Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLASMA PROTEIN 5% INJ 250ML

Facility

$90.90

Hospital Charge Code	6004451
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$45.45
Rate for Payer: Aetna Commercial	$34.54
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.27
Rate for Payer: Oxford Commercial	$18.18
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Commercial	$18.18
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

PLASMA PROTEIN INJ 500ML

Facility

$826.25

Hospital Charge Code	6006761
Hospital Revenue Code	250
Min. Negotiated Rate	$19.91
Max. Negotiated Rate	$413.12
Rate for Payer: Aetna Commercial	$313.98
Rate for Payer: Aetna Medicare Advantage	$247.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.69
Rate for Payer: Cigna Commercial	$413.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.88
Rate for Payer: Oxford Commercial	$165.25
Rate for Payer: Qualcare PPO/HMO/WC	$123.94
Rate for Payer: UnitedHealthcare Commercial	$165.25
Rate for Payer: UnitedHealthcare Community & State	$19.91
Rate for Payer: Wellpoint Medicaid Managed Care	$21.90

PLASMA PROTEIN INJ 500ML

Facility

$826.25

Hospital Charge Code	6006761
Hospital Revenue Code	250
Min. Negotiated Rate	$123.94
Max. Negotiated Rate	$123.94
Rate for Payer: Qualcare PPO/HMO/WC	$123.94

PLASMA RENIN ACTIVITY

Facility

$667.59

Service Code	HCPCS 84244
Hospital Charge Code	39900128
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PLASMA RENIN ACTIVITY

Facility

$667.59

Service Code	HCPCS 84244
Hospital Charge Code	39900128
Hospital Revenue Code	301
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$59.81
Rate for Payer: Aetna Medicare Advantage	$71.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.38
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$21.99
Rate for Payer: Clover Medicare Advantage	$20.89
Rate for Payer: EmblemHealth Commercial	$65.97
Rate for Payer: Humana Medicare Advantage	$22.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.99
Rate for Payer: Wellcare Medicare Advantage	$21.99
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PLASMA STEM STRAIGHT 13x167MM

Facility

$28,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270676119
Hospital Revenue Code	278
Min. Negotiated Rate	$4,263.00
Max. Negotiated Rate	$6,877.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,684.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,877.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,252.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,263.00

PLASMA STEM STRAIGHT 13x167MM

Facility

$28,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270676119
Hospital Revenue Code	278
Min. Negotiated Rate	$684.92
Max. Negotiated Rate	$14,210.00
Rate for Payer: Aetna Commercial	$10,799.60
Rate for Payer: Aetna Medicare Advantage	$8,526.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,684.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,247.10
Rate for Payer: Cigna Commercial	$14,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,877.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,252.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,263.00
Rate for Payer: UnitedHealthcare Community & State	$684.92
Rate for Payer: Wellpoint Medicaid Managed Care	$753.13

PLASMAX 800-0515

Facility

$4,005.00

Hospital Charge Code	270637573
Hospital Revenue Code	272
Min. Negotiated Rate	$96.52
Max. Negotiated Rate	$2,002.50
Rate for Payer: Aetna Commercial	$1,521.90
Rate for Payer: Aetna Medicare Advantage	$1,201.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,021.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,021.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,021.27
Rate for Payer: Cigna Commercial	$2,002.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,201.50
Rate for Payer: Oxford Commercial	$801.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.75
Rate for Payer: UnitedHealthcare Commercial	$801.00
Rate for Payer: UnitedHealthcare Community & State	$96.52
Rate for Payer: Wellpoint Medicaid Managed Care	$106.13

PLASMAX 800-0515

Facility

$4,005.00

Hospital Charge Code	270637573
Hospital Revenue Code	272
Min. Negotiated Rate	$600.75
Max. Negotiated Rate	$600.75
Rate for Payer: Qualcare PPO/HMO/WC	$600.75

PLASMAX 800-0517

Facility

$4,505.00

Service Code	HCPCS C1713
Hospital Charge Code	270640107
Hospital Revenue Code	272
Min. Negotiated Rate	$675.75
Max. Negotiated Rate	$675.75
Rate for Payer: Qualcare PPO/HMO/WC	$675.75

