Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TORSEMIDE 20 MG/2ML INJ

Facility

$16.85

Hospital Charge Code	60628796
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

TORSEMIDE 20 MG TAB

Facility

$24.72

Service Code	NDC 37352001
Hospital Charge Code	60628998
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$3.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.71

TORSEMIDE 20 MG TAB

Facility

$24.72

Service Code	NDC 37352001
Hospital Charge Code	60628998
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna Commercial	$9.39
Rate for Payer: Aetna Medicare Advantage	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.30
Rate for Payer: Cigna Commercial	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.42
Rate for Payer: Oxford Commercial	$4.94
Rate for Payer: Qualcare PPO/HMO/WC	$3.71
Rate for Payer: UnitedHealthcare Commercial	$4.94
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

TORSEMIDE 50 MG/5ML INJ

Facility

$12.40

Hospital Charge Code	60628727
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.20
Rate for Payer: Aetna Commercial	$4.71
Rate for Payer: Aetna Medicare Advantage	$3.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.16
Rate for Payer: Cigna Commercial	$6.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.72
Rate for Payer: Oxford Commercial	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$1.86
Rate for Payer: UnitedHealthcare Commercial	$2.48
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

TORSEMIDE 50 MG/5ML INJ

Facility

$12.40

Hospital Charge Code	60628727
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.86

TORSEMIDE 5 MG TAB

Facility

$4.22

Service Code	NDC 31722052901
Hospital Charge Code	60628728
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.63

TORSEMIDE 5 MG TAB

Facility

$4.22

Service Code	NDC 31722052901
Hospital Charge Code	60628728
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.11
Rate for Payer: Aetna Commercial	$1.60
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.27
Rate for Payer: Oxford Commercial	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.63
Rate for Payer: UnitedHealthcare Commercial	$0.84
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

TOTAL BILI, DIR/IND PANEL***

Facility

$7.20

Service Code	HCPCS 82251
Hospital Charge Code	3000437P
Hospital Revenue Code	301
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

TOTAL BILI, DIR/IND PANEL***

Facility

$7.20

Service Code	HCPCS 82251
Hospital Charge Code	3000437P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$2.74
Rate for Payer: Aetna Medicare Advantage	$2.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.84
Rate for Payer: Cigna Commercial	$3.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

TOTAL HIP ARTHOPLASTY

Facility

$76,260.00

Service Code	HCPCS 27132
Hospital Charge Code	1600000871
Hospital Revenue Code	360
Min. Negotiated Rate	$11,439.00
Max. Negotiated Rate	$11,439.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,439.00

TOTAL HIP ARTHOPLASTY

Facility

$76,260.00

Service Code	HCPCS 27132
Hospital Charge Code	1600000871
Hospital Revenue Code	360
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$55,057.64
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,057.64
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,878.00
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,439.00
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,837.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2,020.89

TOTAL HIP KIT

Facility

$568.00

Hospital Charge Code	270338756
Hospital Revenue Code	272
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$85.20
Rate for Payer: Qualcare PPO/HMO/WC	$85.20

TOTAL HIP KIT

Facility

$568.00

Hospital Charge Code	270338756
Hospital Revenue Code	272
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$284.00
Rate for Payer: Aetna Commercial	$215.84
Rate for Payer: Aetna Medicare Advantage	$170.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.84
Rate for Payer: Cigna Commercial	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.40
Rate for Payer: Oxford Commercial	$113.60
Rate for Payer: Qualcare PPO/HMO/WC	$85.20
Rate for Payer: UnitedHealthcare Commercial	$113.60
Rate for Payer: UnitedHealthcare Community & State	$13.69
Rate for Payer: Wellpoint Medicaid Managed Care	$15.05

TOTAL HIP REPLCMNT(NO IMPT)

