Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$5,862.10

Hospital Charge Code	270656980
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 17MM 1.2 ART SURFACE

Facility

$5,862.10

Hospital Charge Code	270656982
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 17MM 1.2 ART SURFACE

Facility

$5,862.10

Hospital Charge Code	270656982
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

CD55 - CD59

Facility

$38.15

Hospital Charge Code	3035095B
Hospital Revenue Code	300
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$5.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.72

CD55 - CD59

Facility

$38.15

Hospital Charge Code	3035095B
Hospital Revenue Code	300
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.50
Rate for Payer: Aetna Medicare Advantage	$11.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.73
Rate for Payer: Cigna Commercial	$19.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.72
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 8818591
Hospital Charge Code	3035095D
Hospital Revenue Code	311
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

CD55 - CD59

Facility

$75.00

Service Code	HCPCS 88187
Hospital Charge Code	3035095G
Hospital Revenue Code	311
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$27.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 8818591
Hospital Charge Code	3035095F
Hospital Revenue Code	311
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 88184
Hospital Charge Code	3035095C
Hospital Revenue Code	311
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 8818591
Hospital Charge Code	3035095E
Hospital Revenue Code	311
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 8818591
Hospital Charge Code	3035095E
Hospital Revenue Code	311
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 8818591
Hospital Charge Code	3035095D
Hospital Revenue Code	311
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 88184
Hospital Charge Code	3035095C
Hospital Revenue Code	311
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$1,537.15
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,537.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,537.15
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$64.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

CD55 - CD59

Facility

$75.00

Service Code	HCPCS 88187
Hospital Charge Code	3035095G
Hospital Revenue Code	311
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

CD55 - CD59

Facility

$105.00

Service Code	HCPCS 8818591
Hospital Charge Code	3035095F
Hospital Revenue Code	311
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

CD55 - CD59

Facility

$38.15

Hospital Charge Code	3035095A
Hospital Revenue Code	300
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.50
Rate for Payer: Aetna Medicare Advantage	$11.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.73
Rate for Payer: Cigna Commercial	$19.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.72
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

CD55 - CD59

Facility

$38.15

Hospital Charge Code	3035095A
Hospital Revenue Code	300
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$5.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.72

CDC ANEROBE 5% SB WITH PEA

Facility

$50.40

Hospital Charge Code	270651816
Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$7.56

CDC ANEROBE 5% SB WITH PEA

Facility

$50.40

Hospital Charge Code	270651816
Hospital Revenue Code	270
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.20
Rate for Payer: Aetna Commercial	$19.15
Rate for Payer: Aetna Medicare Advantage	$15.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.85
Rate for Payer: Cigna Commercial	$25.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.12
Rate for Payer: Oxford Commercial	$10.08
Rate for Payer: Qualcare PPO/HMO/WC	$7.56
Rate for Payer: UnitedHealthcare Commercial	$10.08
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

CDC ANEROBE 5% SB W/KANAMYCIN

Facility

$53.20

Hospital Charge Code	270651815
Hospital Revenue Code	270
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$7.98
Rate for Payer: Qualcare PPO/HMO/WC	$7.98

CDC ANEROBE 5% SB W/KANAMYCIN

Facility

$53.20

Hospital Charge Code	270651815
Hospital Revenue Code	270
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$26.60
Rate for Payer: Aetna Commercial	$20.22
Rate for Payer: Aetna Medicare Advantage	$15.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.57
Rate for Payer: Cigna Commercial	$26.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.96
Rate for Payer: Oxford Commercial	$10.64
Rate for Payer: Qualcare PPO/HMO/WC	$7.98
Rate for Payer: UnitedHealthcare Commercial	$10.64
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

C/D CLAMP

Facility

$3,315.00

Hospital Charge Code	270656647
Hospital Revenue Code	272
Min. Negotiated Rate	$497.25
Max. Negotiated Rate	$497.25
Rate for Payer: Qualcare PPO/HMO/WC	$497.25

C/D CLAMP

Facility

$3,315.00

Hospital Charge Code	270656647
Hospital Revenue Code	272
Min. Negotiated Rate	$79.89
Max. Negotiated Rate	$1,657.50
Rate for Payer: Aetna Commercial	$1,259.70
Rate for Payer: Aetna Medicare Advantage	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$845.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$845.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$845.33
Rate for Payer: Cigna Commercial	$1,657.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$994.50
Rate for Payer: Oxford Commercial	$663.00
Rate for Payer: Qualcare PPO/HMO/WC	$497.25
Rate for Payer: UnitedHealthcare Commercial	$663.00
Rate for Payer: UnitedHealthcare Community & State	$79.89
Rate for Payer: Wellpoint Medicaid Managed Care	$87.85

CDIFF CULT REFL TOXIN B RT PCR

Facility

$109.12

Service Code	HCPCS 87081
Hospital Charge Code	4013870813
Hospital Revenue Code	309
Min. Negotiated Rate	$16.37
Max. Negotiated Rate	$16.37
Rate for Payer: Qualcare PPO/HMO/WC	$16.37

CDIFF CULT REFL TOXIN B RT PCR

Facility

$109.12

Service Code	HCPCS 87081
Hospital Charge Code	4013870813
Hospital Revenue Code	309
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: Aetna Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.93
Rate for Payer: Cigna Commercial	$54.56
Rate for Payer: Cigna Medicare Advantage	$6.63
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Medicare Advantage	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

Know your out-of-pocket cost for care.

All Charges