Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TYROSINE

Facility

$73.64

Service Code	HCPCS 84510
Hospital Charge Code	38477072
Hospital Revenue Code	301
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.91
Rate for Payer: Aetna Medicare Advantage	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.37
Rate for Payer: Cigna Commercial	$36.82
Rate for Payer: Cigna Medicare Advantage	$10.63
Rate for Payer: Clover Medicare Advantage	$10.10
Rate for Payer: EmblemHealth Commercial	$31.89
Rate for Payer: Humana Medicare Advantage	$10.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.63
Rate for Payer: Wellcare Medicare Advantage	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.95

TZANCK SMEAR***

Facility

$66.00

Hospital Charge Code	3010469
Hospital Revenue Code	309
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$124.00
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	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

TZANCK SMEAR***

Facility

$66.00

Hospital Charge Code	3010469
Hospital Revenue Code	309
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

TZANCK SMEAR GENITAL FEM)902**

Facility

$25.00

Hospital Charge Code	3010931
Hospital Revenue Code	306
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

TZANCK SMEAR GENITAL FEM)902**

Facility

$25.00

Hospital Charge Code	3010931
Hospital Revenue Code	306
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

UA DIPSTICK W/O/MICRO

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502760
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

UA DIPSTICK W/O/MICRO

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502760
Hospital Revenue Code	307
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.56
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.48
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.48
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	$2.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

U-BLADE LAG SCREW SET TITANIUM

Facility

$6,140.00

Hospital Charge Code	270658001
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

U-BLADE LAG SCREW SET TITANIUM

Facility

$6,140.00

Hospital Charge Code	270658001
Hospital Revenue Code	278
Min. Negotiated Rate	$147.97
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$2,333.20
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00
Rate for Payer: UnitedHealthcare Community & State	$147.97
Rate for Payer: Wellpoint Medicaid Managed Care	$162.71

U BLADE SET, TI

Facility

$5,740.00

Hospital Charge Code	270658000
Hospital Revenue Code	272
Min. Negotiated Rate	$861.00
Max. Negotiated Rate	$861.00
Rate for Payer: Qualcare PPO/HMO/WC	$861.00

U BLADE SET, TI

Facility

$5,740.00

Hospital Charge Code	270658000
Hospital Revenue Code	272
Min. Negotiated Rate	$138.33
Max. Negotiated Rate	$2,870.00
Rate for Payer: Aetna Commercial	$2,181.20
Rate for Payer: Aetna Medicare Advantage	$1,722.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.70
Rate for Payer: Cigna Commercial	$2,870.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,722.00
Rate for Payer: Oxford Commercial	$1,148.00
Rate for Payer: Qualcare PPO/HMO/WC	$861.00
Rate for Payer: UnitedHealthcare Commercial	$1,148.00
Rate for Payer: UnitedHealthcare Community & State	$138.33
Rate for Payer: Wellpoint Medicaid Managed Care	$152.11

UBLITUXIMAB-XIIYBRIUMVI25MG/ML

Facility

$4.00

Service Code	HCPCS J2329
Hospital Charge Code	606390554
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$248.17
Rate for Payer: Aetna Commercial	$187.00
Rate for Payer: Aetna Medicare Advantage	$222.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$68.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.17
Rate for Payer: Cigna Medicare Advantage	$68.75
Rate for Payer: Clover Medicare Advantage	$65.31
Rate for Payer: EmblemHealth Commercial	$206.25
Rate for Payer: Humana Medicare Advantage	$70.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$68.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.75
Rate for Payer: Wellcare Medicare Advantage	$68.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

UBLITUXIMAB-XIIYBRIUMVI25MG/ML

Facility

$4.00

Service Code	HCPCS J2329
Hospital Charge Code	606390554
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

U CALCIUM RANDOM***

Facility

$21.00

Hospital Charge Code	3010584
Hospital Revenue Code	301
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

U CALCIUM RANDOM***

Facility

$21.00

Hospital Charge Code	3010584
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

UC HIP INSTRUMENT TRAY

Facility

$2,475.00

Hospital Charge Code	270679416
Hospital Revenue Code	272
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.50
Rate for Payer: Oxford Commercial	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$495.00
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

UC HIP INSTRUMENT TRAY

Facility

$2,475.00

Hospital Charge Code	270679416
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

UGI

Facility

$1,066.95

Service Code	HCPCS 74240
Hospital Charge Code	94061137
Hospital Revenue Code	320
Min. Negotiated Rate	$160.04
Max. Negotiated Rate	$160.04
Rate for Payer: Qualcare PPO/HMO/WC	$160.04

UGI

Facility

$1,066.95

Service Code	HCPCS 74240
Hospital Charge Code	94061137
Hospital Revenue Code	320
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.08
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.04
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$25.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$28.27

UGI 2X W/O KUB W/W/O DELA

Facility

$460.00

Hospital Charge Code	2009030
Hospital Revenue Code	320
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$174.80
Rate for Payer: Aetna Medicare Advantage	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.30
Rate for Payer: Cigna Commercial	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$11.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.19

UGI 2X W/O KUB W/W/O DELA

Facility

$460.00

Hospital Charge Code	2009030
Hospital Revenue Code	320
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

UGI,DIAGNOSTIC-

Facility

$7,963.40

Service Code	HCPCS 43235
Hospital Charge Code	16000196
Hospital Revenue Code	360
Min. Negotiated Rate	$191.92
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,889.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,889.52
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.02
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$191.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$211.03

UGI,DIAGNOSTIC-

Facility

$7,963.40

Service Code	HCPCS 43235
Hospital Charge Code	16000196
Hospital Revenue Code	360
Min. Negotiated Rate	$1,194.51
Max. Negotiated Rate	$1,194.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51

UGI PLACEM GASTROSTOMY TUBE

Facility

$12,032.40

Service Code	HCPCS 43246
Hospital Charge Code	16000962
Hospital Revenue Code	360
Min. Negotiated Rate	$289.98
Max. Negotiated Rate	$8,229.07
Rate for Payer: Aetna Commercial	$6,200.81
Rate for Payer: Aetna Medicare Advantage	$7,386.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,229.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,279.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,229.07
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: Cigna Medicare Advantage	$2,279.71
Rate for Payer: Clover Medicare Advantage	$2,165.72
Rate for Payer: EmblemHealth Commercial	$6,839.13
Rate for Payer: Humana Medicare Advantage	$2,348.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,279.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,609.72
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.86
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$289.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,279.71
Rate for Payer: Wellcare Medicare Advantage	$2,279.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,829.61
Rate for Payer: Wellpoint Medicaid Managed Care	$4,734.91

UGI PLACEM GASTROSTOMY TUBE

Facility

$12,032.40

Service Code	HCPCS 43246
Hospital Charge Code	16000962
Hospital Revenue Code	360
Min. Negotiated Rate	$1,804.86
Max. Negotiated Rate	$1,804.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.86

Know your out-of-pocket cost for care.

All Charges