Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RBC FRAGILITY INCUBATED

Facility

$390.00

Service Code	HCPCS 85557
Hospital Charge Code	3035139
Hospital Revenue Code	305
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$195.00
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	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.23
Rate for Payer: Cigna Commercial	$195.00
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	$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	$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	$10.34

RBC FRAGILITY INCUBATED

Facility

$390.00

Service Code	HCPCS 85557
Hospital Charge Code	3035139
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RBC FRAGILITY INCUBATED

Facility

$91.15

Hospital Charge Code	39708009
Hospital Revenue Code	305
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$34.64
Rate for Payer: Aetna Medicare Advantage	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.24
Rate for Payer: Cigna Commercial	$45.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.67
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

RBC FRAGILITY INCUBATED

Facility

$91.15

Hospital Charge Code	39708009
Hospital Revenue Code	305
Min. Negotiated Rate	$13.67
Max. Negotiated Rate	$13.67
Rate for Payer: Qualcare PPO/HMO/WC	$13.67

RBC FRAGILITY-INCUBATED

Facility

$91.85

Service Code	HCPCS 85557
Hospital Charge Code	39900177
Hospital Revenue Code	305
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$13.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.78

RBC FRAGILITY-INCUBATED

Facility

$91.85

Service Code	HCPCS 85557
Hospital Charge Code	39900177
Hospital Revenue Code	305
Min. Negotiated Rate	$2.43
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	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.23
Rate for Payer: Cigna Commercial	$45.92
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	$27.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.78
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	$2.43

RBC FRAGILITY (UNINCUBATED)

Facility

$50.45

Service Code	HCPCS 85555
Hospital Charge Code	3030343
Hospital Revenue Code	305
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$20.32
Rate for Payer: Aetna Medicare Advantage	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.96
Rate for Payer: Cigna Commercial	$25.23
Rate for Payer: Cigna Medicare Advantage	$7.47
Rate for Payer: Clover Medicare Advantage	$7.10
Rate for Payer: EmblemHealth Commercial	$22.41
Rate for Payer: Humana Medicare Advantage	$7.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.47
Rate for Payer: Wellcare Medicare Advantage	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

RBC FRAGILITY (UNINCUBATED)

Facility

$50.45

Service Code	HCPCS 85555
Hospital Charge Code	3030343
Hospital Revenue Code	305
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.57

RBC HISTOGRAM***

Facility

$44.00

Service Code	HCPCS 85025
Hospital Charge Code	3031184
Hospital Revenue Code	309
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$21.13
Rate for Payer: Aetna Medicare Advantage	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: Cigna Medicare Advantage	$7.77
Rate for Payer: Clover Medicare Advantage	$7.38
Rate for Payer: EmblemHealth Commercial	$23.31
Rate for Payer: Humana Medicare Advantage	$8.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.77
Rate for Payer: Wellcare Medicare Advantage	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

RBC HISTOGRAM***

Facility

$44.00

Service Code	HCPCS 85025
Hospital Charge Code	3031184
Hospital Revenue Code	309
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

RBC IRRADIATED EACH UNIT

Facility

$1,378.79

Hospital Charge Code	3101516
Hospital Revenue Code	390
Min. Negotiated Rate	$206.82
Max. Negotiated Rate	$206.82
Rate for Payer: Qualcare PPO/HMO/WC	$206.82

RBC IRRADIATED EACH UNIT

Facility

$1,378.79

Hospital Charge Code	3101516
Hospital Revenue Code	390
Min. Negotiated Rate	$33.23
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$523.94
Rate for Payer: Aetna Medicare Advantage	$413.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.59
Rate for Payer: Cigna Commercial	$689.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.64
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.82
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$33.23
Rate for Payer: Wellpoint Medicaid Managed Care	$36.54

RBC IRRADIATED LEUKO REDUCED

Facility

$1,036.00

Service Code	HCPCS P9040
Hospital Charge Code	3101038
Hospital Revenue Code	390
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$155.40
Rate for Payer: Qualcare PPO/HMO/WC	$155.40

RBC IRRADIATED LEUKO REDUCED

Facility

$1,036.00

Service Code	HCPCS P9040
Hospital Charge Code	3101038
Hospital Revenue Code	390
Min. Negotiated Rate	$24.97
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$839.47
Rate for Payer: Aetna Medicare Advantage	$999.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,114.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,114.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$308.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,114.06
Rate for Payer: Cigna Commercial	$618.64
Rate for Payer: Cigna Medicare Advantage	$308.63
Rate for Payer: Clover Medicare Advantage	$293.20
Rate for Payer: EmblemHealth Commercial	$925.89
Rate for Payer: Humana Medicare Advantage	$317.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$308.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.80
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$155.40
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$24.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$308.63
Rate for Payer: Wellcare Medicare Advantage	$308.63
Rate for Payer: Wellpoint Medicaid Managed Care	$27.45

