Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

L8-KIDNEY BIOPSY IMMUNO MICRO

Facility

$300.00

Service Code	HCPCS 88346
Hospital Charge Code	3035062
Hospital Revenue Code	312
Min. Negotiated Rate	$7.95
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	$90.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$122.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

L9 - MUSCLE BIOPSY

Facility

$207.25

Service Code	HCPCS 88356
Hospital Charge Code	3035060
Hospital Revenue Code	310
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.09
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$189.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.49

L9 - MUSCLE BIOPSY

Facility

$207.25

Service Code	HCPCS 88356
Hospital Charge Code	3035060
Hospital Revenue Code	310
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$31.09
Rate for Payer: Qualcare PPO/HMO/WC	$31.09

LAAROSCOPE PROC URETER

Facility

$21,530.28

Service Code	HCPCS 50949
Hospital Charge Code	1600000257
Hospital Revenue Code	360
Min. Negotiated Rate	$518.88
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,459.08
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,229.54
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$518.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$570.55

LAAROSCOPE PROC URETER

Facility

$21,530.28

Service Code	HCPCS 50949
Hospital Charge Code	1600000257
Hospital Revenue Code	360
Min. Negotiated Rate	$3,229.54
Max. Negotiated Rate	$3,229.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,229.54

LABEL 30-UP HOLE PUNCHING

Facility

$73.95

Hospital Charge Code	270650407
Hospital Revenue Code	270
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$11.09
Rate for Payer: Qualcare PPO/HMO/WC	$11.09

LABEL 30-UP HOLE PUNCHING

Facility

$73.95

Hospital Charge Code	270650407
Hospital Revenue Code	270
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$36.98
Rate for Payer: Aetna Commercial	$28.10
Rate for Payer: Aetna Medicare Advantage	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.86
Rate for Payer: Cigna Commercial	$36.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.18
Rate for Payer: Oxford Commercial	$14.79
Rate for Payer: Qualcare PPO/HMO/WC	$11.09
Rate for Payer: UnitedHealthcare Commercial	$14.79
Rate for Payer: UnitedHealthcare Community & State	$1.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.96

LABEL 4X1-55/16 WHT/RED PERM

Facility

$53.25

Hospital Charge Code	270657889
Hospital Revenue Code	270
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$7.99
Rate for Payer: Qualcare PPO/HMO/WC	$7.99

LABEL 4X1-55/16 WHT/RED PERM

Facility

$53.25

Hospital Charge Code	270657889
Hospital Revenue Code	270
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$26.62
Rate for Payer: Aetna Commercial	$20.23
Rate for Payer: Aetna Medicare Advantage	$15.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.58
Rate for Payer: Cigna Commercial	$26.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Oxford Commercial	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.99
Rate for Payer: UnitedHealthcare Commercial	$10.65
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

LABEL ALLERGIESDRUG 2.5 X 2.5

Facility

$997.50

Hospital Charge Code	270653923
Hospital Revenue Code	272
Min. Negotiated Rate	$149.62
Max. Negotiated Rate	$149.62
Rate for Payer: Qualcare PPO/HMO/WC	$149.62

LABEL ALLERGIESDRUG 2.5 X 2.5

Facility

$997.50

Hospital Charge Code	270653923
Hospital Revenue Code	272
Min. Negotiated Rate	$24.04
Max. Negotiated Rate	$498.75
Rate for Payer: Aetna Commercial	$379.05
Rate for Payer: Aetna Medicare Advantage	$299.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.36
Rate for Payer: Cigna Commercial	$498.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.25
Rate for Payer: Oxford Commercial	$199.50
Rate for Payer: Qualcare PPO/HMO/WC	$149.62
Rate for Payer: UnitedHealthcare Commercial	$199.50
Rate for Payer: UnitedHealthcare Community & State	$24.04
Rate for Payer: Wellpoint Medicaid Managed Care	$26.43

LABEL ID BRACELET

Facility

$900.00

Hospital Charge Code	270653679
Hospital Revenue Code	272
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.00
Rate for Payer: Oxford Commercial	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$180.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

LABEL ID BRACELET

Facility

$900.00

Hospital Charge Code	270653679
Hospital Revenue Code	272
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

LABEL PHARMACY

Facility

$563.05

Hospital Charge Code	270652611
Hospital Revenue Code	272
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$281.52
Rate for Payer: Aetna Commercial	$213.96
Rate for Payer: Aetna Medicare Advantage	$168.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.58
Rate for Payer: Cigna Commercial	$281.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.91
Rate for Payer: Oxford Commercial	$112.61
Rate for Payer: Qualcare PPO/HMO/WC	$84.46
Rate for Payer: UnitedHealthcare Commercial	$112.61
Rate for Payer: UnitedHealthcare Community & State	$13.57
Rate for Payer: Wellpoint Medicaid Managed Care	$14.92

LABEL PHARMACY

Facility

$563.05

Hospital Charge Code	270652611
Hospital Revenue Code	272
Min. Negotiated Rate	$84.46
Max. Negotiated Rate	$84.46
Rate for Payer: Qualcare PPO/HMO/WC	$84.46

LABETALOL 20MG/4ML

Facility

$10.52

Service Code	NDC 409233934
Hospital Charge Code	60630128
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.26
Rate for Payer: Aetna Commercial	$4.00
Rate for Payer: Aetna Medicare Advantage	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.68
Rate for Payer: Cigna Commercial	$5.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.16
Rate for Payer: Oxford Commercial	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$1.58
Rate for Payer: UnitedHealthcare Commercial	$2.10
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

LABETALOL 20MG/4ML

Facility

$10.52

Service Code	NDC 409233934
Hospital Charge Code	60630128
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$1.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.58

LABETALOL INJ 5MG/ML 20ML

Facility

$40.20

Service Code	NDC 409226720
Hospital Charge Code	6003214
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna Medicare Advantage	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.25
Rate for Payer: Cigna Commercial	$20.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.06
Rate for Payer: Oxford Commercial	$8.04
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$8.04
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

LABETALOL INJ 5MG/ML 20ML

Facility

$40.20

Service Code	NDC 409226720
Hospital Charge Code	6003214
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

LABETALOL TAB 100MG

Facility

$4.00

Service Code	NDC 51079092820
Hospital Charge Code	60627635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

LABETALOL TAB 100MG

Facility

$4.00

Service Code	NDC 51079092820
Hospital Charge Code	60627635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LABETALOL TAB 200MG

Facility

$4.56

Service Code	NDC 51079092920
Hospital Charge Code	60627636
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

LABETALOL TAB 200MG

Facility

$4.56

Service Code	NDC 51079092920
Hospital Charge Code	60627636
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.28
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna Medicare Advantage	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.16
Rate for Payer: Cigna Commercial	$2.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.37
Rate for Payer: Oxford Commercial	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.91
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

LABETALOL VIAL

Facility

$90.90

Hospital Charge Code	6012710
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$45.45
Rate for Payer: Aetna Commercial	$34.54
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.27
Rate for Payer: Oxford Commercial	$18.18
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Commercial	$18.18
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

LABETALOL VIAL

Facility

$90.90

Hospital Charge Code	6012710
Hospital Revenue Code	250
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

Know your out-of-pocket cost for care.

All Charges