Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPIROMETRY W GRAPHIC REC(MACHI

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	83652373
Hospital Revenue Code	460
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.20
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.10
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$8.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$9.38

SPIROMETRY W GRAPHIC REC(MACHI

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	83652373
Hospital Revenue Code	460
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$53.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.10

SPIROMTRY W/DILATOR UP TO 2 YR

Facility

$464.65

Service Code	HCPCS 94012
Hospital Charge Code	9501292
Hospital Revenue Code	460
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$69.70
Rate for Payer: Qualcare PPO/HMO/WC	$69.70

SPIROMTRY W/DILATOR UP TO 2 YR

Facility

$464.65

Service Code	HCPCS 94012
Hospital Charge Code	9501292
Hospital Revenue Code	460
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.40
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.70
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$11.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$12.31

SPIRONOLACTONE 12.5MG TAB

Facility

$2.00

Hospital Charge Code	60635653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

SPIRONOLACTONE 12.5MG TAB

Facility

$2.00

Hospital Charge Code	60635653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

SPIRONOLACTONE 25 MG TAB

Facility

$4.00

Service Code	NDC 51079010320
Hospital Charge Code	60627976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SPIRONOLACTONE 25 MG TAB

Facility

$4.00

Service Code	NDC 51079010320
Hospital Charge Code	60627976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SPIRONOLACTONE (ALDACTONE) 50M

Facility

$5.76

Service Code	NDC 68084020701
Hospital Charge Code	60630142
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.19
Rate for Payer: Aetna Medicare Advantage	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.47
Rate for Payer: Cigna Commercial	$2.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.73
Rate for Payer: Oxford Commercial	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.15
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SPIRONOLACTONE (ALDACTONE) 50M

Facility

$5.76

Service Code	NDC 68084020701
Hospital Charge Code	60630142
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

SPIRONOLACTONE HCTZ/25/25MG

Facility

$2.45

Hospital Charge Code	60628707
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

SPIRONOLACTONE HCTZ/25/25MG

Facility

$2.45

Hospital Charge Code	60628707
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

SPIROTOMY W GRAPHIC REC (MACH)

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	87502725
Hospital Revenue Code	460
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$53.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.10

SPIROTOMY W GRAPHIC REC (MACH)

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	87502725
Hospital Revenue Code	460
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.20
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.10
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$8.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$9.38

SPL AVULSE NP,SGL

Facility

$723.29

Service Code	HCPCS 11730
Hospital Charge Code	1600000565
Hospital Revenue Code	360
Min. Negotiated Rate	$108.49
Max. Negotiated Rate	$108.49
Rate for Payer: Qualcare PPO/HMO/WC	$108.49

SPL AVULSE NP,SGL

Facility

$723.29

Service Code	HCPCS 11730
Hospital Charge Code	1600000565
Hospital Revenue Code	360
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.99
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.49
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$17.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$19.17

SPLENECTOMY,TOTAL

Facility

$12,780.80

Service Code	HCPCS 38100
Hospital Charge Code	1600000498
Hospital Revenue Code	360
Min. Negotiated Rate	$308.02
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$4,856.70
Rate for Payer: Aetna Medicare Advantage	$3,834.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,259.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,259.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,259.10
Rate for Payer: Cigna Commercial	$6,390.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,834.24
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.12
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$308.02
Rate for Payer: Wellpoint Medicaid Managed Care	$338.69

SPLENECTOMY,TOTAL

Facility

$12,780.80

Service Code	HCPCS 38100
Hospital Charge Code	1600000498
Hospital Revenue Code	360
Min. Negotiated Rate	$1,917.12
Max. Negotiated Rate	$1,917.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.12

SPLENECTOMY WITH CC

Facility

$92,938.50

Service Code	MSDRG 800
Min. Negotiated Rate	$28,298.58
Max. Negotiated Rate	$92,938.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65,596.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65,596.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65,596.02

SPLENECTOMY WITH MCC

Facility

$148,515.59

Service Code	MSDRG 799
Min. Negotiated Rate	$45,221.09
Max. Negotiated Rate	$148,515.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115,141.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115,141.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115,141.95

SPLENECTOMY WITHOUT CC/MCC

Facility

$63,832.83

Service Code	MSDRG 801
Min. Negotiated Rate	$19,436.28
Max. Negotiated Rate	$63,832.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,637.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,637.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,637.19

SPLENIC PROCEDURES

Facility

$22,733.07

Service Code	APR-DRG 6502
Min. Negotiated Rate	$22,287.32
Max. Negotiated Rate	$22,733.07
Rate for Payer: UnitedHealthcare Community & State	$22,287.32
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,733.07
Rate for Payer: Wellpoint Medicaid Managed Care	$22,287.32

SPLENIC PROCEDURES

Facility

$32,173.04

Service Code	APR-DRG 6503
Min. Negotiated Rate	$31,542.20
Max. Negotiated Rate	$32,173.04
Rate for Payer: UnitedHealthcare Community & State	$31,542.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$32,173.04
Rate for Payer: Wellpoint Medicaid Managed Care	$31,542.20

SPLENIC PROCEDURES

Facility

$17,358.14

Service Code	APR-DRG 6501
Min. Negotiated Rate	$17,017.78
Max. Negotiated Rate	$17,358.14
Rate for Payer: UnitedHealthcare Community & State	$17,017.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,358.14
Rate for Payer: Wellpoint Medicaid Managed Care	$17,017.78

SPLENIC PROCEDURES

Facility

$51,396.48

Service Code	APR-DRG 6504
Min. Negotiated Rate	$50,388.71
Max. Negotiated Rate	$51,396.48
Rate for Payer: UnitedHealthcare Community & State	$50,388.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$51,396.48
Rate for Payer: Wellpoint Medicaid Managed Care	$50,388.71

Know your out-of-pocket cost for care.

All Charges