Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PRODISC C VIVO 17X14X6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270705157
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 17X14X6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270705157
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC C VIVO 7X16MM H5MM

Facility

$29,750.00

Hospital Charge Code	270702660
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 7X16MM H5MM

Facility

$29,750.00

Hospital Charge Code	270702660
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

PRODISC-C VIVO LD 17X16X6MM

Facility

$42,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698968
Hospital Revenue Code	278
Min. Negotiated Rate	$6,375.00
Max. Negotiated Rate	$10,285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,285.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,375.00

PRODISC-C VIVO LD 17X16X6MM

Facility

$42,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698968
Hospital Revenue Code	278
Min. Negotiated Rate	$1,024.25
Max. Negotiated Rate	$21,250.00
Rate for Payer: Aetna Commercial	$16,150.00
Rate for Payer: Aetna Medicare Advantage	$12,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,837.50
Rate for Payer: Cigna Commercial	$21,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,285.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,375.00
Rate for Payer: UnitedHealthcare Community & State	$1,024.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,126.25

PRODISC C VIVO REPLACE MED 5MM

Facility

$42,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697981
Hospital Revenue Code	278
Min. Negotiated Rate	$6,375.00
Max. Negotiated Rate	$10,285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,285.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,375.00

PRODISC C VIVO REPLACE MED 5MM

Facility

$42,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697981
Hospital Revenue Code	278
Min. Negotiated Rate	$1,024.25
Max. Negotiated Rate	$21,250.00
Rate for Payer: Aetna Commercial	$16,150.00
Rate for Payer: Aetna Medicare Advantage	$12,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,837.50
Rate for Payer: Cigna Commercial	$21,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,285.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,375.00
Rate for Payer: UnitedHealthcare Community & State	$1,024.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,126.25

PRODISC L, INFER. ENDPLATE M,

Facility

$27,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270706001
Hospital Revenue Code	278
Min. Negotiated Rate	$4,128.00
Max. Negotiated Rate	$6,659.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,504.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,659.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,054.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,128.00

PRODISC L, INFER. ENDPLATE M,

Facility

$27,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270706001
Hospital Revenue Code	278
Min. Negotiated Rate	$663.23
Max. Negotiated Rate	$13,760.00
Rate for Payer: Aetna Commercial	$10,457.60
Rate for Payer: Aetna Medicare Advantage	$8,256.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,017.60
Rate for Payer: Cigna Commercial	$13,760.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,659.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,054.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,128.00
Rate for Payer: UnitedHealthcare Community & State	$663.23
Rate for Payer: Wellpoint Medicaid Managed Care	$729.28

PRODISC L, PE INLAY M, 10MM

Facility

$11,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270706000
Hospital Revenue Code	278
Min. Negotiated Rate	$280.04
Max. Negotiated Rate	$5,810.00
Rate for Payer: Aetna Commercial	$4,415.60
Rate for Payer: Aetna Medicare Advantage	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,963.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,963.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,963.10
Rate for Payer: Cigna Commercial	$5,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,812.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,556.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.00
Rate for Payer: UnitedHealthcare Community & State	$280.04
Rate for Payer: Wellpoint Medicaid Managed Care	$307.93

PRODISC L, PE INLAY M, 10MM

Facility

$11,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270706000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.00
Max. Negotiated Rate	$2,812.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,812.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,556.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.00

PRODISC L SUPER. ENDPLATE M 3

Facility

$27,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705999
Hospital Revenue Code	278
Min. Negotiated Rate	$656.73
Max. Negotiated Rate	$13,625.00
Rate for Payer: Aetna Commercial	$10,355.00
Rate for Payer: Aetna Medicare Advantage	$8,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,948.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,948.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,948.75
Rate for Payer: Cigna Commercial	$13,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,594.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,995.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,087.50
Rate for Payer: UnitedHealthcare Community & State	$656.73
Rate for Payer: Wellpoint Medicaid Managed Care	$722.12

PRODISC L SUPER. ENDPLATE M 3

Facility

$27,520.00

Service Code	HCPCS C1713
Hospital Charge Code	27705999
Hospital Revenue Code	278
Min. Negotiated Rate	$663.23
Max. Negotiated Rate	$13,760.00
Rate for Payer: Aetna Commercial	$10,457.60
Rate for Payer: Aetna Medicare Advantage	$8,256.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,017.60
Rate for Payer: Cigna Commercial	$13,760.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,659.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,054.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,128.00
Rate for Payer: UnitedHealthcare Community & State	$663.23
Rate for Payer: Wellpoint Medicaid Managed Care	$729.28

