Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MYELOPEROXIDASE (MPO)

Facility

$240.40

Service Code	HCPCS 83876
Hospital Charge Code	38477190
Hospital Revenue Code	301
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$183.59
Rate for Payer: Aetna Commercial	$138.34
Rate for Payer: Aetna Medicare Advantage	$164.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$50.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.59
Rate for Payer: Cigna Commercial	$120.20
Rate for Payer: Cigna Medicare Advantage	$50.86
Rate for Payer: Clover Medicare Advantage	$48.32
Rate for Payer: EmblemHealth Commercial	$152.58
Rate for Payer: Humana Medicare Advantage	$52.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$50.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.06
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$40.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.86
Rate for Payer: Wellcare Medicare Advantage	$50.86
Rate for Payer: Wellpoint Medicaid Managed Care	$6.37

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$76,835.87

Service Code	MSDRG 827
Min. Negotiated Rate	$23,395.54
Max. Negotiated Rate	$76,835.87
Rate for Payer: Aetna Commercial	$53,052.30
Rate for Payer: Aetna Medicare Advantage	$76,835.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53,965.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53,965.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,626.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53,965.52
Rate for Payer: Cigna Commercial	$43,251.80
Rate for Payer: Cigna Medicare Advantage	$24,626.88
Rate for Payer: Clover Medicare Advantage	$23,395.54
Rate for Payer: EmblemHealth Commercial	$73,880.64
Rate for Payer: Humana Medicare Advantage	$25,365.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,626.88
Rate for Payer: Oxford Commercial	$31,085.64
Rate for Payer: UnitedHealthcare Commercial	$54,509.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,626.88
Rate for Payer: Wellcare Medicare Advantage	$24,626.88

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$153,328.28

Service Code	MSDRG 826
Min. Negotiated Rate	$46,686.50
Max. Negotiated Rate	$153,328.28
Rate for Payer: Aetna Commercial	$105,611.34
Rate for Payer: Aetna Medicare Advantage	$153,328.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107,698.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107,698.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$49,143.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107,698.43
Rate for Payer: Cigna Commercial	$87,540.35
Rate for Payer: Cigna Medicare Advantage	$49,143.68
Rate for Payer: Clover Medicare Advantage	$46,686.50
Rate for Payer: EmblemHealth Commercial	$147,431.04
Rate for Payer: Humana Medicare Advantage	$50,617.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$49,143.68
Rate for Payer: Oxford Commercial	$62,916.41
Rate for Payer: UnitedHealthcare Commercial	$110,325.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$49,143.68
Rate for Payer: Wellcare Medicare Advantage	$49,143.68

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$57,203.70

Service Code	MSDRG 828
Min. Negotiated Rate	$17,417.79
Max. Negotiated Rate	$57,203.70
Rate for Payer: Aetna Commercial	$39,562.79
Rate for Payer: Aetna Medicare Advantage	$57,203.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38,148.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38,148.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,334.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38,148.04
Rate for Payer: Cigna Commercial	$31,884.91
Rate for Payer: Cigna Medicare Advantage	$18,334.52
Rate for Payer: Clover Medicare Advantage	$17,417.79
Rate for Payer: EmblemHealth Commercial	$55,003.56
Rate for Payer: Humana Medicare Advantage	$18,884.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,334.52
Rate for Payer: Oxford Commercial	$22,916.11
Rate for Payer: UnitedHealthcare Commercial	$40,184.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,334.52
Rate for Payer: Wellcare Medicare Advantage	$18,334.52

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$104,270.56

Service Code	MSDRG 829
Min. Negotiated Rate	$31,749.05
Max. Negotiated Rate	$104,270.56
Rate for Payer: Aetna Commercial	$71,903.08
Rate for Payer: Aetna Medicare Advantage	$104,270.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73,272.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73,272.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33,420.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73,272.15
Rate for Payer: Cigna Commercial	$59,136.24
Rate for Payer: Cigna Medicare Advantage	$33,420.05
Rate for Payer: Clover Medicare Advantage	$31,749.05
Rate for Payer: EmblemHealth Commercial	$100,260.15
Rate for Payer: Humana Medicare Advantage	$34,422.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33,420.05
Rate for Payer: Oxford Commercial	$42,502.00
Rate for Payer: UnitedHealthcare Commercial	$74,528.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$33,420.05
Rate for Payer: Wellcare Medicare Advantage	$33,420.05

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$50,778.16

Service Code	MSDRG 830
Min. Negotiated Rate	$15,461.30
Max. Negotiated Rate	$50,778.16
Rate for Payer: Aetna Commercial	$35,147.70
Rate for Payer: Aetna Medicare Advantage	$50,778.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,752.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,752.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,275.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,752.38
Rate for Payer: Cigna Commercial	$28,164.57
Rate for Payer: Cigna Medicare Advantage	$16,275.05
Rate for Payer: Clover Medicare Advantage	$15,461.30
Rate for Payer: EmblemHealth Commercial	$48,825.15
Rate for Payer: Humana Medicare Advantage	$16,763.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,275.05
Rate for Payer: Oxford Commercial	$20,242.25
Rate for Payer: UnitedHealthcare Commercial	$35,495.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,275.05
Rate for Payer: Wellcare Medicare Advantage	$16,275.05

MY KNEE 2R MEDIAL

Facility

$500.00

Hospital Charge Code	270685304
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

MY KNEE 2R MEDIAL

Facility

$500.00

Hospital Charge Code	270685304
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MYKNEE FEM RM#4

Facility

$625.00

Hospital Charge Code	270687439
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

MYKNEE FEM RM#4

Facility

$625.00

Hospital Charge Code	270687439
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$500.00

Hospital Charge Code	270675745
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$500.00

Hospital Charge Code	270675745
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$625.00

Hospital Charge Code	270682050
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$625.00

Hospital Charge Code	270682050
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

MY KNEE TIBIAL CUT BLOCK

Facility

$625.00

Hospital Charge Code	270681471
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

MY KNEE TIBIAL CUT BLOCK

Facility

$625.00

Hospital Charge Code	270681471
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

MYLERAN 2MG TAB

Facility

$5.00

Hospital Charge Code	60635375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

MYLERAN 2MG TAB

Facility

$5.00

Hospital Charge Code	60635375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MYLICON 40

Facility

$3.00

Hospital Charge Code	60634486
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

MYLICON 40

Facility

$3.00

Hospital Charge Code	60634486
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MYLICON/40MG/0.6ML

Facility

$19.00

Hospital Charge Code	60633478
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

MYLICON/40MG/0.6ML

Facility

$19.00

Hospital Charge Code	60633478
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

MYLICON 80

Facility

$1.00

Hospital Charge Code	60634487
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

MYLICON 80

Facility

$1.00

Hospital Charge Code	60634487
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

MYLOTARG 5MG VIAL

Facility

$12,661.00

Hospital Charge Code	60635573
Hospital Revenue Code	636
Min. Negotiated Rate	$305.13
Max. Negotiated Rate	$6,330.50
Rate for Payer: Aetna Commercial	$4,811.18
Rate for Payer: Aetna Medicare Advantage	$3,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,228.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,228.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,228.55
Rate for Payer: Cigna Commercial	$6,330.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,063.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,899.15
Rate for Payer: UnitedHealthcare Community & State	$305.13
Rate for Payer: Wellpoint Medicaid Managed Care	$335.52

Know your out-of-pocket cost for care.

All Charges