Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FULL RING 155MM

Facility

$8,025.00

Hospital Charge Code	270674285
Hospital Revenue Code	272
Min. Negotiated Rate	$1,203.75
Max. Negotiated Rate	$1,203.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75

FULL RING LRF CARBON 155MM

Facility

$11,410.05

Service Code	HCPCS C1713
Hospital Charge Code	270699597
Hospital Revenue Code	278
Min. Negotiated Rate	$274.98
Max. Negotiated Rate	$5,705.02
Rate for Payer: Aetna Commercial	$4,335.82
Rate for Payer: Aetna Medicare Advantage	$3,423.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,909.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,909.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,282.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,909.56
Rate for Payer: Cigna Commercial	$5,705.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,761.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,510.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,711.51
Rate for Payer: UnitedHealthcare Community & State	$274.98
Rate for Payer: Wellpoint Medicaid Managed Care	$302.37

FULL RING LRF CARBON 155MM

Facility

$11,410.05

Service Code	HCPCS C1713
Hospital Charge Code	270699597
Hospital Revenue Code	278
Min. Negotiated Rate	$1,711.51
Max. Negotiated Rate	$2,761.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,282.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,761.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,510.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,711.51

FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility

$136,902.45

Service Code	MSDRG 793
Min. Negotiated Rate	$3,533.00
Max. Negotiated Rate	$136,902.45
Rate for Payer: Aetna Commercial	$94,324.94
Rate for Payer: Aetna Medicare Advantage	$136,902.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97,928.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97,928.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$43,878.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97,928.81
Rate for Payer: Cigna Commercial	$78,029.89
Rate for Payer: Cigna Medicare Advantage	$43,878.99
Rate for Payer: Clover Medicare Advantage	$41,685.04
Rate for Payer: EmblemHealth Commercial	$131,636.97
Rate for Payer: Humana Medicare Advantage	$45,195.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$43,878.99
Rate for Payer: Oxford Commercial	$3,533.00
Rate for Payer: UnitedHealthcare Commercial	$6,193.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$43,878.99
Rate for Payer: Wellcare Medicare Advantage	$43,878.99

FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY

Facility

$73,584.36

Service Code	MSDRG 934
Min. Negotiated Rate	$22,405.49
Max. Negotiated Rate	$73,584.36
Rate for Payer: Aetna Commercial	$50,818.17
Rate for Payer: Aetna Medicare Advantage	$73,584.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48,615.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48,615.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,584.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48,615.49
Rate for Payer: Cigna Commercial	$41,369.17
Rate for Payer: Cigna Medicare Advantage	$23,584.73
Rate for Payer: Clover Medicare Advantage	$22,405.49
Rate for Payer: EmblemHealth Commercial	$70,754.19
Rate for Payer: Humana Medicare Advantage	$24,292.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,584.73
Rate for Payer: Oxford Commercial	$29,732.57
Rate for Payer: UnitedHealthcare Commercial	$52,137.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,584.73
Rate for Payer: Wellcare Medicare Advantage	$23,584.73

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC

Facility

$233,967.61

Service Code	MSDRG 928
Min. Negotiated Rate	$71,240.14
Max. Negotiated Rate	$233,967.61
Rate for Payer: Aetna Commercial	$161,019.76
Rate for Payer: Aetna Medicare Advantage	$233,967.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$74,989.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160,966.12
Rate for Payer: Cigna Commercial	$134,229.91
Rate for Payer: Cigna Medicare Advantage	$74,989.62
Rate for Payer: Clover Medicare Advantage	$71,240.14
Rate for Payer: EmblemHealth Commercial	$224,968.86
Rate for Payer: Humana Medicare Advantage	$77,239.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$74,989.62
Rate for Payer: Oxford Commercial	$96,472.82
Rate for Payer: UnitedHealthcare Commercial	$169,168.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$74,989.62
Rate for Payer: Wellcare Medicare Advantage	$74,989.62

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC

Facility

$106,235.63

Service Code	MSDRG 929
Min. Negotiated Rate	$32,347.39
Max. Negotiated Rate	$106,235.63
Rate for Payer: Aetna Commercial	$73,253.30
Rate for Payer: Aetna Medicare Advantage	$106,235.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74,900.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74,900.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34,049.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74,900.42
Rate for Payer: Cigna Commercial	$60,274.05
Rate for Payer: Cigna Medicare Advantage	$34,049.88
Rate for Payer: Clover Medicare Advantage	$32,347.39
Rate for Payer: EmblemHealth Commercial	$102,149.64
Rate for Payer: Humana Medicare Advantage	$35,071.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34,049.88
Rate for Payer: Oxford Commercial	$43,319.76
Rate for Payer: UnitedHealthcare Commercial	$75,962.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$34,049.88
Rate for Payer: Wellcare Medicare Advantage	$34,049.88

FULVESTRANT 50 MG/ML INJ

Facility

$963.30

Hospital Charge Code	60628648
Hospital Revenue Code	636
Min. Negotiated Rate	$144.50
Max. Negotiated Rate	$233.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.12
Rate for Payer: Qualcare PPO/HMO/WC	$144.50

