Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KEVZARA PFS 200MG/1.14ML

Facility

$13,989.60

Service Code	HCPCS C9399
Hospital Charge Code	606390315
Hospital Revenue Code	636
Min. Negotiated Rate	$337.15
Max. Negotiated Rate	$6,994.80
Rate for Payer: Aetna Commercial	$5,316.05
Rate for Payer: Aetna Medicare Advantage	$4,196.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,567.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,567.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,567.35
Rate for Payer: Cigna Commercial	$6,994.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,385.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,098.44
Rate for Payer: UnitedHealthcare Community & State	$337.15
Rate for Payer: Wellpoint Medicaid Managed Care	$370.72

KEVZARA PFS 200MG/1.14ML

Facility

$13,989.60

Service Code	HCPCS C9399
Hospital Charge Code	606390315
Hospital Revenue Code	636
Min. Negotiated Rate	$2,098.44
Max. Negotiated Rate	$3,385.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,385.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,098.44

KEY DILATOR TD-8/38

Facility

$336.00

Hospital Charge Code	270331220
Hospital Revenue Code	272
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

KEY DILATOR TD-8/38

Facility

$336.00

Hospital Charge Code	270331220
Hospital Revenue Code	272
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$127.68
Rate for Payer: Aetna Medicare Advantage	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.68
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.80
Rate for Payer: Oxford Commercial	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$67.20
Rate for Payer: UnitedHealthcare Community & State	$8.10
Rate for Payer: Wellpoint Medicaid Managed Care	$8.90

KEYSTONE MULTI-STATE ECMO PACK

Facility

$1,127.95

Hospital Charge Code	2703110B
Hospital Revenue Code	272
Min. Negotiated Rate	$169.19
Max. Negotiated Rate	$169.19
Rate for Payer: Qualcare PPO/HMO/WC	$169.19

KEYSTONE MULTI-STATE ECMO PACK

Facility

$1,127.95

Hospital Charge Code	2703110B
Hospital Revenue Code	272
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$563.98
Rate for Payer: Aetna Commercial	$428.62
Rate for Payer: Aetna Medicare Advantage	$338.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.63
Rate for Payer: Cigna Commercial	$563.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.38
Rate for Payer: Oxford Commercial	$225.59
Rate for Payer: Qualcare PPO/HMO/WC	$169.19
Rate for Payer: UnitedHealthcare Commercial	$225.59
Rate for Payer: UnitedHealthcare Community & State	$27.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.89

KI-67 IHC

Facility

$1,082.30

Service Code	HCPCS 88360
Hospital Charge Code	401688360
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$97.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

KI-67 IHC

Facility

$1,082.30

Service Code	HCPCS 88360
Hospital Charge Code	401688360
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

$61,282.70

Service Code	MSDRG 657
Min. Negotiated Rate	$18,659.80
Max. Negotiated Rate	$61,282.70
Rate for Payer: Aetna Commercial	$42,365.51
Rate for Payer: Aetna Medicare Advantage	$61,282.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42,800.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42,800.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,641.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42,800.24
Rate for Payer: Cigna Commercial	$34,246.62
Rate for Payer: Cigna Medicare Advantage	$19,641.89
Rate for Payer: Clover Medicare Advantage	$18,659.80
Rate for Payer: EmblemHealth Commercial	$58,925.67
Rate for Payer: Humana Medicare Advantage	$20,231.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,641.89
Rate for Payer: Oxford Commercial	$24,613.50
Rate for Payer: UnitedHealthcare Commercial	$43,160.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,641.89
Rate for Payer: Wellcare Medicare Advantage	$19,641.89

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

$105,039.79

Service Code	MSDRG 656
Min. Negotiated Rate	$31,983.27
Max. Negotiated Rate	$105,039.79
Rate for Payer: Aetna Commercial	$72,431.60
Rate for Payer: Aetna Medicare Advantage	$105,039.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73,039.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73,039.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33,666.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73,039.54
Rate for Payer: Cigna Commercial	$59,581.63
Rate for Payer: Cigna Medicare Advantage	$33,666.60
Rate for Payer: Clover Medicare Advantage	$31,983.27
Rate for Payer: EmblemHealth Commercial	$100,999.80
Rate for Payer: Humana Medicare Advantage	$34,676.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33,666.60
Rate for Payer: Oxford Commercial	$42,822.11
Rate for Payer: UnitedHealthcare Commercial	$75,089.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$33,666.60
Rate for Payer: Wellcare Medicare Advantage	$33,666.60

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

$52,290.83

Service Code	MSDRG 658
Min. Negotiated Rate	$15,921.89
Max. Negotiated Rate	$52,290.83
Rate for Payer: Aetna Commercial	$36,187.07
Rate for Payer: Aetna Medicare Advantage	$52,290.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34,426.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34,426.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,759.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34,426.28
Rate for Payer: Cigna Commercial	$29,040.39
Rate for Payer: Cigna Medicare Advantage	$16,759.88
Rate for Payer: Clover Medicare Advantage	$15,921.89
Rate for Payer: EmblemHealth Commercial	$50,279.64
Rate for Payer: Humana Medicare Advantage	$17,262.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,759.88
Rate for Payer: Oxford Commercial	$20,871.71
Rate for Payer: UnitedHealthcare Commercial	$36,599.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,759.88
Rate for Payer: Wellcare Medicare Advantage	$16,759.88

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility

$44,853.59

Service Code	MSDRG 660
Min. Negotiated Rate	$13,657.34
Max. Negotiated Rate	$44,853.59
Rate for Payer: Aetna Commercial	$31,076.84
Rate for Payer: Aetna Medicare Advantage	$44,853.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,402.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,402.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,376.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,402.35
Rate for Payer: Cigna Commercial	$24,734.29
Rate for Payer: Cigna Medicare Advantage	$14,376.15
Rate for Payer: Clover Medicare Advantage	$13,657.34
Rate for Payer: EmblemHealth Commercial	$43,128.45
Rate for Payer: Humana Medicare Advantage	$14,807.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,376.15
Rate for Payer: Oxford Commercial	$17,776.87
Rate for Payer: UnitedHealthcare Commercial	$31,172.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,376.15
Rate for Payer: Wellcare Medicare Advantage	$14,376.15

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC

Facility

$84,260.16

Service Code	MSDRG 659
Min. Negotiated Rate	$25,656.14
Max. Negotiated Rate	$84,260.16
Rate for Payer: Aetna Commercial	$58,153.66
Rate for Payer: Aetna Medicare Advantage	$84,260.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60,245.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60,245.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,006.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60,245.99
Rate for Payer: Cigna Commercial	$47,550.40
Rate for Payer: Cigna Medicare Advantage	$27,006.46
Rate for Payer: Clover Medicare Advantage	$25,656.14
Rate for Payer: EmblemHealth Commercial	$81,019.38
Rate for Payer: Humana Medicare Advantage	$27,816.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,006.46
Rate for Payer: Oxford Commercial	$34,175.11
Rate for Payer: UnitedHealthcare Commercial	$59,927.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,006.46
Rate for Payer: Wellcare Medicare Advantage	$27,006.46

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC

Facility

$35,599.89

Service Code	MSDRG 661
Min. Negotiated Rate	$10,839.71
Max. Negotiated Rate	$35,599.89
Rate for Payer: Aetna Commercial	$24,718.50
Rate for Payer: Aetna Medicare Advantage	$35,599.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,424.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,424.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,410.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,424.05
Rate for Payer: Cigna Commercial	$19,376.48
Rate for Payer: Cigna Medicare Advantage	$11,410.22
Rate for Payer: Clover Medicare Advantage	$10,839.71
Rate for Payer: EmblemHealth Commercial	$34,230.66
Rate for Payer: Humana Medicare Advantage	$11,752.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,410.22
Rate for Payer: Oxford Commercial	$13,926.13
Rate for Payer: UnitedHealthcare Commercial	$24,419.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,410.22
Rate for Payer: Wellcare Medicare Advantage	$11,410.22

KIDNEY AND URINARY TRACT INFECTIONS

Facility

$9,982.58

Service Code	APR-DRG 4633
Min. Negotiated Rate	$9,786.84
Max. Negotiated Rate	$9,982.58
Rate for Payer: UnitedHealthcare Community & State	$9,786.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,982.58
Rate for Payer: Wellpoint Medicaid Managed Care	$9,786.84

KIDNEY AND URINARY TRACT INFECTIONS

Facility

$7,398.52

Service Code	APR-DRG 4632
Min. Negotiated Rate	$7,253.45
Max. Negotiated Rate	$7,398.52
Rate for Payer: UnitedHealthcare Community & State	$7,253.45
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,398.52
Rate for Payer: Wellpoint Medicaid Managed Care	$7,253.45

KIDNEY AND URINARY TRACT INFECTIONS

Facility

$5,939.23

Service Code	APR-DRG 4631
Min. Negotiated Rate	$5,822.77
Max. Negotiated Rate	$5,939.23
Rate for Payer: UnitedHealthcare Community & State	$5,822.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,939.23
Rate for Payer: Wellpoint Medicaid Managed Care	$5,822.77

