Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATELET PHERESIS LEUKOREDUCED

Facility

$5,626.57

Service Code	HCPCS P9035
Hospital Charge Code	3101513
Hospital Revenue Code	390
Min. Negotiated Rate	$843.99
Max. Negotiated Rate	$843.99
Rate for Payer: Qualcare PPO/HMO/WC	$843.99

PLATELET PHERESIS LEUKOREDUCED

Facility

$5,626.57

Service Code	HCPCS P9035
Hospital Charge Code	3101513
Hospital Revenue Code	390
Min. Negotiated Rate	$135.60
Max. Negotiated Rate	$2,147.41
Rate for Payer: Aetna Commercial	$1,618.13
Rate for Payer: Aetna Medicare Advantage	$1,927.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,147.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,147.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$594.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,147.41
Rate for Payer: Cigna Commercial	$1,192.48
Rate for Payer: Cigna Medicare Advantage	$594.90
Rate for Payer: Clover Medicare Advantage	$565.15
Rate for Payer: EmblemHealth Commercial	$1,784.70
Rate for Payer: Humana Medicare Advantage	$612.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$594.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.97
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$843.99
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$135.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$594.90
Rate for Payer: Wellcare Medicare Advantage	$594.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

PLATELET PHER LEUK CMV NEG IRR

Facility

$3,706.00

Hospital Charge Code	38471210
Hospital Revenue Code	390
Min. Negotiated Rate	$555.90
Max. Negotiated Rate	$555.90
Rate for Payer: Qualcare PPO/HMO/WC	$555.90

PLATELET PHER LEUK CMV NEG IRR

Facility

$3,706.00

Hospital Charge Code	38471210
Hospital Revenue Code	390
Min. Negotiated Rate	$89.31
Max. Negotiated Rate	$1,853.00
Rate for Payer: Aetna Commercial	$1,408.28
Rate for Payer: Aetna Medicare Advantage	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$945.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$945.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$945.03
Rate for Payer: Cigna Commercial	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,111.80
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$555.90
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$89.31
Rate for Payer: Wellpoint Medicaid Managed Care	$98.21

PLATELET P PLASMA

Facility

$348.85

Hospital Charge Code	8002578
Hospital Revenue Code	270
Min. Negotiated Rate	$8.41
Max. Negotiated Rate	$174.43
Rate for Payer: Aetna Commercial	$132.56
Rate for Payer: Aetna Medicare Advantage	$104.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.96
Rate for Payer: Cigna Commercial	$174.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.66
Rate for Payer: Oxford Commercial	$69.77
Rate for Payer: Qualcare PPO/HMO/WC	$52.33
Rate for Payer: UnitedHealthcare Commercial	$69.77
Rate for Payer: UnitedHealthcare Community & State	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$9.24

PLATELET P PLASMA

Facility

$348.85

Hospital Charge Code	8002578
Hospital Revenue Code	270
Min. Negotiated Rate	$52.33
Max. Negotiated Rate	$52.33
Rate for Payer: Qualcare PPO/HMO/WC	$52.33

PLATELET RICH PLASMA EACH UNIT

Facility

$2,172.22

Hospital Charge Code	3101505
Hospital Revenue Code	390
Min. Negotiated Rate	$325.83
Max. Negotiated Rate	$325.83
Rate for Payer: Qualcare PPO/HMO/WC	$325.83

PLATELET RICH PLASMA EACH UNIT

Facility

$2,172.22

Hospital Charge Code	3101505
Hospital Revenue Code	390
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$825.44
Rate for Payer: Aetna Medicare Advantage	$651.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$553.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$553.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$553.92
Rate for Payer: Cigna Commercial	$1,086.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$651.67
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$325.83
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$52.35
Rate for Payer: Wellpoint Medicaid Managed Care	$57.56

PLATELETS IRRADIATED

Facility

$904.31

Hospital Charge Code	3101510
Hospital Revenue Code	390
Min. Negotiated Rate	$135.65
Max. Negotiated Rate	$135.65
Rate for Payer: Qualcare PPO/HMO/WC	$135.65

PLATELETS IRRADIATED

Facility

$904.31

Hospital Charge Code	3101510
Hospital Revenue Code	390
Min. Negotiated Rate	$21.79
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$343.64
Rate for Payer: Aetna Medicare Advantage	$271.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.60
Rate for Payer: Cigna Commercial	$452.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.29
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.65
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$21.79
Rate for Payer: Wellpoint Medicaid Managed Care	$23.96

PLATELETS, IRRADIATED EA UNIT

Facility

$488.00

Hospital Charge Code	38471096
Hospital Revenue Code	384
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$185.44
Rate for Payer: Aetna Medicare Advantage	$146.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.44
Rate for Payer: Cigna Commercial	$244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.40
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.20
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$11.76
Rate for Payer: Wellpoint Medicaid Managed Care	$12.93

