Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FILTER VENA CAVA PLATINUM

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529S
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

FILTER VENA CAVA PLATINUM

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529S
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

FILTER VENA CAVA PLATINUM

Facility

$7,625.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529N
Hospital Revenue Code	278
Min. Negotiated Rate	$183.76
Max. Negotiated Rate	$3,812.50
Rate for Payer: Aetna Commercial	$2,897.50
Rate for Payer: Aetna Medicare Advantage	$2,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,944.38
Rate for Payer: Cigna Commercial	$3,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,677.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75
Rate for Payer: UnitedHealthcare Community & State	$183.76
Rate for Payer: Wellpoint Medicaid Managed Care	$202.06

FILTER VENA CAVA PLATINUM

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

FILTER VENA CAVA PLATINUM

Facility

$7,625.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.75
Max. Negotiated Rate	$1,845.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,677.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75

FILTER VENA CAVA PLATINUM

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

FILTER W/WATER TRAP AVEA DISPO

Facility

$109.33

Hospital Charge Code	270654996
Hospital Revenue Code	270
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$16.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.40

FILTER W/WATER TRAP AVEA DISPO

Facility

$109.33

Hospital Charge Code	270654996
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$54.66
Rate for Payer: Aetna Commercial	$41.55
Rate for Payer: Aetna Medicare Advantage	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.88
Rate for Payer: Cigna Commercial	$54.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.80
Rate for Payer: Oxford Commercial	$21.87
Rate for Payer: Qualcare PPO/HMO/WC	$16.40
Rate for Payer: UnitedHealthcare Commercial	$21.87
Rate for Payer: UnitedHealthcare Community & State	$2.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

FIMBOPLASTY

Facility

$9,165.70

Service Code	HCPCS 58760
Hospital Charge Code	1600000814
Hospital Revenue Code	360
Min. Negotiated Rate	$220.89
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$3,482.97
Rate for Payer: Aetna Medicare Advantage	$2,749.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,337.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,337.25
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	$2,337.25
Rate for Payer: Cigna Commercial	$4,582.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,749.71
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,374.86
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$220.89
Rate for Payer: Wellpoint Medicaid Managed Care	$242.89

FIMBOPLASTY

Facility

$9,165.70

Service Code	HCPCS 58760
Hospital Charge Code	1600000814
Hospital Revenue Code	360
Min. Negotiated Rate	$1,374.86
Max. Negotiated Rate	$1,374.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,374.86

FINASTERIDE 5 MG TAB

Facility

$20.97

Service Code	NDC 16729009001
Hospital Charge Code	60628191
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.48
Rate for Payer: Aetna Commercial	$7.97
Rate for Payer: Aetna Medicare Advantage	$6.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.35
Rate for Payer: Cigna Commercial	$10.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.29
Rate for Payer: Oxford Commercial	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.19
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

FINASTERIDE 5 MG TAB

Facility

$20.97

Service Code	NDC 16729009001
Hospital Charge Code	60628191
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

FINASTERIDE TAB 5MG

Facility

$19.85

Hospital Charge Code	6008759
Hospital Revenue Code	252
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

FINASTERIDE TAB 5MG

Facility

$19.85

Hospital Charge Code	6008759
Hospital Revenue Code	252
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

FINE NEEDLE ASPIRATION IMMED

Facility

$538.00

Service Code	HCPCS 88172
Hospital Charge Code	38474074
Hospital Revenue Code	311
Min. Negotiated Rate	$80.70
Max. Negotiated Rate	$80.70
Rate for Payer: Qualcare PPO/HMO/WC	$80.70

FINE NEEDLE ASPIRATION IMMED

Facility

$538.00

Service Code	HCPCS 88172
Hospital Charge Code	38474074
Hospital Revenue Code	311
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.70
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$44.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$14.26

FINE NEEDLE ASPIRATION PERMANE

Facility

$806.00

Service Code	HCPCS 88173
Hospital Charge Code	3005387
Hospital Revenue Code	311
Min. Negotiated Rate	$120.90
Max. Negotiated Rate	$120.90
Rate for Payer: Qualcare PPO/HMO/WC	$120.90

FINE NEEDLE ASPIRATION PERMANE

Facility

$806.00

Service Code	HCPCS 88173
Hospital Charge Code	3005387
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

FINE NEEDLE ASPIRATION W IMAGE

Facility

$1,901.69

Service Code	HCPCS 10022
Hospital Charge Code	75190005
Hospital Revenue Code	510
Min. Negotiated Rate	$45.83
Max. Negotiated Rate	$950.85
Rate for Payer: Aetna Commercial	$722.64
Rate for Payer: Aetna Medicare Advantage	$570.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.93
Rate for Payer: Cigna Commercial	$950.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$570.51
Rate for Payer: Qualcare PPO/HMO/WC	$285.25
Rate for Payer: UnitedHealthcare Community & State	$45.83
Rate for Payer: Wellpoint Medicaid Managed Care	$50.39

FINE NEEDLE ASPIRATION W IMAGE

Facility

$1,901.69

Service Code	HCPCS 10022
Hospital Charge Code	75190005
Hospital Revenue Code	510
Min. Negotiated Rate	$285.25
Max. Negotiated Rate	$285.25
Rate for Payer: Qualcare PPO/HMO/WC	$285.25

FINE NEEDLE ASP W/O IMAGING

Facility

$1,870.85

Service Code	HCPCS 10021
Hospital Charge Code	412310021
Hospital Revenue Code	361
Min. Negotiated Rate	$45.09
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
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	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.25
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$280.63
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$45.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$49.58

FINE NEEDLE ASP W/O IMAGING

Facility

$1,870.85

Service Code	HCPCS 10021
Hospital Charge Code	412310021
Hospital Revenue Code	361
Min. Negotiated Rate	$280.63
Max. Negotiated Rate	$280.63
Rate for Payer: Qualcare PPO/HMO/WC	$280.63

FINGER *************

Facility

$55.00

Hospital Charge Code	8002008
Hospital Revenue Code	279
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

FINGER *************

Facility

$55.00

Hospital Charge Code	8002008
Hospital Revenue Code	279
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$11.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

FINGER CAST APPLICATION

Facility

$475.00

Service Code	HCPCS 29086
Hospital Charge Code	5780125
Hospital Revenue Code	450
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$696.85
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

Know your out-of-pocket cost for care.

All Charges