PLASMAX 800-0517

Facility

$4,505.00

Service Code	HCPCS C1713
Hospital Charge Code	270640107
Hospital Revenue Code	272
Min. Negotiated Rate	$108.57
Max. Negotiated Rate	$2,252.50
Rate for Payer: Aetna Commercial	$1,711.90
Rate for Payer: Aetna Medicare Advantage	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,148.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,148.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,148.78
Rate for Payer: Cigna Commercial	$2,252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,351.50
Rate for Payer: Oxford Commercial	$901.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.75
Rate for Payer: UnitedHealthcare Commercial	$901.00
Rate for Payer: UnitedHealthcare Community & State	$108.57
Rate for Payer: Wellpoint Medicaid Managed Care	$119.38

PLASMINOGEN ACTIVATOR INH

Facility

$390.00

Service Code	HCPCS 85415
Hospital Charge Code	39900173
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PLASMINOGEN ACTIVATOR INH

Facility

$390.00

Service Code	HCPCS 85415
Hospital Charge Code	39900173
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.76
Rate for Payer: Aetna Medicare Advantage	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.19
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	$62.05
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.19
Rate for Payer: Clover Medicare Advantage	$16.33
Rate for Payer: EmblemHealth Commercial	$51.57
Rate for Payer: Humana Medicare Advantage	$17.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.19
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	$13.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.19
Rate for Payer: Wellcare Medicare Advantage	$17.19
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PLASMINOGEN ACTIVITY

Facility

$390.00

Service Code	HCPCS 85420
Hospital Charge Code	39900352
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PLASMINOGEN ACTIVITY

Facility

$390.00

Service Code	HCPCS 85420
Hospital Charge Code	39900352
Hospital Revenue Code	305
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$17.76
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.57
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.53
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.53
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	$5.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Medicare Advantage	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PLASMINOGEN AG ( PLASMA)

Facility

$50.90

Service Code	HCPCS 85421
Hospital Charge Code	401185421
Hospital Revenue Code	306
Min. Negotiated Rate	$7.63
Max. Negotiated Rate	$7.63
Rate for Payer: Qualcare PPO/HMO/WC	$7.63

PLASMINOGEN AG ( PLASMA)

Facility

$50.90

Service Code	HCPCS 85421
Hospital Charge Code	401185421
Hospital Revenue Code	306
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.75
Rate for Payer: Cigna Commercial	$25.45
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.63
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

PLASMINOGEN (FUNCTIONAL)

Facility

$91.25

Service Code	HCPCS 85420
Hospital Charge Code	3008455
Hospital Revenue Code	305
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.76
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.57
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: Cigna Medicare Advantage	$6.53
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Medicare Advantage	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

PLASMINOGEN (FUNCTIONAL)

Facility

$91.25

Service Code	HCPCS 85420
Hospital Charge Code	3008455
Hospital Revenue Code	305
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

PLASMINOGEN,FUNCTIONAL

Facility

$44.90

Service Code	HCPCS 85420
Hospital Charge Code	39900174
Hospital Revenue Code	305
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$6.74
Rate for Payer: Qualcare PPO/HMO/WC	$6.74

PLASMINOGEN,FUNCTIONAL

Facility

$48.00

Service Code	HCPCS 85420
Hospital Charge Code	38473151
Hospital Revenue Code	305
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.76
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.57
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: Cigna Medicare Advantage	$6.53
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Medicare Advantage	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

PLASMINOGEN,FUNCTIONAL

Facility

$48.00

Service Code	HCPCS 85420
Hospital Charge Code	38473151
Hospital Revenue Code	305
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

PLASMINOGEN,FUNCTIONAL

Facility

$44.90

Service Code	HCPCS 85420
Hospital Charge Code	39900174
Hospital Revenue Code	305
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.76
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.57
Rate for Payer: Cigna Commercial	$22.45
Rate for Payer: Cigna Medicare Advantage	$6.53
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.47
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.74
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Medicare Advantage	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

PLASTER BANDAGE ROLL 4

Facility

$7.50

Hospital Charge Code	270650472
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.25
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.50
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

PLASTER BANDAGE ROLL 4

Facility

$7.50

Hospital Charge Code	270650472
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

Know your out-of-pocket cost for care.

All Charges