RBC LEUKO DEGLYC/WASHED IRR

Facility

$1,242.45

Hospital Charge Code	3100310
Hospital Revenue Code	390
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$472.13
Rate for Payer: Aetna Medicare Advantage	$372.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.82
Rate for Payer: Cigna Commercial	$621.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.74
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.37
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$29.94
Rate for Payer: Wellpoint Medicaid Managed Care	$32.92

RBC LEUKO DEGLYC/WASHED IRR

Facility

$1,242.45

Hospital Charge Code	3100310
Hospital Revenue Code	390
Min. Negotiated Rate	$186.37
Max. Negotiated Rate	$186.37
Rate for Payer: Qualcare PPO/HMO/WC	$186.37

RBC LEUKO IRRAD CMV NEG

Facility

$1,816.35

Hospital Charge Code	38471215
Hospital Revenue Code	390
Min. Negotiated Rate	$272.45
Max. Negotiated Rate	$272.45
Rate for Payer: Qualcare PPO/HMO/WC	$272.45

RBC LEUKO IRRAD CMV NEG

Facility

$1,816.35

Hospital Charge Code	38471215
Hospital Revenue Code	390
Min. Negotiated Rate	$43.77
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$690.21
Rate for Payer: Aetna Medicare Advantage	$544.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$463.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$463.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$463.17
Rate for Payer: Cigna Commercial	$908.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.90
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$272.45
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$43.77
Rate for Payer: Wellpoint Medicaid Managed Care	$48.13

RBC LEUKO REDUCED CMV-NEG

Facility

$990.90

Hospital Charge Code	3101527
Hospital Revenue Code	390
Min. Negotiated Rate	$148.63
Max. Negotiated Rate	$148.63
Rate for Payer: Qualcare PPO/HMO/WC	$148.63

RBC LEUKO REDUCED CMV-NEG

Facility

$990.90

Hospital Charge Code	3101527
Hospital Revenue Code	390
Min. Negotiated Rate	$23.88
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$376.54
Rate for Payer: Aetna Medicare Advantage	$297.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.68
Rate for Payer: Cigna Commercial	$495.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.27
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$148.63
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$23.88
Rate for Payer: Wellpoint Medicaid Managed Care	$26.26

RBC LEUK REDU CMV-NEG IRRADIAT

Facility

$2,072.35

Hospital Charge Code	3101534
Hospital Revenue Code	390
Min. Negotiated Rate	$49.94
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$787.49
Rate for Payer: Aetna Medicare Advantage	$621.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$528.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$528.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$528.45
Rate for Payer: Cigna Commercial	$1,036.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.71
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.85
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$49.94
Rate for Payer: Wellpoint Medicaid Managed Care	$54.92

RBC LEUK REDU CMV-NEG IRRADIAT

Facility

$2,072.35

Hospital Charge Code	3101534
Hospital Revenue Code	390
Min. Negotiated Rate	$310.85
Max. Negotiated Rate	$310.85
Rate for Payer: Qualcare PPO/HMO/WC	$310.85

RBC LEUK REDU FROZ DEGLY WSH

Facility

$699.05

Hospital Charge Code	3101530
Hospital Revenue Code	390
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$265.64
Rate for Payer: Aetna Medicare Advantage	$209.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.26
Rate for Payer: Cigna Commercial	$349.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.72
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.86
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$16.85
Rate for Payer: Wellpoint Medicaid Managed Care	$18.52

RBC LEUK REDU FROZ DEGLY WSH

Facility

$699.05

Hospital Charge Code	3101530
Hospital Revenue Code	390
Min. Negotiated Rate	$104.86
Max. Negotiated Rate	$104.86
Rate for Payer: Qualcare PPO/HMO/WC	$104.86

RBC MAGNESIUM

Facility

$390.00

Service Code	HCPCS 83735
Hospital Charge Code	39900443
Hospital Revenue Code	301
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.22
Rate for Payer: Aetna Medicare Advantage	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.18
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.70
Rate for Payer: Clover Medicare Advantage	$6.37
Rate for Payer: EmblemHealth Commercial	$20.10
Rate for Payer: Humana Medicare Advantage	$6.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.70
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	$5.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.70
Rate for Payer: Wellcare Medicare Advantage	$6.70
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges