Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BILL FFP

Facility

$170.25

Hospital Charge Code	3100021
Hospital Revenue Code	390
Min. Negotiated Rate	$25.54
Max. Negotiated Rate	$25.54
Rate for Payer: Qualcare PPO/HMO/WC	$25.54

BILL HEMOGLOBIN S NEG BLOOD

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100492
Hospital Revenue Code	300
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.85

BILL HEMOGLOBIN S NEG BLOOD

Facility

$220.85

Service Code	HCPCS 86921
Hospital Charge Code	3100492
Hospital Revenue Code	300
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$33.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

BILL PHERESIS PLTS, SGL DONOR

Facility

$40.17

Service Code	HCPCS 86985
Hospital Charge Code	3100120
Hospital Revenue Code	390
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

BILL PHERESIS PLTS, SGL DONOR

Facility

$40.17

Service Code	HCPCS 86985
Hospital Charge Code	3100120
Hospital Revenue Code	390
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.05
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

BILL PLATELETS

Facility

$174.75

Hospital Charge Code	3100047
Hospital Revenue Code	390
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

BILL PLATELETS

Facility

$174.75

Hospital Charge Code	3100047
Hospital Revenue Code	390
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$66.41
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

BILL RHOGAM PRODUCT

Facility

$587.25

Hospital Charge Code	3100633
Hospital Revenue Code	636
Min. Negotiated Rate	$88.09
Max. Negotiated Rate	$142.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.11
Rate for Payer: Qualcare PPO/HMO/WC	$88.09

BILL RHOGAM PRODUCT

Facility

$587.25

Hospital Charge Code	3100633
Hospital Revenue Code	636
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$293.62
Rate for Payer: Aetna Commercial	$223.16
Rate for Payer: Aetna Medicare Advantage	$176.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.75
Rate for Payer: Cigna Commercial	$293.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.11
Rate for Payer: Qualcare PPO/HMO/WC	$88.09
Rate for Payer: UnitedHealthcare Community & State	$14.15
Rate for Payer: Wellpoint Medicaid Managed Care	$15.56

BILL RHO IMMUNE/GLOBULIN

Facility

$139.25

Hospital Charge Code	3100450
Hospital Revenue Code	636
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$33.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.89

BILL RHO IMMUNE/GLOBULIN

Facility

$139.25

Hospital Charge Code	3100450
Hospital Revenue Code	636
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$69.62
Rate for Payer: Aetna Commercial	$52.91
Rate for Payer: Aetna Medicare Advantage	$41.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.51
Rate for Payer: Cigna Commercial	$69.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.89
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

BILL SDP PLASMA

Facility

$484.00

Hospital Charge Code	3109010
Hospital Revenue Code	399
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

BILL SDP PLASMA

Facility

$484.00

Hospital Charge Code	3109010
Hospital Revenue Code	399
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

BIL RENAL ANGIO W CARD CATH

Facility

$2,132.50

Hospital Charge Code	74110049
Hospital Revenue Code	323
Min. Negotiated Rate	$51.39
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$810.35
Rate for Payer: Aetna Medicare Advantage	$639.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.79
Rate for Payer: Cigna Commercial	$1,066.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$639.75
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$51.39
Rate for Payer: Wellpoint Medicaid Managed Care	$56.51

BIL RENAL ANGIO W CARD CATH

Facility

$2,132.50

Hospital Charge Code	5100436
Hospital Revenue Code	323
Min. Negotiated Rate	$319.88
Max. Negotiated Rate	$319.88
Rate for Payer: Qualcare PPO/HMO/WC	$319.88

BIL RENAL ANGIO W CARD CATH

Facility

$2,132.50

Hospital Charge Code	5100436
Hospital Revenue Code	323
Min. Negotiated Rate	$51.39
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$810.35
Rate for Payer: Aetna Medicare Advantage	$639.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.79
Rate for Payer: Cigna Commercial	$1,066.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$639.75
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$319.88
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$51.39
Rate for Payer: Wellpoint Medicaid Managed Care	$56.51

BIL RENAL ANGIO W CARD CATH

Facility

$2,132.50

Hospital Charge Code	74110049
Hospital Revenue Code	323
Min. Negotiated Rate	$319.88
Max. Negotiated Rate	$319.88
Rate for Payer: Qualcare PPO/HMO/WC	$319.88

BILRY DUCT TRNSHPTIC DLATON

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	5100832
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

BILRY DUCT TRNSHPTIC DLATON

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	5100832
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

BILTRICIDE 600MG TAB

Facility

$66.00

Hospital Charge Code	60635241
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

BILTRICIDE 600MG TAB

Facility

$66.00

Hospital Charge Code	60635241
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

BIMATOPROST OPHT .03% SOL

Facility

$697.65

Hospital Charge Code	60629889
Hospital Revenue Code	250
Min. Negotiated Rate	$104.65
Max. Negotiated Rate	$104.65
Rate for Payer: Qualcare PPO/HMO/WC	$104.65

BIMATOPROST OPHT .03% SOL

Facility

$697.65

Hospital Charge Code	60629889
Hospital Revenue Code	250
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$348.82
Rate for Payer: Aetna Commercial	$265.11
Rate for Payer: Aetna Medicare Advantage	$209.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.90
Rate for Payer: Cigna Commercial	$348.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.29
Rate for Payer: Oxford Commercial	$139.53
Rate for Payer: Qualcare PPO/HMO/WC	$104.65
Rate for Payer: UnitedHealthcare Commercial	$139.53
Rate for Payer: UnitedHealthcare Community & State	$16.81
Rate for Payer: Wellpoint Medicaid Managed Care	$18.49

BI-MENTUM ALTRX LINER 53/28

Facility

$22,860.00

Service Code	HCPCS C1776
Hospital Charge Code	270700358
Hospital Revenue Code	278
Min. Negotiated Rate	$3,429.00
Max. Negotiated Rate	$5,532.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,532.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,029.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,429.00

BI-MENTUM ALTRX LINER 53/28

Facility

$22,860.00

Service Code	HCPCS C1776
Hospital Charge Code	270700358
Hospital Revenue Code	278
Min. Negotiated Rate	$550.93
Max. Negotiated Rate	$11,430.00
Rate for Payer: Aetna Commercial	$8,686.80
Rate for Payer: Aetna Medicare Advantage	$6,858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,829.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,829.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,572.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,829.30
Rate for Payer: Cigna Commercial	$11,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,532.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,029.20
Rate for Payer: Qualcare PPO/HMO/WC	$3,429.00
Rate for Payer: UnitedHealthcare Community & State	$550.93
Rate for Payer: Wellpoint Medicaid Managed Care	$605.79

Know your out-of-pocket cost for care.

All Charges