Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DS3A001 STRL PKG ASSY,AGILIS H

Facility

$250.00

Hospital Charge Code	270702512
Hospital Revenue Code	279
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DSAEK/DSEK PRE CUT

Facility

$21,500.00

Hospital Charge Code	270683330
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

DSAEK/DSEK PRE CUT

Facility

$21,500.00

Hospital Charge Code	270683330
Hospital Revenue Code	278
Min. Negotiated Rate	$518.15
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$518.15
Rate for Payer: Wellpoint Medicaid Managed Care	$569.75

DSE TUBING

Facility

$9.29

Hospital Charge Code	270658599
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

DSE TUBING

Facility

$9.29

Hospital Charge Code	270658599
Hospital Revenue Code	270
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.64
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna Medicare Advantage	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.37
Rate for Payer: Cigna Commercial	$4.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.79
Rate for Payer: Oxford Commercial	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.39
Rate for Payer: UnitedHealthcare Commercial	$1.86
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

DSMT GROUP COUNSELING-EDUC

Facility

$131.00

Service Code	HCPCS 99078
Hospital Charge Code	9200080
Hospital Revenue Code	942
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$1,202.00
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

DSMT GROUP COUNSELING-EDUC

Facility

$131.00

Service Code	HCPCS 99078
Hospital Charge Code	9200080
Hospital Revenue Code	942
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

DST BY NEURO AGT LMB/SAC, SL J

Facility

$5,362.12

Service Code	HCPCS 64635
Hospital Charge Code	84506055
Hospital Revenue Code	361
Min. Negotiated Rate	$129.23
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,608.64
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$804.32
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$129.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$142.10

DST BY NEURO AGT LMB/SAC, SL J

Facility

$5,362.12

Service Code	HCPCS 64635
Hospital Charge Code	84506055
Hospital Revenue Code	361
Min. Negotiated Rate	$804.32
Max. Negotiated Rate	$804.32
Rate for Payer: Qualcare PPO/HMO/WC	$804.32

DST BY NEURO LMB/SAC, EA ADD J

Facility

$3,103.00

Service Code	HCPCS 64636
Hospital Charge Code	84506060
Hospital Revenue Code	361
Min. Negotiated Rate	$74.78
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,179.14
Rate for Payer: Aetna Medicare Advantage	$930.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$791.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$791.26
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	$791.26
Rate for Payer: Cigna Commercial	$1,551.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$930.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.45
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$74.78
Rate for Payer: Wellpoint Medicaid Managed Care	$82.23

DST BY NEURO LMB/SAC, EA ADD J

Facility

$3,103.00

Service Code	HCPCS 64636
Hospital Charge Code	84506060
Hospital Revenue Code	361
Min. Negotiated Rate	$465.45
Max. Negotiated Rate	$465.45
Rate for Payer: Qualcare PPO/HMO/WC	$465.45

DSTR NULYT AGT CNCLR NRV

Facility

$8,060.04

Service Code	HCPCS 64624
Hospital Charge Code	1600000342
Hospital Revenue Code	360
Min. Negotiated Rate	$1,209.01
Max. Negotiated Rate	$1,209.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,209.01

DSTR NULYT AGT CNCLR NRV

Facility

$8,060.04

Service Code	HCPCS 64624
Hospital Charge Code	1600000342
Hospital Revenue Code	360
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,418.01
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,209.01
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$194.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$213.59

DTAP 5ML

Facility

$140.20

Hospital Charge Code	6017859
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$70.10
Rate for Payer: Aetna Commercial	$53.28
Rate for Payer: Aetna Medicare Advantage	$42.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.75
Rate for Payer: Cigna Commercial	$70.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.06
Rate for Payer: Oxford Commercial	$28.04
Rate for Payer: Qualcare PPO/HMO/WC	$21.03
Rate for Payer: UnitedHealthcare Commercial	$28.04
Rate for Payer: UnitedHealthcare Community & State	$3.38
Rate for Payer: Wellpoint Medicaid Managed Care	$3.72

DTAP 5ML

Facility

$140.20

Hospital Charge Code	6017859
Hospital Revenue Code	250
Min. Negotiated Rate	$21.03
Max. Negotiated Rate	$21.03
Rate for Payer: Qualcare PPO/HMO/WC	$21.03

