Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THROMBOLYTIC DEVICE ROTATOR

Facility

$781.30

Hospital Charge Code	270664875
Hospital Revenue Code	270
Min. Negotiated Rate	$117.19
Max. Negotiated Rate	$117.19
Rate for Payer: Qualcare PPO/HMO/WC	$117.19

THROMBOLYTIC VENOUS THEARPY

Facility

$15,468.50

Service Code	HCPCS 37212
Hospital Charge Code	5600230
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

THROMBOLYTIC VENOUS THEARPY

Facility

$15,468.50

Service Code	HCPCS 37212
Hospital Charge Code	5600230
Hospital Revenue Code	361
Min. Negotiated Rate	$372.79
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,640.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$372.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$409.92

THROMBOLYTIC VENOUS THERAPY

Facility

$12,462.85

Service Code	HCPCS 37212
Hospital Charge Code	366837212
Hospital Revenue Code	361
Min. Negotiated Rate	$300.35
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.86
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$300.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$330.27

THROMBOLYTIC VENOUS THERAPY

Facility

$4,631.03

Service Code	HCPCS 37212
Hospital Charge Code	7411504
Hospital Revenue Code	361
Min. Negotiated Rate	$694.65
Max. Negotiated Rate	$694.65
Rate for Payer: Qualcare PPO/HMO/WC	$694.65

THROMBOLYTIC VENOUS THERAPY

Facility

$12,462.85

Service Code	HCPCS 37212
Hospital Charge Code	411037212
Hospital Revenue Code	361
Min. Negotiated Rate	$1,869.43
Max. Negotiated Rate	$1,869.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43

THROMBOLYTIC VENOUS THERAPY

Facility

$4,631.03

Service Code	HCPCS 37212
Hospital Charge Code	7411504
Hospital Revenue Code	361
Min. Negotiated Rate	$111.61
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,389.31
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$694.65
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$111.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$122.72

THROMBOLYTIC VENOUS THERAPY

Facility

$12,462.85

Service Code	HCPCS 37212
Hospital Charge Code	411037212
Hospital Revenue Code	361
Min. Negotiated Rate	$300.35
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.86
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$300.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$330.27

THROMBOLYTIC VENOUS THERAPY

Facility

$5,081.82

Service Code	HCPCS 37212
Hospital Charge Code	2692243
Hospital Revenue Code	361
Min. Negotiated Rate	$762.27
Max. Negotiated Rate	$762.27
Rate for Payer: Qualcare PPO/HMO/WC	$762.27

THROMBOLYTIC VENOUS THERAPY

Facility

$5,081.82

Service Code	HCPCS 37212
Hospital Charge Code	2692243
Hospital Revenue Code	361
Min. Negotiated Rate	$122.47
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$762.27
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$122.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$134.67

THROMBOLYTIC VENOUS THERAPY

Facility

$12,462.85

Service Code	HCPCS 37212
Hospital Charge Code	366837212
Hospital Revenue Code	361
Min. Negotiated Rate	$1,869.43
Max. Negotiated Rate	$1,869.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43

THROMBOPLASTIN INHIBTN,TISSUE

Facility

$53.00

Service Code	HCPCS 85705
Hospital Charge Code	38477051
Hospital Revenue Code	305
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$7.95
Rate for Payer: Qualcare PPO/HMO/WC	$7.95

THROMBOPLASTIN INHIBTN,TISSUE

Facility

$53.00

Service Code	HCPCS 85705
Hospital Charge Code	38477051
Hospital Revenue Code	305
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.19
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.76
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: Cigna Medicare Advantage	$9.63
Rate for Payer: Clover Medicare Advantage	$9.15
Rate for Payer: EmblemHealth Commercial	$28.89
Rate for Payer: Humana Medicare Advantage	$9.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.63
Rate for Payer: Wellcare Medicare Advantage	$9.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

THROMBOPLASTIN TIME PARTIAL

Facility

$390.00

Service Code	HCPCS 85730
Hospital Charge Code	401485730
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

THROMBOPLASTIN TIME PARTIAL

Facility

$390.00

Service Code	HCPCS 85730
Hospital Charge Code	401485730
Hospital Revenue Code	305
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$16.35
Rate for Payer: Aetna Medicare Advantage	$19.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.69
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.01
Rate for Payer: Clover Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$18.03
Rate for Payer: Humana Medicare Advantage	$6.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.01
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	$4.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.01
Rate for Payer: Wellcare Medicare Advantage	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

THROMBOSTAT/10000U/10ML

Facility

$227.00

Hospital Charge Code	60634288
Hospital Revenue Code	250
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$34.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.05

THROMBOSTAT/10000U/10ML

Facility

$227.00

Hospital Charge Code	60634288
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$113.50
Rate for Payer: Aetna Commercial	$86.26
Rate for Payer: Aetna Medicare Advantage	$68.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.88
Rate for Payer: Cigna Commercial	$113.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.10
Rate for Payer: Oxford Commercial	$45.40
Rate for Payer: Qualcare PPO/HMO/WC	$34.05
Rate for Payer: UnitedHealthcare Commercial	$45.40
Rate for Payer: UnitedHealthcare Community & State	$5.47
Rate for Payer: Wellpoint Medicaid Managed Care	$6.02

THROMBOSTAT/10KU

Facility

$210.00

Hospital Charge Code	60634024
Hospital Revenue Code	250
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.00
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$42.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$5.57

THROMBOSTAT/10KU

Facility

$210.00

Hospital Charge Code	60634024
Hospital Revenue Code	250
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

THROMBO W/RFLX

Facility

$121.00

Hospital Charge Code	3035086H
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

THROMBO W/RFLX

Facility

$111.00

Hospital Charge Code	3035086I
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

THROMBO W/RFLX

Facility

$111.00

Hospital Charge Code	3035086I
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

THROMBO W/RFLX

Facility

$121.00

Hospital Charge Code	3035086H
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

THROMBO W/RFLX

Facility

$111.00

Hospital Charge Code	3035086B
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

THROMBO W/RFLX

Facility

$105.00

Hospital Charge Code	3035086D
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

Know your out-of-pocket cost for care.

All Charges