Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THERAPEUTIC FORK

Facility

$39.25

Hospital Charge Code	270613437
Hospital Revenue Code	279
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

THERAPEUTIC GROUP CQ

Facility

$103.25

Service Code	HCPCS 97150GP
Hospital Charge Code	409197150Q
Hospital Revenue Code	420
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$39.23
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.33
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

THERAPEUTIC GROUP CQ

Facility

$103.25

Service Code	HCPCS 97150GP
Hospital Charge Code	409197150Q
Hospital Revenue Code	420
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

THERAPEUTIC INJECTION****

Facility

$2.75

Service Code	HCPCS 90782WF
Hospital Charge Code	9600026
Hospital Revenue Code	519
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.41

THERAPEUTIC INJECTION****

Facility

$2.75

Service Code	HCPCS 90782WF
Hospital Charge Code	9600026
Hospital Revenue Code	519
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.38
Rate for Payer: Aetna Commercial	$1.04
Rate for Payer: Aetna Medicare Advantage	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.70
Rate for Payer: Cigna Commercial	$1.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.41
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.07

THERAPEUTIC KNIFE WITH HANDLE

Facility

$47.25

Hospital Charge Code	270613434
Hospital Revenue Code	279
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$9.45
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

THERAPEUTIC KNIFE WITH HANDLE

Facility

$47.25

Hospital Charge Code	270613434
Hospital Revenue Code	279
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

THERAPEUTIC MULTI-VITAMIN

Facility

$1.00

Hospital Charge Code	60634013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

THERAPEUTIC MULTI-VITAMIN

Facility

$1.00

Hospital Charge Code	60634013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

THERAPEUTIC MULTIVITAMIN

Facility

$3.00

Hospital Charge Code	60634014
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

THERAPEUTIC MULTIVITAMIN

Facility

$3.00

Hospital Charge Code	60634014
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

THERAPEUTIC PHLEBOTOMY

Facility

$394.45

Service Code	HCPCS 99195
Hospital Charge Code	3400090
Hospital Revenue Code	940
Min. Negotiated Rate	$9.51
Max. Negotiated Rate	$2,407.00
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	$118.33
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.17
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$9.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$10.45

THERAPEUTIC PHLEBOTOMY

Facility

$264.80

Service Code	HCPCS 99195
Hospital Charge Code	93500101
Hospital Revenue Code	940
Min. Negotiated Rate	$39.72
Max. Negotiated Rate	$39.72
Rate for Payer: Qualcare PPO/HMO/WC	$39.72

THERAPEUTIC PHLEBOTOMY

Facility

$394.45

Service Code	HCPCS 99195
Hospital Charge Code	3400090
Hospital Revenue Code	940
Min. Negotiated Rate	$59.17
Max. Negotiated Rate	$59.17
Rate for Payer: Qualcare PPO/HMO/WC	$59.17

THERAPEUTIC PHLEBOTOMY

Facility

$264.80

Service Code	HCPCS 99195
Hospital Charge Code	93500101
Hospital Revenue Code	940
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$2,407.00
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	$79.44
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.72
Rate for Payer: UnitedHealthcare Commercial	$2,407.00
Rate for Payer: UnitedHealthcare Community & State	$6.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.02

THERAPEUTIC PILPOTOMY

Facility

$9,790.05

Service Code	HCPCS D3220
Hospital Charge Code	1600000744
Hospital Revenue Code	360
Min. Negotiated Rate	$235.94
Max. Negotiated Rate	$2,937.01
Rate for Payer: Aetna Commercial	$2,089.07
Rate for Payer: Aetna Medicare Advantage	$2,488.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,772.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,772.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$768.04
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	$2,772.39
Rate for Payer: Cigna Commercial	$1,539.55
Rate for Payer: Cigna Medicare Advantage	$768.04
Rate for Payer: Clover Medicare Advantage	$729.64
Rate for Payer: EmblemHealth Commercial	$2,304.12
Rate for Payer: Humana Medicare Advantage	$791.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$768.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,937.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51
Rate for Payer: UnitedHealthcare Community & State	$235.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$768.04
Rate for Payer: Wellcare Medicare Advantage	$768.04
Rate for Payer: Wellpoint Medicaid Managed Care	$259.44

THERAPEUTIC PILPOTOMY

Facility

$9,790.05

Service Code	HCPCS D3220
Hospital Charge Code	1600000744
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.51
Max. Negotiated Rate	$1,468.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

THERAPEUTIC PLASMA APHERESIS

Facility

$5,065.00

Service Code	HCPCS 36514
Hospital Charge Code	3300021
Hospital Revenue Code	361
Min. Negotiated Rate	$122.07
Max. Negotiated Rate	$6,678.88
Rate for Payer: Aetna Commercial	$5,032.71
Rate for Payer: Aetna Medicare Advantage	$5,994.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,678.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,678.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,850.26
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	$6,678.88
Rate for Payer: Cigna Commercial	$3,708.85
Rate for Payer: Cigna Medicare Advantage	$1,850.26
Rate for Payer: Clover Medicare Advantage	$1,757.75
Rate for Payer: EmblemHealth Commercial	$5,550.78
Rate for Payer: Humana Medicare Advantage	$1,905.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,850.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.50
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$759.75
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$122.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,850.26
Rate for Payer: Wellcare Medicare Advantage	$1,850.26
Rate for Payer: Wellpoint Medicaid Managed Care	$134.22

THERAPEUTIC PLASMA APHERESIS

Facility

$5,065.00

Service Code	HCPCS 36514
Hospital Charge Code	3300021
Hospital Revenue Code	361
Min. Negotiated Rate	$759.75
Max. Negotiated Rate	$759.75
Rate for Payer: Qualcare PPO/HMO/WC	$759.75

THERAPEUTIC PUTTY 4 OZ

Facility

$10.45

Hospital Charge Code	270613438
Hospital Revenue Code	279
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

THERAPEUTIC PUTTY 4 OZ

Facility

$10.45

Hospital Charge Code	270613438
Hospital Revenue Code	279
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

THERAPEUTIC ROCKER KNIFE

Facility

$105.65

Hospital Charge Code	270608449
Hospital Revenue Code	270
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$15.85
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

THERAPEUTIC ROCKER KNIFE

Facility

$105.65

Hospital Charge Code	270608449
Hospital Revenue Code	270
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$52.83
Rate for Payer: Aetna Commercial	$40.15
Rate for Payer: Aetna Medicare Advantage	$31.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.94
Rate for Payer: Cigna Commercial	$52.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Oxford Commercial	$21.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.85
Rate for Payer: UnitedHealthcare Commercial	$21.13
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

THERAPEUTIC SCOOP DISH

Facility

$43.25

Hospital Charge Code	270608451
Hospital Revenue Code	279
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.62
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$12.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.03
Rate for Payer: Cigna Commercial	$21.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.97
Rate for Payer: Oxford Commercial	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$6.49
Rate for Payer: UnitedHealthcare Commercial	$8.65
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

THERAPEUTIC SCOOP DISH

Facility

$43.25

Hospital Charge Code	270608451
Hospital Revenue Code	279
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.49

Know your out-of-pocket cost for care.

All Charges