Facility

$75,763.70

Service Code	HCPCS 27130
Hospital Charge Code	16000339
Hospital Revenue Code	360
Min. Negotiated Rate	$11,364.56
Max. Negotiated Rate	$11,364.56
Rate for Payer: Qualcare PPO/HMO/WC	$11,364.56

TOTAL HIP REPLCMNT(NO IMPT)

Facility

$75,763.70

Service Code	HCPCS 27130
Hospital Charge Code	16000339
Hospital Revenue Code	360
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$55,057.64
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,057.64
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,729.11
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,364.56
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,825.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2,007.74

TOTAL IGA BY NEPHELOMETRY

Facility

$30.00

Service Code	HCPCS 82784
Hospital Charge Code	3035163
Hospital Revenue Code	301
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$30.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.57
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: Cigna Medicare Advantage	$9.30
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Medicare Advantage	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

TOTAL IGA BY NEPHELOMETRY

Facility

$30.00

Service Code	HCPCS 82784
Hospital Charge Code	3035163
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

TOTAL IRON BINDING CAPACITY

Facility

$667.59

Service Code	HCPCS 83550
Hospital Charge Code	3009289
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

TOTAL IRON BINDING CAPACITY

Facility

$667.59

Service Code	HCPCS 83550
Hospital Charge Code	3009289
Hospital Revenue Code	301
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$23.77
Rate for Payer: Aetna Medicare Advantage	$28.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.55
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$8.74
Rate for Payer: Clover Medicare Advantage	$8.30
Rate for Payer: EmblemHealth Commercial	$26.22
Rate for Payer: Humana Medicare Advantage	$9.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.74
Rate for Payer: Wellcare Medicare Advantage	$8.74
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

TOTAL IRON BINDING CAPACITY

Facility

$91.25

Service Code	HCPCS 83550
Hospital Charge Code	3003431
Hospital Revenue Code	301
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.77
Rate for Payer: Aetna Medicare Advantage	$28.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.55
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: Cigna Medicare Advantage	$8.74
Rate for Payer: Clover Medicare Advantage	$8.30
Rate for Payer: EmblemHealth Commercial	$26.22
Rate for Payer: Humana Medicare Advantage	$9.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.74
Rate for Payer: Wellcare Medicare Advantage	$8.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

TOTAL IRON BINDING CAPACITY

Facility

$91.25

Service Code	HCPCS 83550
Hospital Charge Code	3003431
Hospital Revenue Code	301
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

TOTAL KNOW ARTHROPLASTY

Facility

$8,536.90

Service Code	HCPCS 27447
Hospital Charge Code	1600171
Hospital Revenue Code	360
Min. Negotiated Rate	$1,280.54
Max. Negotiated Rate	$1,280.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.54

TOTAL KNOW ARTHROPLASTY

Facility

$8,536.90

Service Code	HCPCS 27447
Hospital Charge Code	1600171
Hospital Revenue Code	360
Min. Negotiated Rate	$205.74
Max. Negotiated Rate	$55,057.64
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,057.64
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,561.07
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,280.54
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$205.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$226.23

TOTAL PLUS INFUSION SET

Facility

$996.00

Hospital Charge Code	270332585
Hospital Revenue Code	272
Min. Negotiated Rate	$149.40
Max. Negotiated Rate	$149.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.40

TOTAL PLUS INFUSION SET

Facility

$996.00

Hospital Charge Code	270332585
Hospital Revenue Code	272
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$498.00
Rate for Payer: Aetna Commercial	$378.48
Rate for Payer: Aetna Medicare Advantage	$298.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.98
Rate for Payer: Cigna Commercial	$498.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.80
Rate for Payer: Oxford Commercial	$199.20
Rate for Payer: Qualcare PPO/HMO/WC	$149.40
Rate for Payer: UnitedHealthcare Commercial	$199.20
Rate for Payer: UnitedHealthcare Community & State	$24.00
Rate for Payer: Wellpoint Medicaid Managed Care	$26.39

Know your out-of-pocket cost for care.

All Charges