Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CULTURE,YEAST DEFINITIVE ID @

Facility

$73.00

Service Code	HCPCS 87106
Hospital Charge Code	38477068
Hospital Revenue Code	309
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.07
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
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	$37.25
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: Cigna Medicare Advantage	$10.32
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Medicare Advantage	$10.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

CULTURE,YEAST,GENITAL

Facility

$390.00

Service Code	HCPCS 87102
Hospital Charge Code	39900485
Hospital Revenue Code	309
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$22.88
Rate for Payer: Aetna Medicare Advantage	$27.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.41
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	$30.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.41
Rate for Payer: Clover Medicare Advantage	$7.99
Rate for Payer: EmblemHealth Commercial	$25.23
Rate for Payer: Humana Medicare Advantage	$8.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.41
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	$6.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.41
Rate for Payer: Wellcare Medicare Advantage	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CULTURE,YEAST,GENITAL

Facility

$390.00

Service Code	HCPCS 87102
Hospital Charge Code	39900485
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CULTURE,YEAST WITH ID

Facility

$57.75

Service Code	HCPCS 87102
Hospital Charge Code	39900486
Hospital Revenue Code	309
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.88
Rate for Payer: Aetna Medicare Advantage	$27.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.41
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	$30.36
Rate for Payer: Cigna Commercial	$28.88
Rate for Payer: Cigna Medicare Advantage	$8.41
Rate for Payer: Clover Medicare Advantage	$7.99
Rate for Payer: EmblemHealth Commercial	$25.23
Rate for Payer: Humana Medicare Advantage	$8.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.66
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.41
Rate for Payer: Wellcare Medicare Advantage	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

CULTURE,YEAST WITH ID

Facility

$57.75

Service Code	HCPCS 87102
Hospital Charge Code	39900486
Hospital Revenue Code	309
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$8.66
Rate for Payer: Qualcare PPO/HMO/WC	$8.66

CULTURIA EMB/CLED

Facility

$76.26

Hospital Charge Code	270650556
Hospital Revenue Code	272
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

CULTURIA EMB/CLED

Facility

$76.26

Hospital Charge Code	270650556
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$38.13
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.45
Rate for Payer: Cigna Commercial	$38.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.88
Rate for Payer: Oxford Commercial	$15.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$15.25
Rate for Payer: UnitedHealthcare Community & State	$1.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.02

CUP 36+2 SUT REV UNIV RT

Facility

$4,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270699153
Hospital Revenue Code	278
Min. Negotiated Rate	$669.00
Max. Negotiated Rate	$1,079.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$892.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$981.20
Rate for Payer: Qualcare PPO/HMO/WC	$669.00

CUP 36+2 SUT REV UNIV RT

Facility

$4,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270699153
Hospital Revenue Code	278
Min. Negotiated Rate	$107.49
Max. Negotiated Rate	$2,230.00
Rate for Payer: Aetna Commercial	$1,694.80
Rate for Payer: Aetna Medicare Advantage	$1,338.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,137.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,137.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$892.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,137.30
Rate for Payer: Cigna Commercial	$2,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$981.20
Rate for Payer: Qualcare PPO/HMO/WC	$669.00
Rate for Payer: UnitedHealthcare Community & State	$107.49
Rate for Payer: Wellpoint Medicaid Managed Care	$118.19

CUP 56 MM TRIO VERSA CC

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683289
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CUP 56 MM TRIO VERSA CC

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683289
Hospital Revenue Code	278
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

CUP ACETABULAR 56MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692210
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

CUP ACETABULAR 56MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692210
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

CUP ACETABULAR 62MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692218
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

CUP ACETABULAR 62MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692218
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

CUP ACETABULAR SZ 22+48MM

Facility

$10,540.00

Hospital Charge Code	270645882
Hospital Revenue Code	278
Min. Negotiated Rate	$1,581.00
Max. Negotiated Rate	$2,550.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,550.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,318.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.00

