Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRANSFUSION REACTION

Facility

$249.00

Service Code	HCPCS 86078
Hospital Charge Code	38471064
Hospital Revenue Code	302
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$37.35
Rate for Payer: Qualcare PPO/HMO/WC	$37.35

TRANSFUSION REACTION, URINE

Facility

$100.00

Service Code	HCPCS 86999
Hospital Charge Code	3100435
Hospital Revenue Code	300
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

TRANSFUSION REACTION, URINE

Facility

$100.00

Service Code	HCPCS 86999
Hospital Charge Code	3100435
Hospital Revenue Code	300
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$124.03
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

TRANSFUSION TX ADMIN > 4HRS

Facility

$1,403.75

Service Code	HCPCS 36430
Hospital Charge Code	3401040
Hospital Revenue Code	391
Min. Negotiated Rate	$33.83
Max. Negotiated Rate	$1,891.95
Rate for Payer: Aetna Commercial	$1,425.63
Rate for Payer: Aetna Medicare Advantage	$1,698.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,891.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,891.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$524.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,891.95
Rate for Payer: Cigna Commercial	$1,050.61
Rate for Payer: Cigna Medicare Advantage	$524.13
Rate for Payer: Clover Medicare Advantage	$497.92
Rate for Payer: EmblemHealth Commercial	$1,572.39
Rate for Payer: Humana Medicare Advantage	$539.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$524.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.12
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.56
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$33.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$524.13
Rate for Payer: Wellcare Medicare Advantage	$524.13
Rate for Payer: Wellpoint Medicaid Managed Care	$37.20

TRANSFUSION TX ADMIN > 4HRS

Facility

$1,403.75

Service Code	HCPCS 36430
Hospital Charge Code	3401040
Hospital Revenue Code	391
Min. Negotiated Rate	$210.56
Max. Negotiated Rate	$210.56
Rate for Payer: Qualcare PPO/HMO/WC	$210.56

TRANSFUSION TX ADMIN UP TO 4HR

Facility

$1,403.75

Service Code	HCPCS 36430
Hospital Charge Code	3400074
Hospital Revenue Code	391
Min. Negotiated Rate	$33.83
Max. Negotiated Rate	$1,891.95
Rate for Payer: Aetna Commercial	$1,425.63
Rate for Payer: Aetna Medicare Advantage	$1,698.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,891.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,891.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$524.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,891.95
Rate for Payer: Cigna Commercial	$1,050.61
Rate for Payer: Cigna Medicare Advantage	$524.13
Rate for Payer: Clover Medicare Advantage	$497.92
Rate for Payer: EmblemHealth Commercial	$1,572.39
Rate for Payer: Humana Medicare Advantage	$539.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$524.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.12
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.56
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$33.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$524.13
Rate for Payer: Wellcare Medicare Advantage	$524.13
Rate for Payer: Wellpoint Medicaid Managed Care	$37.20

TRANSFUSION TX ADMIN UP TO 4HR

Facility

$1,403.75

Service Code	HCPCS 36430
Hospital Charge Code	3400074
Hospital Revenue Code	391
Min. Negotiated Rate	$210.56
Max. Negotiated Rate	$210.56
Rate for Payer: Qualcare PPO/HMO/WC	$210.56

TRANSGLUTAMINASE AB (IGA)

Facility

$75.65

Service Code	HCPCS 83516
Hospital Charge Code	39900096
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

TRANSGLUTAMINASE AB (IGA)

Facility

$75.65

Service Code	HCPCS 83516
Hospital Charge Code	39900096
Hospital Revenue Code	301
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

TRANSHEPATIC CHOLANGIOGRAM

Facility

$331.55

Service Code	HCPCS 47500
Hospital Charge Code	5100521
Hospital Revenue Code	361
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$125.99
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
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	$84.55
Rate for Payer: Cigna Commercial	$165.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.47
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

TRANSHEPATIC CHOLANGIOGRAM

Facility

$331.55

Service Code	HCPCS 47500
Hospital Charge Code	5100521
Hospital Revenue Code	361
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

TRANSHEPATIC CHOLANGIOGRAM S&I

Facility

$1,305.00

Service Code	HCPCS 74320
Hospital Charge Code	5100520
Hospital Revenue Code	320
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$495.90
Rate for Payer: Aetna Medicare Advantage	$391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.77
Rate for Payer: Cigna Commercial	$652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.50
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.75
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$31.45
Rate for Payer: Wellpoint Medicaid Managed Care	$34.58

TRANSHEPATIC CHOLANGIOGRAM S&I

Facility

$1,305.00

Service Code	HCPCS 74320
Hospital Charge Code	5100520
Hospital Revenue Code	320
Min. Negotiated Rate	$195.75
Max. Negotiated Rate	$195.75
Rate for Payer: Qualcare PPO/HMO/WC	$195.75

