Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMMONIUM CHLORIDE/5MEQ/1M

Facility

$830.00

Hospital Charge Code	60632447
Hospital Revenue Code	250
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$415.00
Rate for Payer: Aetna Commercial	$315.40
Rate for Payer: Aetna Medicare Advantage	$249.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.65
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.00
Rate for Payer: Oxford Commercial	$166.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.50
Rate for Payer: UnitedHealthcare Commercial	$166.00
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$22.00

AMMONIUM LACTATE CRE

Facility

$256.61

Service Code	NDC 45802049383
Hospital Charge Code	60628825
Hospital Revenue Code	250
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$38.49
Rate for Payer: Qualcare PPO/HMO/WC	$38.49

AMMONIUM LACTATE CRE

Facility

$256.61

Service Code	NDC 45802049383
Hospital Charge Code	60628825
Hospital Revenue Code	250
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$128.31
Rate for Payer: Aetna Commercial	$97.51
Rate for Payer: Aetna Medicare Advantage	$76.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.44
Rate for Payer: Cigna Commercial	$128.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.98
Rate for Payer: Oxford Commercial	$51.32
Rate for Payer: Qualcare PPO/HMO/WC	$38.49
Rate for Payer: UnitedHealthcare Commercial	$51.32
Rate for Payer: UnitedHealthcare Community & State	$6.18
Rate for Payer: Wellpoint Medicaid Managed Care	$6.80

AMMONIUM LACTATE LOT 12%

Facility

$80.74

Service Code	NDC 245002322
Hospital Charge Code	60628449
Hospital Revenue Code	250
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$12.11
Rate for Payer: Qualcare PPO/HMO/WC	$12.11

AMMONIUM LACTATE LOT 12%

Facility

$80.74

Service Code	NDC 245002322
Hospital Charge Code	60628449
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.37
Rate for Payer: Aetna Commercial	$30.68
Rate for Payer: Aetna Medicare Advantage	$24.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.59
Rate for Payer: Cigna Commercial	$40.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.22
Rate for Payer: Oxford Commercial	$16.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.11
Rate for Payer: UnitedHealthcare Commercial	$16.15
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

AMMONIUM LACTATE LOT 5%

Facility

$13.65

Hospital Charge Code	60628450
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

AMMONIUM LACTATE LOT 5%

Facility

$13.65

Hospital Charge Code	60628450
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

AMNI-HOOK STERILE DISP

Facility

$8.50

Hospital Charge Code	270650233
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$1.27

AMNI-HOOK STERILE DISP

Facility

$8.50

Hospital Charge Code	270650233
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.25
Rate for Payer: Aetna Commercial	$3.23
Rate for Payer: Aetna Medicare Advantage	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.17
Rate for Payer: Cigna Commercial	$4.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.55
Rate for Payer: Oxford Commercial	$1.70
Rate for Payer: Qualcare PPO/HMO/WC	$1.27
Rate for Payer: UnitedHealthcare Commercial	$1.70
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

AMNIOCENTESIS TRAY

Facility

$125.00

Hospital Charge Code	270331703
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

AMNIOCENTESIS TRAY

Facility

$125.00

Hospital Charge Code	270331703
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

AMNIOCENTESIS-U/S GUIDANCE

Facility

$1,204.00

Service Code	HCPCS 76946
Hospital Charge Code	83653120
Hospital Revenue Code	402
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$180.60
Rate for Payer: Qualcare PPO/HMO/WC	$180.60

AMNIOCENTESIS-U/S GUIDANCE

Facility

$1,204.00

Service Code	HCPCS 76946
Hospital Charge Code	83653120
Hospital Revenue Code	402
Min. Negotiated Rate	$29.02
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$457.52
Rate for Payer: Aetna Medicare Advantage	$361.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.02
Rate for Payer: Cigna Commercial	$602.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.20
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.60
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$29.02
Rate for Payer: Wellpoint Medicaid Managed Care	$31.91

