Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PKU CARD

Facility

$139.25

Hospital Charge Code	1810027
Hospital Revenue Code	272
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$69.62
Rate for Payer: Aetna Commercial	$52.91
Rate for Payer: Aetna Medicare Advantage	$41.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.51
Rate for Payer: Cigna Commercial	$69.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.77
Rate for Payer: Oxford Commercial	$27.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Commercial	$27.85
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

PKU CARD

Facility

$139.25

Hospital Charge Code	1810027
Hospital Revenue Code	272
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$20.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83091020
Hospital Revenue Code	301
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$17.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.85
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: Cigna Medicare Advantage	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Medicare Advantage	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83080025
Hospital Revenue Code	301
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83091020
Hospital Revenue Code	301
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83080025
Hospital Revenue Code	301
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$17.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.85
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: Cigna Medicare Advantage	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Medicare Advantage	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

PKU TESTING

Facility

$153.00

Service Code	HCPCS 84030
Hospital Charge Code	38472544
Hospital Revenue Code	301
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

PKU TESTING

Facility

$153.00

Service Code	HCPCS 84030
Hospital Charge Code	38472544
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$17.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.85
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: Cigna Medicare Advantage	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Medicare Advantage	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

PL 100 LEUKOCYTE REMVL FILTER

Facility

$573.65

Hospital Charge Code	8003352
Hospital Revenue Code	270
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$286.82
Rate for Payer: Aetna Commercial	$217.99
Rate for Payer: Aetna Medicare Advantage	$172.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.28
Rate for Payer: Cigna Commercial	$286.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.09
Rate for Payer: Oxford Commercial	$114.73
Rate for Payer: Qualcare PPO/HMO/WC	$86.05
Rate for Payer: UnitedHealthcare Commercial	$114.73
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: Wellpoint Medicaid Managed Care	$15.20

PL 100 LEUKOCYTE REMVL FILTER

Facility

$573.65

Hospital Charge Code	8003352
Hospital Revenue Code	270
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$86.05
Rate for Payer: Qualcare PPO/HMO/WC	$86.05

PL 50 LEUKOCYTE REMOVAL FILTER

Facility

$328.85

Hospital Charge Code	8003360
Hospital Revenue Code	270
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$164.43
Rate for Payer: Aetna Commercial	$124.96
Rate for Payer: Aetna Medicare Advantage	$98.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.86
Rate for Payer: Cigna Commercial	$164.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.66
Rate for Payer: Oxford Commercial	$65.77
Rate for Payer: Qualcare PPO/HMO/WC	$49.33
Rate for Payer: UnitedHealthcare Commercial	$65.77
Rate for Payer: UnitedHealthcare Community & State	$7.93
Rate for Payer: Wellpoint Medicaid Managed Care	$8.71

PL 50 LEUKOCYTE REMOVAL FILTER

Facility

$328.85

Hospital Charge Code	8003360
Hospital Revenue Code	270
Min. Negotiated Rate	$49.33
Max. Negotiated Rate	$49.33
Rate for Payer: Qualcare PPO/HMO/WC	$49.33

PLA 4HOLE LT PRO DOR 234801004

Facility

$3,474.15

Hospital Charge Code	270639859
Hospital Revenue Code	278
Min. Negotiated Rate	$521.12
Max. Negotiated Rate	$840.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$694.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.31
Rate for Payer: Qualcare PPO/HMO/WC	$521.12

PLA 4HOLE LT PRO DOR 234801004

Facility

$3,474.15

Hospital Charge Code	270639859
Hospital Revenue Code	278
Min. Negotiated Rate	$83.73
Max. Negotiated Rate	$1,737.08
Rate for Payer: Aetna Commercial	$1,320.18
Rate for Payer: Aetna Medicare Advantage	$1,042.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$694.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.91
Rate for Payer: Cigna Commercial	$1,737.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.31
Rate for Payer: Qualcare PPO/HMO/WC	$521.12
Rate for Payer: UnitedHealthcare Community & State	$83.73
Rate for Payer: Wellpoint Medicaid Managed Care	$92.06

PLACE CATH 1ST ORD ABD/L EXTR

Facility

$414.45

Service Code	HCPCS 36245
Hospital Charge Code	74110003
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

PLACE CATH 1ST ORD ABD/L EXTR

Facility

$414.45

Service Code	HCPCS 36245
Hospital Charge Code	5100014
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

PLACE CATH 1ST ORD ABD/L EXTR

Facility

$414.45

Service Code	HCPCS 36245
Hospital Charge Code	74110003
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

PLACE CATH 1ST ORD ABD/L EXTR

Facility

$414.45

Service Code	HCPCS 36245
Hospital Charge Code	5100014
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

PLACE CATH 1ST ORDER THORA

Facility

$1,214.10

Service Code	HCPCS 36215
Hospital Charge Code	5100370
Hospital Revenue Code	761
Min. Negotiated Rate	$182.12
Max. Negotiated Rate	$182.12
Rate for Payer: Qualcare PPO/HMO/WC	$182.12

PLACE CATH 1ST ORDER THORA

Facility

$1,214.10

Service Code	HCPCS 36215
Hospital Charge Code	5100370
Hospital Revenue Code	761
Min. Negotiated Rate	$29.26
Max. Negotiated Rate	$607.05
Rate for Payer: Aetna Commercial	$461.36
Rate for Payer: Aetna Medicare Advantage	$364.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.60
Rate for Payer: Cigna Commercial	$607.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.23
Rate for Payer: Oxford Commercial	$242.82
Rate for Payer: Qualcare PPO/HMO/WC	$182.12
Rate for Payer: UnitedHealthcare Commercial	$242.82
Rate for Payer: UnitedHealthcare Community & State	$29.26
Rate for Payer: Wellpoint Medicaid Managed Care	$32.17

PLACE CATH 2ND ORDER ABD L EXT

Facility

$331.55

Service Code	HCPCS 36246
Hospital Charge Code	5100480
Hospital Revenue Code	761
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$165.78
Rate for Payer: Aetna Commercial	$125.99
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.55
Rate for Payer: Cigna Commercial	$165.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.47
Rate for Payer: Oxford Commercial	$66.31
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$66.31
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

PLACE CATH 2ND ORDER ABD L EXT

Facility

$331.55

Service Code	HCPCS 36246
Hospital Charge Code	5100480
Hospital Revenue Code	761
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

PLACE CATH 3RD ORD ABD OR LEX

Facility

$331.55

Service Code	HCPCS 36247
Hospital Charge Code	5100460
Hospital Revenue Code	761
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$165.78
Rate for Payer: Aetna Commercial	$125.99
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.55
Rate for Payer: Cigna Commercial	$165.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.47
Rate for Payer: Oxford Commercial	$66.31
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$66.31
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

PLACE CATH 3RD ORD ABD OR LEX

Facility

$331.55

Service Code	HCPCS 36247
Hospital Charge Code	5100460
Hospital Revenue Code	761
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

PLACE CATH 3RD THOR/BRACHCEPH

Facility

$331.55

Service Code	HCPCS 36217
Hospital Charge Code	5100331
Hospital Revenue Code	761
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

Know your out-of-pocket cost for care.

All Charges