TRANSIENT ISCHEMIA

Facility

$8,142.82

Service Code	APR-DRG 0471
Min. Negotiated Rate	$7,983.16
Max. Negotiated Rate	$8,142.82
Rate for Payer: UnitedHealthcare Community & State	$7,983.16
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,142.82
Rate for Payer: Wellpoint Medicaid Managed Care	$7,983.16

TRANSIENT ISCHEMIA

Facility

$19,972.83

Service Code	APR-DRG 0474
Min. Negotiated Rate	$19,581.21
Max. Negotiated Rate	$19,972.83
Rate for Payer: UnitedHealthcare Community & State	$19,581.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,972.83
Rate for Payer: Wellpoint Medicaid Managed Care	$19,581.21

TRANSIENT ISCHEMIA

Facility

$9,334.03

Service Code	APR-DRG 0472
Min. Negotiated Rate	$9,151.01
Max. Negotiated Rate	$9,334.03
Rate for Payer: UnitedHealthcare Community & State	$9,151.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,334.03
Rate for Payer: Wellpoint Medicaid Managed Care	$9,151.01

TRANSIENT ISCHEMIA

Facility

$11,776.34

Service Code	APR-DRG 0473
Min. Negotiated Rate	$11,545.43
Max. Negotiated Rate	$11,776.34
Rate for Payer: UnitedHealthcare Community & State	$11,545.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,776.34
Rate for Payer: Wellpoint Medicaid Managed Care	$11,545.43

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$27,952.61

Service Code	MSDRG 069
Min. Negotiated Rate	$8,511.21
Max. Negotiated Rate	$27,952.61
Rate for Payer: Aetna Medicare Advantage	$27,952.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,608.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,608.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,959.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,608.80
Rate for Payer: Cigna Commercial	$14,948.74
Rate for Payer: Cigna Medicare Advantage	$8,959.17
Rate for Payer: Clover Medicare Advantage	$8,511.21
Rate for Payer: EmblemHealth Commercial	$26,877.51
Rate for Payer: Humana Medicare Advantage	$9,227.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,959.17
Rate for Payer: Oxford Commercial	$10,743.86
Rate for Payer: UnitedHealthcare Commercial	$18,839.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,959.17
Rate for Payer: Wellcare Medicare Advantage	$8,959.17

TRANSL ATHERECTOMY,PERI ARTERY

Facility

$4,666.00

Service Code	HCPCS 75992
Hospital Charge Code	2680355
Hospital Revenue Code	320
Min. Negotiated Rate	$112.45
Max. Negotiated Rate	$2,333.00
Rate for Payer: Aetna Commercial	$1,773.08
Rate for Payer: Aetna Medicare Advantage	$1,399.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,189.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,189.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,189.83
Rate for Payer: Cigna Commercial	$2,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,399.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$699.90
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$112.45
Rate for Payer: Wellpoint Medicaid Managed Care	$123.65

TRANSL ATHERECTOMY,PERI ARTERY

Facility

$4,666.00

Service Code	HCPCS 75992
Hospital Charge Code	2680355
Hospital Revenue Code	320
Min. Negotiated Rate	$699.90
Max. Negotiated Rate	$699.90
Rate for Payer: Qualcare PPO/HMO/WC	$699.90

TRANSLOC 3D SCREW 8.5X40MM

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703905
Hospital Revenue Code	278
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$5,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,675.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50

TRANSLOC 3D SCREW 8.5X40MM

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703905
Hospital Revenue Code	278
Min. Negotiated Rate	$512.12
Max. Negotiated Rate	$10,625.00
Rate for Payer: Aetna Commercial	$8,075.00
Rate for Payer: Aetna Medicare Advantage	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,418.75
Rate for Payer: Cigna Commercial	$10,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,675.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50
Rate for Payer: UnitedHealthcare Community & State	$512.12
Rate for Payer: Wellpoint Medicaid Managed Care	$563.12

TRANSLOC 3D SCREW 8.5X45MM.

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703694
Hospital Revenue Code	278
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$5,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,675.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50

TRANSLOC 3D SCREW 8.5X45MM.

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703694
Hospital Revenue Code	278
Min. Negotiated Rate	$512.12
Max. Negotiated Rate	$10,625.00
Rate for Payer: Aetna Commercial	$8,075.00
Rate for Payer: Aetna Medicare Advantage	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,418.75
Rate for Payer: Cigna Commercial	$10,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,675.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50
Rate for Payer: UnitedHealthcare Community & State	$512.12
Rate for Payer: Wellpoint Medicaid Managed Care	$563.12

TRANSLOC 3D SCREW 8.5X50MM

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704430
Hospital Revenue Code	278
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$5,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,675.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50

Know your out-of-pocket cost for care.

All Charges