Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LIVER ACCESS AND BIOPSY SET

Facility

$2,215.00

Hospital Charge Code	270689191
Hospital Revenue Code	272
Min. Negotiated Rate	$53.38
Max. Negotiated Rate	$1,107.50
Rate for Payer: Aetna Commercial	$841.70
Rate for Payer: Aetna Medicare Advantage	$664.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$564.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$564.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$564.83
Rate for Payer: Cigna Commercial	$1,107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.50
Rate for Payer: Oxford Commercial	$443.00
Rate for Payer: Qualcare PPO/HMO/WC	$332.25
Rate for Payer: UnitedHealthcare Commercial	$443.00
Rate for Payer: UnitedHealthcare Community & State	$53.38
Rate for Payer: Wellpoint Medicaid Managed Care	$58.70

LIVER CYTOSOL (LC-1) ABS

Facility

$390.00

Service Code	HCPCS 86376
Hospital Charge Code	38479747
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER CYTOSOL (LC-1) ABS

Facility

$390.00

Service Code	HCPCS 86376
Hospital Charge Code	38479747
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.58
Rate for Payer: Aetna Medicare Advantage	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.52
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.55
Rate for Payer: Clover Medicare Advantage	$13.82
Rate for Payer: EmblemHealth Commercial	$43.65
Rate for Payer: Humana Medicare Advantage	$14.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.55
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	$11.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.55
Rate for Payer: Wellcare Medicare Advantage	$14.55
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LIVER FIBRO,HEPSCORE (TM) I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990096A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.29
Rate for Payer: Clover Medicare Advantage	$14.53
Rate for Payer: EmblemHealth Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.29
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	$12.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.29
Rate for Payer: Wellcare Medicare Advantage	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LIVER FIBRO,HEPSCORE (TM) I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990096A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER FIBRO,HEPSCORE (TM) II

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
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	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LIVER FIBRO,HEPSCORE (TM) II

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER FIBRO,HEPSCORE (TM) III

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER FIBRO,HEPSCORE (TM) III

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
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	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LIVER FUNCTION ASSESSMENT

Facility

$46.10

Hospital Charge Code	6016315
Hospital Revenue Code	510
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.05
Rate for Payer: Aetna Commercial	$17.52
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.76
Rate for Payer: Cigna Commercial	$23.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.83
Rate for Payer: Qualcare PPO/HMO/WC	$6.92
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

LIVER FUNCTION ASSESSMENT

Facility

$46.10

Hospital Charge Code	6016315
Hospital Revenue Code	510
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$6.92

LIVER KIDNEY MICROSOMAL AB

Facility

$667.59

Service Code	HCPCS 86376
Hospital Charge Code	39900441
Hospital Revenue Code	302
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$39.58
Rate for Payer: Aetna Medicare Advantage	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.52
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$14.55
Rate for Payer: Clover Medicare Advantage	$13.82
Rate for Payer: EmblemHealth Commercial	$43.65
Rate for Payer: Humana Medicare Advantage	$14.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.55
Rate for Payer: Wellcare Medicare Advantage	$14.55
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

LIVER KIDNEY MICROSOMAL AB

Facility

$667.59

Service Code	HCPCS 86376
Hospital Charge Code	39900441
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LIVER/SPLEEN IMAGE W/VASC FLOW

Facility

$12,000.00

Service Code	HCPCS 78216
Hospital Charge Code	4500105
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

LIVER/SPLEEN IMAGE W/VASC FLOW

Facility

$12,000.00

Service Code	HCPCS 78216
Hospital Charge Code	4500105
Hospital Revenue Code	341
Min. Negotiated Rate	$148.74
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,600.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$88,004.87

Service Code	APR-DRG 0012
Min. Negotiated Rate	$86,279.28
Max. Negotiated Rate	$88,004.87
Rate for Payer: UnitedHealthcare Community & State	$86,279.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$88,004.87
Rate for Payer: Wellpoint Medicaid Managed Care	$86,279.28

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$105,480.46

Service Code	APR-DRG 0013
Min. Negotiated Rate	$103,412.22
Max. Negotiated Rate	$105,480.46
Rate for Payer: UnitedHealthcare Community & State	$103,412.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$105,480.46
Rate for Payer: Wellpoint Medicaid Managed Care	$103,412.22

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$78,438.48

Service Code	APR-DRG 0011
Min. Negotiated Rate	$76,900.47
Max. Negotiated Rate	$78,438.48
Rate for Payer: UnitedHealthcare Community & State	$76,900.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$78,438.48
Rate for Payer: Wellpoint Medicaid Managed Care	$76,900.47

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$185,380.75

Service Code	APR-DRG 0014
Min. Negotiated Rate	$181,745.83
Max. Negotiated Rate	$185,380.75
Rate for Payer: UnitedHealthcare Community & State	$181,745.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$185,380.75
Rate for Payer: Wellpoint Medicaid Managed Care	$181,745.83

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$335,386.43

Service Code	MSDRG 005
Min. Negotiated Rate	$102,120.87
Max. Negotiated Rate	$335,386.43
Rate for Payer: Aetna Medicare Advantage	$335,386.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240,751.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240,751.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$107,495.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240,751.35
Rate for Payer: Cigna Commercial	$192,950.70
Rate for Payer: Cigna Medicare Advantage	$107,495.65
Rate for Payer: Clover Medicare Advantage	$102,120.87
Rate for Payer: EmblemHealth Commercial	$322,486.95
Rate for Payer: Humana Medicare Advantage	$110,720.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$107,495.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$107,495.65
Rate for Payer: Wellcare Medicare Advantage	$107,495.65

LIVER TRANSPLANT WITHOUT MCC

Facility

$152,009.55

Service Code	MSDRG 006
Min. Negotiated Rate	$46,284.96
Max. Negotiated Rate	$152,009.55
Rate for Payer: Aetna Medicare Advantage	$152,009.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112,583.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112,583.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$48,721.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112,583.24
Rate for Payer: Cigna Commercial	$86,776.82
Rate for Payer: Cigna Medicare Advantage	$48,721.01
Rate for Payer: Clover Medicare Advantage	$46,284.96
Rate for Payer: EmblemHealth Commercial	$146,163.03
Rate for Payer: Humana Medicare Advantage	$50,182.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$48,721.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$48,721.01
Rate for Payer: Wellcare Medicare Advantage	$48,721.01

LLIF PEAK CAGE 18X55X12H

Facility

$29,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705445
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.00
Max. Negotiated Rate	$7,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,490.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00

LLIF PEAK CAGE 18X55X12H

Facility

$29,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705445
Hospital Revenue Code	278
Min. Negotiated Rate	$710.95
Max. Negotiated Rate	$14,750.00
Rate for Payer: Aetna Commercial	$11,210.00
Rate for Payer: Aetna Medicare Advantage	$8,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,522.50
Rate for Payer: Cigna Commercial	$14,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,490.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00
Rate for Payer: UnitedHealthcare Community & State	$710.95
Rate for Payer: Wellpoint Medicaid Managed Care	$781.75

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	366893285
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	366893285
Hospital Revenue Code	480
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$3.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

Know your out-of-pocket cost for care.

All Charges