Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMBICOR PENILE PROTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687019
Hospital Revenue Code	278
Min. Negotiated Rate	$1,677.96
Max. Negotiated Rate	$34,812.50
Rate for Payer: Aetna Commercial	$26,457.50
Rate for Payer: Aetna Medicare Advantage	$20,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,754.38
Rate for Payer: Cigna Commercial	$34,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,317.50
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75
Rate for Payer: UnitedHealthcare Community & State	$1,677.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1,845.06

AMBIENT HIPVAC 50IFS

Facility

$1,975.00

Hospital Charge Code	270679418
Hospital Revenue Code	272
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

AMBIENT HIPVAC 50IFS

Facility

$1,975.00

Hospital Charge Code	270679418
Hospital Revenue Code	272
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.50
Rate for Payer: Oxford Commercial	$395.00
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$395.00
Rate for Payer: UnitedHealthcare Community & State	$47.60
Rate for Payer: Wellpoint Medicaid Managed Care	$52.34

AMBIEN (ZOLPIDEM)

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3035146
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

AMBIEN (ZOLPIDEM)

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3035146
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
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	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

AMBIODISK AMNIOT MEMBRANE 15MM

Facility

$3,100.00

Service Code	HCPCS C1762
Hospital Charge Code	270665138
Hospital Revenue Code	278
Min. Negotiated Rate	$465.00
Max. Negotiated Rate	$750.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$682.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.00

AMBIODISK AMNIOT MEMBRANE 15MM

Facility

$3,100.00

Service Code	HCPCS C1762
Hospital Charge Code	270665138
Hospital Revenue Code	278
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$1,178.00
Rate for Payer: Aetna Medicare Advantage	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$790.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$790.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$790.50
Rate for Payer: Cigna Commercial	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$682.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.00
Rate for Payer: UnitedHealthcare Community & State	$74.71
Rate for Payer: Wellpoint Medicaid Managed Care	$82.15

AMBIO DRY 2

Facility

$2,975.00

Hospital Charge Code	270655881
Hospital Revenue Code	272
Min. Negotiated Rate	$71.70
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$1,130.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.50
Rate for Payer: Oxford Commercial	$595.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Commercial	$595.00
Rate for Payer: UnitedHealthcare Community & State	$71.70
Rate for Payer: Wellpoint Medicaid Managed Care	$78.84

AMBIO DRY 2

Facility

$2,975.00

Hospital Charge Code	270655881
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$446.25
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

AMBISOME 50MG INJECTION

Facility

$1,391.66

Service Code	HCPCS J0289
Hospital Charge Code	606350938
Hospital Revenue Code	636
Min. Negotiated Rate	$208.75
Max. Negotiated Rate	$336.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.78
Rate for Payer: Qualcare PPO/HMO/WC	$208.75

AMBISOME 50MG INJECTION

Facility

$1,391.66

Service Code	HCPCS J0289
Hospital Charge Code	606350938
Hospital Revenue Code	636
Min. Negotiated Rate	$21.67
Max. Negotiated Rate	$336.78
Rate for Payer: Aetna Commercial	$62.04
Rate for Payer: Aetna Medicare Advantage	$73.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.34
Rate for Payer: Cigna Medicare Advantage	$22.81
Rate for Payer: Clover Medicare Advantage	$21.67
Rate for Payer: EmblemHealth Commercial	$68.43
Rate for Payer: Humana Medicare Advantage	$23.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.78
Rate for Payer: Qualcare PPO/HMO/WC	$208.75
Rate for Payer: UnitedHealthcare Community & State	$33.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.81
Rate for Payer: Wellcare Medicare Advantage	$22.81
Rate for Payer: Wellpoint Medicaid Managed Care	$36.88

