Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLOSTRIDIUM DIFFICILE TOXIN A

Facility

$164.85

Service Code	HCPCS 87230
Hospital Charge Code	3004819
Hospital Revenue Code	309
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$24.73
Rate for Payer: Qualcare PPO/HMO/WC	$24.73

CLOSTRIDIUM DIFFICILE TOXIN A

Facility

$164.85

Service Code	HCPCS 87230
Hospital Charge Code	3004819
Hospital Revenue Code	309
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$53.69
Rate for Payer: Aetna Medicare Advantage	$63.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.26
Rate for Payer: Cigna Commercial	$82.42
Rate for Payer: Cigna Medicare Advantage	$19.74
Rate for Payer: Clover Medicare Advantage	$18.75
Rate for Payer: EmblemHealth Commercial	$59.22
Rate for Payer: Humana Medicare Advantage	$20.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.74
Rate for Payer: Wellcare Medicare Advantage	$19.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

CLOSTRIDIUM DIFFICILE TOXIN DE

Facility

$142.00

Service Code	HCPCS 87230
Hospital Charge Code	38475035
Hospital Revenue Code	309
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

CLOSTRIDIUM DIFFICILE TOXIN DE

Facility

$142.00

Service Code	HCPCS 87230
Hospital Charge Code	38475035
Hospital Revenue Code	309
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$53.69
Rate for Payer: Aetna Medicare Advantage	$63.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.26
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$19.74
Rate for Payer: Clover Medicare Advantage	$18.75
Rate for Payer: EmblemHealth Commercial	$59.22
Rate for Payer: Humana Medicare Advantage	$20.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.74
Rate for Payer: Wellcare Medicare Advantage	$19.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

CLOSTRIDIUM DIF TOXIN B,Q

Facility

$241.20

Service Code	HCPCS 87493
Hospital Charge Code	39900292
Hospital Revenue Code	306
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$134.53
Rate for Payer: Aetna Commercial	$101.37
Rate for Payer: Aetna Medicare Advantage	$120.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.53
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: Cigna Medicare Advantage	$37.27
Rate for Payer: Clover Medicare Advantage	$35.41
Rate for Payer: EmblemHealth Commercial	$111.81
Rate for Payer: Humana Medicare Advantage	$38.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$29.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.27
Rate for Payer: Wellcare Medicare Advantage	$37.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

CLOSTRIDIUM DIF TOXIN B,Q

Facility

$241.20

Service Code	HCPCS 87493
Hospital Charge Code	39900292
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

CLOSURE DEVICE MYNX CON 5F

Facility

$1,025.00

Service Code	HCPCS C1750
Hospital Charge Code	270695678S
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CLOSURE DEVICE MYNX CON 5F

Facility

$1,025.00

Service Code	HCPCS C1750
Hospital Charge Code	270695678S
Hospital Revenue Code	278
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

CLOSURE DEVICE MYNX MX 6700

Facility

$1,025.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941S
Hospital Revenue Code	278
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

CLOSURE DEVICE MYNX MX 6700

Facility

$1,025.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941S
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Hospital Charge Code	270642941
Hospital Revenue Code	279
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941N
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Hospital Charge Code	270642941
Hospital Revenue Code	279
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.00
Rate for Payer: Oxford Commercial	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Commercial	$210.00
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

CLOSURE EYELID BY SUTURES

Facility

$5,703.05

Service Code	HCPCS 67875
Hospital Charge Code	1600000596
Hospital Revenue Code	360
Min. Negotiated Rate	$137.44
Max. Negotiated Rate	$5,311.00
Rate for Payer: Aetna Commercial	$3,221.35
Rate for Payer: Aetna Medicare Advantage	$3,837.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,275.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,275.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,184.32
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	$4,275.04
Rate for Payer: Cigna Commercial	$2,373.97
Rate for Payer: Cigna Medicare Advantage	$1,184.32
Rate for Payer: Clover Medicare Advantage	$1,125.10
Rate for Payer: EmblemHealth Commercial	$3,552.96
Rate for Payer: Humana Medicare Advantage	$1,219.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,184.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,710.91
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.46
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$137.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,184.32
Rate for Payer: Wellcare Medicare Advantage	$1,184.32
Rate for Payer: Wellpoint Medicaid Managed Care	$151.13

CLOSURE EYELID BY SUTURES

Facility

$5,703.05

Service Code	HCPCS 67875
Hospital Charge Code	1600000596
Hospital Revenue Code	360
Min. Negotiated Rate	$855.46
Max. Negotiated Rate	$855.46
Rate for Payer: Qualcare PPO/HMO/WC	$855.46

CLOSUREFAST INTRODUC SET 7

Facility

$152.50

Hospital Charge Code	270703633
Hospital Revenue Code	272
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$76.25
Rate for Payer: Aetna Commercial	$57.95
Rate for Payer: Aetna Medicare Advantage	$45.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.89
Rate for Payer: Cigna Commercial	$76.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.75
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.88
Rate for Payer: UnitedHealthcare Commercial	$30.50
Rate for Payer: UnitedHealthcare Community & State	$3.68
Rate for Payer: Wellpoint Medicaid Managed Care	$4.04

CLOSUREFAST INTRODUC SET 7

Facility

$152.50

Hospital Charge Code	270703633
Hospital Revenue Code	272
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$22.88

CLOSUREFAST PROCEDURE PACK

Facility

$447.50

Hospital Charge Code	270703631
Hospital Revenue Code	272
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$223.75
Rate for Payer: Aetna Commercial	$170.05
Rate for Payer: Aetna Medicare Advantage	$134.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.11
Rate for Payer: Cigna Commercial	$223.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.25
Rate for Payer: Oxford Commercial	$89.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.12
Rate for Payer: UnitedHealthcare Commercial	$89.50
Rate for Payer: UnitedHealthcare Community & State	$10.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11.86

CLOSUREFAST PROCEDURE PACK

Facility

$447.50

Hospital Charge Code	270703631
Hospital Revenue Code	272
Min. Negotiated Rate	$67.12
Max. Negotiated Rate	$67.12
Rate for Payer: Qualcare PPO/HMO/WC	$67.12

CLOSURE NEEDLE-EXCEL DPC610***

Facility

$125.00

Hospital Charge Code	1606094
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CLOSURE NEEDLE-EXCEL DPC610***

Facility

$125.00

Hospital Charge Code	1606094
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

CLOSURE PRELUDE 24CM 10

Facility

$175.00

Hospital Charge Code	270689933S
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

CLOSURE PRELUDE 24CM 10

Facility

$175.00

Hospital Charge Code	270689933S
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

CLOSURE PRELUDE 24 CM 10 ML

Facility

$175.00

Hospital Charge Code	270689933
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

Know your out-of-pocket cost for care.

All Charges