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	74308370
Hospital Revenue Code	402
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Qualcare PPO/HMO/WC	$128.70

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	74308370
Hospital Revenue Code	402
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$326.04
Rate for Payer: Aetna Medicare Advantage	$257.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.79
Rate for Payer: Cigna Commercial	$429.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.40
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.70
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$20.68
Rate for Payer: Wellpoint Medicaid Managed Care	$22.74

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	83653215
Hospital Revenue Code	402
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$326.04
Rate for Payer: Aetna Medicare Advantage	$257.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.79
Rate for Payer: Cigna Commercial	$429.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.40
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.70
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$20.68
Rate for Payer: Wellpoint Medicaid Managed Care	$22.74

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	83653215
Hospital Revenue Code	402
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Qualcare PPO/HMO/WC	$128.70

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	74308340
Hospital Revenue Code	514
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	83653005
Hospital Revenue Code	720
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	83653005
Hospital Revenue Code	720
Min. Negotiated Rate	$35.67
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$2,976.31
Rate for Payer: Aetna Medicare Advantage	$3,545.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,094.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,949.84
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: Cigna Medicare Advantage	$1,094.23
Rate for Payer: Clover Medicare Advantage	$1,039.52
Rate for Payer: EmblemHealth Commercial	$3,282.69
Rate for Payer: Humana Medicare Advantage	$1,127.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,094.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.00
Rate for Payer: Oxford Commercial	$2,624.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$35.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,094.23
Rate for Payer: Wellcare Medicare Advantage	$1,094.23
Rate for Payer: Wellpoint Medicaid Managed Care	$39.22

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	74308340
Hospital Revenue Code	514
Min. Negotiated Rate	$35.67
Max. Negotiated Rate	$3,949.84
Rate for Payer: Aetna Commercial	$2,976.31
Rate for Payer: Aetna Medicare Advantage	$3,545.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,094.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,949.84
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: Cigna Medicare Advantage	$1,094.23
Rate for Payer: Clover Medicare Advantage	$1,039.52
Rate for Payer: EmblemHealth Commercial	$3,282.69
Rate for Payer: Humana Medicare Advantage	$1,127.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,094.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00
Rate for Payer: UnitedHealthcare Community & State	$35.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,094.23
Rate for Payer: Wellcare Medicare Advantage	$1,094.23
Rate for Payer: Wellpoint Medicaid Managed Care	$39.22

AMNIO EXCELL PLUS 3.0 x 4.0 CM

Facility

$13,635.00

Service Code	HCPCS Q4137
Hospital Charge Code	270687808
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$3,299.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,999.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

AMNIO EXCELL PLUS 3.0 x 4.0 CM

Facility

$13,635.00

Service Code	HCPCS Q4137
Hospital Charge Code	270687808
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,299.67
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,999.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25
Rate for Payer: UnitedHealthcare Community & State	$328.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$361.33

AMNIOFIX 7CM X 6CM

Facility

$12,666.50

Hospital Charge Code	270702726
Hospital Revenue Code	278
Min. Negotiated Rate	$1,899.97
Max. Negotiated Rate	$3,065.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,533.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,065.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,786.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,899.97

AMNIOFIX 7CM X 6CM

Facility

$12,666.50

Hospital Charge Code	270702726
Hospital Revenue Code	278
Min. Negotiated Rate	$305.26
Max. Negotiated Rate	$6,333.25
Rate for Payer: Aetna Commercial	$4,813.27
Rate for Payer: Aetna Medicare Advantage	$3,799.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,229.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,229.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,533.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,229.96
Rate for Payer: Cigna Commercial	$6,333.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,065.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,786.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,899.97
Rate for Payer: UnitedHealthcare Community & State	$305.26
Rate for Payer: Wellpoint Medicaid Managed Care	$335.66

Know your out-of-pocket cost for care.

All Charges