CUP ACETABULAR SZ 22+48MM

Facility

$10,540.00

Hospital Charge Code	270645882
Hospital Revenue Code	278
Min. Negotiated Rate	$254.01
Max. Negotiated Rate	$5,270.00
Rate for Payer: Aetna Commercial	$4,005.20
Rate for Payer: Aetna Medicare Advantage	$3,162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,687.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,687.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,687.70
Rate for Payer: Cigna Commercial	$5,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,550.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,318.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.00
Rate for Payer: UnitedHealthcare Community & State	$254.01
Rate for Payer: Wellpoint Medicaid Managed Care	$279.31

CUP ACETABULAR SZ 24 +56mm LTD

Facility

$10,540.00

Hospital Charge Code	270645775
Hospital Revenue Code	278
Min. Negotiated Rate	$254.01
Max. Negotiated Rate	$5,270.00
Rate for Payer: Aetna Commercial	$4,005.20
Rate for Payer: Aetna Medicare Advantage	$3,162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,687.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,687.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,687.70
Rate for Payer: Cigna Commercial	$5,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,550.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,318.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.00
Rate for Payer: UnitedHealthcare Community & State	$254.01
Rate for Payer: Wellpoint Medicaid Managed Care	$279.31

CUP ACETABULAR SZ 24 +56mm LTD

Facility

$10,540.00

Hospital Charge Code	270645775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,581.00
Max. Negotiated Rate	$2,550.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,550.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,318.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.00

CUP/BEARNG SELF ALIGNG 50x28MM

Facility

$4,005.00

Hospital Charge Code	270677209
Hospital Revenue Code	278
Min. Negotiated Rate	$96.52
Max. Negotiated Rate	$2,002.50
Rate for Payer: Aetna Commercial	$1,521.90
Rate for Payer: Aetna Medicare Advantage	$1,201.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,021.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,021.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$801.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,021.27
Rate for Payer: Cigna Commercial	$2,002.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$969.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$881.10
Rate for Payer: Qualcare PPO/HMO/WC	$600.75
Rate for Payer: UnitedHealthcare Community & State	$96.52
Rate for Payer: Wellpoint Medicaid Managed Care	$106.13

CUP/BEARNG SELF ALIGNG 50x28MM

Facility

$4,005.00

Hospital Charge Code	270677209
Hospital Revenue Code	278
Min. Negotiated Rate	$600.75
Max. Negotiated Rate	$969.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$801.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$969.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$881.10
Rate for Payer: Qualcare PPO/HMO/WC	$600.75

CUP BIPOL 28/47MM 50004728***

Facility

$3,250.00

Hospital Charge Code	1604248
Hospital Revenue Code	274
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

CUP BIPOL 28/47MM 50004728***

Facility

$3,250.00

Hospital Charge Code	1604248
Hospital Revenue Code	274
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

CUP BIPOL 28/55MM 50005528***

Facility

$3,514.00

Hospital Charge Code	1604255
Hospital Revenue Code	274
Min. Negotiated Rate	$527.10
Max. Negotiated Rate	$850.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$702.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$850.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$773.08
Rate for Payer: Qualcare PPO/HMO/WC	$527.10

CUP BIPOL 28/55MM 50005528***

Facility

$3,514.00

Hospital Charge Code	1604255
Hospital Revenue Code	274
Min. Negotiated Rate	$84.69
Max. Negotiated Rate	$1,757.00
Rate for Payer: Aetna Commercial	$1,335.32
Rate for Payer: Aetna Medicare Advantage	$1,054.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$896.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$896.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$702.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$896.07
Rate for Payer: Cigna Commercial	$1,757.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$850.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$773.08
Rate for Payer: Qualcare PPO/HMO/WC	$527.10
Rate for Payer: UnitedHealthcare Community & State	$84.69
Rate for Payer: Wellpoint Medicaid Managed Care	$93.12

Know your out-of-pocket cost for care.

All Charges