Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INFUSE BONE GFT KIT MEDIUM

Facility

$22,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270630534
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$5,324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00

INFUSE BONE GFT KIT MEDIUM

Facility

$22,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270630534
Hospital Revenue Code	278
Min. Negotiated Rate	$530.20
Max. Negotiated Rate	$11,000.00
Rate for Payer: Aetna Commercial	$8,360.00
Rate for Payer: Aetna Medicare Advantage	$6,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,610.00
Rate for Payer: Cigna Commercial	$11,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$530.20
Rate for Payer: Wellpoint Medicaid Managed Care	$583.00

INFUSE BONE GRAFT

Facility

$9,525.00

Service Code	HCPCS C1889
Hospital Charge Code	270652417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.75
Max. Negotiated Rate	$2,305.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,305.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,095.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,428.75

INFUSE BONE GRAFT

Facility

$9,525.00

Service Code	HCPCS C1889
Hospital Charge Code	270652417
Hospital Revenue Code	278
Min. Negotiated Rate	$229.55
Max. Negotiated Rate	$4,762.50
Rate for Payer: Aetna Commercial	$3,619.50
Rate for Payer: Aetna Medicare Advantage	$2,857.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,428.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,428.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,428.88
Rate for Payer: Cigna Commercial	$4,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,305.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,095.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,428.75
Rate for Payer: UnitedHealthcare Community & State	$229.55
Rate for Payer: Wellpoint Medicaid Managed Care	$252.41

INFUSE BONE GRAFT KIT LARGE

Facility

$30,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270670495
Hospital Revenue Code	278
Min. Negotiated Rate	$732.64
Max. Negotiated Rate	$15,200.00
Rate for Payer: Aetna Commercial	$11,552.00
Rate for Payer: Aetna Medicare Advantage	$9,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,752.00
Rate for Payer: Cigna Commercial	$15,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,356.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,560.00
Rate for Payer: UnitedHealthcare Community & State	$732.64
Rate for Payer: Wellpoint Medicaid Managed Care	$805.60

INFUSE BONE GRAFT KIT LARGE

Facility

$30,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270670495
Hospital Revenue Code	278
Min. Negotiated Rate	$4,560.00
Max. Negotiated Rate	$7,356.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,356.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,560.00

INFUSION FOR THROMBOLYSIS

Facility

$382.20

Service Code	HCPCS 37201
Hospital Charge Code	5100541
Hospital Revenue Code	361
Min. Negotiated Rate	$9.21
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$145.24
Rate for Payer: Aetna Medicare Advantage	$114.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.46
Rate for Payer: Cigna Commercial	$191.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.66
Rate for Payer: Qualcare PPO/HMO/WC	$57.33
Rate for Payer: UnitedHealthcare Community & State	$9.21
Rate for Payer: Wellpoint Medicaid Managed Care	$10.13

INFUSION FOR THROMBOLYSIS

Facility

$382.20

Service Code	HCPCS 37201
Hospital Charge Code	5100541
Hospital Revenue Code	361
Min. Negotiated Rate	$57.33
Max. Negotiated Rate	$57.33
Rate for Payer: Qualcare PPO/HMO/WC	$57.33

INFUSION FOR THROMBOLYSIS S&I

Facility

$2,399.00

Service Code	HCPCS 75896
Hospital Charge Code	5100540
Hospital Revenue Code	320
Min. Negotiated Rate	$57.82
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$911.62
Rate for Payer: Aetna Medicare Advantage	$719.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$611.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$611.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$611.75
Rate for Payer: Cigna Commercial	$1,199.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$359.85
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$57.82
Rate for Payer: Wellpoint Medicaid Managed Care	$63.57

INFUSION FOR THROMBOLYSIS S&I

Facility

$2,399.00

Service Code	HCPCS 75896
Hospital Charge Code	5100540
Hospital Revenue Code	320
Min. Negotiated Rate	$359.85
Max. Negotiated Rate	$359.85
Rate for Payer: Qualcare PPO/HMO/WC	$359.85

INFUSION PORT 8FR POL SIL SGL

Facility

$10,636.80

Service Code	HCPCS C1788
Hospital Charge Code	270701578
Hospital Revenue Code	278
Min. Negotiated Rate	$256.35
Max. Negotiated Rate	$5,318.40
Rate for Payer: Aetna Commercial	$4,041.98
Rate for Payer: Aetna Medicare Advantage	$3,191.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,712.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,712.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,712.38
Rate for Payer: Cigna Commercial	$5,318.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.52
Rate for Payer: UnitedHealthcare Community & State	$256.35
Rate for Payer: Wellpoint Medicaid Managed Care	$281.88

