Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PORPHYRINS, FRACT, PLASMA

Facility

$231.25

Service Code	HCPCS 84202
Hospital Charge Code	3035079
Hospital Revenue Code	300
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

PORPHYRINS, FRACT, PLASMA

Facility

$231.25

Service Code	HCPCS 84202
Hospital Charge Code	3035079
Hospital Revenue Code	300
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.03
Rate for Payer: Aetna Medicare Advantage	$46.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.80
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$14.35
Rate for Payer: Clover Medicare Advantage	$13.63
Rate for Payer: EmblemHealth Commercial	$43.05
Rate for Payer: Humana Medicare Advantage	$14.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.35
Rate for Payer: Wellcare Medicare Advantage	$14.35
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

PORPHYRINS QUALI***

Facility

$27.00

Hospital Charge Code	3012143
Hospital Revenue Code	309
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

PORPHYRINS QUALI***

Facility

$27.00

Hospital Charge Code	3012143
Hospital Revenue Code	309
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

PORPHYRINS URINE FRACT

Facility

$231.25

Service Code	HCPCS 84120
Hospital Charge Code	3004363
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.01
Rate for Payer: Aetna Medicare Advantage	$47.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.10
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$14.71
Rate for Payer: Clover Medicare Advantage	$13.97
Rate for Payer: EmblemHealth Commercial	$44.13
Rate for Payer: Humana Medicare Advantage	$15.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.71
Rate for Payer: Wellcare Medicare Advantage	$14.71
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

PORPHYRINS URINE FRACT

Facility

$231.25

Service Code	HCPCS 84120
Hospital Charge Code	3004363
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

PORPHYRINS, URINE QUAL

Facility

$91.25

Service Code	HCPCS 84119
Hospital Charge Code	3002144
Hospital Revenue Code	301
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

PORPHYRINS, URINE QUAL

Facility

$91.25

Service Code	HCPCS 84119
Hospital Charge Code	3002144
Hospital Revenue Code	301
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.34
Rate for Payer: Aetna Medicare Advantage	$43.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.23
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: Cigna Medicare Advantage	$13.36
Rate for Payer: Clover Medicare Advantage	$12.69
Rate for Payer: EmblemHealth Commercial	$40.08
Rate for Payer: Humana Medicare Advantage	$13.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.36
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	$10.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.36
Rate for Payer: Wellcare Medicare Advantage	$13.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

PORPHYRINS,URINE,QUANT & FCT

Facility

$148.00

Service Code	HCPCS 84120
Hospital Charge Code	38472548
Hospital Revenue Code	301
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.01
Rate for Payer: Aetna Medicare Advantage	$47.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.10
Rate for Payer: Cigna Commercial	$74.00
Rate for Payer: Cigna Medicare Advantage	$14.71
Rate for Payer: Clover Medicare Advantage	$13.97
Rate for Payer: EmblemHealth Commercial	$44.13
Rate for Payer: Humana Medicare Advantage	$15.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.71
Rate for Payer: Wellcare Medicare Advantage	$14.71
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

PORPHYRINS,URINE,QUANT & FCT

Facility

$148.00

Service Code	HCPCS 84120
Hospital Charge Code	38472548
Hospital Revenue Code	301
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

PORT 8 FR LOW PROFILE

Facility

$3,545.55

Service Code	HCPCS C1713
Hospital Charge Code	270701572
Hospital Revenue Code	278
Min. Negotiated Rate	$85.45
Max. Negotiated Rate	$1,772.78
Rate for Payer: Aetna Commercial	$1,347.31
Rate for Payer: Aetna Medicare Advantage	$1,063.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$904.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$904.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$709.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$904.12
Rate for Payer: Cigna Commercial	$1,772.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$780.02
Rate for Payer: Qualcare PPO/HMO/WC	$531.83
Rate for Payer: UnitedHealthcare Community & State	$85.45
Rate for Payer: Wellpoint Medicaid Managed Care	$93.96

PORT 8 FR LOW PROFILE

Facility

$3,545.55

Service Code	HCPCS C1713
Hospital Charge Code	270701572
Hospital Revenue Code	278
Min. Negotiated Rate	$531.83
Max. Negotiated Rate	$858.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$709.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$780.02
Rate for Payer: Qualcare PPO/HMO/WC	$531.83

PORT A CATH 607100 **********

Facility

$1,114.00

Hospital Charge Code	1608090
Hospital Revenue Code	272
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$557.00
Rate for Payer: Aetna Commercial	$423.32
Rate for Payer: Aetna Medicare Advantage	$334.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.07
Rate for Payer: Cigna Commercial	$557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.20
Rate for Payer: Oxford Commercial	$222.80
Rate for Payer: Qualcare PPO/HMO/WC	$167.10
Rate for Payer: UnitedHealthcare Commercial	$222.80
Rate for Payer: UnitedHealthcare Community & State	$26.85
Rate for Payer: Wellpoint Medicaid Managed Care	$29.52

PORT A CATH 607100 **********

Facility

$1,114.00

Hospital Charge Code	1608090
Hospital Revenue Code	272
Min. Negotiated Rate	$167.10
Max. Negotiated Rate	$167.10
Rate for Payer: Qualcare PPO/HMO/WC	$167.10

PORTACATH 6FR 1716000

Facility

$2,375.00

Hospital Charge Code	270644108
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

PORTACATH 6FR 1716000

Facility

$2,375.00

Hospital Charge Code	270644108
Hospital Revenue Code	278
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$574.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

PORTACATH ATTACH 12FR 0603500

Facility

$2,491.25

Hospital Charge Code	270614596
Hospital Revenue Code	278
Min. Negotiated Rate	$60.04
Max. Negotiated Rate	$1,245.62
Rate for Payer: Aetna Commercial	$946.67
Rate for Payer: Aetna Medicare Advantage	$747.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$635.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$635.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$635.27
Rate for Payer: Cigna Commercial	$1,245.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$602.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$548.08
Rate for Payer: Qualcare PPO/HMO/WC	$373.69
Rate for Payer: UnitedHealthcare Community & State	$60.04
Rate for Payer: Wellpoint Medicaid Managed Care	$66.02

PORTACATH ATTACH 12FR 0603500

Facility

$2,491.25

Hospital Charge Code	270614596
Hospital Revenue Code	278
Min. Negotiated Rate	$373.69
Max. Negotiated Rate	$602.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$602.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$548.08
Rate for Payer: Qualcare PPO/HMO/WC	$373.69

PORTACATH ATTACH 8FR 0605420

Facility

$2,085.00

Service Code	HCPCS C1751
Hospital Charge Code	270614597
Hospital Revenue Code	278
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$1,042.50
Rate for Payer: Aetna Commercial	$792.30
Rate for Payer: Aetna Medicare Advantage	$625.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$417.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.67
Rate for Payer: Cigna Commercial	$1,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$458.70
Rate for Payer: Qualcare PPO/HMO/WC	$312.75
Rate for Payer: UnitedHealthcare Community & State	$50.25
Rate for Payer: Wellpoint Medicaid Managed Care	$55.25

PORTACATH ATTACH 8FR 0605420

Facility

$2,085.00

Service Code	HCPCS C1751
Hospital Charge Code	270614597
Hospital Revenue Code	278
Min. Negotiated Rate	$312.75
Max. Negotiated Rate	$504.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$417.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$458.70
Rate for Payer: Qualcare PPO/HMO/WC	$312.75

PORT-A-CATH DUAL 607100

Facility

$4,271.25

Hospital Charge Code	270603496
Hospital Revenue Code	272
Min. Negotiated Rate	$102.94
Max. Negotiated Rate	$2,135.62
Rate for Payer: Aetna Commercial	$1,623.08
Rate for Payer: Aetna Medicare Advantage	$1,281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,089.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,089.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,089.17
Rate for Payer: Cigna Commercial	$2,135.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,281.38
Rate for Payer: Oxford Commercial	$854.25
Rate for Payer: Qualcare PPO/HMO/WC	$640.69
Rate for Payer: UnitedHealthcare Commercial	$854.25
Rate for Payer: UnitedHealthcare Community & State	$102.94
Rate for Payer: Wellpoint Medicaid Managed Care	$113.19

PORT-A-CATH DUAL 607100

Facility

$4,271.25

Hospital Charge Code	270603496
Hospital Revenue Code	272
Min. Negotiated Rate	$640.69
Max. Negotiated Rate	$640.69
Rate for Payer: Qualcare PPO/HMO/WC	$640.69

PORT-A-CATH DUAL MRI 0605930

Facility

$4,667.25

Hospital Charge Code	270606446
Hospital Revenue Code	278
Min. Negotiated Rate	$700.09
Max. Negotiated Rate	$1,129.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$933.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,129.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,026.80
Rate for Payer: Qualcare PPO/HMO/WC	$700.09

PORT-A-CATH DUAL MRI 0605930

Facility

$4,667.25

Hospital Charge Code	270606446
Hospital Revenue Code	278
Min. Negotiated Rate	$112.48
Max. Negotiated Rate	$2,333.62
Rate for Payer: Aetna Commercial	$1,773.56
Rate for Payer: Aetna Medicare Advantage	$1,400.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,190.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,190.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$933.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,190.15
Rate for Payer: Cigna Commercial	$2,333.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,129.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,026.80
Rate for Payer: Qualcare PPO/HMO/WC	$700.09
Rate for Payer: UnitedHealthcare Community & State	$112.48
Rate for Payer: Wellpoint Medicaid Managed Care	$123.68

PORT A CATH POWER PORT 8F S

Facility

$3,215.00

Service Code	HCPCS C1788
Hospital Charge Code	270688735
Hospital Revenue Code	278
Min. Negotiated Rate	$482.25
Max. Negotiated Rate	$778.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$707.30
Rate for Payer: Qualcare PPO/HMO/WC	$482.25

Know your out-of-pocket cost for care.

All Charges