FULVESTRANT 50 MG/ML INJ

Facility

$963.30

Hospital Charge Code	60628648
Hospital Revenue Code	636
Min. Negotiated Rate	$23.22
Max. Negotiated Rate	$481.65
Rate for Payer: Aetna Commercial	$366.05
Rate for Payer: Aetna Medicare Advantage	$288.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.64
Rate for Payer: Cigna Commercial	$481.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.12
Rate for Payer: Qualcare PPO/HMO/WC	$144.50
Rate for Payer: UnitedHealthcare Community & State	$23.22
Rate for Payer: Wellpoint Medicaid Managed Care	$25.53

FULVESTRANT(FASLODEX)50MG/ML

Facility

$8,525.80

Hospital Charge Code	60630123
Hospital Revenue Code	636
Min. Negotiated Rate	$1,278.87
Max. Negotiated Rate	$2,063.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,063.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,278.87

FULVESTRANT(FASLODEX)50MG/ML

Facility

$8,525.80

Hospital Charge Code	60630123
Hospital Revenue Code	636
Min. Negotiated Rate	$205.47
Max. Negotiated Rate	$4,262.90
Rate for Payer: Aetna Commercial	$3,239.80
Rate for Payer: Aetna Medicare Advantage	$2,557.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,174.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,174.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,174.08
Rate for Payer: Cigna Commercial	$4,262.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,063.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,278.87
Rate for Payer: UnitedHealthcare Community & State	$205.47
Rate for Payer: Wellpoint Medicaid Managed Care	$225.93

FULVESTRANT INJ 25MG

Facility

$1,933.45

Hospital Charge Code	60629243
Hospital Revenue Code	636
Min. Negotiated Rate	$290.02
Max. Negotiated Rate	$467.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.89
Rate for Payer: Qualcare PPO/HMO/WC	$290.02

FULVESTRANT INJ 25MG

Facility

$1,933.45

Hospital Charge Code	60629243
Hospital Revenue Code	636
Min. Negotiated Rate	$46.60
Max. Negotiated Rate	$966.73
Rate for Payer: Aetna Commercial	$734.71
Rate for Payer: Aetna Medicare Advantage	$580.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$493.03
Rate for Payer: Cigna Commercial	$966.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.89
Rate for Payer: Qualcare PPO/HMO/WC	$290.02
Rate for Payer: UnitedHealthcare Community & State	$46.60
Rate for Payer: Wellpoint Medicaid Managed Care	$51.24

FULVICIN/500MG

Facility

$3.00

Hospital Charge Code	60634959
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

FULVICIN/500MG

Facility

$3.00

Hospital Charge Code	60634959
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FULVICIN P/G/250MG/TAB

Facility

$6.00

Hospital Charge Code	60633017
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

FULVICIN P/G/250MG/TAB

Facility

$6.00

Hospital Charge Code	60633017
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

FULVICIN P/G/330MG/TAB

Facility

$6.00

Hospital Charge Code	60633016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

FULVICIN P/G/330MG/TAB

Facility

$6.00

Hospital Charge Code	60633016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

FUNCT ACT @ COMPLMT/COMPONENT

Facility

$85.50

Service Code	HCPCS 86161
Hospital Charge Code	38478079
Hospital Revenue Code	300
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.32
Rate for Payer: Cigna Commercial	$42.75
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.82
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.27

FUNCT ACT @ COMPLMT/COMPONENT

Facility

$85.50

Service Code	HCPCS 86161
Hospital Charge Code	38478079
Hospital Revenue Code	300
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$12.82
Rate for Payer: Qualcare PPO/HMO/WC	$12.82

FUNGAL ANTIBODIES

Facility

$339.00

Service Code	HCPCS 86671
Hospital Charge Code	38476190
Hospital Revenue Code	302
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$169.50
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna Medicare Advantage	$39.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.22
Rate for Payer: Cigna Commercial	$169.50
Rate for Payer: Cigna Medicare Advantage	$12.25
Rate for Payer: Clover Medicare Advantage	$11.64
Rate for Payer: EmblemHealth Commercial	$36.75
Rate for Payer: Humana Medicare Advantage	$12.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.25
Rate for Payer: Wellcare Medicare Advantage	$12.25
Rate for Payer: Wellpoint Medicaid Managed Care	$8.98

FUNGAL ANTIBODIES

Facility

$339.00

Service Code	HCPCS 86671
Hospital Charge Code	38476190
Hospital Revenue Code	302
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$50.85
Rate for Payer: Qualcare PPO/HMO/WC	$50.85

FUNGAL ID

Facility

$390.00

Service Code	HCPCS 87106
Hospital Charge Code	39900488
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FUNGAL ID

Facility

$390.00

Service Code	HCPCS 87106
Hospital Charge Code	39900488
Hospital Revenue Code	309
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$28.07
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.25
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$10.32
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.32
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	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Medicare Advantage	$10.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges