Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OYSTER IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003I
Hospital Revenue Code	302
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

OYSTER SHELL CALCIUM/1.25

Facility

$3.00

Hospital Charge Code	60633599
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

OYSTER SHELL CALCIUM/1.25

Facility

$3.00

Hospital Charge Code	60633599
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

OYSTER SHELL CALCIUM/1.25

Facility

$3.00

Hospital Charge Code	60633597
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

OYSTER SHELL CALCIUM/1.25

Facility

$3.00

Hospital Charge Code	60633597
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

P16 IHC

Facility

$2,164.00

Service Code	HCPCS 88342
Hospital Charge Code	4016883429
Hospital Revenue Code	310
Min. Negotiated Rate	$324.60
Max. Negotiated Rate	$324.60
Rate for Payer: Qualcare PPO/HMO/WC	$324.60

P16 IHC

Facility

$2,164.00

Service Code	HCPCS 88342
Hospital Charge Code	4016883429
Hospital Revenue Code	310
Min. Negotiated Rate	$57.35
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) 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	$649.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$324.60
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$57.35

P1 E1/15ML

Facility

$71.00

Hospital Charge Code	60634560
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

P1 E1/15ML

Facility

$71.00

Hospital Charge Code	60634560
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

P29 ALCOHOL SCREEN W/COC***

Facility

$50.00

Hospital Charge Code	3032695
Hospital Revenue Code	309
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

P29 ALCOHOL SCREEN W/COC***

Facility

$50.00

Hospital Charge Code	3032695
Hospital Revenue Code	309
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

P2 E1/15ML

Facility

$71.00

Hospital Charge Code	60634559
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

P2 E1/15ML

Facility

$71.00

Hospital Charge Code	60634559
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

P2Y12 PLATELET FUNCTION

Facility

$147.65

Service Code	HCPCS 85576
Hospital Charge Code	3038137
Hospital Revenue Code	305
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$67.76
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.92
Rate for Payer: Cigna Commercial	$73.83
Rate for Payer: Cigna Medicare Advantage	$24.91
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Medicare Advantage	$24.91
Rate for Payer: Wellpoint Medicaid Managed Care	$3.91

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	5100833
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	411085576
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

P2Y12 PLATELET FUNCTION

Facility

$147.65

Service Code	HCPCS 85576
Hospital Charge Code	3038137
Hospital Revenue Code	305
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$22.15
Rate for Payer: Qualcare PPO/HMO/WC	$22.15

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	411085576
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$67.76
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.92
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.91
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.91
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	$19.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Medicare Advantage	$24.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	5100833
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$67.76
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.92
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.91
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.91
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	$19.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Medicare Advantage	$24.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

P4 E1/15ML

Facility

$61.00

Hospital Charge Code	60634558
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

P4 E1/15ML

Facility

$61.00

Hospital Charge Code	60634558
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

P50-153-2010

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270701870
Hospital Revenue Code	278
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Community & State	$15.91
Rate for Payer: Wellpoint Medicaid Managed Care	$17.49

P50-153-2010

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270701870
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

P6 E1/15ML

Facility

$89.00

Hospital Charge Code	60634557
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

P6 E1/15ML

Facility

$89.00

Hospital Charge Code	60634557
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$17.80
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

Know your out-of-pocket cost for care.

All Charges