Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

$105.00

Hospital Charge Code	3000365J
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	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

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

$105.00

Hospital Charge Code	3000365K
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	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 GENE QN, PCR W/RFLX

Facility

$535.15

Hospital Charge Code	3000365
Hospital Revenue Code	301
Min. Negotiated Rate	$80.27
Max. Negotiated Rate	$80.27
Rate for Payer: Qualcare PPO/HMO/WC	$80.27

BCR/ABL GENE QN, PCR W/RFLX

Facility

$535.15

Hospital Charge Code	3000365
Hospital Revenue Code	301
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$267.57
Rate for Payer: Aetna Commercial	$203.36
Rate for Payer: Aetna Medicare Advantage	$160.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.46
Rate for Payer: Cigna Commercial	$267.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.27
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.90
Rate for Payer: Wellpoint Medicaid Managed Care	$14.18

BCR GENE PCR

Facility

$111.00

Hospital Charge Code	3036013
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 GENE PCR

Facility

$111.00

Hospital Charge Code	3036013
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

BD DEXA FOREARM BMD LEFT

Facility

$5,100.00

Service Code	HCPCS 77081
Hospital Charge Code	2709005
Hospital Revenue Code	320
Min. Negotiated Rate	$72.37
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

BD DEXA FOREARM BMD LEFT

Facility

$5,100.00

Service Code	HCPCS 77081
Hospital Charge Code	2709005
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

BD DEXA FOREARM BMD RIGHT

Facility

$607.50

Service Code	HCPCS 77081
Hospital Charge Code	2709006
Hospital Revenue Code	320
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.12
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$14.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$16.10

BD DEXA FOREARM BMD RIGHT

Facility

$607.50

Service Code	HCPCS 77081
Hospital Charge Code	2709006
Hospital Revenue Code	320
Min. Negotiated Rate	$91.12
Max. Negotiated Rate	$91.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.12

BD DEXA HIP AND/OR SPINE BMD

Facility

$1,571.90

Service Code	HCPCS 77080
Hospital Charge Code	2709004
Hospital Revenue Code	320
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.57
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$235.78
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$37.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$41.66

BD DEXA HIP AND/OR SPINE BMD

Facility

$1,571.90

Service Code	HCPCS 77080
Hospital Charge Code	2709004
Hospital Revenue Code	320
Min. Negotiated Rate	$235.78
Max. Negotiated Rate	$235.78
Rate for Payer: Qualcare PPO/HMO/WC	$235.78

BD DEXA HIP & FOREARM LEFT

Facility

$1,571.90

Service Code	HCPCS 77080
Hospital Charge Code	2709007
Hospital Revenue Code	320
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.57
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$235.78
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$37.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$41.66

BD DEXA HIP & FOREARM LEFT

Facility

$1,571.90

Service Code	HCPCS 77080
Hospital Charge Code	2709007
Hospital Revenue Code	320
Min. Negotiated Rate	$235.78
Max. Negotiated Rate	$235.78
Rate for Payer: Qualcare PPO/HMO/WC	$235.78

BD DEXA HIP & FOREARM RIGHT

Facility

$1,571.90

Service Code	HCPCS 77080
Hospital Charge Code	2709008
Hospital Revenue Code	320
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.57
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$235.78
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$37.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$41.66

BD DEXA HIP & FOREARM RIGHT

Facility

$1,571.90

Service Code	HCPCS 77080
Hospital Charge Code	2709008
Hospital Revenue Code	320
Min. Negotiated Rate	$235.78
Max. Negotiated Rate	$235.78
Rate for Payer: Qualcare PPO/HMO/WC	$235.78

B-D NEEDLE 18G x 1-5

Facility

$4.65

Hospital Charge Code	60629322
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.33
Rate for Payer: Aetna Commercial	$1.77
Rate for Payer: Aetna Medicare Advantage	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.19
Rate for Payer: Cigna Commercial	$2.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$0.93
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

B-D NEEDLE 18G x 1-5

Facility

$4.65

Hospital Charge Code	60629322
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

BD OF ED DRUG/ALCOHL SCREEN ID

Facility

$128.00

Service Code	HCPCS 80102
Hospital Charge Code	9400178
Hospital Revenue Code	301
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

BD OF ED DRUG/ALCOHL SCREEN ID

Facility

$128.00

Service Code	HCPCS 80102
Hospital Charge Code	9400178
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

B DRILL FOR TRANSFIX

Facility

$1,025.00

Hospital Charge Code	270656491
Hospital Revenue Code	272
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.50
Rate for Payer: Oxford Commercial	$205.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Commercial	$205.00
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

Know your out-of-pocket cost for care.

All Charges