Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RESPIRATORY SYNCYTIAL VIRUS AN

Facility

$180.00

Service Code	HCPCS 86756
Hospital Charge Code	38476182
Hospital Revenue Code	302
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.22
Rate for Payer: Aetna Medicare Advantage	$51.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.36
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: Cigna Medicare Advantage	$15.89
Rate for Payer: Clover Medicare Advantage	$15.10
Rate for Payer: EmblemHealth Commercial	$47.67
Rate for Payer: Humana Medicare Advantage	$16.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.89
Rate for Payer: Wellcare Medicare Advantage	$15.89
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$90,976.61

Service Code	MSDRG 208
Min. Negotiated Rate	$27,701.21
Max. Negotiated Rate	$90,976.61
Rate for Payer: Aetna Commercial	$62,768.64
Rate for Payer: Aetna Medicare Advantage	$90,976.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62,804.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62,804.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29,159.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62,804.70
Rate for Payer: Cigna Commercial	$51,439.17
Rate for Payer: Cigna Medicare Advantage	$29,159.17
Rate for Payer: Clover Medicare Advantage	$27,701.21
Rate for Payer: EmblemHealth Commercial	$87,477.51
Rate for Payer: Humana Medicare Advantage	$30,033.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29,159.17
Rate for Payer: Oxford Commercial	$36,970.01
Rate for Payer: UnitedHealthcare Commercial	$64,828.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$29,159.17
Rate for Payer: Wellcare Medicare Advantage	$29,159.17

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$50,362.39

Service Code	APR-DRG 1303
Min. Negotiated Rate	$49,374.89
Max. Negotiated Rate	$50,362.39
Rate for Payer: UnitedHealthcare Community & State	$49,374.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$50,362.39
Rate for Payer: Wellpoint Medicaid Managed Care	$49,374.89

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$37,513.56

Service Code	APR-DRG 1301
Min. Negotiated Rate	$36,778.00
Max. Negotiated Rate	$37,513.56
Rate for Payer: UnitedHealthcare Community & State	$36,778.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$37,513.56
Rate for Payer: Wellpoint Medicaid Managed Care	$36,778.00

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$65,837.36

Service Code	APR-DRG 1304
Min. Negotiated Rate	$64,546.43
Max. Negotiated Rate	$65,837.36
Rate for Payer: UnitedHealthcare Community & State	$64,546.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$65,837.36
Rate for Payer: Wellpoint Medicaid Managed Care	$64,546.43

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$42,428.88

Service Code	APR-DRG 1302
Min. Negotiated Rate	$41,596.94
Max. Negotiated Rate	$42,428.88
Rate for Payer: UnitedHealthcare Community & State	$41,596.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$42,428.88
Rate for Payer: Wellpoint Medicaid Managed Care	$41,596.94

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$210,114.22

Service Code	MSDRG 207
Min. Negotiated Rate	$63,977.08
Max. Negotiated Rate	$210,114.22
Rate for Payer: Aetna Commercial	$144,629.73
Rate for Payer: Aetna Medicare Advantage	$210,114.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160,733.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160,733.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$67,344.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160,733.51
Rate for Payer: Cigna Commercial	$120,418.98
Rate for Payer: Cigna Medicare Advantage	$67,344.30
Rate for Payer: Clover Medicare Advantage	$63,977.08
Rate for Payer: EmblemHealth Commercial	$202,032.90
Rate for Payer: Humana Medicare Advantage	$69,364.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$67,344.30
Rate for Payer: Oxford Commercial	$86,546.71
Rate for Payer: UnitedHealthcare Commercial	$151,762.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$67,344.30
Rate for Payer: Wellcare Medicare Advantage	$67,344.30

RESPIRATORY VIRUS PCR PANEL 1

Facility

$1,090.30

Service Code	HCPCS 87632
Hospital Charge Code	401387632
Hospital Revenue Code	306
Min. Negotiated Rate	$28.89
Max. Negotiated Rate	$787.13
Rate for Payer: Aetna Commercial	$593.12
Rate for Payer: Aetna Medicare Advantage	$706.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$787.13
Rate for Payer: Cigna Commercial	$545.15
Rate for Payer: Cigna Medicare Advantage	$218.06
Rate for Payer: Clover Medicare Advantage	$207.16
Rate for Payer: EmblemHealth Commercial	$654.18
Rate for Payer: Humana Medicare Advantage	$224.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$218.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.54
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$174.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$218.06
Rate for Payer: Wellcare Medicare Advantage	$218.06
Rate for Payer: Wellpoint Medicaid Managed Care	$28.89

