Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALPHA-GLOBIN COMPLETE

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900030
Hospital Revenue Code	310
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$819.67
Rate for Payer: Aetna Medicare Advantage	$976.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,087.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,087.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,087.78
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$301.35
Rate for Payer: Clover Medicare Advantage	$286.28
Rate for Payer: EmblemHealth Commercial	$904.05
Rate for Payer: Humana Medicare Advantage	$310.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$301.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$241.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.35
Rate for Payer: Wellcare Medicare Advantage	$301.35
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

ALPHA-GLOBIN SEQUENCING

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900322
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

ALPHA-GLOBIN SEQUENCING

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39900322
Hospital Revenue Code	310
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$819.67
Rate for Payer: Aetna Medicare Advantage	$976.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,087.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,087.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,087.78
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$301.35
Rate for Payer: Clover Medicare Advantage	$286.28
Rate for Payer: EmblemHealth Commercial	$904.05
Rate for Payer: Humana Medicare Advantage	$310.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$301.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$241.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.35
Rate for Payer: Wellcare Medicare Advantage	$301.35
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

ALPHAGRAFT CBM 10CC

Facility

$23,225.00

Hospital Charge Code	270703551
Hospital Revenue Code	278
Min. Negotiated Rate	$3,483.75
Max. Negotiated Rate	$5,620.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,620.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,109.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,483.75

ALPHAGRAFT CBM 10CC

Facility

$23,225.00

Hospital Charge Code	270703551
Hospital Revenue Code	278
Min. Negotiated Rate	$559.72
Max. Negotiated Rate	$11,612.50
Rate for Payer: Aetna Commercial	$8,825.50
Rate for Payer: Aetna Medicare Advantage	$6,967.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,922.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,922.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,922.38
Rate for Payer: Cigna Commercial	$11,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,620.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,109.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,483.75
Rate for Payer: UnitedHealthcare Community & State	$559.72
Rate for Payer: Wellpoint Medicaid Managed Care	$615.46

ALPHAGRAFT CBM 5CC

Facility

$13,145.00

Hospital Charge Code	270702571
Hospital Revenue Code	278
Min. Negotiated Rate	$316.79
Max. Negotiated Rate	$6,572.50
Rate for Payer: Aetna Commercial	$4,995.10
Rate for Payer: Aetna Medicare Advantage	$3,943.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,351.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,351.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,351.97
Rate for Payer: Cigna Commercial	$6,572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,181.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.75
Rate for Payer: UnitedHealthcare Community & State	$316.79
Rate for Payer: Wellpoint Medicaid Managed Care	$348.34

ALPHAGRAFT CBM 5CC

Facility

$13,145.00

Hospital Charge Code	270702571
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.75
Max. Negotiated Rate	$3,181.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,629.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,181.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.75

ALPHAGRAFT DBM FIBER 5CC

Facility

$6,500.00

Service Code	HCPCS C1762
Hospital Charge Code	270704196
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

ALPHAGRAFT DBM FIBER 5CC

Facility

$6,500.00

Service Code	HCPCS C1762
Hospital Charge Code	270704196
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

ALPHAGRAFT DBM FIBER FLOW 2.5C

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270703774
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

ALPHAGRAFT DBM FIBER FLOW 2.5C

Facility

$3,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270703774
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ALPHA SUBUNIT

Facility

$390.00

Service Code	HCPCS 82397
Hospital Charge Code	401182397
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ALPHA SUBUNIT

Facility

$390.00

Service Code	HCPCS 82397
Hospital Charge Code	401182397
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$38.41
Rate for Payer: Aetna Medicare Advantage	$45.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.97
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.12
Rate for Payer: Clover Medicare Advantage	$13.41
Rate for Payer: EmblemHealth Commercial	$42.36
Rate for Payer: Humana Medicare Advantage	$14.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.12
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	$11.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.12
Rate for Payer: Wellcare Medicare Advantage	$14.12
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ALPHA-THALASSEMIA

Facility

$200.00

Service Code	HCPCS 81257
Hospital Charge Code	3038117
Hospital Revenue Code	310
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

ALPHA-THALASSEMIA

Facility

$200.00

Service Code	HCPCS 81257
Hospital Charge Code	3038117
Hospital Revenue Code	310
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$369.13
Rate for Payer: Aetna Commercial	$278.15
Rate for Payer: Aetna Medicare Advantage	$331.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$102.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.13
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: Cigna Medicare Advantage	$102.26
Rate for Payer: Clover Medicare Advantage	$97.15
Rate for Payer: EmblemHealth Commercial	$306.78
Rate for Payer: Humana Medicare Advantage	$105.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$102.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$81.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.26
Rate for Payer: Wellcare Medicare Advantage	$102.26
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

ALPHA THALASSEMIA, DNA

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900019
Hospital Revenue Code	310
Min. Negotiated Rate	$348.45
Max. Negotiated Rate	$348.45
Rate for Payer: Qualcare PPO/HMO/WC	$348.45

ALPHA THALASSEMIA, DNA

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900019
Hospital Revenue Code	310
Min. Negotiated Rate	$61.56
Max. Negotiated Rate	$1,161.50
Rate for Payer: Aetna Commercial	$278.15
Rate for Payer: Aetna Medicare Advantage	$331.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$102.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.13
Rate for Payer: Cigna Commercial	$1,161.50
Rate for Payer: Cigna Medicare Advantage	$102.26
Rate for Payer: Clover Medicare Advantage	$97.15
Rate for Payer: EmblemHealth Commercial	$306.78
Rate for Payer: Humana Medicare Advantage	$105.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$102.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$696.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.45
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$81.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.26
Rate for Payer: Wellcare Medicare Advantage	$102.26
Rate for Payer: Wellpoint Medicaid Managed Care	$61.56

ALPRAZOLAM 0.25 MG TAB

Facility

$4.29

Service Code	NDC 51079078820
Hospital Charge Code	60627839
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.15
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: Aetna Medicare Advantage	$1.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.09
Rate for Payer: Cigna Commercial	$2.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.29
Rate for Payer: Oxford Commercial	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.64
Rate for Payer: UnitedHealthcare Commercial	$0.86
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ALPRAZOLAM 0.25 MG TAB

Facility

$4.29

Service Code	NDC 51079078820
Hospital Charge Code	60627839
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.64

ALPRAZOLAM 0.5 MG TAB

Facility

$5.36

Service Code	NDC 68084067201
Hospital Charge Code	6020036
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

ALPRAZOLAM 0.5 MG TAB

Facility

$5.36

Service Code	NDC 68084067201
Hospital Charge Code	6020036
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

ALPRAZOLAM 1.25MG

Facility

$1.95

Hospital Charge Code	6020028
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

ALPRAZOLAM 1.25MG

Facility

$1.95

Hospital Charge Code	6020028
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

ALPRAZOLAM TAB 0.125 MG/0.5

Facility

$3.20

Hospital Charge Code	60628921
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

ALPRAZOLAM TAB 0.125 MG/0.5

Facility

$3.20

Hospital Charge Code	60628921
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

Know your out-of-pocket cost for care.

All Charges