Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ECHO POR FMRL RPP NC 12 X 140

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691571
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

ECHO POR RFMRL RPP NC 13X145MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690808
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

ECHO POR RFMRL RPP NC 13X145MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690808
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

ECHOTHIOPHATE OPH SOL 0.03%

Facility

$240.85

Hospital Charge Code	60628055
Hospital Revenue Code	250
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$120.42
Rate for Payer: Aetna Commercial	$91.52
Rate for Payer: Aetna Medicare Advantage	$72.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.42
Rate for Payer: Cigna Commercial	$120.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.25
Rate for Payer: Oxford Commercial	$48.17
Rate for Payer: Qualcare PPO/HMO/WC	$36.13
Rate for Payer: UnitedHealthcare Commercial	$48.17
Rate for Payer: UnitedHealthcare Community & State	$5.80
Rate for Payer: Wellpoint Medicaid Managed Care	$6.38

ECHOTHIOPHATE OPH SOL 0.03%

Facility

$240.85

Hospital Charge Code	60628055
Hospital Revenue Code	250
Min. Negotiated Rate	$36.13
Max. Negotiated Rate	$36.13
Rate for Payer: Qualcare PPO/HMO/WC	$36.13

ECHOTHIOPHATE OPH SOL 0.25%

Facility

$320.85

Hospital Charge Code	60628056
Hospital Revenue Code	250
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$160.43
Rate for Payer: Aetna Commercial	$121.92
Rate for Payer: Aetna Medicare Advantage	$96.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.82
Rate for Payer: Cigna Commercial	$160.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.25
Rate for Payer: Oxford Commercial	$64.17
Rate for Payer: Qualcare PPO/HMO/WC	$48.13
Rate for Payer: UnitedHealthcare Commercial	$64.17
Rate for Payer: UnitedHealthcare Community & State	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$8.50

ECHOTHIOPHATE OPH SOL 0.25%

Facility

$320.85

Hospital Charge Code	60628056
Hospital Revenue Code	250
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$48.13
Rate for Payer: Qualcare PPO/HMO/WC	$48.13

ECHOTHIOP IOD OPH SOL .06% 5ML

Facility

$31.40

Hospital Charge Code	6002117
Hospital Revenue Code	252
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$15.70
Rate for Payer: Aetna Commercial	$11.93
Rate for Payer: Aetna Medicare Advantage	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.01
Rate for Payer: Cigna Commercial	$15.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.42
Rate for Payer: Oxford Commercial	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.71
Rate for Payer: UnitedHealthcare Commercial	$6.28
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

ECHOTHIOP IOD OPH SOL .06% 5ML

Facility

$31.40

Hospital Charge Code	6002117
Hospital Revenue Code	252
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$4.71

ECHOTHIOP IOD OPH SOL .125% 5M

Facility

$44.00

Hospital Charge Code	6002125
Hospital Revenue Code	252
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

ECHOTHIOP IOD OPH SOL .125% 5M

Facility

$44.00

Hospital Charge Code	6002125
Hospital Revenue Code	252
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

ECHOTHIOP IOD OPH SOL .25% 5ML

Facility

$203.55

Hospital Charge Code	6002133
Hospital Revenue Code	252
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$101.78
Rate for Payer: Aetna Commercial	$77.35
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.06
Rate for Payer: Oxford Commercial	$40.71
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$40.71
Rate for Payer: UnitedHealthcare Community & State	$4.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.39

ECHOTHIOP IOD OPH SOL .25% 5ML

Facility

$203.55

Hospital Charge Code	6002133
Hospital Revenue Code	252
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

ECHO TRANSESOPHAGEAL TEE

Facility

$7,257.67

Service Code	HCPCS 93312
Hospital Charge Code	94053120
Hospital Revenue Code	483
Min. Negotiated Rate	$174.91
Max. Negotiated Rate	$2,656.00
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$649.16
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,177.30
Rate for Payer: Oxford Commercial	$1,514.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,088.65
Rate for Payer: UnitedHealthcare Commercial	$2,656.00
Rate for Payer: UnitedHealthcare Community & State	$174.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$192.33

ECHO TRANSESOPHAGEAL TEE

Facility

$7,257.67

Service Code	HCPCS 93312
Hospital Charge Code	94053120
Hospital Revenue Code	483
Min. Negotiated Rate	$1,088.65
Max. Negotiated Rate	$1,088.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,088.65

ECHO TRANSESOPHAGEAL TEE

Facility

$5,900.00

Service Code	HCPCS 93312
Hospital Charge Code	5300124
Hospital Revenue Code	483
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$2,656.00
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,343.27
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$649.16
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,770.00
Rate for Payer: Oxford Commercial	$1,514.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00
Rate for Payer: UnitedHealthcare Commercial	$2,656.00
Rate for Payer: UnitedHealthcare Community & State	$142.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$156.35

ECHO TRANSESOPHAGEAL TEE

Facility

$5,900.00

Service Code	HCPCS 93312
Hospital Charge Code	5300124
Hospital Revenue Code	483
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00

ECHOVIRUS AB (4,7,9,11,30 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ECHOVIRUS AB (4,7,9,11,30 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ECHOVIRUS AB (4,7,9,11,30 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ECHOVIRUS AB (4,7,9,11,30 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038D
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ECHOVIRUS AB (4,7,9,11,30 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges