Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TPMT GENOTYPE

Facility

$390.00

Hospital Charge Code	3035132D
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TPMT GENOTYPE

Facility

$390.00

Hospital Charge Code	3035132C
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TPMT GENOTYPE

Facility

$390.00

Service Code	HCPCS 81335
Hospital Charge Code	3035132A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$631.01
Rate for Payer: Aetna Commercial	$475.48
Rate for Payer: Aetna Medicare Advantage	$566.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$174.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.01
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$174.81
Rate for Payer: Clover Medicare Advantage	$166.07
Rate for Payer: EmblemHealth Commercial	$524.43
Rate for Payer: Humana Medicare Advantage	$180.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$174.81
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	$139.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$174.81
Rate for Payer: Wellcare Medicare Advantage	$174.81
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TPN

Facility

$886.00

Hospital Charge Code	60634760
Hospital Revenue Code	250
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$443.00
Rate for Payer: Aetna Commercial	$336.68
Rate for Payer: Aetna Medicare Advantage	$265.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.93
Rate for Payer: Cigna Commercial	$443.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.80
Rate for Payer: Oxford Commercial	$177.20
Rate for Payer: Qualcare PPO/HMO/WC	$132.90
Rate for Payer: UnitedHealthcare Commercial	$177.20
Rate for Payer: UnitedHealthcare Community & State	$21.35
Rate for Payer: Wellpoint Medicaid Managed Care	$23.48

TPN

Facility

$886.00

Hospital Charge Code	60634760
Hospital Revenue Code	250
Min. Negotiated Rate	$132.90
Max. Negotiated Rate	$132.90
Rate for Payer: Qualcare PPO/HMO/WC	$132.90

TPN

Facility

$886.00

Hospital Charge Code	60635155
Hospital Revenue Code	250
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$443.00
Rate for Payer: Aetna Commercial	$336.68
Rate for Payer: Aetna Medicare Advantage	$265.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.93
Rate for Payer: Cigna Commercial	$443.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.80
Rate for Payer: Oxford Commercial	$177.20
Rate for Payer: Qualcare PPO/HMO/WC	$132.90
Rate for Payer: UnitedHealthcare Commercial	$177.20
Rate for Payer: UnitedHealthcare Community & State	$21.35
Rate for Payer: Wellpoint Medicaid Managed Care	$23.48

TPN

Facility

$886.00

Hospital Charge Code	60635155
Hospital Revenue Code	250
Min. Negotiated Rate	$132.90
Max. Negotiated Rate	$132.90
Rate for Payer: Qualcare PPO/HMO/WC	$132.90

TPRLC 133 FP FTYPE PPS SO 6.0

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685253
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TPRLC 133 FP FTYPE PPS SO 6.0

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685253
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC 133 FP TYPE1 PPS SO 8.0

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687973
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC 133 FP TYPE1 PPS SO 8.0

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687973
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TPRLC 133 T1PPS HO 11 X 142MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680825
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TPRLC 133 T1PPS HO 11 X 142MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680825
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC 133 T1 PPS HO 12 X 144MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686369
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TPRLC 133 T1 PPS HO 12 X 144MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686369
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC 133 T1 PPS SO 10X140MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681801
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC 133 T1 PPS SO 10X140MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681801
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TPRLC 133 T1 PPS SO 20X160MM

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695711
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC 133 T1 PPS SO 20X160MM

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695711
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TPRLC 133 TYPE 1 PPS SO 17.0

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679848
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TPRLC 133 TYPE 1 PPS SO 17.0

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679848
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC XR FP TYPE1 PPS 5X130MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC XR FP TYPE1 PPS 5X130MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696781
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TPRLC XR T1 PPS 10 X 140 MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687014
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TPRLC XR T1 PPS 10 X 140 MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687014
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

Know your out-of-pocket cost for care.

All Charges