Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POTASSIUM URINE

Facility

$390.00

Service Code	HCPCS 84133
Hospital Charge Code	39990241I
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

POTASSIUM URINE

Facility

$390.00

Service Code	HCPCS 84133
Hospital Charge Code	39990241I
Hospital Revenue Code	301
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$12.87
Rate for Payer: Aetna Medicare Advantage	$15.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.07
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.73
Rate for Payer: Clover Medicare Advantage	$4.49
Rate for Payer: EmblemHealth Commercial	$14.19
Rate for Payer: Humana Medicare Advantage	$4.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.73
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	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.73
Rate for Payer: Wellcare Medicare Advantage	$4.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

POTASSIUM, URINE

Facility

$169.89

Service Code	HCPCS 84133
Hospital Charge Code	3030814
Hospital Revenue Code	301
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$25.48
Rate for Payer: Qualcare PPO/HMO/WC	$25.48

POTASSIUM, URINE

Facility

$169.89

Service Code	HCPCS 84133
Hospital Charge Code	3030814
Hospital Revenue Code	301
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.87
Rate for Payer: Aetna Medicare Advantage	$15.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.07
Rate for Payer: Cigna Commercial	$84.94
Rate for Payer: Cigna Medicare Advantage	$4.73
Rate for Payer: Clover Medicare Advantage	$4.49
Rate for Payer: EmblemHealth Commercial	$14.19
Rate for Payer: Humana Medicare Advantage	$4.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.48
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.73
Rate for Payer: Wellcare Medicare Advantage	$4.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

POTASSIUM, URINE, 24 HOUR

Facility

$667.59

Service Code	HCPCS 84133
Hospital Charge Code	3030889
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

POTASSIUM, URINE, 24 HOUR

Facility

$667.59

Service Code	HCPCS 84133
Hospital Charge Code	3030889
Hospital Revenue Code	301
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$12.87
Rate for Payer: Aetna Medicare Advantage	$15.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.07
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$4.73
Rate for Payer: Clover Medicare Advantage	$4.49
Rate for Payer: EmblemHealth Commercial	$14.19
Rate for Payer: Humana Medicare Advantage	$4.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.73
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	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.73
Rate for Payer: Wellcare Medicare Advantage	$4.73
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

POTASSIUM,URINE K

Facility

$119.00

Service Code	HCPCS 84133
Hospital Charge Code	38472554
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.87
Rate for Payer: Aetna Medicare Advantage	$15.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.07
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: Cigna Medicare Advantage	$4.73
Rate for Payer: Clover Medicare Advantage	$4.49
Rate for Payer: EmblemHealth Commercial	$14.19
Rate for Payer: Humana Medicare Advantage	$4.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.73
Rate for Payer: Wellcare Medicare Advantage	$4.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

POTASSIUM,URINE K

Facility

$119.00

Service Code	HCPCS 84133
Hospital Charge Code	38472554
Hospital Revenue Code	301
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

POT. CHL 10% LIQ/3840ML

Facility

$6.00

Hospital Charge Code	60634670
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

POT. CHL 10% LIQ/3840ML

Facility

$6.00

Hospital Charge Code	60634670
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

POUCH 1ST CHOICE POSTOP 9763

Facility

$52.00

Hospital Charge Code	270610999
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

POUCH 1ST CHOICE POSTOP 9763

Facility

$52.00

Hospital Charge Code	270610999
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

POUCH CLOSED-END 1 1/2

Facility

$9.65

Hospital Charge Code	270303155
Hospital Revenue Code	270
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

POUCH CLOSED-END 1 1/2

Facility

$9.65

Hospital Charge Code	270303155
Hospital Revenue Code	270
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

POUCH COLOSTOMY OPENEND ALL SZ

Facility

$14.45

Hospital Charge Code	270632018
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

POUCH COLOSTOMY OPENEND ALL SZ

Facility

$14.45

Hospital Charge Code	270632018
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.22
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: Aetna Medicare Advantage	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.68
Rate for Payer: Cigna Commercial	$7.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.33
Rate for Payer: Oxford Commercial	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Commercial	$2.89
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

POUCH COLOST OPEN 2.75 401936

Facility

$14.45

Hospital Charge Code	270624127
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

POUCH COLOST OPEN 2.75 401936

Facility

$14.45

Hospital Charge Code	270624127
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.22
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: Aetna Medicare Advantage	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.68
Rate for Payer: Cigna Commercial	$7.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.33
Rate for Payer: Oxford Commercial	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Commercial	$2.89
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

POUCH DRAINA 1 3/4 45MM 413312

Facility

$10.47

Hospital Charge Code	270649908
Hospital Revenue Code	270
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.24
Rate for Payer: Aetna Commercial	$3.98
Rate for Payer: Aetna Medicare Advantage	$3.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.67
Rate for Payer: Cigna Commercial	$5.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.14
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

POUCH DRAINA 1 3/4 45MM 413312

Facility

$10.47

Hospital Charge Code	270649908
Hospital Revenue Code	270
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

POUCH DRAINABLE CUSTOM

Facility

$5.44

Hospital Charge Code	270649485
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Qualcare PPO/HMO/WC	$0.82

POUCH DRAINABLE CUSTOM

Facility

$5.44

Hospital Charge Code	270649485
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.72
Rate for Payer: Aetna Commercial	$2.07
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.39
Rate for Payer: Cigna Commercial	$2.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.63
Rate for Payer: Oxford Commercial	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.82
Rate for Payer: UnitedHealthcare Commercial	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

POUCH DRAINAGE 2-3/4 413314

Facility

$10.27

Hospital Charge Code	270649949
Hospital Revenue Code	270
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.13
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.62
Rate for Payer: Cigna Commercial	$5.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.08
Rate for Payer: Oxford Commercial	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$2.05
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

POUCH DRAINAGE 2-3/4 413314

Facility

$10.27

Hospital Charge Code	270649949
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

POUCH DRAIN INVISICLOSE 2-1/4

Facility

$10.27

Hospital Charge Code	270650524
Hospital Revenue Code	272
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

Know your out-of-pocket cost for care.

All Charges