Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FREEDOM CONSTR HD 36MM T1 STD

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270692097
Hospital Revenue Code	278
Min. Negotiated Rate	$190.87
Max. Negotiated Rate	$3,960.00
Rate for Payer: Aetna Commercial	$3,009.60
Rate for Payer: Aetna Medicare Advantage	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.60
Rate for Payer: Cigna Commercial	$3,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00
Rate for Payer: UnitedHealthcare Community & State	$190.87
Rate for Payer: Wellpoint Medicaid Managed Care	$209.88

FREE HGBU (HEMOGLOBIN,FREE,URI

Facility

$43.25

Service Code	HCPCS 83069
Hospital Charge Code	3009065
Hospital Revenue Code	301
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.74
Rate for Payer: Aetna Medicare Advantage	$12.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.26
Rate for Payer: Cigna Commercial	$21.62
Rate for Payer: Cigna Medicare Advantage	$3.95
Rate for Payer: Clover Medicare Advantage	$3.75
Rate for Payer: EmblemHealth Commercial	$11.85
Rate for Payer: Humana Medicare Advantage	$4.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.95
Rate for Payer: Wellcare Medicare Advantage	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

FREE HGBU (HEMOGLOBIN,FREE,URI

Facility

$43.25

Service Code	HCPCS 83069
Hospital Charge Code	3009065
Hospital Revenue Code	301
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.49

FREEING OF BOWEL ADHESION

Facility

$15,014.00

Service Code	HCPCS 44005
Hospital Charge Code	16000162
Hospital Revenue Code	360
Min. Negotiated Rate	$361.84
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,705.32
Rate for Payer: Aetna Medicare Advantage	$4,504.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,828.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,828.57
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	$3,828.57
Rate for Payer: Cigna Commercial	$7,507.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,504.20
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,252.10
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$361.84
Rate for Payer: Wellpoint Medicaid Managed Care	$397.87

FREEING OF BOWEL ADHESION

Facility

$15,014.00

Service Code	HCPCS 44005
Hospital Charge Code	16000162
Hospital Revenue Code	360
Min. Negotiated Rate	$2,252.10
Max. Negotiated Rate	$2,252.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,252.10

FREE KAPPA/LAMBDA,RANDOM URINE

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3035137B
Hospital Revenue Code	301
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

FREE KAPPA/LAMBDA,RANDOM URINE

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3035137A
Hospital Revenue Code	301
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

FREE KAPPA/LAMBDA,RANDOM URINE

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3035137B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$171.49
Rate for Payer: Aetna Commercial	$36.99
Rate for Payer: Aetna Medicare Advantage	$44.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.09
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: Cigna Medicare Advantage	$13.60
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Medicare Advantage	$13.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

FREE KAPPA/LAMBDA,RANDOM URINE

Facility

$150.00

Service Code	HCPCS 83883
Hospital Charge Code	3035137A
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$171.49
Rate for Payer: Aetna Commercial	$36.99
Rate for Payer: Aetna Medicare Advantage	$44.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.09
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: Cigna Medicare Advantage	$13.60
Rate for Payer: Clover Medicare Advantage	$12.92
Rate for Payer: EmblemHealth Commercial	$40.80
Rate for Payer: Humana Medicare Advantage	$14.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.60
Rate for Payer: Wellcare Medicare Advantage	$13.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

FREE KAPPA/LAMBDA RND UR I

Facility

$93.45

Service Code	HCPCS 8388391
Hospital Charge Code	39990014A
Hospital Revenue Code	301
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.02

FREE KAPPA/LAMBDA RND UR I

Facility

$93.45

Service Code	HCPCS 8388391
Hospital Charge Code	39990014A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.51
Rate for Payer: Aetna Medicare Advantage	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.83
Rate for Payer: Cigna Commercial	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

FREE KAPPA/LAMBDA RND UR II

Facility

$93.45

Service Code	HCPCS 8388391
Hospital Charge Code	39990014B
Hospital Revenue Code	301
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.02

FREE KAPPA/LAMBDA RND UR II

Facility

$93.45

Service Code	HCPCS 8388391
Hospital Charge Code	39990014B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.51
Rate for Payer: Aetna Medicare Advantage	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.83
Rate for Payer: Cigna Commercial	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.04
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

FREE KAPPA & LAMBDA W/ RA I

Facility

$390.00

Service Code	HCPCS 8388391
Hospital Charge Code	39990013A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FREE KAPPA & LAMBDA W/ RA I

Facility

$390.00

Service Code	HCPCS 8388391
Hospital Charge Code	39990013A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

FREE KAPPA & LAMBDA W/ RA II

Facility

$390.00

Service Code	HCPCS 8388391
Hospital Charge Code	39990013B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

FREE KAPPA & LAMBDA W/ RA II

Facility

$390.00

Service Code	HCPCS 8388391
Hospital Charge Code	39990013B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FREELINK REMOTE CONTROL KIT

Facility

$6,750.00

Service Code	HCPCS C1787
Hospital Charge Code	270696218
Hospital Revenue Code	271
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

FREELINK REMOTE CONTROL KIT

Facility

$6,750.00

Service Code	HCPCS C1787
Hospital Charge Code	270696218
Hospital Revenue Code	271
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,025.00
Rate for Payer: Oxford Commercial	$1,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Commercial	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

FREE T3

Facility

$390.00

Service Code	HCPCS 84481
Hospital Charge Code	39900506
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.08
Rate for Payer: Aetna Medicare Advantage	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.15
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.94
Rate for Payer: Clover Medicare Advantage	$16.09
Rate for Payer: EmblemHealth Commercial	$50.82
Rate for Payer: Humana Medicare Advantage	$17.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.94
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	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.94
Rate for Payer: Wellcare Medicare Advantage	$16.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

FREE T3

Facility

$390.00

Service Code	HCPCS 84481
Hospital Charge Code	39900506
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FREE THYROXINE INDEX***

Facility

$48.00

Service Code	HCPCS 84439
Hospital Charge Code	3031689
Hospital Revenue Code	312
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

FREE THYROXINE INDEX***

Facility

$48.00

Service Code	HCPCS 84439
Hospital Charge Code	3031689
Hospital Revenue Code	312
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$24.53
Rate for Payer: Aetna Medicare Advantage	$29.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.56
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: Cigna Medicare Advantage	$9.02
Rate for Payer: Clover Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$27.06
Rate for Payer: Humana Medicare Advantage	$9.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$7.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.02
Rate for Payer: Wellcare Medicare Advantage	$9.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

FRENOPLASTY

Facility

$42,339.20

Service Code	HCPCS 41520
Hospital Charge Code	1600000631
Hospital Revenue Code	360
Min. Negotiated Rate	$1,016.00
Max. Negotiated Rate	$14,218.07
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,218.07
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,701.76
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,350.88
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,020.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1,121.99

FRENOPLASTY

Facility

$42,339.20

Service Code	HCPCS 41520
Hospital Charge Code	1600000631
Hospital Revenue Code	360
Min. Negotiated Rate	$6,350.88
Max. Negotiated Rate	$6,350.88
Rate for Payer: Qualcare PPO/HMO/WC	$6,350.88

Know your out-of-pocket cost for care.

All Charges