Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	94061488
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	94270268
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	94270268
Hospital Revenue Code	320
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$225.44
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$15.72

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	94061488
Hospital Revenue Code	320
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$225.44
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$15.72

HIP W/WO PELVIS MIN 4V LT

Facility

$5,100.00

Service Code	HCPCS 73503LT
Hospital Charge Code	2011547
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	75190641
Hospital Revenue Code	320
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$225.44
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$15.72

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	75190641
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V LT

Facility

$5,100.00

Service Code	HCPCS 73503LT
Hospital Charge Code	2011547
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

HIP W/WO PELVIS MIN 4V RT

Facility

$5,100.00

Service Code	HCPCS 73503RT
Hospital Charge Code	2011549
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

HIP W/WO PELVIS MIN 4V RT

Facility

$5,100.00

Service Code	HCPCS 73503RT
Hospital Charge Code	2011549
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	94061490
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	94061490
Hospital Revenue Code	320
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$225.44
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$15.72

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	75190643
Hospital Revenue Code	320
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$225.44
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$15.72

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	75190643
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	94270270
Hospital Revenue Code	320
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$225.44
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.98
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$15.72

HIP W/WO PELVIS MIN 4V RT

Facility

$593.26

Service Code	HCPCS 73503RT
Hospital Charge Code	94270270
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HISTAMINE

Facility

$390.00

Service Code	HCPCS 83088
Hospital Charge Code	39900458
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$80.32
Rate for Payer: Aetna Medicare Advantage	$95.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.59
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$29.53
Rate for Payer: Clover Medicare Advantage	$28.05
Rate for Payer: EmblemHealth Commercial	$88.59
Rate for Payer: Humana Medicare Advantage	$30.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.53
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	$23.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.53
Rate for Payer: Wellcare Medicare Advantage	$29.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

HISTAMINE

Facility

$390.00

Service Code	HCPCS 83088
Hospital Charge Code	39900458
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HISTAMINE

Facility

$534.00

Service Code	HCPCS 83088
Hospital Charge Code	38473078
Hospital Revenue Code	301
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$267.00
Rate for Payer: Aetna Commercial	$80.32
Rate for Payer: Aetna Medicare Advantage	$95.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.59
Rate for Payer: Cigna Commercial	$267.00
Rate for Payer: Cigna Medicare Advantage	$29.53
Rate for Payer: Clover Medicare Advantage	$28.05
Rate for Payer: EmblemHealth Commercial	$88.59
Rate for Payer: Humana Medicare Advantage	$30.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$23.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.53
Rate for Payer: Wellcare Medicare Advantage	$29.53
Rate for Payer: Wellpoint Medicaid Managed Care	$14.15

HISTAMINE

Facility

$534.00

Service Code	HCPCS 83088
Hospital Charge Code	38473078
Hospital Revenue Code	301
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$80.10
Rate for Payer: Qualcare PPO/HMO/WC	$80.10

HISTAMINE (BLOOD)

Facility

$281.65

Service Code	HCPCS 83088
Hospital Charge Code	3007499
Hospital Revenue Code	301
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

HISTAMINE (BLOOD)

Facility

$281.65

Service Code	HCPCS 83088
Hospital Charge Code	3007499
Hospital Revenue Code	301
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$80.32
Rate for Payer: Aetna Medicare Advantage	$95.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.59
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: Cigna Medicare Advantage	$29.53
Rate for Payer: Clover Medicare Advantage	$28.05
Rate for Payer: EmblemHealth Commercial	$88.59
Rate for Payer: Humana Medicare Advantage	$30.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$23.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.53
Rate for Payer: Wellcare Medicare Advantage	$29.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

HISTAMINE PHOS INJ 2.75MG/1ML

Facility

$21.15

Hospital Charge Code	6002778
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

HISTAMINE PHOS INJ 2.75MG/1ML

Facility

$21.15

Hospital Charge Code	6002778
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

HISTAMINE RELEASE

Facility

$390.00

Service Code	HCPCS 86343
Hospital Charge Code	39900219
Hospital Revenue Code	302
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$33.89
Rate for Payer: Aetna Medicare Advantage	$40.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.46
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	$44.98
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.46
Rate for Payer: Clover Medicare Advantage	$11.84
Rate for Payer: EmblemHealth Commercial	$37.38
Rate for Payer: Humana Medicare Advantage	$12.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.46
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	$9.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.46
Rate for Payer: Wellcare Medicare Advantage	$12.46
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges