEL***

Facility

$7.20

Service Code	HCPCS 84075
Hospital Charge Code	3000197P
Hospital Revenue Code	301
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

ALKALINE PHOS PANEL***

Facility

$7.20

Service Code	HCPCS 84075
Hospital Charge Code	3000197P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$3.60
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

ALKALINE PHOSPHATASE

Facility

$158.00

Service Code	HCPCS 84075
Hospital Charge Code	38472050
Hospital Revenue Code	301
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

ALKALINE PHOSPHATASE

Facility

$158.00

Service Code	HCPCS 84075
Hospital Charge Code	38472050
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$79.00
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

ALKALINE PHOSPHATASE

Facility

$54.45

Service Code	HCPCS 84075
Hospital Charge Code	8200321RS
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.17

ALKALINE PHOSPHATASE

Facility

$54.45

Service Code	HCPCS 84075
Hospital Charge Code	8200321RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$27.23
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.17
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

ALKALINE PHOSPHATASE***

Facility

$19.00

Hospital Charge Code	3010196
Hospital Revenue Code	309
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

ALKALINE PHOSPHATASE***

Facility

$19.00

Hospital Charge Code	3010196
Hospital Revenue Code	309
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

ALKALINE PHOSPHATASE ISOENZYME

Facility

$451.00

Service Code	HCPCS 84080
Hospital Charge Code	38472053
Hospital Revenue Code	301
Min. Negotiated Rate	$67.65
Max. Negotiated Rate	$67.65
Rate for Payer: Qualcare PPO/HMO/WC	$67.65

ALKALINE PHOSPHATASE ISOENZYME

Facility

$83.25

Service Code	HCPCS 84080
Hospital Charge Code	3006103A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.20
Rate for Payer: Aetna Medicare Advantage	$47.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.35
Rate for Payer: Cigna Commercial	$41.62
Rate for Payer: Cigna Medicare Advantage	$14.78
Rate for Payer: Clover Medicare Advantage	$14.04
Rate for Payer: EmblemHealth Commercial	$44.34
Rate for Payer: Humana Medicare Advantage	$15.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.78
Rate for Payer: Wellcare Medicare Advantage	$14.78
Rate for Payer: Wellpoint Medicaid Managed Care	$2.21

ALKALINE PHOSPHATASE ISOENZYME

Facility

$83.25

Service Code	HCPCS 84080
Hospital Charge Code	3006103A
Hospital Revenue Code	301
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$12.49
Rate for Payer: Qualcare PPO/HMO/WC	$12.49

Know your out-of-pocket cost for care.

All Charges