Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AUTOLOGOUS TRANSFUSION UP TO 4

Facility

$2,492.00

Service Code	HCPCS 86891
Hospital Charge Code	38470100
Hospital Revenue Code	309
Min. Negotiated Rate	$373.80
Max. Negotiated Rate	$373.80
Rate for Payer: Qualcare PPO/HMO/WC	$373.80

AUTOLOGOUS TRANSFUSION UP TO 4

Facility

$2,492.00

Service Code	HCPCS 86891
Hospital Charge Code	38470100
Hospital Revenue Code	309
Min. Negotiated Rate	$66.04
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	$747.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$373.80
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	$66.04

AUTOLOGOUS WHOLE BLD

Facility

$419.85

Hospital Charge Code	3100013
Hospital Revenue Code	390
Min. Negotiated Rate	$62.98
Max. Negotiated Rate	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$62.98

AUTOLOGOUS WHOLE BLD

Facility

$419.85

Hospital Charge Code	3100013
Hospital Revenue Code	390
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$159.54
Rate for Payer: Aetna Medicare Advantage	$125.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.06
Rate for Payer: Cigna Commercial	$209.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.95
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.98
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

AUTOPLEX SYSTEM W/11G NEEDLE

Facility

$4,750.00

Hospital Charge Code	270641891
Hospital Revenue Code	270
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$712.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

AUTOPLEX SYSTEM W/11G NEEDLE

Facility

$4,750.00

Hospital Charge Code	270641891
Hospital Revenue Code	270
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.00
Rate for Payer: Oxford Commercial	$950.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Commercial	$950.00
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

AUTOPSY GROSS&MICRO INFN W BRN

Facility

$215.00

Service Code	HCPCS 88028
Hospital Charge Code	3035170
Hospital Revenue Code	310
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

AUTOPSY GROSS&MICRO INFN W BRN

Facility

$215.00

Service Code	HCPCS 88028
Hospital Charge Code	3035170
Hospital Revenue Code	310
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

AUTOPSY GROSS&MICRO SB/NB W BR

Facility

$215.00

Service Code	HCPCS 88029
Hospital Charge Code	3035171
Hospital Revenue Code	310
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

AUTOPSY GROSS&MICRO SB/NB W BR

Facility

$215.00

Service Code	HCPCS 88029
Hospital Charge Code	3035171
Hospital Revenue Code	310
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

AUTOPSY GROSS&MICRO W BRN&SPIN

Facility

$215.00

Service Code	HCPCS 88027
Hospital Charge Code	3035169
Hospital Revenue Code	310
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

AUTOPSY GROSS&MICRO W BRN&SPIN

Facility

$215.00

Service Code	HCPCS 88027
Hospital Charge Code	3035169
Hospital Revenue Code	310
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

AUTOPSY GROSS&MICRO WITH BRAIN

Facility

$215.00

Service Code	HCPCS 88025
Hospital Charge Code	3035066
Hospital Revenue Code	310
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

AUTOPSY GROSS&MICRO WITH BRAIN

Facility

$215.00

Service Code	HCPCS 88025
Hospital Charge Code	3035066
Hospital Revenue Code	310
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

AUTOPSY GROSS&MICRO WITH CNS

Facility

$215.00

Service Code	HCPCS 88020
Hospital Charge Code	3035168
Hospital Revenue Code	310
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

AUTOPSY GROSS&MICRO WITH CNS

Facility

$215.00

Service Code	HCPCS 88020
Hospital Charge Code	3035168
Hospital Revenue Code	310
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

AUTOPSY LTD GROSS&MICRO REGION

Facility

$215.00

Service Code	HCPCS 88036
Hospital Charge Code	3035172
Hospital Revenue Code	310
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

AUTOPSY LTD GROSS&MICRO REGION

Facility

$215.00

Service Code	HCPCS 88036
Hospital Charge Code	3035172
Hospital Revenue Code	310
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

AUTOSRIVER DISP

Facility

$1,255.00

Hospital Charge Code	270703591
Hospital Revenue Code	278
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$627.50
Rate for Payer: Aetna Commercial	$476.90
Rate for Payer: Aetna Medicare Advantage	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.02
Rate for Payer: Cigna Commercial	$627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.10
Rate for Payer: Qualcare PPO/HMO/WC	$188.25
Rate for Payer: UnitedHealthcare Community & State	$30.25
Rate for Payer: Wellpoint Medicaid Managed Care	$33.26

AUTOSRIVER DISP

Facility

$1,255.00

Hospital Charge Code	270703591
Hospital Revenue Code	278
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$303.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.10
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

AUTO STITCH 173022 *******

Facility

$146.00

Hospital Charge Code	1605849
Hospital Revenue Code	272
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

AUTO STITCH 173022 *******

Facility

$146.00

Hospital Charge Code	1605849
Hospital Revenue Code	272
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$55.48
Rate for Payer: Aetna Medicare Advantage	$43.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.23
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.80
Rate for Payer: Oxford Commercial	$29.20
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$29.20
Rate for Payer: UnitedHealthcare Community & State	$3.52
Rate for Payer: Wellpoint Medicaid Managed Care	$3.87

AUTO SUTURE- POLY****

Facility

$1,465.00

Hospital Charge Code	1800093
Hospital Revenue Code	279
Min. Negotiated Rate	$219.75
Max. Negotiated Rate	$219.75
Rate for Payer: Qualcare PPO/HMO/WC	$219.75

AUTO SUTURE- POLY****

Facility

$1,465.00

Hospital Charge Code	1800093
Hospital Revenue Code	279
Min. Negotiated Rate	$35.31
Max. Negotiated Rate	$732.50
Rate for Payer: Aetna Commercial	$556.70
Rate for Payer: Aetna Medicare Advantage	$439.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.57
Rate for Payer: Cigna Commercial	$732.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.50
Rate for Payer: Oxford Commercial	$293.00
Rate for Payer: Qualcare PPO/HMO/WC	$219.75
Rate for Payer: UnitedHealthcare Commercial	$293.00
Rate for Payer: UnitedHealthcare Community & State	$35.31
Rate for Payer: Wellpoint Medicaid Managed Care	$38.82

AUTO SYRINGE (TUBING) ******

Facility

$8.00

Hospital Charge Code	1801067
Hospital Revenue Code	279
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

Know your out-of-pocket cost for care.

All Charges