Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAVUX FAC FIX SY 4MM

Facility

$14,000.00

Hospital Charge Code	270702429
Hospital Revenue Code	278
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

CAVUX FAC FIX SY 4MM

Facility

$14,000.00

Hospital Charge Code	270702429
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

CBC (NO DIFF)

Facility

$667.59

Service Code	HCPCS 85027
Hospital Charge Code	3005403
Hospital Revenue Code	305
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

CBC (NO DIFF)

Facility

$667.59

Service Code	HCPCS 85027
Hospital Charge Code	3005403
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CBC NO DIFF

Facility

$46.35

Service Code	HCPCS 85027
Hospital Charge Code	3005394
Hospital Revenue Code	305
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$23.18
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

CBC NO DIFF

Facility

$46.35

Service Code	HCPCS 85027
Hospital Charge Code	3005394
Hospital Revenue Code	305
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$6.95
Rate for Payer: Qualcare PPO/HMO/WC	$6.95

CBC ONCOLOGY CLINIC

Facility

$531.04

Service Code	HCPCS 85025
Hospital Charge Code	3030871
Hospital Revenue Code	305
Min. Negotiated Rate	$79.66
Max. Negotiated Rate	$79.66
Rate for Payer: Qualcare PPO/HMO/WC	$79.66

CBC ONCOLOGY CLINIC

Facility

$531.04

Service Code	HCPCS 85025
Hospital Charge Code	3030871
Hospital Revenue Code	305
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$265.52
Rate for Payer: Aetna Commercial	$21.13
Rate for Payer: Aetna Medicare Advantage	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$265.52
Rate for Payer: Cigna Medicare Advantage	$7.77
Rate for Payer: Clover Medicare Advantage	$7.38
Rate for Payer: EmblemHealth Commercial	$23.31
Rate for Payer: Humana Medicare Advantage	$8.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.66
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.77
Rate for Payer: Wellcare Medicare Advantage	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$14.07

CBC PATHOLOGIST REVIEW

Facility

$133.65

Service Code	HCPCS 85060
Hospital Charge Code	3007978
Hospital Revenue Code	305
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

CBC PATHOLOGIST REVIEW

Facility

$133.65

Service Code	HCPCS 85060
Hospital Charge Code	3007978
Hospital Revenue Code	305
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.79
Rate for Payer: Aetna Medicare Advantage	$40.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$66.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.52
Rate for Payer: Wellpoint Medicaid Managed Care	$3.54

CBC W/AUTO DIFFERNTIAL

Facility

$449.40

Service Code	HCPCS 85025
Hospital Charge Code	38473003
Hospital Revenue Code	305
Min. Negotiated Rate	$67.41
Max. Negotiated Rate	$67.41
Rate for Payer: Qualcare PPO/HMO/WC	$67.41

CBC W/AUTO DIFFERNTIAL

Facility

$449.40

Service Code	HCPCS 85025
Hospital Charge Code	38473003
Hospital Revenue Code	305
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$224.70
Rate for Payer: Aetna Commercial	$21.13
Rate for Payer: Aetna Medicare Advantage	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$224.70
Rate for Payer: Cigna Medicare Advantage	$7.77
Rate for Payer: Clover Medicare Advantage	$7.38
Rate for Payer: EmblemHealth Commercial	$23.31
Rate for Payer: Humana Medicare Advantage	$8.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.41
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.77
Rate for Payer: Wellcare Medicare Advantage	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$11.91

CBC W/O DIFFERENTIAL

Facility

$183.00

Service Code	HCPCS 85027
Hospital Charge Code	38474116
Hospital Revenue Code	305
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

CBC W/O DIFFERENTIAL

Facility

$183.00

Service Code	HCPCS 85027
Hospital Charge Code	38474116
Hospital Revenue Code	305
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$91.50
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$4.85

CCIIV4 VAC NO PRSV 0.5 ML IM

Facility

$72.45

Service Code	HCPCS 90674
Hospital Charge Code	412390674
Hospital Revenue Code	636
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$17.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$10.87

CCIIV4 VAC NO PRSV 0.5 ML IM

Facility

$72.45

Service Code	HCPCS 90674
Hospital Charge Code	412390674
Hospital Revenue Code	636
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$36.23
Rate for Payer: Aetna Commercial	$27.53
Rate for Payer: Aetna Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.47
Rate for Payer: Cigna Commercial	$36.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$10.87
Rate for Payer: UnitedHealthcare Community & State	$1.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

CCP IGG

Facility

$390.00

Service Code	HCPCS 86200
Hospital Charge Code	39900361
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CCP IGG

Facility

$390.00

Service Code	HCPCS 86200
Hospital Charge Code	39900361
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.22
Rate for Payer: Aetna Medicare Advantage	$41.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.75
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.95
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.95
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	$10.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.95
Rate for Payer: Wellcare Medicare Advantage	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

C,D 10MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656977
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

C,D 10MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656977
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C,D 12MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656978
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

C,D 12MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656978
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C, D 12MM 5, 6 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656974
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

C, D 12MM 5, 6 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270656974
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

C,D 14MM PLATE 1,2 LPS-FLEX

Facility

$5,862.10

Hospital Charge Code	270656980
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

Know your out-of-pocket cost for care.

All Charges