Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RESP RT-ARTERIAL BLOOD GASES

Facility

$733.49

Service Code	HCPCS 82803
Hospital Charge Code	9508010
Hospital Revenue Code	300
Min. Negotiated Rate	$110.02
Max. Negotiated Rate	$110.02
Rate for Payer: Qualcare PPO/HMO/WC	$110.02

RESP RT-ARTERIAL BLOOD GASES

Facility

$733.49

Service Code	HCPCS 82803
Hospital Charge Code	9508010
Hospital Revenue Code	300
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$366.75
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.10
Rate for Payer: Cigna Commercial	$366.75
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$110.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.44

RESP RT-CARBOXY HEMOGLOBIN

Facility

$390.00

Service Code	HCPCS 82375
Hospital Charge Code	9508005
Hospital Revenue Code	301
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$33.51
Rate for Payer: Aetna Medicare Advantage	$39.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.47
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.32
Rate for Payer: Clover Medicare Advantage	$11.70
Rate for Payer: EmblemHealth Commercial	$36.96
Rate for Payer: Humana Medicare Advantage	$12.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.32
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	$9.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.32
Rate for Payer: Wellcare Medicare Advantage	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

RESP RT-CARBOXY HEMOGLOBIN

Facility

$390.00

Service Code	HCPCS 82375
Hospital Charge Code	9508005
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RESP RT-NEBUPENT

Facility

$587.12

Service Code	HCPCS 94642
Hospital Charge Code	9507005
Hospital Revenue Code	410
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$939.06
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.14
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.07
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$14.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$15.56

RESP RT-NEBUPENT

Facility

$587.12

Service Code	HCPCS 94642
Hospital Charge Code	9507005
Hospital Revenue Code	410
Min. Negotiated Rate	$88.07
Max. Negotiated Rate	$88.07
Rate for Payer: Qualcare PPO/HMO/WC	$88.07

RESP SMOKING CESSATION GTR 10M

Facility

$138.00

Service Code	HCPCS 94770
Hospital Charge Code	9509030
Hospital Revenue Code	460
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.70

RESP SMOKING CESSATION GTR 10M

Facility

$138.00

Service Code	HCPCS 94770
Hospital Charge Code	9509030
Hospital Revenue Code	460
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$52.44
Rate for Payer: Aetna Medicare Advantage	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.19
Rate for Payer: Cigna Commercial	$69.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.70
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$3.33
Rate for Payer: Wellpoint Medicaid Managed Care	$3.66

RESP SODIUM

Facility

$47.25

Hospital Charge Code	9509015
Hospital Revenue Code	301
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

RESP SODIUM

Facility

$47.25

Hospital Charge Code	9509015
Hospital Revenue Code	301
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

RESP SURFACTANT ADM-INTRAPULMO

Facility

$176.55

Service Code	HCPCS 94610
Hospital Charge Code	9507001
Hospital Revenue Code	469
Min. Negotiated Rate	$26.48
Max. Negotiated Rate	$26.48
Rate for Payer: Qualcare PPO/HMO/WC	$26.48

RESP SURFACTANT ADM-INTRAPULMO

Facility

$176.55

Service Code	HCPCS 94610
Hospital Charge Code	9507001
Hospital Revenue Code	469
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$939.06
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.97
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.48
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$4.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.68

RESP SYNCTIAL VIRUS AG (RSV)

Facility

$231.25

Service Code	HCPCS 87280
Hospital Charge Code	3006715
Hospital Revenue Code	309
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.50
Rate for Payer: Aetna Medicare Advantage	$43.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.44
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$13.42
Rate for Payer: Clover Medicare Advantage	$12.75
Rate for Payer: EmblemHealth Commercial	$40.26
Rate for Payer: Humana Medicare Advantage	$13.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.42
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	$10.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.42
Rate for Payer: Wellcare Medicare Advantage	$13.42
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

RESP SYNCTIAL VIRUS AG (RSV)

Facility

$231.25

Service Code	HCPCS 87280
Hospital Charge Code	3006715
Hospital Revenue Code	309
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

