Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

B COMPLEX THIAM C B12 INJ

Facility

$3.85

Hospital Charge Code	6025043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

B COMPLEX VIT C FOLIC ACD CAP

Facility

$5.65

Hospital Charge Code	60628496
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

B COMPLEX VIT C FOLIC ACD CAP

Facility

$5.65

Hospital Charge Code	60628496
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

BCR1

Facility

$1,118.45

Service Code	HCPCS 81206
Hospital Charge Code	39708026A
Hospital Revenue Code	310
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$591.85
Rate for Payer: Aetna Commercial	$445.97
Rate for Payer: Aetna Medicare Advantage	$531.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$163.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.85
Rate for Payer: Cigna Commercial	$559.23
Rate for Payer: Cigna Medicare Advantage	$163.96
Rate for Payer: Clover Medicare Advantage	$155.76
Rate for Payer: EmblemHealth Commercial	$491.88
Rate for Payer: Humana Medicare Advantage	$168.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$163.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.77
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$131.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$163.96
Rate for Payer: Wellcare Medicare Advantage	$163.96
Rate for Payer: Wellpoint Medicaid Managed Care	$29.64

BCR1

Facility

$1,118.45

Service Code	HCPCS 81206
Hospital Charge Code	39708026A
Hospital Revenue Code	310
Min. Negotiated Rate	$167.77
Max. Negotiated Rate	$167.77
Rate for Payer: Qualcare PPO/HMO/WC	$167.77

BCR2

Facility

$987.95

Service Code	HCPCS 81207
Hospital Charge Code	39708026B
Hospital Revenue Code	310
Min. Negotiated Rate	$148.19
Max. Negotiated Rate	$148.19
Rate for Payer: Qualcare PPO/HMO/WC	$148.19

BCR2

Facility

$987.95

Service Code	HCPCS 81207
Hospital Charge Code	39708026B
Hospital Revenue Code	310
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$522.83
Rate for Payer: Aetna Commercial	$393.96
Rate for Payer: Aetna Medicare Advantage	$469.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.83
Rate for Payer: Cigna Commercial	$493.98
Rate for Payer: Cigna Medicare Advantage	$144.84
Rate for Payer: Clover Medicare Advantage	$137.60
Rate for Payer: EmblemHealth Commercial	$434.52
Rate for Payer: Humana Medicare Advantage	$149.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$144.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$148.19
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$115.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$144.84
Rate for Payer: Wellcare Medicare Advantage	$144.84
Rate for Payer: Wellpoint Medicaid Managed Care	$26.18

BCR/ABL COMP

Facility

$121.00

Hospital Charge Code	3000365E
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

BCR/ABL COMP

Facility

$121.00

Hospital Charge Code	3000365F
Hospital Revenue Code	301
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.98
Rate for Payer: Aetna Medicare Advantage	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.86
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

BCR/ABL COMP

Facility

$48.70

Hospital Charge Code	3000365G
Hospital Revenue Code	301
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.30

BCR/ABL COMP

Facility

$48.70

Service Code	HCPCS 81207
Hospital Charge Code	3000365B
Hospital Revenue Code	310
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$522.83
Rate for Payer: Aetna Commercial	$393.96
Rate for Payer: Aetna Medicare Advantage	$469.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.83
Rate for Payer: Cigna Commercial	$24.35
Rate for Payer: Cigna Medicare Advantage	$144.84
Rate for Payer: Clover Medicare Advantage	$137.60
Rate for Payer: EmblemHealth Commercial	$434.52
Rate for Payer: Humana Medicare Advantage	$149.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$144.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.30
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$115.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$144.84
Rate for Payer: Wellcare Medicare Advantage	$144.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

BCR/ABL COMP

Facility

$48.70

Hospital Charge Code	3000365C
Hospital Revenue Code	301
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.51
Rate for Payer: Aetna Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.42
Rate for Payer: Cigna Commercial	$24.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

BCR/ABL COMP

Facility

$48.70

Hospital Charge Code	3000365C
Hospital Revenue Code	301
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.30

BCR/ABL COMP

Facility

$48.70

Hospital Charge Code	3000365D
Hospital Revenue Code	301
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.30

BCR/ABL COMP

Facility

$121.00

Hospital Charge Code	3000365E
Hospital Revenue Code	301
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.98
Rate for Payer: Aetna Medicare Advantage	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.86
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

BCR/ABL COMP

Facility

$105.00

Hospital Charge Code	3000365J
Hospital Revenue Code	301
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

BCR/ABL COMP

Facility

$48.70

Hospital Charge Code	3000365D
Hospital Revenue Code	301
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.51
Rate for Payer: Aetna Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.42
Rate for Payer: Cigna Commercial	$24.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

BCR/ABL COMP

Facility

$105.00

Hospital Charge Code	3000365K
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

BCR/ABL COMP

Facility

$48.70

Hospital Charge Code	3000365H
Hospital Revenue Code	301
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.30

BCR/ABL COMP

Facility

$121.00

Hospital Charge Code	3000365F
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

BCR/ABL COMP

Facility

$111.00

Service Code	HCPCS 81206
Hospital Charge Code	3000365A
Hospital Revenue Code	310
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

BCR/ABL COMP

Facility

$105.00

Hospital Charge Code	3000365I
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

BCR/ABL COMP

Facility

$111.00

Hospital Charge Code	3000365KL
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

BCR/ABL COMP

Facility

$48.70

Service Code	HCPCS 81207
Hospital Charge Code	3000365B
Hospital Revenue Code	310
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.30

BCR/ABL COMP

Facility

$48.70

Hospital Charge Code	3000365H
Hospital Revenue Code	301
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.51
Rate for Payer: Aetna Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.42
Rate for Payer: Cigna Commercial	$24.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

Know your out-of-pocket cost for care.

All Charges