Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$9,533.16

Service Code	APR-DRG 6942
Min. Negotiated Rate	$9,346.24
Max. Negotiated Rate	$9,533.16
Rate for Payer: UnitedHealthcare Community & State	$9,346.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,533.16
Rate for Payer: Wellpoint Medicaid Managed Care	$9,346.24

LYMPH NODE-SUPER-BI

Facility

$9,303.00

Service Code	HCPCS 3850550
Hospital Charge Code	2101190
Hospital Revenue Code	361
Min. Negotiated Rate	$224.20
Max. Negotiated Rate	$4,651.50
Rate for Payer: Aetna Commercial	$3,535.14
Rate for Payer: Aetna Medicare Advantage	$2,790.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,372.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,372.26
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	$2,372.26
Rate for Payer: Cigna Commercial	$4,651.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,790.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45
Rate for Payer: UnitedHealthcare Community & State	$224.20
Rate for Payer: Wellpoint Medicaid Managed Care	$246.53

LYMPH NODE-SUPER-BI

Facility

$9,303.00

Service Code	HCPCS 3850550
Hospital Charge Code	2101190
Hospital Revenue Code	361
Min. Negotiated Rate	$1,395.45
Max. Negotiated Rate	$1,395.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,395.45

LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2250444
Hospital Revenue Code	361
Min. Negotiated Rate	$930.30
Max. Negotiated Rate	$930.30
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2250444
Hospital Revenue Code	361
Min. Negotiated Rate	$149.47
Max. Negotiated Rate	$3,101.00
Rate for Payer: Aetna Commercial	$2,356.76
Rate for Payer: Aetna Medicare Advantage	$1,860.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.51
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	$1,581.51
Rate for Payer: Cigna Commercial	$3,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,860.60
Rate for Payer: Qualcare PPO/HMO/WC	$930.30
Rate for Payer: UnitedHealthcare Community & State	$149.47
Rate for Payer: Wellpoint Medicaid Managed Care	$164.35

LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2101191
Hospital Revenue Code	361
Min. Negotiated Rate	$930.30
Max. Negotiated Rate	$930.30
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

LYMPH NODE-SUPER-LT

Facility

$6,202.00

Service Code	HCPCS 38505LT
Hospital Charge Code	2101191
Hospital Revenue Code	361
Min. Negotiated Rate	$149.47
Max. Negotiated Rate	$3,101.00
Rate for Payer: Aetna Commercial	$2,356.76
Rate for Payer: Aetna Medicare Advantage	$1,860.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.51
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	$1,581.51
Rate for Payer: Cigna Commercial	$3,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,860.60
Rate for Payer: Qualcare PPO/HMO/WC	$930.30
Rate for Payer: UnitedHealthcare Community & State	$149.47
Rate for Payer: Wellpoint Medicaid Managed Care	$164.35

LYMPHOCYTE SUBSET 1 I

Facility

$390.00

Service Code	HCPCS 86355
Hospital Charge Code	39990132A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$102.63
Rate for Payer: Aetna Medicare Advantage	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$37.73
Rate for Payer: Clover Medicare Advantage	$35.84
Rate for Payer: EmblemHealth Commercial	$113.19
Rate for Payer: Humana Medicare Advantage	$38.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.73
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	$30.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.73
Rate for Payer: Wellcare Medicare Advantage	$37.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LYMPHOCYTE SUBSET 1 I

Facility

$390.00

Service Code	HCPCS 86355
Hospital Charge Code	39990132A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYMPHOCYTE SUBSET 1 II

Facility

$390.00

Service Code	HCPCS 86357
Hospital Charge Code	39990132B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYMPHOCYTE SUBSET 1 II

Facility

$390.00

Service Code	HCPCS 86357
Hospital Charge Code	39990132B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$102.63
Rate for Payer: Aetna Medicare Advantage	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$37.73
Rate for Payer: Clover Medicare Advantage	$35.84
Rate for Payer: EmblemHealth Commercial	$113.19
Rate for Payer: Humana Medicare Advantage	$38.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.73
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	$30.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.73
Rate for Payer: Wellcare Medicare Advantage	$37.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LYMPHOCYTE SUBSET 1 III

Facility

$390.00

Service Code	HCPCS 86359
Hospital Charge Code	39990132C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYMPHOCYTE SUBSET 1 III

Facility

$390.00

Service Code	HCPCS 86359
Hospital Charge Code	39990132C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$102.63
Rate for Payer: Aetna Medicare Advantage	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$37.73
Rate for Payer: Clover Medicare Advantage	$35.84
Rate for Payer: EmblemHealth Commercial	$113.19
Rate for Payer: Humana Medicare Advantage	$38.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.73
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	$30.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.73
Rate for Payer: Wellcare Medicare Advantage	$37.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LYMPHOCYTE SUBSET 1 IV

Facility

$390.00

Service Code	HCPCS 86360
Hospital Charge Code	39990132D
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$127.79
Rate for Payer: Aetna Medicare Advantage	$152.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.58
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$46.98
Rate for Payer: Clover Medicare Advantage	$44.63
Rate for Payer: EmblemHealth Commercial	$140.94
Rate for Payer: Humana Medicare Advantage	$48.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$46.98
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	$37.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.98
Rate for Payer: Wellcare Medicare Advantage	$46.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LYMPHOCYTE SUBSET 1 IV

Facility

$390.00

Service Code	HCPCS 86360
Hospital Charge Code	39990132D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYMPHOCYTE SUBSET 3 I

Facility

$390.00

Service Code	HCPCS 86359
Hospital Charge Code	39990081A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYMPHOCYTE SUBSET 3 I

Facility

$390.00

Service Code	HCPCS 86359
Hospital Charge Code	39990081A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$102.63
Rate for Payer: Aetna Medicare Advantage	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$37.73
Rate for Payer: Clover Medicare Advantage	$35.84
Rate for Payer: EmblemHealth Commercial	$113.19
Rate for Payer: Humana Medicare Advantage	$38.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.73
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	$30.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.73
Rate for Payer: Wellcare Medicare Advantage	$37.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LYMPHOCYTE SUBSET 3 II

Facility

$390.00

Service Code	HCPCS 86360
Hospital Charge Code	39990081B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$127.79
Rate for Payer: Aetna Medicare Advantage	$152.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.58
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$46.98
Rate for Payer: Clover Medicare Advantage	$44.63
Rate for Payer: EmblemHealth Commercial	$140.94
Rate for Payer: Humana Medicare Advantage	$48.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$46.98
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	$37.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.98
Rate for Payer: Wellcare Medicare Advantage	$46.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LYMPHOCYTE SUBSET 3 II

Facility

$390.00

Service Code	HCPCS 86360
Hospital Charge Code	39990081B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYMPHOCYTE SUBSET 4

Facility

$667.59

Service Code	HCPCS 86360
Hospital Charge Code	39900431
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LYMPHOCYTE SUBSET 4

Facility

$667.59

Service Code	HCPCS 86360
Hospital Charge Code	39900431
Hospital Revenue Code	302
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$127.79
Rate for Payer: Aetna Medicare Advantage	$152.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.58
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$46.98
Rate for Payer: Clover Medicare Advantage	$44.63
Rate for Payer: EmblemHealth Commercial	$140.94
Rate for Payer: Humana Medicare Advantage	$48.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$46.98
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	$37.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.98
Rate for Payer: Wellcare Medicare Advantage	$46.98
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

LYMPHOCYTE SUBSTATS

Facility

$543.00

Hospital Charge Code	38473051
Hospital Revenue Code	302
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$81.45
Rate for Payer: Qualcare PPO/HMO/WC	$81.45

LYMPHOCYTE SUBSTATS

Facility

$543.00

Hospital Charge Code	38473051
Hospital Revenue Code	302
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$271.50
Rate for Payer: Aetna Commercial	$206.34
Rate for Payer: Aetna Medicare Advantage	$162.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.47
Rate for Payer: Cigna Commercial	$271.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.09
Rate for Payer: Wellpoint Medicaid Managed Care	$14.39

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$74,489.34

Service Code	MSDRG 821
Min. Negotiated Rate	$22,681.05
Max. Negotiated Rate	$74,489.34
Rate for Payer: Aetna Commercial	$51,440.00
Rate for Payer: Aetna Medicare Advantage	$74,489.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,872.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,872.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,874.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,872.03
Rate for Payer: Cigna Commercial	$41,893.16
Rate for Payer: Cigna Medicare Advantage	$23,874.79
Rate for Payer: Clover Medicare Advantage	$22,681.05
Rate for Payer: EmblemHealth Commercial	$71,624.37
Rate for Payer: Humana Medicare Advantage	$24,591.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,874.79
Rate for Payer: Oxford Commercial	$30,109.17
Rate for Payer: UnitedHealthcare Commercial	$52,797.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,874.79
Rate for Payer: Wellcare Medicare Advantage	$23,874.79

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$191,694.11

Service Code	MSDRG 820
Min. Negotiated Rate	$58,368.40
Max. Negotiated Rate	$191,694.11
Rate for Payer: Aetna Commercial	$131,973.03
Rate for Payer: Aetna Medicare Advantage	$191,694.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140,729.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140,729.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61,440.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140,729.05
Rate for Payer: Cigna Commercial	$109,753.87
Rate for Payer: Cigna Medicare Advantage	$61,440.42
Rate for Payer: Clover Medicare Advantage	$58,368.40
Rate for Payer: EmblemHealth Commercial	$184,321.26
Rate for Payer: Humana Medicare Advantage	$63,283.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61,440.42
Rate for Payer: Oxford Commercial	$78,881.56
Rate for Payer: UnitedHealthcare Commercial	$138,321.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$61,440.42
Rate for Payer: Wellcare Medicare Advantage	$61,440.42

Know your out-of-pocket cost for care.

All Charges