DTAP < 7 YRS

Facility

$174.60

Service Code	HCPCS 90700
Hospital Charge Code	83652319
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna Commercial	$66.35
Rate for Payer: Aetna Medicare Advantage	$52.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.52
Rate for Payer: Cigna Commercial	$87.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.38
Rate for Payer: Oxford Commercial	$34.92
Rate for Payer: Qualcare PPO/HMO/WC	$26.19
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

DTAP < 7 YRS

Facility

$174.60

Service Code	HCPCS 90700
Hospital Charge Code	83652319
Hospital Revenue Code	250
Min. Negotiated Rate	$26.19
Max. Negotiated Rate	$26.19
Rate for Payer: Qualcare PPO/HMO/WC	$26.19

DTAP DIPH PERUSS EX

Facility

$165.49

Service Code	NDC 58160081011
Hospital Charge Code	606351020X
Hospital Revenue Code	259
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$24.82
Rate for Payer: Qualcare PPO/HMO/WC	$24.82

DTAP DIPH PERUSS EX

Facility

$165.49

Service Code	NDC 58160081011
Hospital Charge Code	606351020X
Hospital Revenue Code	259
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$82.75
Rate for Payer: Aetna Commercial	$62.89
Rate for Payer: Aetna Medicare Advantage	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.20
Rate for Payer: Cigna Commercial	$82.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.65
Rate for Payer: Oxford Commercial	$33.10
Rate for Payer: Qualcare PPO/HMO/WC	$24.82
Rate for Payer: UnitedHealthcare Commercial	$33.10
Rate for Payer: UnitedHealthcare Community & State	$3.99
Rate for Payer: Wellpoint Medicaid Managed Care	$4.39

DTAP-HIB-IPV INTRAMUSCULAR

Facility

$553.02

Service Code	HCPCS 90698
Hospital Charge Code	83652609
Hospital Revenue Code	636
Min. Negotiated Rate	$13.33
Max. Negotiated Rate	$276.51
Rate for Payer: Aetna Commercial	$210.15
Rate for Payer: Aetna Medicare Advantage	$165.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.02
Rate for Payer: Cigna Commercial	$276.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.83
Rate for Payer: Qualcare PPO/HMO/WC	$82.95
Rate for Payer: UnitedHealthcare Community & State	$13.33
Rate for Payer: Wellpoint Medicaid Managed Care	$14.66

DTAP-HIB-IPV INTRAMUSCULAR

Facility

$553.02

Service Code	HCPCS 90698
Hospital Charge Code	83652609
Hospital Revenue Code	636
Min. Negotiated Rate	$82.95
Max. Negotiated Rate	$133.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.83
Rate for Payer: Qualcare PPO/HMO/WC	$82.95

DTAP-IPV VACCINE (4-6YRS)

Facility

$251.90

Service Code	HCPCS 90696
Hospital Charge Code	412390696
Hospital Revenue Code	636
Min. Negotiated Rate	$37.78
Max. Negotiated Rate	$60.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.96
Rate for Payer: Qualcare PPO/HMO/WC	$37.78

DTAP-IPV VACCINE (4-6YRS)

Facility

$251.90

Service Code	HCPCS 90696
Hospital Charge Code	412390696
Hospital Revenue Code	636
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$125.95
Rate for Payer: Aetna Commercial	$95.72
Rate for Payer: Aetna Medicare Advantage	$75.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.23
Rate for Payer: Cigna Commercial	$125.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.96
Rate for Payer: Qualcare PPO/HMO/WC	$37.78
Rate for Payer: UnitedHealthcare Community & State	$6.07
Rate for Payer: Wellpoint Medicaid Managed Care	$6.68

DTAP VACCINE >7 YRS IM

Facility

$234.27

Service Code	HCPCS 90715
Hospital Charge Code	606380012
Hospital Revenue Code	636
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$117.14
Rate for Payer: Aetna Commercial	$89.02
Rate for Payer: Aetna Medicare Advantage	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.74
Rate for Payer: Cigna Commercial	$117.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14
Rate for Payer: UnitedHealthcare Community & State	$5.65
Rate for Payer: Wellpoint Medicaid Managed Care	$6.21

DTAP VACCINE >7 YRS IM

Facility

$234.27

Service Code	HCPCS 90715
Hospital Charge Code	606380012
Hospital Revenue Code	636
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$56.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

Know your out-of-pocket cost for care.

All Charges