Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EVEROLIMUS

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3037005
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

EVEROLIMUS

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3037005
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

EVEROLIMUS,LC/MS/MS

Facility

$390.00

Service Code	HCPCS 80169
Hospital Charge Code	401180169
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.35
Rate for Payer: Aetna Medicare Advantage	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.56
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.73
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.73
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	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Medicare Advantage	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

EVEROLIMUS,LC/MS/MS

Facility

$390.00

Service Code	HCPCS 80169
Hospital Charge Code	401180169
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EV FEMPOP ARTL REVASC

Facility

$61,839.20

Service Code	HCPCS 0505T
Hospital Charge Code	41100505T
Hospital Revenue Code	360
Min. Negotiated Rate	$1,490.32
Max. Negotiated Rate	$49,506.31
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,506.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
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	$49,506.31
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,551.76
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,275.88
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,490.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,638.74

EV FEMPOP ARTL REVASC

Facility

$61,839.20

Service Code	HCPCS 0505T
Hospital Charge Code	41100505T
Hospital Revenue Code	360
Min. Negotiated Rate	$9,275.88
Max. Negotiated Rate	$9,275.88
Rate for Payer: Qualcare PPO/HMO/WC	$9,275.88

EVICEL FIBRIN SEALANT

Facility

$3,400.00

Hospital Charge Code	270666998
Hospital Revenue Code	270
Min. Negotiated Rate	$81.94
Max. Negotiated Rate	$1,700.00
Rate for Payer: Aetna Commercial	$1,292.00
Rate for Payer: Aetna Medicare Advantage	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.00
Rate for Payer: Cigna Commercial	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,020.00
Rate for Payer: Oxford Commercial	$680.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00
Rate for Payer: UnitedHealthcare Commercial	$680.00
Rate for Payer: UnitedHealthcare Community & State	$81.94
Rate for Payer: Wellpoint Medicaid Managed Care	$90.10

EVICEL FIBRIN SEALANT

Facility

$3,400.00

Hospital Charge Code	270666998
Hospital Revenue Code	270
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

EVICEL TIP RIGID 35 CM

Facility

$259.50

Hospital Charge Code	270667032
Hospital Revenue Code	270
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$38.92
Rate for Payer: Qualcare PPO/HMO/WC	$38.92

EVICEL TIP RIGID 35 CM

Facility

$259.50

Hospital Charge Code	270667032
Hospital Revenue Code	270
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Commercial	$98.61
Rate for Payer: Aetna Medicare Advantage	$77.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.17
Rate for Payer: Cigna Commercial	$129.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.85
Rate for Payer: Oxford Commercial	$51.90
Rate for Payer: Qualcare PPO/HMO/WC	$38.92
Rate for Payer: UnitedHealthcare Commercial	$51.90
Rate for Payer: UnitedHealthcare Community & State	$6.25
Rate for Payer: Wellpoint Medicaid Managed Care	$6.88

EVIVA STEREOTACTC 12MM BRST BX

Facility

$1,161.88

Hospital Charge Code	270675349R
Hospital Revenue Code	272
Min. Negotiated Rate	$174.28
Max. Negotiated Rate	$174.28
Rate for Payer: Qualcare PPO/HMO/WC	$174.28

EVIVA STEREOTACTC 12MM BRST BX

Facility

$1,161.88

Hospital Charge Code	270675349R
Hospital Revenue Code	272
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$580.94
Rate for Payer: Aetna Commercial	$441.51
Rate for Payer: Aetna Medicare Advantage	$348.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.28
Rate for Payer: Cigna Commercial	$580.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.56
Rate for Payer: Oxford Commercial	$232.38
Rate for Payer: Qualcare PPO/HMO/WC	$174.28
Rate for Payer: UnitedHealthcare Commercial	$232.38
Rate for Payer: UnitedHealthcare Community & State	$28.00
Rate for Payer: Wellpoint Medicaid Managed Care	$30.79

EVOGRAFT DBM FIBERS 10CC

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694132
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

EVOGRAFT DBM FIBERS 10CC

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694132
Hospital Revenue Code	278
Min. Negotiated Rate	$385.60
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$385.60
Rate for Payer: Wellpoint Medicaid Managed Care	$424.00

EVUSHELD 300MG EUA

Facility

$0.01

Service Code	HCPCS Q0220
Hospital Charge Code	606390480
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

EVUSHELD 300MG EUA

Facility

$0.01

Service Code	HCPCS Q0220
Hospital Charge Code	606390480
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	4201M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3248M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3020M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3020M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3121M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3048M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3048M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3190M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3500M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.75
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.94

Know your out-of-pocket cost for care.

All Charges