Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DLU ENDO UNIV 65 4.0 173054

Facility

$1,660.00

Hospital Charge Code	270600085
Hospital Revenue Code	272
Min. Negotiated Rate	$40.01
Max. Negotiated Rate	$830.00
Rate for Payer: Aetna Commercial	$630.80
Rate for Payer: Aetna Medicare Advantage	$498.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.30
Rate for Payer: Cigna Commercial	$830.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$498.00
Rate for Payer: Oxford Commercial	$332.00
Rate for Payer: Qualcare PPO/HMO/WC	$249.00
Rate for Payer: UnitedHealthcare Commercial	$332.00
Rate for Payer: UnitedHealthcare Community & State	$40.01
Rate for Payer: Wellpoint Medicaid Managed Care	$43.99

DLU TA 30 3.5 15711L

Facility

$358.45

Hospital Charge Code	270600142
Hospital Revenue Code	272
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$179.22
Rate for Payer: Aetna Commercial	$136.21
Rate for Payer: Aetna Medicare Advantage	$107.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.40
Rate for Payer: Cigna Commercial	$179.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.53
Rate for Payer: Oxford Commercial	$71.69
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$71.69
Rate for Payer: UnitedHealthcare Community & State	$8.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.50

DLU TA 30 3.5 15711L

Facility

$358.45

Hospital Charge Code	270600142
Hospital Revenue Code	272
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

DLU TA 60 3.5 010318

Facility

$372.00

Hospital Charge Code	270600039
Hospital Revenue Code	272
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

DLU TA 60 3.5 010318

Facility

$372.00

Hospital Charge Code	270600039
Hospital Revenue Code	272
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$141.36
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.60
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: Wellpoint Medicaid Managed Care	$9.86

DLYD PLMT XTN PROSTH 1ST VSL

Facility

$13,570.00

Service Code	HCPCS 34710
Hospital Charge Code	2004960
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

DLYD PLMT XTN PROSTH 1ST VSL

Facility

$13,570.00

Service Code	HCPCS 34710
Hospital Charge Code	321034710
Hospital Revenue Code	361
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,071.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

DLYD PLMT XTN PROSTH 1ST VSL

Facility

$13,570.00

Service Code	HCPCS 34710
Hospital Charge Code	321034710
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

DLYD PLMT XTN PROSTH 1ST VSL

Facility

$13,570.00

Service Code	HCPCS 34710
Hospital Charge Code	2004960
Hospital Revenue Code	361
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,071.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

DLYD PLMT XTN PROSTH EA ADDL

Facility

$13,570.00

Service Code	HCPCS 34711
Hospital Charge Code	2004961
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

DLYD PLMT XTN PROSTH EA ADDL

Facility

$13,570.00

Service Code	HCPCS 34711
Hospital Charge Code	321034711
Hospital Revenue Code	361
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,071.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

DLYD PLMT XTN PROSTH EA ADDL

Facility

$13,570.00

Service Code	HCPCS 34711
Hospital Charge Code	2004961
Hospital Revenue Code	361
Min. Negotiated Rate	$327.04
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,071.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$327.04
Rate for Payer: Wellpoint Medicaid Managed Care	$359.61

DLYD PLMT XTN PROSTH EA ADDL

Facility

$13,570.00

Service Code	HCPCS 34711
Hospital Charge Code	321034711
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

DLY INS BREAST PROSTH S/P M

Facility

$57,566.30

Service Code	HCPCS 19342
Hospital Charge Code	16000466
Hospital Revenue Code	360
Min. Negotiated Rate	$1,355.00
Max. Negotiated Rate	$35,050.91
Rate for Payer: Aetna Commercial	$26,411.74
Rate for Payer: Aetna Medicare Advantage	$31,461.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,050.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,050.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,710.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,050.91
Rate for Payer: Cigna Commercial	$19,464.07
Rate for Payer: Cigna Medicare Advantage	$9,710.20
Rate for Payer: Clover Medicare Advantage	$9,224.69
Rate for Payer: EmblemHealth Commercial	$29,130.60
Rate for Payer: Humana Medicare Advantage	$10,001.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,710.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,269.89
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,387.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,710.20
Rate for Payer: Wellcare Medicare Advantage	$9,710.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1,525.51

