Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEMATOCRIT

Facility

$44.00

Service Code	HCPCS 85014
Hospital Charge Code	38474117
Hospital Revenue Code	305
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

HEMATOCRIT

Facility

$44.00

Service Code	HCPCS 85014
Hospital Charge Code	38474117
Hospital Revenue Code	305
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$6.45
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.55
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: Cigna Medicare Advantage	$2.37
Rate for Payer: Clover Medicare Advantage	$2.25
Rate for Payer: EmblemHealth Commercial	$7.11
Rate for Payer: Humana Medicare Advantage	$2.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.37
Rate for Payer: Wellcare Medicare Advantage	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

HEMATOXYLIN AND EOSIN STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005322
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

HEMATOXYLIN AND EOSIN STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005322
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

HEMEPATH INTERPRETATION

Facility

$101.35

Service Code	HCPCS 80500
Hospital Charge Code	3030780
Hospital Revenue Code	310
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$38.51
Rate for Payer: Aetna Medicare Advantage	$30.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.84
Rate for Payer: Cigna Commercial	$50.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.41
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.20
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$2.44
Rate for Payer: Wellpoint Medicaid Managed Care	$2.69

HEMEPATH INTERPRETATION

Facility

$101.35

Service Code	HCPCS 80500
Hospital Charge Code	3030780
Hospital Revenue Code	310
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$15.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.20

HEMICAP MTP CE 1.5X3.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270699529
Hospital Revenue Code	278
Min. Negotiated Rate	$362.22
Max. Negotiated Rate	$7,515.00
Rate for Payer: Aetna Commercial	$5,711.40
Rate for Payer: Aetna Medicare Advantage	$4,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,832.65
Rate for Payer: Cigna Commercial	$7,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,306.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50
Rate for Payer: UnitedHealthcare Community & State	$362.22
Rate for Payer: Wellpoint Medicaid Managed Care	$398.30

HEMICAP MTP CE 1.5X3.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270699529
Hospital Revenue Code	278
Min. Negotiated Rate	$2,254.50
Max. Negotiated Rate	$3,637.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,306.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50

HEMICAP TOE JT TAPER 9.5X18MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270696338
Hospital Revenue Code	278
Min. Negotiated Rate	$362.22
Max. Negotiated Rate	$7,515.00
Rate for Payer: Aetna Commercial	$5,711.40
Rate for Payer: Aetna Medicare Advantage	$4,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,832.65
Rate for Payer: Cigna Commercial	$7,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,306.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50
Rate for Payer: UnitedHealthcare Community & State	$362.22
Rate for Payer: Wellpoint Medicaid Managed Care	$398.30

HEMICAP TOE JT TAPER 9.5X18MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270696338
Hospital Revenue Code	278
Min. Negotiated Rate	$2,254.50
Max. Negotiated Rate	$3,637.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,306.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50

HEMI DRILL BIT

Facility

$750.00

Hospital Charge Code	270681046
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

HEMI DRILL BIT

Facility

$750.00

Hospital Charge Code	270681046
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

HEMIN IV VIAL 313MG

Facility

$1,657.60

Hospital Charge Code	6010557
Hospital Revenue Code	250
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$828.80
Rate for Payer: Aetna Commercial	$629.89
Rate for Payer: Aetna Medicare Advantage	$497.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.69
Rate for Payer: Cigna Commercial	$828.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.28
Rate for Payer: Oxford Commercial	$331.52
Rate for Payer: Qualcare PPO/HMO/WC	$248.64
Rate for Payer: UnitedHealthcare Commercial	$331.52
Rate for Payer: UnitedHealthcare Community & State	$39.95
Rate for Payer: Wellpoint Medicaid Managed Care	$43.93

HEMIN IV VIAL 313MG

Facility

$1,657.60

Hospital Charge Code	6010557
Hospital Revenue Code	250
Min. Negotiated Rate	$248.64
Max. Negotiated Rate	$248.64
Rate for Payer: Qualcare PPO/HMO/WC	$248.64

HEMISPH COATED SHELL 54MM OD

Facility

$30,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703824
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

HEMISPH COATED SHELL 54MM OD

Facility

$30,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703824
Hospital Revenue Code	278
Min. Negotiated Rate	$723.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$11,400.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Community & State	$723.00
Rate for Payer: Wellpoint Medicaid Managed Care	$795.00

HEMI W/SHAPED BONE BLOCKS 10MM

Facility

$16,715.00

Service Code	HCPCS C1776
Hospital Charge Code	270673449
Hospital Revenue Code	278
Min. Negotiated Rate	$402.83
Max. Negotiated Rate	$8,357.50
Rate for Payer: Aetna Commercial	$6,351.70
Rate for Payer: Aetna Medicare Advantage	$5,014.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,262.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,262.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,343.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,262.32
Rate for Payer: Cigna Commercial	$8,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,045.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,677.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,507.25
Rate for Payer: UnitedHealthcare Community & State	$402.83
Rate for Payer: Wellpoint Medicaid Managed Care	$442.95

HEMI W/SHAPED BONE BLOCKS 10MM

Facility

$16,715.00

Service Code	HCPCS C1776
Hospital Charge Code	270673449
Hospital Revenue Code	278
Min. Negotiated Rate	$2,507.25
Max. Negotiated Rate	$4,045.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,343.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,045.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,677.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,507.25

HEMOCLIP LIGATION TA MEDIUM

Facility

$210.00

Hospital Charge Code	270695604
Hospital Revenue Code	272
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.00
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$42.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$5.57

HEMOCLIP LIGATION TA MEDIUM

Facility

$210.00

Hospital Charge Code	270695604
Hospital Revenue Code	272
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

HEMOCRIT (WAIVED TEST)WHC***

Facility

$1.50

Service Code	HCPCS 85013WF
Hospital Charge Code	9600029
Hospital Revenue Code	309
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$0.57
Rate for Payer: Aetna Medicare Advantage	$0.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.38
Rate for Payer: Cigna Commercial	$0.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.23
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

HEMOCRIT (WAIVED TEST)WHC***

Facility

$1.50

Service Code	HCPCS 85013WF
Hospital Charge Code	9600029
Hospital Revenue Code	309
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.23

HEMODIALYSIS IP

Facility

$2,800.00

Hospital Charge Code	8200024
Hospital Revenue Code	801
Min. Negotiated Rate	$67.48
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$1,064.00
Rate for Payer: Aetna Medicare Advantage	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.00
Rate for Payer: Oxford Commercial	$560.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$560.00
Rate for Payer: UnitedHealthcare Community & State	$67.48
Rate for Payer: Wellpoint Medicaid Managed Care	$74.20

HEMODIALYSIS IP

Facility

$2,800.00

Hospital Charge Code	8200024
Hospital Revenue Code	801
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

HEMODIALYSIS OP ESRD

Facility

$2,800.00

Service Code	HCPCS 90999
Hospital Charge Code	8200040
Hospital Revenue Code	821
Min. Negotiated Rate	$67.48
Max. Negotiated Rate	$4,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$714.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$753.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$714.00
Rate for Payer: Cigna Commercial	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$700.00
Rate for Payer: Oxford Commercial	$2,546.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$4,468.00
Rate for Payer: UnitedHealthcare Community & State	$67.48
Rate for Payer: Wellpoint Medicaid Managed Care	$74.20

Know your out-of-pocket cost for care.

All Charges