Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RETENTIVE POLY LINER +6

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688884
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,399.26
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

RETENTIVE POLY LINER +6

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688884
Hospital Revenue Code	278
Min. Negotiated Rate	$153.28
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$2,416.89
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,399.26
Rate for Payer: Qualcare PPO/HMO/WC	$954.04
Rate for Payer: UnitedHealthcare Community & State	$153.28
Rate for Payer: Wellpoint Medicaid Managed Care	$168.55

RETENTIVE POLY LINER +9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688780
Hospital Revenue Code	278
Min. Negotiated Rate	$153.28
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$2,416.89
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,399.26
Rate for Payer: Qualcare PPO/HMO/WC	$954.04
Rate for Payer: UnitedHealthcare Community & State	$153.28
Rate for Payer: Wellpoint Medicaid Managed Care	$168.55

RETENTIVE POLY LINER +9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688780
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,399.26
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

RETEPLASE 10 UNITS INJ KIT

Facility

$8,976.90

Hospital Charge Code	60629268
Hospital Revenue Code	636
Min. Negotiated Rate	$216.34
Max. Negotiated Rate	$4,488.45
Rate for Payer: Aetna Commercial	$3,411.22
Rate for Payer: Aetna Medicare Advantage	$2,693.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,289.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,289.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,289.11
Rate for Payer: Cigna Commercial	$4,488.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,172.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.54
Rate for Payer: UnitedHealthcare Community & State	$216.34
Rate for Payer: Wellpoint Medicaid Managed Care	$237.89

RETEPLASE 10 UNITS INJ KIT

Facility

$8,976.90

Hospital Charge Code	60629268
Hospital Revenue Code	636
Min. Negotiated Rate	$1,346.54
Max. Negotiated Rate	$2,172.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,172.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.54

RETEPLASE 20U INJ

Facility

$14,362.50

Hospital Charge Code	60628785
Hospital Revenue Code	636
Min. Negotiated Rate	$346.14
Max. Negotiated Rate	$7,181.25
Rate for Payer: Aetna Commercial	$5,457.75
Rate for Payer: Aetna Medicare Advantage	$4,308.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,662.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,662.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,662.44
Rate for Payer: Cigna Commercial	$7,181.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,475.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,154.38
Rate for Payer: UnitedHealthcare Community & State	$346.14
Rate for Payer: Wellpoint Medicaid Managed Care	$380.61

RETEPLASE 20U INJ

Facility

$14,362.50

Hospital Charge Code	60628785
Hospital Revenue Code	636
Min. Negotiated Rate	$2,154.38
Max. Negotiated Rate	$3,475.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,475.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,154.38

RETEPLASE INJ 20 U

Facility

$6,051.00

Hospital Charge Code	60635242
Hospital Revenue Code	636
Min. Negotiated Rate	$907.65
Max. Negotiated Rate	$1,464.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.34
Rate for Payer: Qualcare PPO/HMO/WC	$907.65

RETEPLASE INJ 20 U

Facility

$6,051.00

Hospital Charge Code	60635242
Hospital Revenue Code	636
Min. Negotiated Rate	$145.83
Max. Negotiated Rate	$3,025.50
Rate for Payer: Aetna Commercial	$2,299.38
Rate for Payer: Aetna Medicare Advantage	$1,815.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,543.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,543.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,543.01
Rate for Payer: Cigna Commercial	$3,025.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.34
Rate for Payer: Qualcare PPO/HMO/WC	$907.65
Rate for Payer: UnitedHealthcare Community & State	$145.83
Rate for Payer: Wellpoint Medicaid Managed Care	$160.35

RETEVASE 18.1MG-TRANSPORT

Facility

$6,382.00

Hospital Charge Code	60635394
Hospital Revenue Code	636
Min. Negotiated Rate	$957.30
Max. Negotiated Rate	$1,544.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,544.44
Rate for Payer: Qualcare PPO/HMO/WC	$957.30

RETEVASE 18.1MG-TRANSPORT

Facility

$6,382.00

Hospital Charge Code	60635394
Hospital Revenue Code	636
Min. Negotiated Rate	$153.81
Max. Negotiated Rate	$3,191.00
Rate for Payer: Aetna Commercial	$2,425.16
Rate for Payer: Aetna Medicare Advantage	$1,914.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,627.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,627.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,627.41
Rate for Payer: Cigna Commercial	$3,191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,544.44
Rate for Payer: Qualcare PPO/HMO/WC	$957.30
Rate for Payer: UnitedHealthcare Community & State	$153.81
Rate for Payer: Wellpoint Medicaid Managed Care	$169.12

RETEVASE 18.1MG/VIAL

Facility

$6,382.00

Hospital Charge Code	60635352
Hospital Revenue Code	636
Min. Negotiated Rate	$957.30
Max. Negotiated Rate	$1,544.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,544.44
Rate for Payer: Qualcare PPO/HMO/WC	$957.30

