Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ARBOVIRUS AB PNL,IFA,CSF VII

Facility

$390.00

Service Code	HCPCS 8665491
Hospital Charge Code	39990094H
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ARBOVIRUS AB PNL,IFA,CSF VII

Facility

$390.00

Service Code	HCPCS 8665491
Hospital Charge Code	39990094H
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ARBOVIRUS AB PNL,IFA,CSF VII

Facility

$390.00

Service Code	HCPCS 8665491
Hospital Charge Code	39990094G
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ARBOVIRUS AB PNL,IFA,CSF VII

Facility

$390.00

Service Code	HCPCS 8665491
Hospital Charge Code	39990094G
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ARBOVIRUS ENCEPHALITIS ABS IGG

Facility

$67.25

Service Code	HCPCS 86651
Hospital Charge Code	3001749
Hospital Revenue Code	302
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

ARBOVIRUS ENCEPHALITIS ABS IGG

Facility

$67.25

Service Code	HCPCS 86651
Hospital Charge Code	3001749
Hospital Revenue Code	302
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.61
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

ARCH SUPPORT

Facility

$1,105.00

Hospital Charge Code	270629690
Hospital Revenue Code	270
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$165.75
Rate for Payer: Qualcare PPO/HMO/WC	$165.75

ARCH SUPPORT

Facility

$1,105.00

Hospital Charge Code	270629690
Hospital Revenue Code	270
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$552.50
Rate for Payer: Aetna Commercial	$419.90
Rate for Payer: Aetna Medicare Advantage	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.77
Rate for Payer: Cigna Commercial	$552.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.50
Rate for Payer: Oxford Commercial	$221.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.75
Rate for Payer: UnitedHealthcare Commercial	$221.00
Rate for Payer: UnitedHealthcare Community & State	$26.63
Rate for Payer: Wellpoint Medicaid Managed Care	$29.28

ARCOM XL 28 X 38MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688599
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

ARCOM XL 28 X 38MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688599
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ARCOS 16X150MM SPL TPR DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270686540
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$4,515.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,105.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

ARCOS 16X150MM SPL TPR DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270686540
Hospital Revenue Code	278
Min. Negotiated Rate	$449.71
Max. Negotiated Rate	$9,330.00
Rate for Payer: Aetna Commercial	$7,090.80
Rate for Payer: Aetna Medicare Advantage	$5,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,758.30
Rate for Payer: Cigna Commercial	$9,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,105.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00
Rate for Payer: UnitedHealthcare Community & State	$449.71
Rate for Payer: Wellpoint Medicaid Managed Care	$494.49

ARCOS 17X200MM CYL DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270688683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$4,515.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,105.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

ARCOS 17X200MM CYL DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270688683
Hospital Revenue Code	278
Min. Negotiated Rate	$449.71
Max. Negotiated Rate	$9,330.00
Rate for Payer: Aetna Commercial	$7,090.80
Rate for Payer: Aetna Medicare Advantage	$5,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,758.30
Rate for Payer: Cigna Commercial	$9,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,105.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00
Rate for Payer: UnitedHealthcare Community & State	$449.71
Rate for Payer: Wellpoint Medicaid Managed Care	$494.49

ARCOS 18X190MM SPL TPR DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270686542
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$4,515.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,105.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

ARCOS 18X190MM SPL TPR DIST

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270686542
Hospital Revenue Code	278
Min. Negotiated Rate	$449.71
Max. Negotiated Rate	$9,330.00
Rate for Payer: Aetna Commercial	$7,090.80
Rate for Payer: Aetna Medicare Advantage	$5,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,758.30
Rate for Payer: Cigna Commercial	$9,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,105.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00
Rate for Payer: UnitedHealthcare Community & State	$449.71
Rate for Payer: Wellpoint Medicaid Managed Care	$494.49

ARCOS 1PC 18X210MM+0CALC STD

Facility

$37,495.00

Hospital Charge Code	270702527
Hospital Revenue Code	278
Min. Negotiated Rate	$903.63
Max. Negotiated Rate	$18,747.50
Rate for Payer: Aetna Commercial	$14,248.10
Rate for Payer: Aetna Medicare Advantage	$11,248.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,561.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,561.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,561.23
Rate for Payer: Cigna Commercial	$18,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,073.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,248.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,624.25
Rate for Payer: UnitedHealthcare Community & State	$903.63
Rate for Payer: Wellpoint Medicaid Managed Care	$993.62

ARCOS 1PC 18X210MM+0CALC STD

Facility

$37,495.00

Hospital Charge Code	270702527
Hospital Revenue Code	278
Min. Negotiated Rate	$5,624.25
Max. Negotiated Rate	$9,073.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,073.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,248.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,624.25

ARCOS CON CON SZ A HI 50MM

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270686541
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.50
Max. Negotiated Rate	$8,762.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,966.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50

ARCOS CON CON SZ A HI 50MM

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270686541
Hospital Revenue Code	278
Min. Negotiated Rate	$872.66
Max. Negotiated Rate	$18,105.00
Rate for Payer: Aetna Commercial	$13,759.80
Rate for Payer: Aetna Medicare Advantage	$10,863.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,233.55
Rate for Payer: Cigna Commercial	$18,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,966.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50
Rate for Payer: UnitedHealthcare Community & State	$872.66
Rate for Payer: Wellpoint Medicaid Managed Care	$959.57

ARCOS CON SZ A STD 50MM

Facility

$39,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270675924
Hospital Revenue Code	278
Min. Negotiated Rate	$5,913.00
Max. Negotiated Rate	$9,539.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,884.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,539.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,672.40
Rate for Payer: Qualcare PPO/HMO/WC	$5,913.00

ARCOS CON SZ A STD 50MM

Facility

$39,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270675924
Hospital Revenue Code	278
Min. Negotiated Rate	$950.02
Max. Negotiated Rate	$19,710.00
Rate for Payer: Aetna Commercial	$14,979.60
Rate for Payer: Aetna Medicare Advantage	$11,826.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,052.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,052.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,884.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,052.10
Rate for Payer: Cigna Commercial	$19,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,539.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,672.40
Rate for Payer: Qualcare PPO/HMO/WC	$5,913.00
Rate for Payer: UnitedHealthcare Community & State	$950.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1,044.63

ARCUS GUIDED ACCESS

Facility

$6,600.00

Hospital Charge Code	270703563
Hospital Revenue Code	278
Min. Negotiated Rate	$159.06
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$159.06
Rate for Payer: Wellpoint Medicaid Managed Care	$174.90

ARCUS GUIDED ACCESS

Facility

$6,600.00

Hospital Charge Code	270703563
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

ARCUS GUIDED ACCESS

Facility

$6,600.00

Hospital Charge Code	270703550
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

Know your out-of-pocket cost for care.

All Charges