Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SETUP TPA*****

Facility

$220.00

Hospital Charge Code	8003600
Hospital Revenue Code	272
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.10
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.00
Rate for Payer: Oxford Commercial	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00
Rate for Payer: UnitedHealthcare Commercial	$44.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$5.83

SET VAGINAL IRRIGATION

Facility

$11.25

Hospital Charge Code	270301940
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

SET VAGINAL IRRIGATION

Facility

$11.25

Hospital Charge Code	270301940
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

SEVELAMER 400 MG TAB

Facility

$21.37

Service Code	NDC 58468002001
Hospital Charge Code	60629367
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.69
Rate for Payer: Aetna Commercial	$8.12
Rate for Payer: Aetna Medicare Advantage	$6.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.45
Rate for Payer: Cigna Commercial	$10.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.41
Rate for Payer: Oxford Commercial	$4.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.21
Rate for Payer: UnitedHealthcare Commercial	$4.27
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

SEVELAMER 400 MG TAB

Facility

$21.37

Service Code	NDC 58468002001
Hospital Charge Code	60629367
Hospital Revenue Code	251
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

SEVELAMER 403MG CAPSULE

Facility

$5.00

Service Code	HCPCS J8499
Hospital Charge Code	60629242
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SEVELAMER 403MG CAPSULE

Facility

$5.00

Service Code	HCPCS J8499
Hospital Charge Code	60629242
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SEVOFLURANE INH. BTL

Facility

$1,094.00

Hospital Charge Code	60635672
Hospital Revenue Code	250
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$164.10
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

SEVOFLURANE INH. BTL

Facility

$1,094.00

Hospital Charge Code	60635672
Hospital Revenue Code	250
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$547.00
Rate for Payer: Aetna Commercial	$415.72
Rate for Payer: Aetna Medicare Advantage	$328.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.97
Rate for Payer: Cigna Commercial	$547.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.20
Rate for Payer: Oxford Commercial	$218.80
Rate for Payer: Qualcare PPO/HMO/WC	$164.10
Rate for Payer: UnitedHealthcare Commercial	$218.80
Rate for Payer: UnitedHealthcare Community & State	$26.37
Rate for Payer: Wellpoint Medicaid Managed Care	$28.99

SEVOFLURANE - INH LIQ

Facility

$1,511.52

Service Code	NDC 74445651
Hospital Charge Code	60629265
Hospital Revenue Code	250
Min. Negotiated Rate	$226.73
Max. Negotiated Rate	$226.73
Rate for Payer: Qualcare PPO/HMO/WC	$226.73

SEVOFLURANE - INH LIQ

Facility

$1,511.52

Service Code	NDC 74445651
Hospital Charge Code	60629265
Hospital Revenue Code	250
Min. Negotiated Rate	$36.43
Max. Negotiated Rate	$755.76
Rate for Payer: Aetna Commercial	$574.38
Rate for Payer: Aetna Medicare Advantage	$453.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$385.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$385.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$385.44
Rate for Payer: Cigna Commercial	$755.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.46
Rate for Payer: Oxford Commercial	$302.30
Rate for Payer: Qualcare PPO/HMO/WC	$226.73
Rate for Payer: UnitedHealthcare Commercial	$302.30
Rate for Payer: UnitedHealthcare Community & State	$36.43
Rate for Payer: Wellpoint Medicaid Managed Care	$40.06

SEX HORMONE BIND GLOBULN#B04**

Facility

$21.00

Hospital Charge Code	3010691
Hospital Revenue Code	301
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

SEX HORMONE BIND GLOBULN#B04**

Facility

$21.00

Hospital Charge Code	3010691
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

SEX HORMONE BINDING GLOBU

Facility

$390.00

Service Code	HCPCS 84270
Hospital Charge Code	39900132
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$59.11
Rate for Payer: Aetna Medicare Advantage	$70.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.44
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$21.73
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.73
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	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Medicare Advantage	$21.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SEX HORMONE BINDING GLOBU

Facility

$390.00

Service Code	HCPCS 84270
Hospital Charge Code	39900132
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SEX HORMONE BINDING GLOBULIN

Facility

$153.90

Service Code	HCPCS 84270
Hospital Charge Code	38477170
Hospital Revenue Code	301
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$59.11
Rate for Payer: Aetna Medicare Advantage	$70.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.44
Rate for Payer: Cigna Commercial	$76.95
Rate for Payer: Cigna Medicare Advantage	$21.73
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Medicare Advantage	$21.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

SEX HORMONE BINDING GLOBULIN

Facility

$179.25

Service Code	HCPCS 84270
Hospital Charge Code	3000692
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

SEX HORMONE BINDING GLOBULIN

Facility

$179.25

Service Code	HCPCS 84270
Hospital Charge Code	3000692
Hospital Revenue Code	301
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$59.11
Rate for Payer: Aetna Medicare Advantage	$70.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.44
Rate for Payer: Cigna Commercial	$89.62
Rate for Payer: Cigna Medicare Advantage	$21.73
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Medicare Advantage	$21.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

SEX HORMONE BINDING GLOBULIN

Facility

$153.90

Service Code	HCPCS 84270
Hospital Charge Code	38477170
Hospital Revenue Code	301
Min. Negotiated Rate	$23.09
Max. Negotiated Rate	$23.09
Rate for Payer: Qualcare PPO/HMO/WC	$23.09

SEXUAL ASSAULT KIT

Facility

$118.00

Hospital Charge Code	60635642
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.40
Rate for Payer: Oxford Commercial	$23.60
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$23.60
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

SEXUAL ASSAULT KIT

Facility

$118.00

Hospital Charge Code	60635642
Hospital Revenue Code	250
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

SFT NON BRDED MKLSSON 5FRX80CM

Facility

$510.00

Hospital Charge Code	270663267
Hospital Revenue Code	278
Min. Negotiated Rate	$12.29
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.05
Rate for Payer: Cigna Commercial	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.20
Rate for Payer: Qualcare PPO/HMO/WC	$76.50
Rate for Payer: UnitedHealthcare Community & State	$12.29
Rate for Payer: Wellpoint Medicaid Managed Care	$13.52

SFT NON BRDED MKLSSON 5FRX80CM

Facility

$510.00

Hospital Charge Code	270663267
Hospital Revenue Code	278
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.20
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

SFT TISS BX - NECK/THORAX

Facility

$13,615.50

Service Code	HCPCS 21550
Hospital Charge Code	16000798
Hospital Revenue Code	360
Min. Negotiated Rate	$328.13
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,084.65
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$328.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$360.81

SFT TISS BX - NECK/THORAX

Facility

$13,615.50

Service Code	HCPCS 21550
Hospital Charge Code	16000798
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

Know your out-of-pocket cost for care.

All Charges