Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTRALIPID 20% 250ML EMULSION

Facility

$278.59

Service Code	NDC 338051902
Hospital Charge Code	60630044
Hospital Revenue Code	250
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$139.29
Rate for Payer: Aetna Commercial	$105.86
Rate for Payer: Aetna Medicare Advantage	$83.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.04
Rate for Payer: Cigna Commercial	$139.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.58
Rate for Payer: Oxford Commercial	$55.72
Rate for Payer: Qualcare PPO/HMO/WC	$41.79
Rate for Payer: UnitedHealthcare Commercial	$55.72
Rate for Payer: UnitedHealthcare Community & State	$6.71
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

INTRALIPID 20% 250ML EMULSION

Facility

$278.59

Service Code	NDC 338051902
Hospital Charge Code	60630044
Hospital Revenue Code	250
Min. Negotiated Rate	$41.79
Max. Negotiated Rate	$41.79
Rate for Payer: Qualcare PPO/HMO/WC	$41.79

INTRALIPID 20% 500ML EMULSION

Facility

$292.52

Service Code	NDC 338051903
Hospital Charge Code	60630045
Hospital Revenue Code	250
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$43.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

INTRALIPID 20% 500ML EMULSION

Facility

$292.52

Service Code	NDC 338051903
Hospital Charge Code	60630045
Hospital Revenue Code	250
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$146.26
Rate for Payer: Aetna Commercial	$111.16
Rate for Payer: Aetna Medicare Advantage	$87.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.59
Rate for Payer: Cigna Commercial	$146.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.76
Rate for Payer: Oxford Commercial	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.88
Rate for Payer: UnitedHealthcare Commercial	$58.50
Rate for Payer: UnitedHealthcare Community & State	$7.05
Rate for Payer: Wellpoint Medicaid Managed Care	$7.75

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$60,574.86

Service Code	MSDRG 116
Min. Negotiated Rate	$18,444.27
Max. Negotiated Rate	$60,574.86
Rate for Payer: Aetna Commercial	$41,879.15
Rate for Payer: Aetna Medicare Advantage	$60,574.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42,567.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42,567.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,415.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42,567.63
Rate for Payer: Cigna Commercial	$33,836.78
Rate for Payer: Cigna Medicare Advantage	$19,415.02
Rate for Payer: Clover Medicare Advantage	$18,444.27
Rate for Payer: EmblemHealth Commercial	$58,245.06
Rate for Payer: Humana Medicare Advantage	$19,997.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,415.02
Rate for Payer: Oxford Commercial	$24,318.94
Rate for Payer: UnitedHealthcare Commercial	$42,644.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,415.02
Rate for Payer: Wellcare Medicare Advantage	$19,415.02

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$37,199.82

Service Code	MSDRG 117
Min. Negotiated Rate	$11,326.87
Max. Negotiated Rate	$37,199.82
Rate for Payer: Aetna Commercial	$25,817.83
Rate for Payer: Aetna Medicare Advantage	$37,199.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,913.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,913.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,923.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,913.20
Rate for Payer: Cigna Commercial	$20,302.82
Rate for Payer: Cigna Medicare Advantage	$11,923.02
Rate for Payer: Clover Medicare Advantage	$11,326.87
Rate for Payer: EmblemHealth Commercial	$35,769.06
Rate for Payer: Humana Medicare Advantage	$12,280.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,923.02
Rate for Payer: Oxford Commercial	$14,591.91
Rate for Payer: UnitedHealthcare Commercial	$25,587.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,923.02
Rate for Payer: Wellcare Medicare Advantage	$11,923.02

INTRAOSSESOUS INFUSION SYSTEM

Facility

$1,475.00

Hospital Charge Code	270658942
Hospital Revenue Code	272
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.50
Rate for Payer: Oxford Commercial	$295.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$295.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

INTRAOSSESOUS INFUSION SYSTEM

Facility

$1,475.00

Hospital Charge Code	270658942
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

INTRAPLEU.AEROSOL SUR.TALC(BRY

Facility

$668.00

Hospital Charge Code	270335411
Hospital Revenue Code	272
Min. Negotiated Rate	$100.20
Max. Negotiated Rate	$100.20
Rate for Payer: Qualcare PPO/HMO/WC	$100.20

INTRAPLEU.AEROSOL SUR.TALC(BRY

Facility

$668.00

Hospital Charge Code	270335411
Hospital Revenue Code	272
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$334.00
Rate for Payer: Aetna Commercial	$253.84
Rate for Payer: Aetna Medicare Advantage	$200.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.34
Rate for Payer: Cigna Commercial	$334.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.40
Rate for Payer: Oxford Commercial	$133.60
Rate for Payer: Qualcare PPO/HMO/WC	$100.20
Rate for Payer: UnitedHealthcare Commercial	$133.60
Rate for Payer: UnitedHealthcare Community & State	$16.10
Rate for Payer: Wellpoint Medicaid Managed Care	$17.70