INFUSION PORT 8FR POL SIL SGL

Facility

$10,636.80

Service Code	HCPCS C1788
Hospital Charge Code	270701578
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.52
Max. Negotiated Rate	$2,574.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.52

INFUSION SET EZ HUBER 20g 3/4

Facility

$31.50

Hospital Charge Code	270642543
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Commercial	$11.97
Rate for Payer: Aetna Medicare Advantage	$9.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.03
Rate for Payer: Cigna Commercial	$15.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.45
Rate for Payer: Oxford Commercial	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.72
Rate for Payer: UnitedHealthcare Commercial	$6.30
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

INFUSION SET EZ HUBER 20g 3/4

Facility

$31.50

Hospital Charge Code	270642543
Hospital Revenue Code	272
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$4.72
Rate for Payer: Qualcare PPO/HMO/WC	$4.72

INFUSION SET PRIMARY SAPPHIRE

Facility

$54.80

Hospital Charge Code	270675461
Hospital Revenue Code	272
Min. Negotiated Rate	$8.22
Max. Negotiated Rate	$8.22
Rate for Payer: Qualcare PPO/HMO/WC	$8.22

INFUSION SET PRIMARY SAPPHIRE

Facility

$54.80

Hospital Charge Code	270675461
Hospital Revenue Code	272
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.40
Rate for Payer: Aetna Commercial	$20.82
Rate for Payer: Aetna Medicare Advantage	$16.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.97
Rate for Payer: Cigna Commercial	$27.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.44
Rate for Payer: Oxford Commercial	$10.96
Rate for Payer: Qualcare PPO/HMO/WC	$8.22
Rate for Payer: UnitedHealthcare Commercial	$10.96
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

INFUSION THERAPY 0-1 HR***

Facility

$135.00

Hospital Charge Code	3401011
Hospital Revenue Code	289
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

INFUSION THERAPY 0-1 HR***

Facility

$135.00

Hospital Charge Code	3401011
Hospital Revenue Code	289
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

INFUSION THERAPY 1-2 HRS****

Facility

$179.00

Hospital Charge Code	3401012
Hospital Revenue Code	289
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$68.02
Rate for Payer: Aetna Medicare Advantage	$53.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.65
Rate for Payer: Cigna Commercial	$89.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.70
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.85
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: Wellpoint Medicaid Managed Care	$4.74

INFUSION THERAPY 1-2 HRS****

Facility

$179.00

Hospital Charge Code	3401012
Hospital Revenue Code	289
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

INFUSION THERAPY 2-4 HRS***

Facility

$211.00

Hospital Charge Code	3401014
Hospital Revenue Code	289
Min. Negotiated Rate	$31.65
Max. Negotiated Rate	$31.65
Rate for Payer: Qualcare PPO/HMO/WC	$31.65

INFUSION THERAPY 2-4 HRS***

Facility

$211.00

Hospital Charge Code	3401014
Hospital Revenue Code	289
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$80.18
Rate for Payer: Aetna Medicare Advantage	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.80
Rate for Payer: Cigna Commercial	$105.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.30
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.65
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$5.09
Rate for Payer: Wellpoint Medicaid Managed Care	$5.59

INFUSION THERAPY 4-6 HRS****

Facility

$243.00

Hospital Charge Code	3401015
Hospital Revenue Code	289
Min. Negotiated Rate	$36.45
Max. Negotiated Rate	$36.45
Rate for Payer: Qualcare PPO/HMO/WC	$36.45

INFUSION THERAPY 4-6 HRS****

Facility

$243.00

Hospital Charge Code	3401015
Hospital Revenue Code	289
Min. Negotiated Rate	$5.86
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$92.34
Rate for Payer: Aetna Medicare Advantage	$72.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.97
Rate for Payer: Cigna Commercial	$121.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.90
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.45
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$5.86
Rate for Payer: Wellpoint Medicaid Managed Care	$6.44

INFUSION THERAPY 6-8 HRS****

Facility

$287.00

Hospital Charge Code	3401016
Hospital Revenue Code	289
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$43.05
Rate for Payer: Qualcare PPO/HMO/WC	$43.05

Know your out-of-pocket cost for care.

All Charges