Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

5.5X90MM ROD MIS CREO

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270705937
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

56MM SZ.4 CLUSTER SHELL

Facility

$5,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270705867
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

56MM SZ.4 CLUSTER SHELL

Facility

$5,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270705867
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

58MM TM MUTLIHOLE

Facility

$8,660.65

Hospital Charge Code	270656916
Hospital Revenue Code	278
Min. Negotiated Rate	$208.72
Max. Negotiated Rate	$4,330.32
Rate for Payer: Aetna Commercial	$3,291.05
Rate for Payer: Aetna Medicare Advantage	$2,598.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.47
Rate for Payer: Cigna Commercial	$4,330.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10
Rate for Payer: UnitedHealthcare Community & State	$208.72
Rate for Payer: Wellpoint Medicaid Managed Care	$229.51

58MM TM MUTLIHOLE

Facility

$8,660.65

Hospital Charge Code	270656916
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.10
Max. Negotiated Rate	$2,095.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10

5 BEVEL NEUROTRACE

Facility

$51.65

Hospital Charge Code	270628623
Hospital Revenue Code	272
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$7.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.75

5 BEVEL NEUROTRACE

Facility

$51.65

Hospital Charge Code	270628623
Hospital Revenue Code	272
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$25.82
Rate for Payer: Aetna Commercial	$19.63
Rate for Payer: Aetna Medicare Advantage	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.17
Rate for Payer: Cigna Commercial	$25.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.49
Rate for Payer: Oxford Commercial	$10.33
Rate for Payer: Qualcare PPO/HMO/WC	$7.75
Rate for Payer: UnitedHealthcare Commercial	$10.33
Rate for Payer: UnitedHealthcare Community & State	$1.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1.37

5CC BONE FIBER

Facility

$3,395.00

Service Code	HCPCS C1765
Hospital Charge Code	270703923
Hospital Revenue Code	278
Min. Negotiated Rate	$81.82
Max. Negotiated Rate	$1,697.50
Rate for Payer: Aetna Commercial	$1,290.10
Rate for Payer: Aetna Medicare Advantage	$1,018.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$865.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$865.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$679.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$865.73
Rate for Payer: Cigna Commercial	$1,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$821.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$746.90
Rate for Payer: Qualcare PPO/HMO/WC	$509.25
Rate for Payer: UnitedHealthcare Community & State	$81.82
Rate for Payer: Wellpoint Medicaid Managed Care	$89.97

5CC BONE FIBER

Facility

$3,395.00

Service Code	HCPCS C1765
Hospital Charge Code	270703923
Hospital Revenue Code	278
Min. Negotiated Rate	$509.25
Max. Negotiated Rate	$821.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$679.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$821.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$746.90
Rate for Payer: Qualcare PPO/HMO/WC	$509.25

5CC PROTEIOS GROWTH FACTOR

Facility

$3,250.00

Service Code	HCPCS C1765
Hospital Charge Code	270705816
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

5CC PROTEIOS GROWTH FACTOR

Facility

$3,250.00

Service Code	HCPCS C1765
Hospital Charge Code	270705816
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

5%DEXT0.225%SODIUM CHLOR 1000ML

Facility

$42.21

Service Code	NDC 409792409
Hospital Charge Code	606350934
Hospital Revenue Code	258
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$6.33

5%DEXT0.225%SODIUM CHLOR 1000ML

Facility

$42.21

Service Code	NDC 409792409
Hospital Charge Code	606350934
Hospital Revenue Code	258
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.11
Rate for Payer: Aetna Commercial	$16.04
Rate for Payer: Aetna Medicare Advantage	$12.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.76
Rate for Payer: Cigna Commercial	$21.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.66
Rate for Payer: Oxford Commercial	$8.44
Rate for Payer: Qualcare PPO/HMO/WC	$6.33
Rate for Payer: UnitedHealthcare Commercial	$8.44
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

5 FLUOROURACIL 1GM

Facility

$34.00

Hospital Charge Code	60635593
Hospital Revenue Code	636
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$8.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

5 FLUOROURACIL 1GM

Facility

$34.00

Hospital Charge Code	60635593
Hospital Revenue Code	636
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

5FR JL 6.0

Facility

$40.00

Hospital Charge Code	270658158
Hospital Revenue Code	270
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

5FR JL 6.0

Facility

$40.00

Hospital Charge Code	2709002918
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

5FR JL 6.0

Facility

$40.00

Hospital Charge Code	270658158
Hospital Revenue Code	270
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

5FR JL 6.0

Facility

$40.00

Hospital Charge Code	2709002918
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

5-HIAA

Facility

$150.45

Service Code	HCPCS 83497
Hospital Charge Code	3001618
Hospital Revenue Code	301
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$22.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.57

5-HIAA

Facility

$150.45

Service Code	HCPCS 83497
Hospital Charge Code	3001618
Hospital Revenue Code	301
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.09
Rate for Payer: Aetna Medicare Advantage	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.57
Rate for Payer: Cigna Commercial	$75.22
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Medicare Advantage	$12.90
Rate for Payer: Wellpoint Medicaid Managed Care	$3.99

5-HIAA,24HR URINE

Facility

$390.00

Service Code	HCPCS 83497
Hospital Charge Code	39900094
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

5-HIAA,24HR URINE

Facility

$390.00

Service Code	HCPCS 83497
Hospital Charge Code	39900094
Hospital Revenue Code	301
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.09
Rate for Payer: Aetna Medicare Advantage	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.57
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.90
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	$10.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Medicare Advantage	$12.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

5 - HYDROXYINDOLEACETIC ACID 5

Facility

$257.00

Service Code	HCPCS 83497
Hospital Charge Code	38472479
Hospital Revenue Code	301
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$38.55
Rate for Payer: Qualcare PPO/HMO/WC	$38.55

5 - HYDROXYINDOLEACETIC ACID 5

Facility

$257.00

Service Code	HCPCS 83497
Hospital Charge Code	38472479
Hospital Revenue Code	301
Min. Negotiated Rate	$6.81
Max. Negotiated Rate	$128.50
Rate for Payer: Aetna Commercial	$35.09
Rate for Payer: Aetna Medicare Advantage	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.57
Rate for Payer: Cigna Commercial	$128.50
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Medicare Advantage	$12.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.81

Know your out-of-pocket cost for care.

All Charges