RETEVASE 18.1MG/VIAL

Facility

$6,382.00

Hospital Charge Code	60635352
Hospital Revenue Code	636
Min. Negotiated Rate	$153.81
Max. Negotiated Rate	$3,191.00
Rate for Payer: Aetna Commercial	$2,425.16
Rate for Payer: Aetna Medicare Advantage	$1,914.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,627.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,627.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,627.41
Rate for Payer: Cigna Commercial	$3,191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,544.44
Rate for Payer: Qualcare PPO/HMO/WC	$957.30
Rate for Payer: UnitedHealthcare Community & State	$153.81
Rate for Payer: Wellpoint Medicaid Managed Care	$169.12

RETICOLOCYTE COUNT

Facility

$57.00

Service Code	HCPCS 85044
Hospital Charge Code	38473012
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

RETICOLOCYTE COUNT

Facility

$57.00

Service Code	HCPCS 85044
Hospital Charge Code	38473012
Hospital Revenue Code	301
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.72
Rate for Payer: Aetna Medicare Advantage	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.56
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare Advantage	$4.31
Rate for Payer: Clover Medicare Advantage	$4.09
Rate for Payer: EmblemHealth Commercial	$12.93
Rate for Payer: Humana Medicare Advantage	$4.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.31
Rate for Payer: Wellcare Medicare Advantage	$4.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

RETICULINE IGG SCREEN W REFLEX

Facility

$60.25

Service Code	HCPCS 86255
Hospital Charge Code	401186255
Hospital Revenue Code	306
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$30.12
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.04
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.60

RETICULINE IGG SCREEN W REFLEX

Facility

$60.25

Service Code	HCPCS 86255
Hospital Charge Code	401186255
Hospital Revenue Code	306
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$9.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.04

RETICULIN STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005317
Hospital Revenue Code	310
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$100.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.80

RETICULIN STAIN

Facility

$672.00

Service Code	HCPCS 88313
Hospital Charge Code	3005317
Hospital Revenue Code	310
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.80
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$68.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.81

RETICULOCYTES COUNT

Facility

$667.59

Service Code	HCPCS 85044
Hospital Charge Code	3002359
Hospital Revenue Code	305
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$11.72
Rate for Payer: Aetna Medicare Advantage	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.56
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$4.31
Rate for Payer: Clover Medicare Advantage	$4.09
Rate for Payer: EmblemHealth Commercial	$12.93
Rate for Payer: Humana Medicare Advantage	$4.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.31
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	$3.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.31
Rate for Payer: Wellcare Medicare Advantage	$4.31
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

RETICULOCYTES COUNT

Facility

$667.59

Service Code	HCPCS 85044
Hospital Charge Code	3002359
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$34,908.21

Service Code	MSDRG 815
Min. Negotiated Rate	$10,629.10
Max. Negotiated Rate	$34,908.21
Rate for Payer: Aetna Commercial	$24,243.26
Rate for Payer: Aetna Medicare Advantage	$34,908.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,028.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,028.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,188.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,028.39
Rate for Payer: Cigna Commercial	$18,976.00
Rate for Payer: Cigna Medicare Advantage	$11,188.53
Rate for Payer: Clover Medicare Advantage	$10,629.10
Rate for Payer: EmblemHealth Commercial	$33,565.59
Rate for Payer: Humana Medicare Advantage	$11,524.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,188.53
Rate for Payer: Oxford Commercial	$13,638.30
Rate for Payer: UnitedHealthcare Commercial	$23,915.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,188.53
Rate for Payer: Wellcare Medicare Advantage	$11,188.53

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$70,872.48

Service Code	MSDRG 814
Min. Negotiated Rate	$21,579.76
Max. Negotiated Rate	$70,872.48
Rate for Payer: Aetna Commercial	$48,954.81
Rate for Payer: Aetna Medicare Advantage	$70,872.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,545.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,545.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,715.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,545.93
Rate for Payer: Cigna Commercial	$39,799.06
Rate for Payer: Cigna Medicare Advantage	$22,715.54
Rate for Payer: Clover Medicare Advantage	$21,579.76
Rate for Payer: EmblemHealth Commercial	$68,146.62
Rate for Payer: Humana Medicare Advantage	$23,397.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,715.54
Rate for Payer: Oxford Commercial	$28,604.12
Rate for Payer: UnitedHealthcare Commercial	$50,158.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,715.54
Rate for Payer: Wellcare Medicare Advantage	$22,715.54

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$22,561.34

Service Code	MSDRG 816
Min. Negotiated Rate	$6,869.64
Max. Negotiated Rate	$22,561.34
Rate for Payer: Aetna Commercial	$15,759.53
Rate for Payer: Aetna Medicare Advantage	$22,561.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,515.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,515.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,231.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,515.31
Rate for Payer: Cigna Commercial	$11,827.25
Rate for Payer: Cigna Medicare Advantage	$7,231.20
Rate for Payer: Clover Medicare Advantage	$6,869.64
Rate for Payer: EmblemHealth Commercial	$21,693.60
Rate for Payer: Humana Medicare Advantage	$7,448.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,231.20
Rate for Payer: Oxford Commercial	$8,500.40
Rate for Payer: UnitedHealthcare Commercial	$14,905.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,231.20
Rate for Payer: Wellcare Medicare Advantage	$7,231.20

Know your out-of-pocket cost for care.

All Charges