PRODISC L SUPER. ENDPLATE M 3

Facility

$27,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705999
Hospital Revenue Code	278
Min. Negotiated Rate	$4,087.50
Max. Negotiated Rate	$6,594.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,594.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,995.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,087.50

PRODISC L SUPER. ENDPLATE M 3

Facility

$27,520.00

Service Code	HCPCS C1713
Hospital Charge Code	27705999
Hospital Revenue Code	278
Min. Negotiated Rate	$4,128.00
Max. Negotiated Rate	$6,659.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,504.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,659.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,054.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,128.00

PRODUCT AUTOLOG PACKED CELLS

Facility

$484.00

Service Code	HCPCS 86891
Hospital Charge Code	3100286
Hospital Revenue Code	300
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PRODUCT AUTOLOG PACKED CELLS

Facility

$484.00

Service Code	HCPCS 86891
Hospital Charge Code	3100286
Hospital Revenue Code	300
Min. Negotiated Rate	$12.83
Max. Negotiated Rate	$3,455.10
Rate for Payer: Aetna Commercial	$2,603.50
Rate for Payer: Aetna Medicare Advantage	$3,101.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,455.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$957.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,455.10
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$957.17
Rate for Payer: Clover Medicare Advantage	$909.31
Rate for Payer: EmblemHealth Commercial	$2,871.51
Rate for Payer: Humana Medicare Advantage	$985.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$75.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$957.17
Rate for Payer: Wellcare Medicare Advantage	$957.17
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

PRODUCT CRYOPRECIPITATES

Facility

$142.10

Hospital Charge Code	3100104
Hospital Revenue Code	390
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$54.00
Rate for Payer: Aetna Medicare Advantage	$42.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.24
Rate for Payer: Cigna Commercial	$71.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.63
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.32
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.77

PRODUCT CRYOPRECIPITATES

Facility

$142.10

Hospital Charge Code	3100104
Hospital Revenue Code	390
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$21.32
Rate for Payer: Qualcare PPO/HMO/WC	$21.32

PRODUCT DIRECT DONOR FFP

Facility

$203.55

Hospital Charge Code	3100377
Hospital Revenue Code	390
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

PRODUCT DIRECT DONOR FFP

Facility

$203.55

Hospital Charge Code	3100377
Hospital Revenue Code	390
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$77.35
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.06
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$4.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.39

PRODUCT FACTOR 8

Facility

$240.85

Hospital Charge Code	3100328
Hospital Revenue Code	636
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$120.42
Rate for Payer: Aetna Commercial	$91.52
Rate for Payer: Aetna Medicare Advantage	$72.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.42
Rate for Payer: Cigna Commercial	$120.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.29
Rate for Payer: Qualcare PPO/HMO/WC	$36.13
Rate for Payer: UnitedHealthcare Community & State	$5.80
Rate for Payer: Wellpoint Medicaid Managed Care	$6.38

PRODUCT FACTOR 8

Facility

$240.85

Hospital Charge Code	3100328
Hospital Revenue Code	636
Min. Negotiated Rate	$36.13
Max. Negotiated Rate	$58.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.29
Rate for Payer: Qualcare PPO/HMO/WC	$36.13

PRODUCTFRESH FROZEN PLASMA

Facility

$352.35

Service Code	HCPCS P9017
Hospital Charge Code	3100922
Hospital Revenue Code	390
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$271.95
Rate for Payer: Aetna Medicare Advantage	$323.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$99.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.90
Rate for Payer: Cigna Commercial	$200.40
Rate for Payer: Cigna Medicare Advantage	$99.98
Rate for Payer: Clover Medicare Advantage	$94.98
Rate for Payer: EmblemHealth Commercial	$299.94
Rate for Payer: Humana Medicare Advantage	$102.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$99.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.70
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.85
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$8.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$99.98
Rate for Payer: Wellcare Medicare Advantage	$99.98
Rate for Payer: Wellpoint Medicaid Managed Care	$9.34

Know your out-of-pocket cost for care.

All Charges