Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FROZEN SECTION

Facility

$412.85

Service Code	HCPCS 88331
Hospital Charge Code	3004934
Hospital Revenue Code	310
Min. Negotiated Rate	$61.93
Max. Negotiated Rate	$61.93
Rate for Payer: Qualcare PPO/HMO/WC	$61.93

FROZEN SECTION

Facility

$390.00

Service Code	HCPCS 88332
Hospital Charge Code	3004935
Hospital Revenue Code	312
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FROZEN SECTION

Facility

$412.85

Service Code	HCPCS 88331
Hospital Charge Code	3004934
Hospital Revenue Code	310
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.93
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$81.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.94

FROZEN SECTION*****

Facility

$161.00

Service Code	HCPCS 8833159
Hospital Charge Code	3004934A
Hospital Revenue Code	312
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$175.00
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	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$3.88
Rate for Payer: Wellpoint Medicaid Managed Care	$4.27

FROZEN SECTION*****

Facility

$161.00

Service Code	HCPCS 8833159
Hospital Charge Code	3004934A
Hospital Revenue Code	312
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

FROZEN SECTION ADD BLOCK

Facility

$390.00

Service Code	HCPCS 88332
Hospital Charge Code	3004942
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FROZEN SECTION ADD BLOCK

Facility

$300.85

Service Code	HCPCS 88332
Hospital Charge Code	3004943
Hospital Revenue Code	312
Min. Negotiated Rate	$45.13
Max. Negotiated Rate	$45.13
Rate for Payer: Qualcare PPO/HMO/WC	$45.13

FROZEN SECTION ADD BLOCK

Facility

$300.85

Service Code	HCPCS 88332
Hospital Charge Code	3004943
Hospital Revenue Code	312
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$114.32
Rate for Payer: Aetna Medicare Advantage	$90.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.72
Rate for Payer: Cigna Commercial	$150.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.13
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$43.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.97

FROZEN SECTION ADD BLOCK

Facility

$390.00

Service Code	HCPCS 88332
Hospital Charge Code	3004942
Hospital Revenue Code	310
Min. Negotiated Rate	$10.34
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	$175.00
Rate for Payer: UnitedHealthcare Community & State	$43.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

FROZEN SECTION ADDTIONAL SURGE

Facility

$186.00

Service Code	HCPCS 88332
Hospital Charge Code	38474034
Hospital Revenue Code	310
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$43.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

FROZEN SECTION ADDTIONAL SURGE

Facility

$186.00

Service Code	HCPCS 88332
Hospital Charge Code	38474034
Hospital Revenue Code	310
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

FROZEN SECTION CYTOLOGY

Facility

$211.25

Service Code	HCPCS 88333
Hospital Charge Code	3005395
Hospital Revenue Code	311
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$3,455.10
Rate for Payer: Aetna Commercial	$2,603.50
Rate for Payer: Aetna Medicare Advantage	$3,101.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$957.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,455.10
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$957.17
Rate for Payer: Clover Medicare Advantage	$909.31
Rate for Payer: EmblemHealth Commercial	$2,871.51
Rate for Payer: Humana Medicare Advantage	$985.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.69
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$73.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$957.17
Rate for Payer: Wellcare Medicare Advantage	$957.17
Rate for Payer: Wellpoint Medicaid Managed Care	$5.60

FROZEN SECTION CYTOLOGY

Facility

$211.25

Service Code	HCPCS 88333
Hospital Charge Code	3005395
Hospital Revenue Code	311
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$31.69
Rate for Payer: Qualcare PPO/HMO/WC	$31.69

FROZEN SECTION DURING SURGERY

Facility

$401.00

Service Code	HCPCS 88331
Hospital Charge Code	38474031
Hospital Revenue Code	310
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.15
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$81.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.63

FROZEN SECTION DURING SURGERY

Facility

$401.00

Service Code	HCPCS 88331
Hospital Charge Code	38474031
Hospital Revenue Code	310
Min. Negotiated Rate	$60.15
Max. Negotiated Rate	$60.15
Rate for Payer: Qualcare PPO/HMO/WC	$60.15

FROZEN THAWED RBC,DEGLYCEROLYZ

Facility

$2,167.00

Hospital Charge Code	38471034
Hospital Revenue Code	390
Min. Negotiated Rate	$325.05
Max. Negotiated Rate	$325.05
Rate for Payer: Qualcare PPO/HMO/WC	$325.05

FROZEN THAWED RBC,DEGLYCEROLYZ

Facility

$2,167.00

Hospital Charge Code	38471034
Hospital Revenue Code	390
Min. Negotiated Rate	$52.22
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$823.46
Rate for Payer: Aetna Medicare Advantage	$650.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$552.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$552.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$552.59
Rate for Payer: Cigna Commercial	$1,083.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.10
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$325.05
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$52.22
Rate for Payer: Wellpoint Medicaid Managed Care	$57.43

FRUCTOSAMINE

Facility

$667.59

Service Code	HCPCS 82985
Hospital Charge Code	39900088
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

FRUCTOSAMINE

Facility

$667.59

Service Code	HCPCS 82985
Hospital Charge Code	39900088
Hospital Revenue Code	301
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$45.59
Rate for Payer: Aetna Medicare Advantage	$54.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.50
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$16.76
Rate for Payer: Clover Medicare Advantage	$15.92
Rate for Payer: EmblemHealth Commercial	$50.28
Rate for Payer: Humana Medicare Advantage	$17.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.76
Rate for Payer: Wellcare Medicare Advantage	$16.76
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

FRUCTOSAMINE

Facility

$141.65

Service Code	HCPCS 82985
Hospital Charge Code	3007408
Hospital Revenue Code	301
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

FRUCTOSAMINE

Facility

$141.65

Service Code	HCPCS 82985
Hospital Charge Code	3007408
Hospital Revenue Code	301
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.59
Rate for Payer: Aetna Medicare Advantage	$54.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.50
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: Cigna Medicare Advantage	$16.76
Rate for Payer: Clover Medicare Advantage	$15.92
Rate for Payer: EmblemHealth Commercial	$50.28
Rate for Payer: Humana Medicare Advantage	$17.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.76
Rate for Payer: Wellcare Medicare Advantage	$16.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

FRUCTOSAMINE, SERUM

Facility

$446.00

Service Code	HCPCS 82985
Hospital Charge Code	38474105
Hospital Revenue Code	301
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

FRUCTOSAMINE, SERUM

Facility

$446.00

Service Code	HCPCS 82985
Hospital Charge Code	38474105
Hospital Revenue Code	301
Min. Negotiated Rate	$11.82
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$45.59
Rate for Payer: Aetna Medicare Advantage	$54.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.50
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: Cigna Medicare Advantage	$16.76
Rate for Payer: Clover Medicare Advantage	$15.92
Rate for Payer: EmblemHealth Commercial	$50.28
Rate for Payer: Humana Medicare Advantage	$17.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.76
Rate for Payer: Wellcare Medicare Advantage	$16.76
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

FRUCTOSE,SEMEN,QN

Facility

$390.00

Service Code	HCPCS 82757
Hospital Charge Code	39900081
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$47.16
Rate for Payer: Aetna Medicare Advantage	$56.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.59
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.34
Rate for Payer: Clover Medicare Advantage	$16.47
Rate for Payer: EmblemHealth Commercial	$52.02
Rate for Payer: Humana Medicare Advantage	$17.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.34
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	$13.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.34
Rate for Payer: Wellcare Medicare Advantage	$17.34
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

FRUCTOSE,SEMEN,QN

Facility

$390.00

Service Code	HCPCS 82757
Hospital Charge Code	39900081
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

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