Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANA COMP 1

Facility

$175.25

Service Code	HCPCS 86225
Hospital Charge Code	3036009A
Hospital Revenue Code	302
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.37
Rate for Payer: Aetna Medicare Advantage	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.60
Rate for Payer: Cigna Commercial	$87.62
Rate for Payer: Cigna Medicare Advantage	$13.74
Rate for Payer: Clover Medicare Advantage	$13.05
Rate for Payer: EmblemHealth Commercial	$41.22
Rate for Payer: Humana Medicare Advantage	$14.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.29
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.74
Rate for Payer: Wellcare Medicare Advantage	$13.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

ANA COMP 2

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3036009B
Hospital Revenue Code	300
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

ANA COMP 2

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3036009B
Hospital Revenue Code	300
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

ANA COMP 3

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009C
Hospital Revenue Code	300
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

ANA COMP 3

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009C
Hospital Revenue Code	300
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

ANA COMP 4

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009D
Hospital Revenue Code	300
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

ANA COMP 4

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009D
Hospital Revenue Code	300
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

ANA COMP 5

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009E
Hospital Revenue Code	300
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

ANA COMP 5

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009E
Hospital Revenue Code	300
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

ANA COMP 6

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009F
Hospital Revenue Code	300
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

ANA COMP 6

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009F
Hospital Revenue Code	300
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

ANA COMP 7

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009G
Hospital Revenue Code	300
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

ANA COMP 7

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009G
Hospital Revenue Code	300
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

ANA COMP 8

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009H
Hospital Revenue Code	300
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

ANA COMP 8

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009H
Hospital Revenue Code	300
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

ANA COMP 9

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009I
Hospital Revenue Code	300
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

ANA COMP 9

Facility

$143.99

Service Code	HCPCS 8623591
Hospital Charge Code	3036009I
Hospital Revenue Code	300
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

ANAEROBIC CULT/GRAM

Facility

$410.00

Service Code	HCPCS 87075
Hospital Charge Code	38479069
Hospital Revenue Code	309
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

ANAEROBIC CULT/GRAM

Facility

$410.00

Service Code	HCPCS 87075
Hospital Charge Code	38479069
Hospital Revenue Code	309
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$25.76
Rate for Payer: Aetna Medicare Advantage	$30.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.47
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	$34.18
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: Cigna Medicare Advantage	$9.47
Rate for Payer: Clover Medicare Advantage	$9.00
Rate for Payer: EmblemHealth Commercial	$28.41
Rate for Payer: Humana Medicare Advantage	$9.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.47
Rate for Payer: Wellcare Medicare Advantage	$9.47
Rate for Payer: Wellpoint Medicaid Managed Care	$10.87

ANAEROBIC CULTURE

Facility

$410.00

Service Code	HCPCS 87075
Hospital Charge Code	38475071
Hospital Revenue Code	309
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$25.76
Rate for Payer: Aetna Medicare Advantage	$30.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.47
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	$34.18
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: Cigna Medicare Advantage	$9.47
Rate for Payer: Clover Medicare Advantage	$9.00
Rate for Payer: EmblemHealth Commercial	$28.41
Rate for Payer: Humana Medicare Advantage	$9.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.47
Rate for Payer: Wellcare Medicare Advantage	$9.47
Rate for Payer: Wellpoint Medicaid Managed Care	$10.87

ANAEROBIC CULTURE

Facility

$410.00

Service Code	HCPCS 87075
Hospital Charge Code	38475071
Hospital Revenue Code	309
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

ANAFIANIL/75MG/U/D

Facility

$6.00

Hospital Charge Code	60634709
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

ANAFIANIL/75MG/U/D

Facility

$6.00

Hospital Charge Code	60634709
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

ANAFRANIL/25MG/CAP

Facility

$6.00

Hospital Charge Code	60632456
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

ANAFRANIL/25MG/CAP

Facility

$6.00

Hospital Charge Code	60632455
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

Know your out-of-pocket cost for care.

All Charges