Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PANEL 9

Facility

$390.00

Service Code	HCPCS 86148
Hospital Charge Code	366886148
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PANEL 9

Facility

$390.00

Service Code	HCPCS 86148
Hospital Charge Code	366886148
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.01
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
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	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PANEL 9

Facility

$667.59

Service Code	HCPCS 86148
Hospital Charge Code	39708028I
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Panel, Gastrointestinal

Facility

$545.40

Service Code	HCPCS 38470
Hospital Charge Code	3000077
Hospital Revenue Code	306
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$272.70
Rate for Payer: Aetna Commercial	$207.25
Rate for Payer: Aetna Medicare Advantage	$163.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.08
Rate for Payer: Cigna Commercial	$272.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.81
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.14
Rate for Payer: Wellpoint Medicaid Managed Care	$14.45

Panel, Gastrointestinal

Facility

$545.40

Service Code	HCPCS 38470
Hospital Charge Code	3000077
Hospital Revenue Code	306
Min. Negotiated Rate	$81.81
Max. Negotiated Rate	$81.81
Rate for Payer: Qualcare PPO/HMO/WC	$81.81

PANEL MENINGOENCEPHALITIS

Facility

$2,136.90

Service Code	HCPCS 86695
Hospital Charge Code	399900536
Hospital Revenue Code	302
Min. Negotiated Rate	$320.54
Max. Negotiated Rate	$320.54
Rate for Payer: Qualcare PPO/HMO/WC	$320.54

PANEL MENINGOENCEPHALITIS

Facility

$2,136.90

Service Code	HCPCS 86695
Hospital Charge Code	399900536
Hospital Revenue Code	302
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$1,068.45
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.61
Rate for Payer: Cigna Commercial	$1,068.45
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$320.54
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$56.63

PANITUMUMAB 20MG/ML (20ML) INJ

Facility

$18,715.00

Hospital Charge Code	60635702
Hospital Revenue Code	636
Min. Negotiated Rate	$2,807.25
Max. Negotiated Rate	$4,529.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,529.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,807.25

PANITUMUMAB 20MG/ML (20ML) INJ

Facility

$18,715.00

Hospital Charge Code	60635702
Hospital Revenue Code	636
Min. Negotiated Rate	$451.03
Max. Negotiated Rate	$9,357.50
Rate for Payer: Aetna Commercial	$7,111.70
Rate for Payer: Aetna Medicare Advantage	$5,614.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,772.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,772.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,772.32
Rate for Payer: Cigna Commercial	$9,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,529.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,807.25
Rate for Payer: UnitedHealthcare Community & State	$451.03
Rate for Payer: Wellpoint Medicaid Managed Care	$495.95

PANITUMUMAB 20 MG/ML (5ML) INJ

Facility

$4,679.00

Hospital Charge Code	60635701
Hospital Revenue Code	636
Min. Negotiated Rate	$701.85
Max. Negotiated Rate	$1,132.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,132.32
Rate for Payer: Qualcare PPO/HMO/WC	$701.85

PANITUMUMAB 20 MG/ML (5ML) INJ

Facility

$4,679.00

Hospital Charge Code	60635701
Hospital Revenue Code	636
Min. Negotiated Rate	$112.76
Max. Negotiated Rate	$2,339.50
Rate for Payer: Aetna Commercial	$1,778.02
Rate for Payer: Aetna Medicare Advantage	$1,403.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,193.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,193.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,193.14
Rate for Payer: Cigna Commercial	$2,339.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,132.32
Rate for Payer: Qualcare PPO/HMO/WC	$701.85
Rate for Payer: UnitedHealthcare Community & State	$112.76
Rate for Payer: Wellpoint Medicaid Managed Care	$123.99

PAN OPTIC LAMP

Facility

$96.80

Hospital Charge Code	270654005
Hospital Revenue Code	270
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$14.52
Rate for Payer: Qualcare PPO/HMO/WC	$14.52

PAN OPTIC LAMP

Facility

$96.80

Hospital Charge Code	270654005
Hospital Revenue Code	270
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$48.40
Rate for Payer: Aetna Commercial	$36.78
Rate for Payer: Aetna Medicare Advantage	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.68
Rate for Payer: Cigna Commercial	$48.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.04
Rate for Payer: Oxford Commercial	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$14.52
Rate for Payer: UnitedHealthcare Commercial	$19.36
Rate for Payer: UnitedHealthcare Community & State	$2.33
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

