Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLOUR,NON INF.AB SCREEN(2)

Facility

$225.00

Service Code	HCPCS 86255
Hospital Charge Code	38476258
Hospital Revenue Code	302
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
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	$43.50
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

FLOUR,NON INF.AB SCREEN(2)

Facility

$225.00

Service Code	HCPCS 86255
Hospital Charge Code	38476258
Hospital Revenue Code	302
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

FLOUR.NON INF.AB SCREEN(3)

Facility

$225.00

Service Code	HCPCS 86255
Hospital Charge Code	38476259
Hospital Revenue Code	302
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
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	$43.50
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

FLOUR.NON INF.AB SCREEN(3)

Facility

$225.00

Service Code	HCPCS 86255
Hospital Charge Code	38476259
Hospital Revenue Code	302
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

FLOUR.NON INF.AB SCREEN(4)

Facility

$225.00

Service Code	HCPCS 86255
Hospital Charge Code	38476260
Hospital Revenue Code	302
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
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	$43.50
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

FLOUR.NON INF.AB SCREEN(4)

Facility

$225.00

Service Code	HCPCS 86255
Hospital Charge Code	38476260
Hospital Revenue Code	302
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

FLOUROSCOPY- 1 HR

Facility

$3,032.40

Service Code	HCPCS 76000
Hospital Charge Code	84506085
Hospital Revenue Code	320
Min. Negotiated Rate	$73.08
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$909.72
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$454.86
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$73.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$80.36

FLOUROSCOPY- 1 HR

Facility

$3,032.40

Service Code	HCPCS 76000
Hospital Charge Code	84506085
Hospital Revenue Code	320
Min. Negotiated Rate	$454.86
Max. Negotiated Rate	$454.86
Rate for Payer: Qualcare PPO/HMO/WC	$454.86

FLOVENT 110MCG

Facility

$161.00

Hospital Charge Code	60635175
Hospital Revenue Code	250
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

FLOVENT 110MCG

Facility

$161.00

Hospital Charge Code	60635175
Hospital Revenue Code	250
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$80.50
Rate for Payer: Aetna Commercial	$61.18
Rate for Payer: Aetna Medicare Advantage	$48.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.05
Rate for Payer: Cigna Commercial	$80.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.30
Rate for Payer: Oxford Commercial	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$32.20
Rate for Payer: UnitedHealthcare Community & State	$3.88
Rate for Payer: Wellpoint Medicaid Managed Care	$4.27

FLOVENT 220MCG

Facility

$414.00

Hospital Charge Code	60635177
Hospital Revenue Code	250
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.20
Rate for Payer: Oxford Commercial	$82.80
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$82.80
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

FLOVENT 220MCG

Facility

$414.00

Hospital Charge Code	60635177
Hospital Revenue Code	250
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

FLOVENT 44MCG

Facility

$138.00

Hospital Charge Code	60635176
Hospital Revenue Code	250
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.70

FLOVENT 44MCG

Facility

$138.00

Hospital Charge Code	60635176
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$52.44
Rate for Payer: Aetna Medicare Advantage	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.19
Rate for Payer: Cigna Commercial	$69.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.40
Rate for Payer: Oxford Commercial	$27.60
Rate for Payer: Qualcare PPO/HMO/WC	$20.70
Rate for Payer: UnitedHealthcare Commercial	$27.60
Rate for Payer: UnitedHealthcare Community & State	$3.33
Rate for Payer: Wellpoint Medicaid Managed Care	$3.66

FLOWABLE 10CC OAFL-10

Facility

$13,320.00

Service Code	HCPCS C1889
Hospital Charge Code	270704064
Hospital Revenue Code	278
Min. Negotiated Rate	$1,998.00
Max. Negotiated Rate	$3,223.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,664.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,223.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,930.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,998.00

FLOWABLE 10CC OAFL-10

Facility

$13,320.00

Service Code	HCPCS C1889
Hospital Charge Code	270704064
Hospital Revenue Code	278
Min. Negotiated Rate	$321.01
Max. Negotiated Rate	$6,660.00
Rate for Payer: Aetna Commercial	$5,061.60
Rate for Payer: Aetna Medicare Advantage	$3,996.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,396.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,396.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,664.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,396.60
Rate for Payer: Cigna Commercial	$6,660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,223.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,930.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,998.00
Rate for Payer: UnitedHealthcare Community & State	$321.01
Rate for Payer: Wellpoint Medicaid Managed Care	$352.98

FLOWABLE, 2.5CC

Facility

$5,065.00

Hospital Charge Code	270703497
Hospital Revenue Code	278
Min. Negotiated Rate	$122.07
Max. Negotiated Rate	$2,532.50
Rate for Payer: Aetna Commercial	$1,924.70
Rate for Payer: Aetna Medicare Advantage	$1,519.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,291.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,291.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,013.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,291.58
Rate for Payer: Cigna Commercial	$2,532.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,114.30
Rate for Payer: Qualcare PPO/HMO/WC	$759.75
Rate for Payer: UnitedHealthcare Community & State	$122.07
Rate for Payer: Wellpoint Medicaid Managed Care	$134.22

FLOWABLE, 2.5CC

Facility

$5,065.00

Hospital Charge Code	270703497
Hospital Revenue Code	278
Min. Negotiated Rate	$759.75
Max. Negotiated Rate	$1,225.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,013.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,114.30
Rate for Payer: Qualcare PPO/HMO/WC	$759.75

FLOW CYTOM, CELL SURF,CYTO

Facility

$101.00

Service Code	HCPCS 88184
Hospital Charge Code	38476306
Hospital Revenue Code	311
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

FLOW CYTOM, CELL SURF,CYTO

Facility

$101.00

Service Code	HCPCS 88184
Hospital Charge Code	38476306
Hospital Revenue Code	311
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$1,537.15
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,537.15
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$64.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

FLOW CYTOMETRY

Facility

$310.00

Service Code	HCPCS 88182
Hospital Charge Code	38474157
Hospital Revenue Code	311
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

FLOW CYTOMETRY

Facility

$310.00

Service Code	HCPCS 88182
Hospital Charge Code	38474157
Hospital Revenue Code	311
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

FLOW CYTOMETRY;16 OR MORE

Facility

$218.74

Service Code	HCPCS 88189
Hospital Charge Code	38474162
Hospital Revenue Code	311
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$83.12
Rate for Payer: Aetna Medicare Advantage	$65.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.78
Rate for Payer: Cigna Commercial	$109.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$64.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.80

FLOW CYTOMETRY;16 OR MORE

Facility

$218.74

Service Code	HCPCS 88189
Hospital Charge Code	38474162
Hospital Revenue Code	311
Min. Negotiated Rate	$32.81
Max. Negotiated Rate	$32.81
Rate for Payer: Qualcare PPO/HMO/WC	$32.81

FLOW CYTOMETRY ADDL MARKER

Facility

$631.50

Service Code	HCPCS 88185
Hospital Charge Code	401088184B
Hospital Revenue Code	301
Min. Negotiated Rate	$94.72
Max. Negotiated Rate	$94.72
Rate for Payer: Qualcare PPO/HMO/WC	$94.72

Know your out-of-pocket cost for care.

All Charges