RESPIRATORY VIRUS PCR PANEL 1

Facility

$1,090.30

Service Code	HCPCS 87632
Hospital Charge Code	401387632
Hospital Revenue Code	306
Min. Negotiated Rate	$163.54
Max. Negotiated Rate	$163.54
Rate for Payer: Qualcare PPO/HMO/WC	$163.54

RESP LACTIC ACID

Facility

$113.65

Hospital Charge Code	9509005
Hospital Revenue Code	301
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

RESP LACTIC ACID

Facility

$113.65

Hospital Charge Code	9509005
Hospital Revenue Code	301
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.19
Rate for Payer: Aetna Medicare Advantage	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.98
Rate for Payer: Cigna Commercial	$56.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

RESP MAXIMUM BREATHING CAP-MVV

Facility

$6,100.00

Service Code	HCPCS 94200
Hospital Charge Code	9507015
Hospital Revenue Code	460
Min. Negotiated Rate	$66.58
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$147.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$161.65

RESP MAXIMUM BREATHING CAP-MVV

Facility

$6,100.00

Service Code	HCPCS 94200
Hospital Charge Code	9507015
Hospital Revenue Code	460
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$915.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

RESP MVV

Facility

$190.00

Service Code	HCPCS 94200
Hospital Charge Code	9509020
Hospital Revenue Code	460
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

RESP MVV

Facility

$190.00

Service Code	HCPCS 94200
Hospital Charge Code	9509020
Hospital Revenue Code	460
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

RESP PATH PROF PCR (BIOFIRE)

Facility

$2,083.90

Service Code	HCPCS 0099U
Hospital Charge Code	4013099U
Hospital Revenue Code	306
Min. Negotiated Rate	$312.58
Max. Negotiated Rate	$312.58
Rate for Payer: Qualcare PPO/HMO/WC	$312.58

RESP PATH PROF PCR (BIOFIRE)

Facility

$2,083.90

Service Code	HCPCS 0099U
Hospital Charge Code	4013099U
Hospital Revenue Code	306
Min. Negotiated Rate	$50.22
Max. Negotiated Rate	$1,041.95
Rate for Payer: Aetna Commercial	$791.88
Rate for Payer: Aetna Medicare Advantage	$625.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.39
Rate for Payer: Cigna Commercial	$1,041.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$625.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.58
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$50.22
Rate for Payer: Wellpoint Medicaid Managed Care	$55.22

RESP PLETHYSMOGRAPHY

Facility

$460.00

Service Code	HCPCS 94726
Hospital Charge Code	9507010
Hospital Revenue Code	460
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$11.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$12.19

RESP PLETHYSMOGRAPHY

Facility

$460.00

Service Code	HCPCS 94726
Hospital Charge Code	9507010
Hospital Revenue Code	460
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

RESP POTASSIUM

Facility

$45.25

Hospital Charge Code	9509010
Hospital Revenue Code	301
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.20
Rate for Payer: Aetna Medicare Advantage	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.54
Rate for Payer: Cigna Commercial	$22.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.79
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

RESP POTASSIUM

Facility

$45.25

Hospital Charge Code	9509010
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$6.79
Rate for Payer: Qualcare PPO/HMO/WC	$6.79

RESP PULSE OX-CONTINOUS

Facility

$313.00

Service Code	HCPCS 9476159
Hospital Charge Code	9507020
Hospital Revenue Code	460
Min. Negotiated Rate	$46.95
Max. Negotiated Rate	$46.95
Rate for Payer: Qualcare PPO/HMO/WC	$46.95

RESP PULSE OX-CONTINOUS

Facility

$313.00

Service Code	HCPCS 9476159
Hospital Charge Code	9507020
Hospital Revenue Code	460
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$118.94
Rate for Payer: Aetna Medicare Advantage	$93.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.81
Rate for Payer: Cigna Commercial	$156.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.90
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.95
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.54
Rate for Payer: Wellpoint Medicaid Managed Care	$8.29

RESP RAW

Facility

$6,100.00

Service Code	HCPCS 94728
Hospital Charge Code	9509025
Hospital Revenue Code	460
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$915.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

RESP RAW

Facility

$6,100.00

Service Code	HCPCS 94728
Hospital Charge Code	9509025
Hospital Revenue Code	460
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$415.81
Rate for Payer: Aetna Medicare Advantage	$495.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$551.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$551.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$152.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$551.81
Rate for Payer: Cigna Commercial	$306.43
Rate for Payer: Cigna Medicare Advantage	$152.87
Rate for Payer: Clover Medicare Advantage	$145.23
Rate for Payer: EmblemHealth Commercial	$458.61
Rate for Payer: Humana Medicare Advantage	$157.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$152.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$147.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$152.87
Rate for Payer: Wellcare Medicare Advantage	$152.87
Rate for Payer: Wellpoint Medicaid Managed Care	$161.65

Know your out-of-pocket cost for care.

All Charges