Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AUTH FOR DEVIA/STAND BB PROC

Facility

$207.25

Service Code	HCPCS 86079
Hospital Charge Code	3108008
Hospital Revenue Code	302
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$31.09
Rate for Payer: Qualcare PPO/HMO/WC	$31.09

AUTO BLOOD PROCESSING&STORAGE

Facility

$405.00

Service Code	HCPCS 86890
Hospital Charge Code	38470103
Hospital Revenue Code	309
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

AUTO BLOOD PROCESSING&STORAGE

Facility

$405.00

Service Code	HCPCS 86890
Hospital Charge Code	38470103
Hospital Revenue Code	309
Min. Negotiated Rate	$10.73
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) NJ Health	$58.18
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	$121.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$75.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

AUTOCHONDROCYTE IMPLANT KNEE

Facility

$22,425.68

Service Code	HCPCS 27412
Hospital Charge Code	16000885
Hospital Revenue Code	360
Min. Negotiated Rate	$3,363.85
Max. Negotiated Rate	$3,363.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,363.85

AUTOCHONDROCYTE IMPLANT KNEE

Facility

$22,425.68

Service Code	HCPCS 27412
Hospital Charge Code	16000885
Hospital Revenue Code	360
Min. Negotiated Rate	$540.46
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,727.70
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,363.85
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$540.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$594.28

AUTOINJECTOR 2

Facility

$5,300.00

Hospital Charge Code	270690552
Hospital Revenue Code	270
Min. Negotiated Rate	$127.73
Max. Negotiated Rate	$2,650.00
Rate for Payer: Aetna Commercial	$2,014.00
Rate for Payer: Aetna Medicare Advantage	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,351.50
Rate for Payer: Cigna Commercial	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$795.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$127.73
Rate for Payer: Wellpoint Medicaid Managed Care	$140.45

AUTOINJECTOR 2

Facility

$5,300.00

Hospital Charge Code	270690552
Hospital Revenue Code	270
Min. Negotiated Rate	$795.00
Max. Negotiated Rate	$795.00
Rate for Payer: Qualcare PPO/HMO/WC	$795.00

AUTOINJECTOR O-PRIME PMA

Facility

$1,250.00

Hospital Charge Code	270677358
Hospital Revenue Code	272
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

AUTOINJECTOR O-PRIME PMA

Facility

$1,250.00

Hospital Charge Code	270677358
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

AUTOLOGOUS BLOOD EA UNIT

Facility

$296.00

Service Code	HCPCS 86890
Hospital Charge Code	38471083
Hospital Revenue Code	309
Min. Negotiated Rate	$7.84
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) NJ Health	$58.18
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	$88.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$75.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7.84

AUTOLOGOUS BLOOD EA UNIT

Facility

$296.00

Service Code	HCPCS 86890
Hospital Charge Code	38471083
Hospital Revenue Code	309
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$44.40
Rate for Payer: Qualcare PPO/HMO/WC	$44.40

AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$28,874.07

Service Code	APR-DRG 0081
Min. Negotiated Rate	$28,307.91
Max. Negotiated Rate	$28,874.07
Rate for Payer: UnitedHealthcare Community & State	$28,307.91
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$28,874.07
Rate for Payer: Wellpoint Medicaid Managed Care	$28,307.91

AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$46,464.56

Service Code	APR-DRG 0082
Min. Negotiated Rate	$45,553.49
Max. Negotiated Rate	$46,464.56
Rate for Payer: UnitedHealthcare Community & State	$45,553.49
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$46,464.56
Rate for Payer: Wellpoint Medicaid Managed Care	$45,553.49

AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$92,819.33

Service Code	APR-DRG 0084
Min. Negotiated Rate	$90,999.34
Max. Negotiated Rate	$92,819.33
Rate for Payer: UnitedHealthcare Community & State	$90,999.34
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$92,819.33
Rate for Payer: Wellpoint Medicaid Managed Care	$90,999.34

AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$55,624.93

Service Code	APR-DRG 0083
Min. Negotiated Rate	$54,534.25
Max. Negotiated Rate	$55,624.93
Rate for Payer: UnitedHealthcare Community & State	$54,534.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$55,624.93
Rate for Payer: Wellpoint Medicaid Managed Care	$54,534.25

AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC

Facility

$193,791.78

Service Code	MSDRG 016
Min. Negotiated Rate	$59,007.11
Max. Negotiated Rate	$193,791.78
Rate for Payer: Aetna Medicare Advantage	$193,791.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143,752.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143,752.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$62,112.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143,752.98
Rate for Payer: Cigna Commercial	$110,968.41
Rate for Payer: Cigna Medicare Advantage	$62,112.75
Rate for Payer: Clover Medicare Advantage	$59,007.11
Rate for Payer: EmblemHealth Commercial	$186,338.25
Rate for Payer: Humana Medicare Advantage	$63,976.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$62,112.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$62,112.75
Rate for Payer: Wellcare Medicare Advantage	$62,112.75

AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC

Facility

$177,714.98

Service Code	MSDRG 017
Min. Negotiated Rate	$54,111.93
Max. Negotiated Rate	$177,714.98
Rate for Payer: Aetna Medicare Advantage	$177,714.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143,752.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143,752.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$56,959.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143,752.98
Rate for Payer: Cigna Commercial	$90,543.95
Rate for Payer: Cigna Medicare Advantage	$56,959.93
Rate for Payer: Clover Medicare Advantage	$54,111.93
Rate for Payer: EmblemHealth Commercial	$170,879.79
Rate for Payer: Humana Medicare Advantage	$58,668.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$56,959.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$56,959.93
Rate for Payer: Wellcare Medicare Advantage	$56,959.93

AUTOLOGOUS FIBRIN PLATELET SYS

Facility

$17,500.00

Hospital Charge Code	270670729
Hospital Revenue Code	272
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$2,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

AUTOLOGOUS FIBRIN PLATELET SYS

Facility

$17,500.00

Hospital Charge Code	270670729
Hospital Revenue Code	272
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,250.00
Rate for Payer: Oxford Commercial	$3,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Commercial	$3,500.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

AUTOLOGOUS FRESH FROZEN PLASMA

Facility

$484.00

Service Code	HCPCS 86891
Hospital Charge Code	3100948
Hospital Revenue Code	300
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

AUTOLOGOUS FRESH FROZEN PLASMA

Facility

$484.00

Service Code	HCPCS 86891
Hospital Charge Code	3100948
Hospital Revenue Code	300
Min. Negotiated Rate	$12.83
Max. Negotiated Rate	$3,455.10
Rate for Payer: Aetna Commercial	$2,603.50
Rate for Payer: Aetna Medicare Advantage	$3,101.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$957.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,455.10
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$957.17
Rate for Payer: Clover Medicare Advantage	$909.31
Rate for Payer: EmblemHealth Commercial	$2,871.51
Rate for Payer: Humana Medicare Advantage	$985.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$75.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$957.17
Rate for Payer: Wellcare Medicare Advantage	$957.17
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

AUTOLOGOUS PLATELET SYSTEM 60M

Facility

$6,975.00

Service Code	HCPCS A4649
Hospital Charge Code	270696437
Hospital Revenue Code	272
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,092.50
Rate for Payer: Oxford Commercial	$1,395.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Commercial	$1,395.00
Rate for Payer: UnitedHealthcare Community & State	$168.10
Rate for Payer: Wellpoint Medicaid Managed Care	$184.84

AUTOLOGOUS PLATELET SYSTEM 60M

Facility

$6,975.00

Service Code	HCPCS A4649
Hospital Charge Code	270696437
Hospital Revenue Code	272
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,046.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

AUTOLOGOUS PREDEPOSIT DONOR

Facility

$452.85

Service Code	HCPCS 86890
Hospital Charge Code	3100146
Hospital Revenue Code	300
Min. Negotiated Rate	$67.93
Max. Negotiated Rate	$67.93
Rate for Payer: Qualcare PPO/HMO/WC	$67.93

AUTOLOGOUS PREDEPOSIT DONOR

Facility

$452.85

Service Code	HCPCS 86890
Hospital Charge Code	3100146
Hospital Revenue Code	300
Min. Negotiated Rate	$12.00
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) NJ Health	$58.18
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	$135.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.93
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$75.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$12.00

Know your out-of-pocket cost for care.

All Charges