Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLOSURE PRELUDE 24 CM 10 ML

Facility

$175.00

Hospital Charge Code	270689933
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 SUR FIT TAIL 1756-35

Facility

$3.49

Hospital Charge Code	270649374
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.75
Rate for Payer: Aetna Commercial	$1.33
Rate for Payer: Aetna Medicare Advantage	$1.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.89
Rate for Payer: Cigna Commercial	$1.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.05
Rate for Payer: Oxford Commercial	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.52
Rate for Payer: UnitedHealthcare Commercial	$0.70
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

CLOSURE SUR FIT TAIL 1756-35

Facility

$3.49

Hospital Charge Code	270649374
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Qualcare PPO/HMO/WC	$0.52

CLOSURE SYSTEM WECK EFX

Facility

$525.00

Service Code	HCPCS C1760
Hospital Charge Code	270693986
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

CLOSURE SYSTEM WECK EFX

Facility

$525.00

Service Code	HCPCS C1760
Hospital Charge Code	270693986
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

CLOSURE TOP

Facility

$393.00

Hospital Charge Code	270339053
Hospital Revenue Code	272
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$196.50
Rate for Payer: Aetna Commercial	$149.34
Rate for Payer: Aetna Medicare Advantage	$117.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.22
Rate for Payer: Cigna Commercial	$196.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.90
Rate for Payer: Oxford Commercial	$78.60
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$78.60
Rate for Payer: UnitedHealthcare Community & State	$9.47
Rate for Payer: Wellpoint Medicaid Managed Care	$10.41

CLOSURE TOP

Facility

$393.00

Hospital Charge Code	270339053
Hospital Revenue Code	272
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

CLOTALYST STD SOLUTION 60ML

Facility

$5,750.00

Hospital Charge Code	270663732
Hospital Revenue Code	272
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,725.00
Rate for Payer: Oxford Commercial	$1,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$1,150.00
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

CLOTALYST STD SOLUTION 60ML

Facility

$5,750.00

Hospital Charge Code	270663732
Hospital Revenue Code	272
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

CLO TEST*****

Facility

$188.00

Service Code	HCPCS 87072
Hospital Charge Code	2300697
Hospital Revenue Code	306
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$71.44
Rate for Payer: Aetna Medicare Advantage	$56.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.94
Rate for Payer: Cigna Commercial	$94.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.98

CLO TEST*****

Facility

$188.00

Service Code	HCPCS 87072
Hospital Charge Code	2300697
Hospital Revenue Code	306
Min. Negotiated Rate	$28.20
Max. Negotiated Rate	$28.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.20

CLOTEST RAPID UREASE TEST

Facility

$51.05

Hospital Charge Code	270658250
Hospital Revenue Code	270
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$7.66
Rate for Payer: Qualcare PPO/HMO/WC	$7.66

CLOTEST RAPID UREASE TEST

Facility

$51.05

Hospital Charge Code	270658250
Hospital Revenue Code	270
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.52
Rate for Payer: Aetna Commercial	$19.40
Rate for Payer: Aetna Medicare Advantage	$15.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.02
Rate for Payer: Cigna Commercial	$25.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.31
Rate for Payer: Oxford Commercial	$10.21
Rate for Payer: Qualcare PPO/HMO/WC	$7.66
Rate for Payer: UnitedHealthcare Commercial	$10.21
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

CLO TESTS, ENDO AEROBIC ISOL

Facility

$389.24

Service Code	HCPCS 87077
Hospital Charge Code	3009356
Hospital Revenue Code	309
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$194.62
Rate for Payer: Aetna Commercial	$21.98
Rate for Payer: Aetna Medicare Advantage	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.17
Rate for Payer: Cigna Commercial	$194.62
Rate for Payer: Cigna Medicare Advantage	$8.08
Rate for Payer: Clover Medicare Advantage	$7.68
Rate for Payer: EmblemHealth Commercial	$24.24
Rate for Payer: Humana Medicare Advantage	$8.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.39
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.08
Rate for Payer: Wellcare Medicare Advantage	$8.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10.31

CLO TESTS, ENDO AEROBIC ISOL

Facility

$389.24

Service Code	HCPCS 87077
Hospital Charge Code	3009356
Hospital Revenue Code	309
Min. Negotiated Rate	$58.39
Max. Negotiated Rate	$58.39
Rate for Payer: Qualcare PPO/HMO/WC	$58.39

CLO TESTS, ENDO ANAEROBIC ISOL

Facility

$244.85

Service Code	HCPCS 87076
Hospital Charge Code	3009355
Hospital Revenue Code	309
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$21.98
Rate for Payer: Aetna Medicare Advantage	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.08
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	$29.17
Rate for Payer: Cigna Commercial	$122.42
Rate for Payer: Cigna Medicare Advantage	$8.08
Rate for Payer: Clover Medicare Advantage	$7.68
Rate for Payer: EmblemHealth Commercial	$24.24
Rate for Payer: Humana Medicare Advantage	$8.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.08
Rate for Payer: Wellcare Medicare Advantage	$8.08
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

CLO TESTS, ENDO ANAEROBIC ISOL

Facility

$244.85

Service Code	HCPCS 87076
Hospital Charge Code	3009355
Hospital Revenue Code	309
Min. Negotiated Rate	$36.73
Max. Negotiated Rate	$36.73
Rate for Payer: Qualcare PPO/HMO/WC	$36.73

CLO TESTS, ENDO CLO TEST

Facility

$306.00

Service Code	HCPCS 87072
Hospital Charge Code	3009354
Hospital Revenue Code	306
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$116.28
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.37
Rate for Payer: Wellpoint Medicaid Managed Care	$8.11

CLO TESTS, ENDO CLO TEST

Facility

$306.00

Service Code	HCPCS 87072
Hospital Charge Code	3009354
Hospital Revenue Code	306
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

CLOT FACTOR VIII AHG 1 STAGE

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	401085240
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOT FACTOR VIII AHG 1 STAGE

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	401085240
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.61
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
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	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CLOTH BARRIER 3% CREAM

Facility

$12.42

Hospital Charge Code	270663233
Hospital Revenue Code	270
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.86

CLOTH BARRIER 3% CREAM

Facility

$12.42

Hospital Charge Code	270663233
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.21
Rate for Payer: Aetna Commercial	$4.72
Rate for Payer: Aetna Medicare Advantage	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.17
Rate for Payer: Cigna Commercial	$6.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.73
Rate for Payer: Oxford Commercial	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$1.86
Rate for Payer: UnitedHealthcare Commercial	$2.48
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

CLOT INHIBIT PROT C ACTIVITY

Facility

$390.00

Service Code	HCPCS 85303
Hospital Charge Code	401485303
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CLOT INHIBIT PROT C ACTIVITY

Facility

$390.00

Service Code	HCPCS 85303
Hospital Charge Code	401485303
Hospital Revenue Code	305
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.64
Rate for Payer: Aetna Medicare Advantage	$44.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.96
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.84
Rate for Payer: Clover Medicare Advantage	$13.15
Rate for Payer: EmblemHealth Commercial	$41.52
Rate for Payer: Humana Medicare Advantage	$14.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.84
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	$11.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.84
Rate for Payer: Wellcare Medicare Advantage	$13.84
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges