Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FNA BIOPSY/US 1ST LESION

Facility

$3,396.55

Service Code	HCPCS 10005
Hospital Charge Code	404210005
Hospital Revenue Code	361
Min. Negotiated Rate	$509.48
Max. Negotiated Rate	$509.48
Rate for Payer: Qualcare PPO/HMO/WC	$509.48

FNA BIOPSY/US 1ST LESION

Facility

$9,500.00

Service Code	HCPCS 10005
Hospital Charge Code	404310005
Hospital Revenue Code	361
Min. Negotiated Rate	$228.95
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

FNA BIOPSY/US EA ADD LESION

Facility

$1,698.28

Service Code	HCPCS 10006
Hospital Charge Code	404610006
Hospital Revenue Code	361
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$645.35
Rate for Payer: Aetna Medicare Advantage	$509.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.06
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	$433.06
Rate for Payer: Cigna Commercial	$849.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$509.48
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$254.74
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$40.93
Rate for Payer: Wellpoint Medicaid Managed Care	$45.00

FNA BIOPSY/US EA ADD LESION

Facility

$1,698.28

Service Code	HCPCS 10006
Hospital Charge Code	404610006
Hospital Revenue Code	361
Min. Negotiated Rate	$254.74
Max. Negotiated Rate	$254.74
Rate for Payer: Qualcare PPO/HMO/WC	$254.74

FNA BIOPSY/US EA ADD LESION

Facility

$1,698.28

Service Code	HCPCS 10006
Hospital Charge Code	321010006
Hospital Revenue Code	361
Min. Negotiated Rate	$254.74
Max. Negotiated Rate	$254.74
Rate for Payer: Qualcare PPO/HMO/WC	$254.74

FNA BIOPSY/US EA ADD LESION

Facility

$1,698.28

Service Code	HCPCS 10006
Hospital Charge Code	404210006
Hospital Revenue Code	361
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$645.35
Rate for Payer: Aetna Medicare Advantage	$509.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.06
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	$433.06
Rate for Payer: Cigna Commercial	$849.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$509.48
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$254.74
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$40.93
Rate for Payer: Wellpoint Medicaid Managed Care	$45.00

FNA BIOPSY/US EA ADD LESION

Facility

$9,500.00

Service Code	HCPCS 10006
Hospital Charge Code	404310006
Hospital Revenue Code	361
Min. Negotiated Rate	$228.95
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
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	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

FNA BIOPSY/US EA ADD LESION

Facility

$1,698.28

Service Code	HCPCS 10006
Hospital Charge Code	321010006
Hospital Revenue Code	361
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$645.35
Rate for Payer: Aetna Medicare Advantage	$509.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.06
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	$433.06
Rate for Payer: Cigna Commercial	$849.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$509.48
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$254.74
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$40.93
Rate for Payer: Wellpoint Medicaid Managed Care	$45.00

FNA BIOPSY/US EA ADD LESION

Facility

$1,698.28

Service Code	HCPCS 10006
Hospital Charge Code	404210006
Hospital Revenue Code	361
Min. Negotiated Rate	$254.74
Max. Negotiated Rate	$254.74
Rate for Payer: Qualcare PPO/HMO/WC	$254.74

FNA BIOPSY/US EA ADD LESION

Facility

$9,500.00

Service Code	HCPCS 10006
Hospital Charge Code	404310006
Hospital Revenue Code	361
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

FNA BX W/CT GDN 1ST LES

Facility

$2,714.04

Service Code	HCPCS 10009
Hospital Charge Code	16000529
Hospital Revenue Code	360
Min. Negotiated Rate	$407.11
Max. Negotiated Rate	$407.11
Rate for Payer: Qualcare PPO/HMO/WC	$407.11

FNA BX W/CT GDN 1ST LES

Facility

$2,714.04

Service Code	HCPCS 10009
Hospital Charge Code	16000529
Hospital Revenue Code	360
Min. Negotiated Rate	$65.41
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$814.21
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$407.11
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$65.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$71.92

FNA BX W/CT GDN EA ADDL

Facility

$1,785.95

Service Code	HCPCS 10010
Hospital Charge Code	16000775
Hospital Revenue Code	360
Min. Negotiated Rate	$267.89
Max. Negotiated Rate	$267.89
Rate for Payer: Qualcare PPO/HMO/WC	$267.89

FNA BX W/CT GDN EA ADDL

Facility

$1,785.95

Service Code	HCPCS 10010
Hospital Charge Code	16000775
Hospital Revenue Code	360
Min. Negotiated Rate	$43.04
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$678.66
Rate for Payer: Aetna Medicare Advantage	$535.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$455.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$455.42
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	$455.42
Rate for Payer: Cigna Commercial	$892.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$535.78
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$267.89
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$43.04
Rate for Payer: Wellpoint Medicaid Managed Care	$47.33

FNA BX W/US GND 1ST LES

Facility

$2,714.04

Service Code	HCPCS 10005
Hospital Charge Code	16000174
Hospital Revenue Code	360
Min. Negotiated Rate	$65.41
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$814.21
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$407.11
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$65.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$71.92

FNA BX W/US GND 1ST LES

Facility

$2,714.04

Service Code	HCPCS 10005
Hospital Charge Code	16000174
Hospital Revenue Code	360
Min. Negotiated Rate	$407.11
Max. Negotiated Rate	$407.11
Rate for Payer: Qualcare PPO/HMO/WC	$407.11

FNA W/O IMAGE

Facility

$1,838.13

Service Code	HCPCS 10021
Hospital Charge Code	1600000560
Hospital Revenue Code	360
Min. Negotiated Rate	$44.30
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	$551.44
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$275.72
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$44.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$48.71

FNA W/O IMAGE

Facility

$1,838.13

Service Code	HCPCS 10021
Hospital Charge Code	1600000560
Hospital Revenue Code	360
Min. Negotiated Rate	$275.72
Max. Negotiated Rate	$275.72
Rate for Payer: Qualcare PPO/HMO/WC	$275.72

FOAM DBM LG STRIP 100x25x5MM

Facility

$7,875.00

Hospital Charge Code	270671260
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,905.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

FOAM DBM LG STRIP 100x25x5MM

Facility

$7,875.00

Hospital Charge Code	270671260
Hospital Revenue Code	278
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$3,937.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.12
Rate for Payer: Cigna Commercial	$3,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25
Rate for Payer: UnitedHealthcare Community & State	$189.79
Rate for Payer: Wellpoint Medicaid Managed Care	$208.69

FOAM DBM MED STRIP 50x25x5MM

Facility

$5,065.00

Hospital Charge Code	270671261
Hospital Revenue Code	278
Min. Negotiated Rate	$759.75
Max. Negotiated Rate	$1,225.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,013.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,114.30
Rate for Payer: Qualcare PPO/HMO/WC	$759.75

FOAM DBM MED STRIP 50x25x5MM

Facility

$5,065.00

Hospital Charge Code	270671261
Hospital Revenue Code	278
Min. Negotiated Rate	$122.07
Max. Negotiated Rate	$2,532.50
Rate for Payer: Aetna Commercial	$1,924.70
Rate for Payer: Aetna Medicare Advantage	$1,519.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,291.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,291.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,013.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,291.58
Rate for Payer: Cigna Commercial	$2,532.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,114.30
Rate for Payer: Qualcare PPO/HMO/WC	$759.75
Rate for Payer: UnitedHealthcare Community & State	$122.07
Rate for Payer: Wellpoint Medicaid Managed Care	$134.22

FOAM DBM SKINNY STP 100x10x8MM

Facility

$8,550.00

Hospital Charge Code	270671259
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.50
Max. Negotiated Rate	$2,069.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,881.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50

FOAM DBM SKINNY STP 100x10x8MM

Facility

$8,550.00

Hospital Charge Code	270671259
Hospital Revenue Code	278
Min. Negotiated Rate	$206.06
Max. Negotiated Rate	$4,275.00
Rate for Payer: Aetna Commercial	$3,249.00
Rate for Payer: Aetna Medicare Advantage	$2,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,180.25
Rate for Payer: Cigna Commercial	$4,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,881.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50
Rate for Payer: UnitedHealthcare Community & State	$206.06
Rate for Payer: Wellpoint Medicaid Managed Care	$226.57

FOAM DBM SM STRIP 15x15x8MM

Facility

$1,575.00

Hospital Charge Code	270671262
Hospital Revenue Code	278
Min. Negotiated Rate	$37.96
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare Advantage	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.62
Rate for Payer: Cigna Commercial	$787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25
Rate for Payer: UnitedHealthcare Community & State	$37.96
Rate for Payer: Wellpoint Medicaid Managed Care	$41.74

Know your out-of-pocket cost for care.

All Charges