Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FAT,STOOL,QUANT

Facility

$121.00

Service Code	HCPCS 82710
Hospital Charge Code	38475096
Hospital Revenue Code	301
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.70
Rate for Payer: Aetna Medicare Advantage	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.64
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: Cigna Medicare Advantage	$16.80
Rate for Payer: Clover Medicare Advantage	$15.96
Rate for Payer: EmblemHealth Commercial	$50.40
Rate for Payer: Humana Medicare Advantage	$17.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.80
Rate for Payer: Wellcare Medicare Advantage	$16.80
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

FATTY LIQUID

Facility

$24.00

Hospital Charge Code	60629137
Hospital Revenue Code	259
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

FATTY LIQUID

Facility

$24.00

Hospital Charge Code	60629137
Hospital Revenue Code	259
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

FBRWIRE3-0 w/Taprd Needle 15MM

Facility

$1,320.00

Hospital Charge Code	270681580
Hospital Revenue Code	272
Min. Negotiated Rate	$31.81
Max. Negotiated Rate	$660.00
Rate for Payer: Aetna Commercial	$501.60
Rate for Payer: Aetna Medicare Advantage	$396.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$336.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$336.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$336.60
Rate for Payer: Cigna Commercial	$660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.00
Rate for Payer: Oxford Commercial	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.00
Rate for Payer: UnitedHealthcare Commercial	$264.00
Rate for Payer: UnitedHealthcare Community & State	$31.81
Rate for Payer: Wellpoint Medicaid Managed Care	$34.98

FBRWIRE3-0 w/Taprd Needle 15MM

Facility

$1,320.00

Hospital Charge Code	270681580
Hospital Revenue Code	272
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.00

FBRWIRE4-0 w/Taprd Needle 12.3

Facility

$110.00

Hospital Charge Code	270681582
Hospital Revenue Code	272
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$22.00
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

FBRWIRE4-0 w/Taprd Needle 12.3

Facility

$110.00

Hospital Charge Code	270681582
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

FCEP F/3.5mm-6.5mm SCR4812-001

Facility

$212.10

Hospital Charge Code	270634937
Hospital Revenue Code	272
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$31.82
Rate for Payer: Qualcare PPO/HMO/WC	$31.82

FCEP F/3.5mm-6.5mm SCR4812-001

Facility

$212.10

Hospital Charge Code	270634937
Hospital Revenue Code	272
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$106.05
Rate for Payer: Aetna Commercial	$80.60
Rate for Payer: Aetna Medicare Advantage	$63.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.09
Rate for Payer: Cigna Commercial	$106.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.63
Rate for Payer: Oxford Commercial	$42.42
Rate for Payer: Qualcare PPO/HMO/WC	$31.82
Rate for Payer: UnitedHealthcare Commercial	$42.42
Rate for Payer: UnitedHealthcare Community & State	$5.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.62

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	4501022
Hospital Revenue Code	343
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$671.92
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.46
Rate for Payer: Qualcare PPO/HMO/WC	$265.23
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74115072
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Service Code	HCPCS A9552
Hospital Charge Code	80000031
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	4501022
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Service Code	HCPCS A9552
Hospital Charge Code	80000031
Hospital Revenue Code	343
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$931.22
Rate for Payer: Aetna Commercial	$671.92
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$931.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.46
Rate for Payer: Qualcare PPO/HMO/WC	$265.23
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74117072
Hospital Revenue Code	343
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$671.92
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.46
Rate for Payer: Qualcare PPO/HMO/WC	$265.23
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74115072
Hospital Revenue Code	343
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$671.92
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.46
Rate for Payer: Qualcare PPO/HMO/WC	$265.23
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	4501052
Hospital Revenue Code	343
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$671.92
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.46
Rate for Payer: Qualcare PPO/HMO/WC	$265.23
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74117072
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	4501052
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Service Code	HCPCS A9552
Hospital Charge Code	80000045
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Service Code	HCPCS A9552
Hospital Charge Code	80000045
Hospital Revenue Code	343
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$931.22
Rate for Payer: Aetna Commercial	$671.92
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$931.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.46
Rate for Payer: Qualcare PPO/HMO/WC	$265.23
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74116072
Hospital Revenue Code	343
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$884.10
Rate for Payer: Aetna Commercial	$671.92
Rate for Payer: Aetna Medicare Advantage	$530.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.89
Rate for Payer: Cigna Commercial	$884.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.46
Rate for Payer: Qualcare PPO/HMO/WC	$265.23
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

FDG DIAG/STUDY DOSE UP TO 45

Facility

$1,768.20

Hospital Charge Code	74116072
Hospital Revenue Code	343
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$265.23
Rate for Payer: Qualcare PPO/HMO/WC	$265.23

FDL DUALLINK

Facility

$12,675.25

Service Code	HCPCS C1762
Hospital Charge Code	270702637
Hospital Revenue Code	278
Min. Negotiated Rate	$305.47
Max. Negotiated Rate	$6,337.62
Rate for Payer: Aetna Commercial	$4,816.60
Rate for Payer: Aetna Medicare Advantage	$3,802.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,232.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,232.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,535.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,232.19
Rate for Payer: Cigna Commercial	$6,337.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,788.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.29
Rate for Payer: UnitedHealthcare Community & State	$305.47
Rate for Payer: Wellpoint Medicaid Managed Care	$335.89

FDL DUALLINK

Facility

$12,675.25

Service Code	HCPCS C1762
Hospital Charge Code	270702637
Hospital Revenue Code	278
Min. Negotiated Rate	$1,901.29
Max. Negotiated Rate	$3,067.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,535.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,788.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.29

Know your out-of-pocket cost for care.

All Charges