KIDNEY AND URINARY TRACT INFECTIONS

Facility

$16,532.10

Service Code	APR-DRG 4634
Min. Negotiated Rate	$16,207.94
Max. Negotiated Rate	$16,532.10
Rate for Payer: UnitedHealthcare Community & State	$16,207.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,532.10
Rate for Payer: Wellpoint Medicaid Managed Care	$16,207.94

KIDNEY AND URINARY TRACT INFECTIONS WITH MCC

Facility

$39,636.89

Service Code	MSDRG 689
Min. Negotiated Rate	$12,068.92
Max. Negotiated Rate	$39,636.89
Rate for Payer: Aetna Commercial	$27,492.39
Rate for Payer: Aetna Medicare Advantage	$39,636.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,215.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,215.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,704.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,215.37
Rate for Payer: Cigna Commercial	$21,713.85
Rate for Payer: Cigna Medicare Advantage	$12,704.13
Rate for Payer: Clover Medicare Advantage	$12,068.92
Rate for Payer: EmblemHealth Commercial	$38,112.39
Rate for Payer: Humana Medicare Advantage	$13,085.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,704.13
Rate for Payer: Oxford Commercial	$15,606.03
Rate for Payer: UnitedHealthcare Commercial	$27,365.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,704.13
Rate for Payer: Wellcare Medicare Advantage	$12,704.13

KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC

Facility

$28,298.46

Service Code	MSDRG 690
Min. Negotiated Rate	$8,616.52
Max. Negotiated Rate	$28,298.46
Rate for Payer: Aetna Commercial	$19,701.59
Rate for Payer: Aetna Medicare Advantage	$28,298.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,841.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,841.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,070.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,841.41
Rate for Payer: Cigna Commercial	$15,148.98
Rate for Payer: Cigna Medicare Advantage	$9,070.02
Rate for Payer: Clover Medicare Advantage	$8,616.52
Rate for Payer: EmblemHealth Commercial	$27,210.06
Rate for Payer: Humana Medicare Advantage	$9,342.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,070.02
Rate for Payer: Oxford Commercial	$10,887.77
Rate for Payer: UnitedHealthcare Commercial	$19,092.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,070.02
Rate for Payer: Wellcare Medicare Advantage	$9,070.02

KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$20,636.74

Service Code	APR-DRG 4614
Min. Negotiated Rate	$20,232.10
Max. Negotiated Rate	$20,636.74
Rate for Payer: UnitedHealthcare Community & State	$20,232.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,636.74
Rate for Payer: Wellpoint Medicaid Managed Care	$20,232.10

KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$13,663.35

Service Code	APR-DRG 4613
Min. Negotiated Rate	$13,395.44
Max. Negotiated Rate	$13,663.35
Rate for Payer: UnitedHealthcare Community & State	$13,395.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,663.35
Rate for Payer: Wellpoint Medicaid Managed Care	$13,395.44

KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$7,254.25

Service Code	APR-DRG 4611
Min. Negotiated Rate	$7,112.01
Max. Negotiated Rate	$7,254.25
Rate for Payer: UnitedHealthcare Community & State	$7,112.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,254.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7,112.01

KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$9,198.70

Service Code	APR-DRG 4612
Min. Negotiated Rate	$9,018.33
Max. Negotiated Rate	$9,198.70
Rate for Payer: UnitedHealthcare Community & State	$9,018.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,198.70
Rate for Payer: Wellpoint Medicaid Managed Care	$9,018.33

KIDNEY AND URINARY TRACT NEOPLASMS WITH CC

Facility

$36,000.74

Service Code	MSDRG 687
Min. Negotiated Rate	$10,961.76
Max. Negotiated Rate	$36,000.74
Rate for Payer: Aetna Commercial	$24,993.94
Rate for Payer: Aetna Medicare Advantage	$36,000.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,424.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,424.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,538.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,424.05
Rate for Payer: Cigna Commercial	$19,608.53
Rate for Payer: Cigna Medicare Advantage	$11,538.70
Rate for Payer: Clover Medicare Advantage	$10,961.76
Rate for Payer: EmblemHealth Commercial	$34,616.10
Rate for Payer: Humana Medicare Advantage	$11,884.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,538.70
Rate for Payer: Oxford Commercial	$14,092.91
Rate for Payer: UnitedHealthcare Commercial	$24,712.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,538.70
Rate for Payer: Wellcare Medicare Advantage	$11,538.70

Know your out-of-pocket cost for care.

All Charges