PANSIGMOIDOSCOPY***

Facility

$190.00

Service Code	HCPCS 45330
Hospital Charge Code	2300309
Hospital Revenue Code	759
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$3,988.03
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,988.03
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

PANSIGMOIDOSCOPY***

Facility

$190.00

Service Code	HCPCS 45330
Hospital Charge Code	2300309
Hospital Revenue Code	759
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

PANSIGMOIDOSCOPY W/BICP CAUT**

Facility

$253.00

Service Code	HCPCS 99999
Hospital Charge Code	2300465
Hospital Revenue Code	759
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

PANSIGMOIDOSCOPY W/BICP CAUT**

Facility

$253.00

Service Code	HCPCS 99999
Hospital Charge Code	2300465
Hospital Revenue Code	759
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$96.14
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.90
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Community & State	$6.10
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

PANSIGMOIDOSCOPY W/IRC***

Facility

$377.00

Service Code	HCPCS 99999
Hospital Charge Code	2300317
Hospital Revenue Code	759
Min. Negotiated Rate	$56.55
Max. Negotiated Rate	$56.55
Rate for Payer: Qualcare PPO/HMO/WC	$56.55

PANSIGMOIDOSCOPY W/IRC***

Facility

$377.00

Service Code	HCPCS 99999
Hospital Charge Code	2300317
Hospital Revenue Code	759
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$188.50
Rate for Payer: Aetna Commercial	$143.26
Rate for Payer: Aetna Medicare Advantage	$113.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.14
Rate for Payer: Cigna Commercial	$188.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.10
Rate for Payer: Qualcare PPO/HMO/WC	$56.55
Rate for Payer: UnitedHealthcare Community & State	$9.09
Rate for Payer: Wellpoint Medicaid Managed Care	$9.99

PANSIGMOIDOSCOPY W/POLYPECT***

Facility

$552.00

Service Code	HCPCS 45333
Hospital Charge Code	2300325
Hospital Revenue Code	759
Min. Negotiated Rate	$82.80
Max. Negotiated Rate	$82.80
Rate for Payer: Qualcare PPO/HMO/WC	$82.80

PANSIGMOIDOSCOPY W/POLYPECT***

Facility

$552.00

Service Code	HCPCS 45333
Hospital Charge Code	2300325
Hospital Revenue Code	759
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$3,988.03
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,988.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,988.03
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.60
Rate for Payer: Qualcare PPO/HMO/WC	$82.80
Rate for Payer: UnitedHealthcare Community & State	$13.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81
Rate for Payer: Wellpoint Medicaid Managed Care	$14.63

PANSIGMOIDOSCOPY W/REMOVAL FB

Facility

$460.00

Service Code	HCPCS 45332
Hospital Charge Code	2300333
Hospital Revenue Code	759
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

PANSIGMOIDOSCOPY W/REMOVAL FB

Facility

$460.00

Service Code	HCPCS 45332
Hospital Charge Code	2300333
Hospital Revenue Code	759
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$5,131.69
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,131.69
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00
Rate for Payer: UnitedHealthcare Community & State	$11.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$12.19

PANTALAR ARTHRODESIS

Facility

$57,834.50

Service Code	HCPCS 28705
Hospital Charge Code	1600000886
Hospital Revenue Code	360
Min. Negotiated Rate	$1,393.81
Max. Negotiated Rate	$75,192.36
Rate for Payer: Aetna Commercial	$56,659.34
Rate for Payer: Aetna Medicare Advantage	$67,491.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,192.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,192.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,830.64
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	$75,192.36
Rate for Payer: Cigna Commercial	$41,754.94
Rate for Payer: Cigna Medicare Advantage	$20,830.64
Rate for Payer: Clover Medicare Advantage	$19,789.11
Rate for Payer: EmblemHealth Commercial	$62,491.92
Rate for Payer: Humana Medicare Advantage	$21,455.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,830.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,350.35
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,393.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,830.64
Rate for Payer: Wellcare Medicare Advantage	$20,830.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1,532.61

PANTALAR ARTHRODESIS

Facility

$57,834.50

Service Code	HCPCS 28705
Hospital Charge Code	1600000886
Hospital Revenue Code	360
Min. Negotiated Rate	$8,675.17
Max. Negotiated Rate	$8,675.17
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17

Know your out-of-pocket cost for care.

All Charges