DLY INS BREAST PROSTH S/P M

Facility

$57,566.30

Service Code	HCPCS 19342
Hospital Charge Code	16000466
Hospital Revenue Code	360
Min. Negotiated Rate	$8,634.94
Max. Negotiated Rate	$8,634.94
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94

DM5500 ASSERT IQ EL+_ICM_UMRI_

Facility

$23,000.00

Hospital Charge Code	270705797
Hospital Revenue Code	274
Min. Negotiated Rate	$554.30
Max. Negotiated Rate	$11,500.00
Rate for Payer: Aetna Commercial	$8,740.00
Rate for Payer: Aetna Medicare Advantage	$6,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,865.00
Rate for Payer: Cigna Commercial	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00
Rate for Payer: UnitedHealthcare Community & State	$554.30
Rate for Payer: Wellpoint Medicaid Managed Care	$609.50

DM5500 ASSERT IQ EL+_ICM_UMRI_

Facility

$23,000.00

Hospital Charge Code	270705797
Hospital Revenue Code	274
Min. Negotiated Rate	$3,450.00
Max. Negotiated Rate	$5,566.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00

DNA ANTIBODIES, NATIVE

Facility

$390.00

Service Code	HCPCS 86225
Hospital Charge Code	39900200
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DNA ANTIBODIES, NATIVE

Facility

$390.00

Service Code	HCPCS 86225
Hospital Charge Code	39900200
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.37
Rate for Payer: Aetna Medicare Advantage	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.60
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.74
Rate for Payer: Clover Medicare Advantage	$13.05
Rate for Payer: EmblemHealth Commercial	$41.22
Rate for Payer: Humana Medicare Advantage	$14.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.74
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	$10.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.74
Rate for Payer: Wellcare Medicare Advantage	$13.74
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

DNA ANTIBODY NATIVE

Facility

$68.70

Service Code	HCPCS 86225
Hospital Charge Code	401386225C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$10.30
Rate for Payer: Qualcare PPO/HMO/WC	$10.30

DNA ANTIBODY NATIVE

Facility

$68.70

Service Code	HCPCS 86225
Hospital Charge Code	401386225C
Hospital Revenue Code	302
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.37
Rate for Payer: Aetna Medicare Advantage	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.60
Rate for Payer: Cigna Commercial	$34.35
Rate for Payer: Cigna Medicare Advantage	$13.74
Rate for Payer: Clover Medicare Advantage	$13.05
Rate for Payer: EmblemHealth Commercial	$41.22
Rate for Payer: Humana Medicare Advantage	$14.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.74
Rate for Payer: Wellcare Medicare Advantage	$13.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

DNA CELL CYCLE ANALYSIS

Facility

$1,012.50

Service Code	HCPCS 88182
Hospital Charge Code	3005139
Hospital Revenue Code	311
Min. Negotiated Rate	$26.83
Max. Negotiated Rate	$303.75
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$151.88
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$26.83

DNA CELL CYCLE ANALYSIS

Facility

$1,012.50

Service Code	HCPCS 88182
Hospital Charge Code	3005139
Hospital Revenue Code	311
Min. Negotiated Rate	$151.88
Max. Negotiated Rate	$151.88
Rate for Payer: Qualcare PPO/HMO/WC	$151.88

DNA HOMOCYSTINE LEVEL MUTATION

Facility

$111.00

Hospital Charge Code	3000705
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

DNA HOMOCYSTINE LEVEL MUTATION

Facility

$111.00

Hospital Charge Code	3000705
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

Know your out-of-pocket cost for care.

All Charges