RESP. SYNCYTIAL VIRUS AG

Facility

$667.59

Service Code	HCPCS 87807
Hospital Charge Code	3036055
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

RESP. SYNCYTIAL VIRUS AG

Facility

$667.59

Service Code	HCPCS 87807
Hospital Charge Code	3036055
Hospital Revenue Code	306
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$35.63
Rate for Payer: Aetna Medicare Advantage	$42.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.29
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.10
Rate for Payer: Clover Medicare Advantage	$12.45
Rate for Payer: EmblemHealth Commercial	$39.30
Rate for Payer: Humana Medicare Advantage	$13.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.10
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	$10.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.10
Rate for Payer: Wellcare Medicare Advantage	$13.10
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

RESRVR CEREBROSPINAL FLD 44105

Facility

$1,881.60

Hospital Charge Code	270659679
Hospital Revenue Code	278
Min. Negotiated Rate	$45.35
Max. Negotiated Rate	$940.80
Rate for Payer: Aetna Commercial	$715.01
Rate for Payer: Aetna Medicare Advantage	$564.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.81
Rate for Payer: Cigna Commercial	$940.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$413.95
Rate for Payer: Qualcare PPO/HMO/WC	$282.24
Rate for Payer: UnitedHealthcare Community & State	$45.35
Rate for Payer: Wellpoint Medicaid Managed Care	$49.86

RESRVR CEREBROSPINAL FLD 44105

Facility

$1,881.60

Hospital Charge Code	270659679
Hospital Revenue Code	278
Min. Negotiated Rate	$282.24
Max. Negotiated Rate	$455.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$413.95
Rate for Payer: Qualcare PPO/HMO/WC	$282.24

RESTON

Facility

$845.65

Hospital Charge Code	270606039
Hospital Revenue Code	270
Min. Negotiated Rate	$126.85
Max. Negotiated Rate	$126.85
Rate for Payer: Qualcare PPO/HMO/WC	$126.85

RESTON

Facility

$845.65

Hospital Charge Code	270606039
Hospital Revenue Code	270
Min. Negotiated Rate	$20.38
Max. Negotiated Rate	$422.82
Rate for Payer: Aetna Commercial	$321.35
Rate for Payer: Aetna Medicare Advantage	$253.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.64
Rate for Payer: Cigna Commercial	$422.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.69
Rate for Payer: Oxford Commercial	$169.13
Rate for Payer: Qualcare PPO/HMO/WC	$126.85
Rate for Payer: UnitedHealthcare Commercial	$169.13
Rate for Payer: UnitedHealthcare Community & State	$20.38
Rate for Payer: Wellpoint Medicaid Managed Care	$22.41

RESTON ************

Facility

$81.00

Hospital Charge Code	8001513
Hospital Revenue Code	279
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.30
Rate for Payer: Oxford Commercial	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$16.20
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

RESTON ************

Facility

$81.00

Hospital Charge Code	8001513
Hospital Revenue Code	279
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

RESTORAT ADM/MDM 28/52MM SZ46F

Facility

$3,361.40

Service Code	HCPCS C1776
Hospital Charge Code	270699691
Hospital Revenue Code	278
Min. Negotiated Rate	$81.01
Max. Negotiated Rate	$1,680.70
Rate for Payer: Aetna Commercial	$1,277.33
Rate for Payer: Aetna Medicare Advantage	$1,008.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$857.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$857.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$857.16
Rate for Payer: Cigna Commercial	$1,680.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$739.51
Rate for Payer: Qualcare PPO/HMO/WC	$504.21
Rate for Payer: UnitedHealthcare Community & State	$81.01
Rate for Payer: Wellpoint Medicaid Managed Care	$89.08

RESTORAT ADM/MDM 28/52MM SZ46F

Facility

$3,361.40

Service Code	HCPCS C1776
Hospital Charge Code	270699691
Hospital Revenue Code	278
Min. Negotiated Rate	$504.21
Max. Negotiated Rate	$813.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$739.51
Rate for Payer: Qualcare PPO/HMO/WC	$504.21

RESTORE INSTRUMENT SET MITEK

Facility

$1,500.00

Hospital Charge Code	270645770
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges