Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COVER ULTRASOUND PROBE 63-0174

Facility

$8.85

Hospital Charge Code	270600434
Hospital Revenue Code	272
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.42
Rate for Payer: Aetna Commercial	$3.36
Rate for Payer: Aetna Medicare Advantage	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.26
Rate for Payer: Cigna Commercial	$4.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.65
Rate for Payer: Oxford Commercial	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.33
Rate for Payer: UnitedHealthcare Commercial	$1.77
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

COVER VERTEB BODY LOCKING 6MM

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694366
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

COVER VERTEB BODY LOCKING 6MM

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694366
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

COVID19 AMPLIFIED PROBE TECHNI

Facility

$387.00

Service Code	HCPCS 87635
Hospital Charge Code	401387635
Hospital Revenue Code	306
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$139.56
Rate for Payer: Aetna Medicare Advantage	$166.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$51.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.21
Rate for Payer: Cigna Commercial	$193.50
Rate for Payer: Cigna Medicare Advantage	$51.31
Rate for Payer: Clover Medicare Advantage	$48.74
Rate for Payer: EmblemHealth Commercial	$153.93
Rate for Payer: Humana Medicare Advantage	$52.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$51.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$41.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.31
Rate for Payer: Wellcare Medicare Advantage	$51.31
Rate for Payer: Wellpoint Medicaid Managed Care	$10.26

COVID19 AMPLIFIED PROBE TECHNI

Facility

$387.00

Service Code	HCPCS 87635
Hospital Charge Code	401387635
Hospital Revenue Code	306
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

COVID19 QL REAL TIME RT-PCR

Facility

$387.00

Service Code	HCPCS 87635
Hospital Charge Code	401387635A
Hospital Revenue Code	306
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$139.56
Rate for Payer: Aetna Medicare Advantage	$166.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$51.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.21
Rate for Payer: Cigna Commercial	$193.50
Rate for Payer: Cigna Medicare Advantage	$51.31
Rate for Payer: Clover Medicare Advantage	$48.74
Rate for Payer: EmblemHealth Commercial	$153.93
Rate for Payer: Humana Medicare Advantage	$52.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$51.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$41.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.31
Rate for Payer: Wellcare Medicare Advantage	$51.31
Rate for Payer: Wellpoint Medicaid Managed Care	$10.26

COVID19 QL REAL TIME RT-PCR

Facility

$387.00

Service Code	HCPCS 87635
Hospital Charge Code	401387635A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

COVID19 RNA PCR CEPHEID

Facility

$387.00

Service Code	HCPCS 87635QW
Hospital Charge Code	401187635A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

COVID19 RNA PCR CEPHEID

Facility

$387.00

Service Code	HCPCS 87635QW
Hospital Charge Code	401187635A
Hospital Revenue Code	306
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$147.06
Rate for Payer: Aetna Medicare Advantage	$116.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.69
Rate for Payer: Cigna Commercial	$193.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.33
Rate for Payer: Wellpoint Medicaid Managed Care	$10.26

COXSACKIE A AB (2,4,7,9,1 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COXSACKIE A AB (2,4,7,9,1 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COXSACKIE A AB (2,4,7,9,1 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039C
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COXSACKIE A AB (2,4,7,9,1 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039D
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COXSACKIE A AB (2,4,7,9,1 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 V

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039E
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 V

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039E
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COXSACKIE A AB (2,4,7,9,1 VI

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039F
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COXSACKIE A AB (2,4,7,9,1 VI

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990039F
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

COXSACKIE AB I

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624A
Hospital Revenue Code	302
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.44
Rate for Payer: Aetna Medicare Advantage	$42.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.03
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: Cigna Medicare Advantage	$13.03
Rate for Payer: Clover Medicare Advantage	$12.38
Rate for Payer: EmblemHealth Commercial	$39.09
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.03
Rate for Payer: Wellcare Medicare Advantage	$13.03
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

COXSACKIE AB I

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624A
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

COXSACKIE AB II

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624B
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

COXSACKIE AB II

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3006624B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.44
Rate for Payer: Aetna Medicare Advantage	$42.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.03
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: Cigna Medicare Advantage	$13.03
Rate for Payer: Clover Medicare Advantage	$12.38
Rate for Payer: EmblemHealth Commercial	$39.09
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.03
Rate for Payer: Wellcare Medicare Advantage	$13.03
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

Know your out-of-pocket cost for care.

All Charges