Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EVAC RPR A-BIILIAC NDGFT

Facility

$13,570.00

Service Code	HCPCS 34705
Hospital Charge Code	321034705
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

EVAC RPR A-BIILIAC NDGFT

Facility

$13,570.00

Service Code	HCPCS 34705
Hospital Charge Code	321034705
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

EVAC RPR A-BIILIAC NDGFT

Facility

$13,570.00

Service Code	HCPCS 34705
Hospital Charge Code	2004955
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

EVAC RPR A-BIILIAC NDGFT

Facility

$13,570.00

Service Code	HCPCS 34705
Hospital Charge Code	2004955
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

EVACUATOR 400CC 3 SPRG 0043650

Facility

$32.50

Hospital Charge Code	270641180
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna Commercial	$12.35
Rate for Payer: Aetna Medicare Advantage	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.29
Rate for Payer: Cigna Commercial	$16.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Commercial	$6.50
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

EVACUATOR 400CC 3 SPRG 0043650

Facility

$32.50

Hospital Charge Code	270641180
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

EVACUATOR 400CC 3SPRNG 0043610

Facility

$47.74

Hospital Charge Code	270654309
Hospital Revenue Code	272
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$7.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.16

EVACUATOR 400CC 3SPRNG 0043610

Facility

$47.74

Hospital Charge Code	270654309
Hospital Revenue Code	272
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$23.87
Rate for Payer: Aetna Commercial	$18.14
Rate for Payer: Aetna Medicare Advantage	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.17
Rate for Payer: Cigna Commercial	$23.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.32
Rate for Payer: Oxford Commercial	$9.55
Rate for Payer: Qualcare PPO/HMO/WC	$7.16
Rate for Payer: UnitedHealthcare Commercial	$9.55
Rate for Payer: UnitedHealthcare Community & State	$1.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

EVACUATOR BD BLADDER 000451

Facility

$103.20

Hospital Charge Code	270614999
Hospital Revenue Code	272
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$15.48
Rate for Payer: Qualcare PPO/HMO/WC	$15.48

EVACUATOR BD BLADDER 000451

Facility

$103.20

Hospital Charge Code	270614999
Hospital Revenue Code	272
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$51.60
Rate for Payer: Aetna Commercial	$39.22
Rate for Payer: Aetna Medicare Advantage	$30.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.32
Rate for Payer: Cigna Commercial	$51.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.96
Rate for Payer: Oxford Commercial	$20.64
Rate for Payer: Qualcare PPO/HMO/WC	$15.48
Rate for Payer: UnitedHealthcare Commercial	$20.64
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

EVACUATOR ELLIK BLADDER DISP.

Facility

$103.00

Hospital Charge Code	270331361
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.90
Rate for Payer: Oxford Commercial	$20.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$20.60
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

EVACUATOR ELLIK BLADDER DISP.

Facility

$103.00

Hospital Charge Code	270331361
Hospital Revenue Code	272
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

EVACUATOR LAP-VAC SMOKE ******

Facility

$49.00

Hospital Charge Code	1608272
Hospital Revenue Code	272
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

EVACUATOR LAP-VAC SMOKE ******

Facility

$49.00

Hospital Charge Code	1608272
Hospital Revenue Code	272
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

EVACUATOR MCV BLADDER 730-125

Facility

$194.26

Hospital Charge Code	270621095
Hospital Revenue Code	272
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$97.13
Rate for Payer: Aetna Commercial	$73.82
Rate for Payer: Aetna Medicare Advantage	$58.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.54
Rate for Payer: Cigna Commercial	$97.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.28
Rate for Payer: Oxford Commercial	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$29.14
Rate for Payer: UnitedHealthcare Commercial	$38.85
Rate for Payer: UnitedHealthcare Community & State	$4.68
Rate for Payer: Wellpoint Medicaid Managed Care	$5.15

EVACUATOR MCV BLADDER 730-125

Facility

$194.26

Hospital Charge Code	270621095
Hospital Revenue Code	272
Min. Negotiated Rate	$29.14
Max. Negotiated Rate	$29.14
Rate for Payer: Qualcare PPO/HMO/WC	$29.14

EVACUATOR SMOKE LAPVAC 600272

Facility

$128.00

Hospital Charge Code	270600272
Hospital Revenue Code	272
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

EVACUATOR SMOKE LAPVAC 600272

Facility

$128.00

Hospital Charge Code	270600272
Hospital Revenue Code	272
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$25.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$25.60
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

EVACUATOR UROVAC BLADDER

Facility

$194.26

Hospital Charge Code	270660163
Hospital Revenue Code	272
Min. Negotiated Rate	$29.14
Max. Negotiated Rate	$29.14
Rate for Payer: Qualcare PPO/HMO/WC	$29.14

EVACUATOR UROVAC BLADDER

Facility

$194.26

Hospital Charge Code	270660163
Hospital Revenue Code	272
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$97.13
Rate for Payer: Aetna Commercial	$73.82
Rate for Payer: Aetna Medicare Advantage	$58.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.54
Rate for Payer: Cigna Commercial	$97.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.28
Rate for Payer: Oxford Commercial	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$29.14
Rate for Payer: UnitedHealthcare Commercial	$38.85
Rate for Payer: UnitedHealthcare Community & State	$4.68
Rate for Payer: Wellpoint Medicaid Managed Care	$5.15

EVAL AMNIOTIC FLUID PROTEIN

Facility

$490.55

Service Code	HCPCS 84112
Hospital Charge Code	319084112
Hospital Revenue Code	301
Min. Negotiated Rate	$73.58
Max. Negotiated Rate	$73.58
Rate for Payer: Qualcare PPO/HMO/WC	$73.58

EVAL AMNIOTIC FLUID PROTEIN

Facility

$490.55

Service Code	HCPCS 84112
Hospital Charge Code	319084112
Hospital Revenue Code	301
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$354.15
Rate for Payer: Aetna Commercial	$266.86
Rate for Payer: Aetna Medicare Advantage	$317.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$98.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.15
Rate for Payer: Cigna Commercial	$245.28
Rate for Payer: Cigna Medicare Advantage	$98.11
Rate for Payer: Clover Medicare Advantage	$93.20
Rate for Payer: EmblemHealth Commercial	$294.33
Rate for Payer: Humana Medicare Advantage	$101.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$98.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.58
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$78.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$98.11
Rate for Payer: Wellcare Medicare Advantage	$98.11
Rate for Payer: Wellpoint Medicaid Managed Care	$13.00

EVALUATION FINE NEEDLE ASPIRAT

Facility

$806.00

Service Code	HCPCS 88173
Hospital Charge Code	38474070
Hospital Revenue Code	311
Min. Negotiated Rate	$120.90
Max. Negotiated Rate	$120.90
Rate for Payer: Qualcare PPO/HMO/WC	$120.90

EVALUATION FINE NEEDLE ASPIRAT

Facility

$806.00

Service Code	HCPCS 88173
Hospital Charge Code	38474070
Hospital Revenue Code	311
Min. Negotiated Rate	$21.36
Max. Negotiated Rate	$241.80
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	$241.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.90
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$135.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$21.36

EVALUATION OF WHEEZING

Facility

$6,100.00

Service Code	HCPCS 94070
Hospital Charge Code	917094070
Hospital Revenue Code	460
Min. Negotiated Rate	$147.01
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$867.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$147.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$161.65

Know your out-of-pocket cost for care.

All Charges