INTRAVASC US COR VESS/GFT ADD

Facility

$6,070.00

Service Code	HCPCS 92979
Hospital Charge Code	74110061
Hospital Revenue Code	480
Min. Negotiated Rate	$146.29
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,821.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$146.29
Rate for Payer: Wellpoint Medicaid Managed Care	$160.85

INTRAVASC US COR VESS/GFT ADD

Facility

$6,070.00

Service Code	HCPCS 92979
Hospital Charge Code	74110061
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

INTRAVASC US COR VESS/GFT ADD

Facility

$6,070.00

Service Code	HCPCS 92979
Hospital Charge Code	5100651
Hospital Revenue Code	480
Min. Negotiated Rate	$146.29
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,821.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$146.29
Rate for Payer: Wellpoint Medicaid Managed Care	$160.85

INTRAVASC US COR VESS/GFT ADD

Facility

$6,070.00

Service Code	HCPCS 92979
Hospital Charge Code	5100651
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

INTRAVASC US COR VESS/GFT INIT

Facility

$4,403.75

Service Code	HCPCS 92978
Hospital Charge Code	5100650
Hospital Revenue Code	481
Min. Negotiated Rate	$106.13
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$1,673.42
Rate for Payer: Aetna Medicare Advantage	$1,321.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.96
Rate for Payer: Cigna Commercial	$2,201.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,321.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.56
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$106.13
Rate for Payer: Wellpoint Medicaid Managed Care	$116.70

INTRAVASC US COR VESS/GFT INIT

Facility

$4,403.75

Service Code	HCPCS 92978
Hospital Charge Code	74110060
Hospital Revenue Code	481
Min. Negotiated Rate	$106.13
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$1,673.42
Rate for Payer: Aetna Medicare Advantage	$1,321.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.96
Rate for Payer: Cigna Commercial	$2,201.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,321.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.56
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$106.13
Rate for Payer: Wellpoint Medicaid Managed Care	$116.70

INTRAVASC US COR VESS/GFT INIT

Facility

$4,403.75

Service Code	HCPCS 92978
Hospital Charge Code	74110060
Hospital Revenue Code	481
Min. Negotiated Rate	$660.56
Max. Negotiated Rate	$660.56
Rate for Payer: Qualcare PPO/HMO/WC	$660.56

INTRAVASC US COR VESS/GFT INIT

Facility

$4,403.75

Service Code	HCPCS 92978
Hospital Charge Code	5100650
Hospital Revenue Code	481
Min. Negotiated Rate	$660.56
Max. Negotiated Rate	$660.56
Rate for Payer: Qualcare PPO/HMO/WC	$660.56

INTRAVENOUS

Facility

$21.15

Hospital Charge Code	7000011
Hospital Revenue Code	258
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

INTRAVENOUS

Facility

$21.15

Hospital Charge Code	7000011
Hospital Revenue Code	258
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

INTRAVU NEEDLE SCOPE SUPERIOR

Facility

$3,000.00

Hospital Charge Code	270691835
Hospital Revenue Code	272
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.00
Rate for Payer: Oxford Commercial	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Commercial	$600.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

INTRAVU NEEDLE SCOPE SUPERIOR

Facility

$3,000.00

Hospital Charge Code	270691835
Hospital Revenue Code	272
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

INTRDCR CHCKFLO GUIDSHEATH16FR

Facility

$595.15

Service Code	HCPCS C1893
Hospital Charge Code	270622441N
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.57
Rate for Payer: Aetna Commercial	$226.16
Rate for Payer: Aetna Medicare Advantage	$178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.76
Rate for Payer: Cigna Commercial	$297.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.93
Rate for Payer: Qualcare PPO/HMO/WC	$89.27
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

INTRDCR CHCKFLO GUIDSHEATH16FR

Facility

$595.15

Service Code	HCPCS C1893
Hospital Charge Code	270622441C
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.57
Rate for Payer: Aetna Commercial	$226.16
Rate for Payer: Aetna Medicare Advantage	$178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.76
Rate for Payer: Cigna Commercial	$297.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.93
Rate for Payer: Qualcare PPO/HMO/WC	$89.27
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

INTRDCR CHCKFLO GUIDSHEATH16FR

Facility

$595.15

Service Code	HCPCS C1893
Hospital Charge Code	270622441N
Hospital Revenue Code	278
Min. Negotiated Rate	$89.27
Max. Negotiated Rate	$144.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.93
Rate for Payer: Qualcare PPO/HMO/WC	$89.27

Know your out-of-pocket cost for care.

All Charges