AMBISONE 50MG/VIAL

Facility

$704.00

Hospital Charge Code	60635353
Hospital Revenue Code	636
Min. Negotiated Rate	$16.97
Max. Negotiated Rate	$352.00
Rate for Payer: Aetna Commercial	$267.52
Rate for Payer: Aetna Medicare Advantage	$211.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.52
Rate for Payer: Cigna Commercial	$352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.37
Rate for Payer: Qualcare PPO/HMO/WC	$105.60
Rate for Payer: UnitedHealthcare Community & State	$16.97
Rate for Payer: Wellpoint Medicaid Managed Care	$18.66

AMBISONE 50MG/VIAL

Facility

$704.00

Hospital Charge Code	60635353
Hospital Revenue Code	636
Min. Negotiated Rate	$105.60
Max. Negotiated Rate	$170.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.37
Rate for Payer: Qualcare PPO/HMO/WC	$105.60

AMB RESP AND TRMT NO TRANSPORT

Facility

$300.00

Hospital Charge Code	26000515
Hospital Revenue Code	540
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

AMB RESP AND TRMT NO TRANSPORT

Facility

$300.00

Hospital Charge Code	26000515
Hospital Revenue Code	540
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

AMBU AURA GAIN SZ 4

Facility

$75.00

Hospital Charge Code	270684105
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

AMBU AURA GAIN SZ 4

Facility

$75.00

Hospital Charge Code	270684105
Hospital Revenue Code	272
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

AMBULANCE BAYONNE

Facility

$577.30

Hospital Charge Code	1000017
Hospital Revenue Code	540
Min. Negotiated Rate	$86.59
Max. Negotiated Rate	$86.59
Rate for Payer: Qualcare PPO/HMO/WC	$86.59

AMBULANCE BAYONNE

Facility

$577.30

Hospital Charge Code	1000017
Hospital Revenue Code	540
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$219.37
Rate for Payer: Aetna Medicare Advantage	$173.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.21
Rate for Payer: Cigna Commercial	$288.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.19
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.59
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$13.91
Rate for Payer: Wellpoint Medicaid Managed Care	$15.30

AMBULANCE JERSEY CITY

Facility

$698.90

Hospital Charge Code	1000025
Hospital Revenue Code	540
Min. Negotiated Rate	$104.83
Max. Negotiated Rate	$104.83
Rate for Payer: Qualcare PPO/HMO/WC	$104.83

AMBULANCE JERSEY CITY

Facility

$698.90

Hospital Charge Code	1000025
Hospital Revenue Code	540
Min. Negotiated Rate	$16.84
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$265.58
Rate for Payer: Aetna Medicare Advantage	$209.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.22
Rate for Payer: Cigna Commercial	$349.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.67
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.83
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$16.84
Rate for Payer: Wellpoint Medicaid Managed Care	$18.52

AMBULANCE NEWARK

Facility

$896.00

Hospital Charge Code	1000041
Hospital Revenue Code	540
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$134.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.40

AMBULANCE NEWARK

Facility

$896.00

Hospital Charge Code	1000041
Hospital Revenue Code	540
Min. Negotiated Rate	$21.59
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$340.48
Rate for Payer: Aetna Medicare Advantage	$268.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.48
Rate for Payer: Cigna Commercial	$448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.80
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.40
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$21.59
Rate for Payer: Wellpoint Medicaid Managed Care	$23.74

AMBULANCE OTHER

Facility

$1,430.40

Hospital Charge Code	1009992
Hospital Revenue Code	540
Min. Negotiated Rate	$214.56
Max. Negotiated Rate	$214.56
Rate for Payer: Qualcare PPO/HMO/WC	$214.56

AMBULANCE OTHER

Facility

$1,430.40

Hospital Charge Code	1009992
Hospital Revenue Code	540
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$543.55
Rate for Payer: Aetna Medicare Advantage	$429.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$364.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$364.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$364.75
Rate for Payer: Cigna Commercial	$715.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.12
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.56
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$34.47
Rate for Payer: Wellpoint Medicaid Managed Care	$37.91

Know your out-of-pocket cost for care.

All Charges