Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTRDCR CHCKFLO GUIDSHEATH16FR

Facility

$595.15

Service Code	HCPCS C1893
Hospital Charge Code	270622441C
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

INTRDCR TRACHAL TUBE ST TTIC10

Facility

$42.25

Hospital Charge Code	270634129
Hospital Revenue Code	272
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$6.34
Rate for Payer: Qualcare PPO/HMO/WC	$6.34

INTRDCR TRACHAL TUBE ST TTIC10

Facility

$42.25

Hospital Charge Code	270634129
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.12
Rate for Payer: Aetna Commercial	$16.05
Rate for Payer: Aetna Medicare Advantage	$12.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.77
Rate for Payer: Cigna Commercial	$21.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Oxford Commercial	$8.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.34
Rate for Payer: UnitedHealthcare Commercial	$8.45
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

INTRDCR TRACHAL TUBE ST TTIS10

Facility

$42.25

Hospital Charge Code	270634130
Hospital Revenue Code	272
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$6.34
Rate for Payer: Qualcare PPO/HMO/WC	$6.34

INTRDCR TRACHAL TUBE ST TTIS10

Facility

$42.25

Hospital Charge Code	270634130
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.12
Rate for Payer: Aetna Commercial	$16.05
Rate for Payer: Aetna Medicare Advantage	$12.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.77
Rate for Payer: Cigna Commercial	$21.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Oxford Commercial	$8.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.34
Rate for Payer: UnitedHealthcare Commercial	$8.45
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

INT REP FACE 2.5-5.0

Facility

$687.50

Service Code	HCPCS 12052
Hospital Charge Code	1600000730
Hospital Revenue Code	360
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
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	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.25
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.12
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$16.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95

INT REP FACE 2.5-5.0

Facility

$687.50

Service Code	HCPCS 12052
Hospital Charge Code	1600000730
Hospital Revenue Code	360
Min. Negotiated Rate	$103.12
Max. Negotiated Rate	$103.12
Rate for Payer: Qualcare PPO/HMO/WC	$103.12

INTREPID I/A TIP 0.3MM BENT

Facility

$1,500.00

Hospital Charge Code	270662665
Hospital Revenue Code	270
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

INTREPID I/A TIP 0.3MM BENT

Facility

$1,500.00

Hospital Charge Code	270662665
Hospital Revenue Code	270
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

INTRFRN ALFA-2B 10MILL IU/VIAL

Facility

$1,620.06

Service Code	HCPCS J9214
Hospital Charge Code	60627390
Hospital Revenue Code	636
Min. Negotiated Rate	$243.01
Max. Negotiated Rate	$392.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.05
Rate for Payer: Qualcare PPO/HMO/WC	$243.01

INTRFRN ALFA-2B 10MILL IU/VIAL

Facility

$1,620.06

Service Code	HCPCS J9214
Hospital Charge Code	60627390
Hospital Revenue Code	636
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$810.03
Rate for Payer: Aetna Commercial	$615.62
Rate for Payer: Aetna Medicare Advantage	$486.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.12
Rate for Payer: Cigna Commercial	$810.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.05
Rate for Payer: Qualcare PPO/HMO/WC	$243.01
Rate for Payer: UnitedHealthcare Community & State	$39.04
Rate for Payer: Wellpoint Medicaid Managed Care	$42.93

INTRINSIC FACTOR ANTIBODY

Facility

$133.65

Service Code	HCPCS 86340
Hospital Charge Code	3007556
Hospital Revenue Code	302
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$66.83
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.54

INTRINSIC FACTOR ANTIBODY

Facility

$145.00

Service Code	HCPCS 86340
Hospital Charge Code	38476229
Hospital Revenue Code	302
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

INTRINSIC FACTOR ANTIBODY

Facility

$145.00

Service Code	HCPCS 86340
Hospital Charge Code	38476229
Hospital Revenue Code	302
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

INTRINSIC FACTOR ANTIBODY

Facility

$133.65

Service Code	HCPCS 86340
Hospital Charge Code	3007556
Hospital Revenue Code	302
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

INTRINSIC FACTOR BLOCKING

Facility

$390.00

Service Code	HCPCS 86340
Hospital Charge Code	39900218
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INTRINSIC FACTOR BLOCKING

Facility

$390.00

Service Code	HCPCS 86340
Hospital Charge Code	39900218
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
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	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

INTRO CATH DIALYSIS CIRC BALLO

Facility

$20,340.00

Service Code	HCPCS 36902
Hospital Charge Code	16000949
Hospital Revenue Code	360
Min. Negotiated Rate	$490.19
Max. Negotiated Rate	$24,407.82
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,407.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,407.82
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,102.00
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$490.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$539.01

INTRO CATH DIALYSIS CIRC BALLO

Facility

$20,340.00

Service Code	HCPCS 36902
Hospital Charge Code	16000949
Hospital Revenue Code	360
Min. Negotiated Rate	$3,051.00
Max. Negotiated Rate	$3,051.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00

INTRO CATH DIALYSIS CIRCUIT

Facility

$3,419.20

Service Code	HCPCS 36901
Hospital Charge Code	2709022
Hospital Revenue Code	361
Min. Negotiated Rate	$512.88
Max. Negotiated Rate	$512.88
Rate for Payer: Qualcare PPO/HMO/WC	$512.88

INTRO CATH DIALYSIS CIRCUIT

Facility

$3,419.20

Service Code	HCPCS 36901
Hospital Charge Code	7412056
Hospital Revenue Code	361
Min. Negotiated Rate	$512.88
Max. Negotiated Rate	$512.88
Rate for Payer: Qualcare PPO/HMO/WC	$512.88

INTRO CATH DIALYSIS CIRCUIT

Facility

$3,419.20

Service Code	HCPCS 36901
Hospital Charge Code	366836901
Hospital Revenue Code	361
Min. Negotiated Rate	$512.88
Max. Negotiated Rate	$512.88
Rate for Payer: Qualcare PPO/HMO/WC	$512.88

INTRO CATH DIALYSIS CIRCUIT

Facility

$3,419.20

Service Code	HCPCS 36901
Hospital Charge Code	366836901
Hospital Revenue Code	361
Min. Negotiated Rate	$82.40
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,025.76
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$512.88
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$82.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$90.61

INTRO CATH DIALYSIS CIRCUIT

Facility

$6,404.20

Service Code	HCPCS 36901
Hospital Charge Code	2692127
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

INTRO CATH DIALYSIS CIRCUIT

Facility

$6,404.20

Service Code	HCPCS 36901
Hospital Charge Code	321036901
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

Know your out-of-pocket cost for care.

All Charges