PLATELETS, IRRADIATED EA UNIT

Facility

$488.00

Hospital Charge Code	38471096
Hospital Revenue Code	384
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$73.20
Rate for Payer: Qualcare PPO/HMO/WC	$73.20

PLATELETS PHERESIS EACH UNIT

Facility

$2,577.63

Hospital Charge Code	3101512
Hospital Revenue Code	390
Min. Negotiated Rate	$62.12
Max. Negotiated Rate	$1,288.82
Rate for Payer: Aetna Commercial	$979.50
Rate for Payer: Aetna Medicare Advantage	$773.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$657.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$657.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$657.30
Rate for Payer: Cigna Commercial	$1,288.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$773.29
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$386.64
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$62.12
Rate for Payer: Wellpoint Medicaid Managed Care	$68.31

PLATELETS PHERESIS EACH UNIT

Facility

$2,577.63

Hospital Charge Code	3101512
Hospital Revenue Code	390
Min. Negotiated Rate	$386.64
Max. Negotiated Rate	$386.64
Rate for Payer: Qualcare PPO/HMO/WC	$386.64

PLATELETS PHERESIS LEUKORED

Facility

$3,198.72

Hospital Charge Code	38471204
Hospital Revenue Code	390
Min. Negotiated Rate	$77.09
Max. Negotiated Rate	$1,599.36
Rate for Payer: Aetna Commercial	$1,215.51
Rate for Payer: Aetna Medicare Advantage	$959.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$815.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$815.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$815.67
Rate for Payer: Cigna Commercial	$1,599.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$959.62
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$479.81
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$77.09
Rate for Payer: Wellpoint Medicaid Managed Care	$84.77

PLATELETS PHERESIS LEUKORED

Facility

$3,198.72

Hospital Charge Code	38471204
Hospital Revenue Code	390
Min. Negotiated Rate	$479.81
Max. Negotiated Rate	$479.81
Rate for Payer: Qualcare PPO/HMO/WC	$479.81

PLATELETS PHER IRRAD LEUKORED

Facility

$4,106.63

Hospital Charge Code	38471205
Hospital Revenue Code	390
Min. Negotiated Rate	$615.99
Max. Negotiated Rate	$615.99
Rate for Payer: Qualcare PPO/HMO/WC	$615.99

PLATELETS PHER IRRAD LEUKORED

Facility

$4,106.63

Hospital Charge Code	38471205
Hospital Revenue Code	390
Min. Negotiated Rate	$98.97
Max. Negotiated Rate	$2,053.32
Rate for Payer: Aetna Commercial	$1,560.52
Rate for Payer: Aetna Medicare Advantage	$1,231.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,047.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,047.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,047.19
Rate for Payer: Cigna Commercial	$2,053.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,231.99
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$615.99
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$98.97
Rate for Payer: Wellpoint Medicaid Managed Care	$108.83

PLATELETS PHER LEUKO CMV NEG

Facility

$2,638.00

Hospital Charge Code	38471212
Hospital Revenue Code	390
Min. Negotiated Rate	$395.70
Max. Negotiated Rate	$395.70
Rate for Payer: Qualcare PPO/HMO/WC	$395.70

PLATELETS PHER LEUKO CMV NEG

Facility

$2,638.00

Hospital Charge Code	38471212
Hospital Revenue Code	390
Min. Negotiated Rate	$63.58
Max. Negotiated Rate	$1,319.00
Rate for Payer: Aetna Commercial	$1,002.44
Rate for Payer: Aetna Medicare Advantage	$791.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$672.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$672.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$672.69
Rate for Payer: Cigna Commercial	$1,319.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$791.40
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$395.70
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$63.58
Rate for Payer: Wellpoint Medicaid Managed Care	$69.91

PLATE LEVEL 1 26 MM PYRENEES

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270689798
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE LEVEL 1 26 MM PYRENEES

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270689798
Hospital Revenue Code	278
Min. Negotiated Rate	$157.13
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$157.13
Rate for Payer: Wellpoint Medicaid Managed Care	$172.78

PLATE LEVEL 1 32MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692337
Hospital Revenue Code	278
Min. Negotiated Rate	$157.13
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$157.13
Rate for Payer: Wellpoint Medicaid Managed Care	$172.78

PLATE LEVEL 1 32MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692337
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE L-FUSION 2.4/2.7MM SH RT

Facility

$3,828.00

Service Code	HCPCS C1713
Hospital Charge Code	270675598
Hospital Revenue Code	278
Min. Negotiated Rate	$574.20
Max. Negotiated Rate	$926.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.16
Rate for Payer: Qualcare PPO/HMO/WC	$574.20

Know your out-of-pocket cost for care.

All Charges