Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HOLDING SLEEVE FOR STARDRIVE

Facility

$3,344.05

Hospital Charge Code	270688592
Hospital Revenue Code	272
Min. Negotiated Rate	$80.59
Max. Negotiated Rate	$1,672.03
Rate for Payer: Aetna Commercial	$1,270.74
Rate for Payer: Aetna Medicare Advantage	$1,003.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$852.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$852.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$852.73
Rate for Payer: Cigna Commercial	$1,672.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,003.22
Rate for Payer: Oxford Commercial	$668.81
Rate for Payer: Qualcare PPO/HMO/WC	$501.61
Rate for Payer: UnitedHealthcare Commercial	$668.81
Rate for Payer: UnitedHealthcare Community & State	$80.59
Rate for Payer: Wellpoint Medicaid Managed Care	$88.62

HOLISTER/PLASTIBILL 1.2****

Facility

$11.00

Hospital Charge Code	1800036
Hospital Revenue Code	272
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

HOLISTER/PLASTIBILL 1.2****

Facility

$11.00

Hospital Charge Code	1800036
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

HOLISTER/PLASTIBILL 1.5***

Facility

$8.00

Hospital Charge Code	1800044
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

HOLISTER/PLASTIBILL 1.5***

Facility

$8.00

Hospital Charge Code	1800044
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

HOLMIUM 1000MICRON LASER FIBER

Facility

$1,610.00

Hospital Charge Code	270632053
Hospital Revenue Code	272
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$241.50
Rate for Payer: Qualcare PPO/HMO/WC	$241.50

HOLMIUM 1000MICRON LASER FIBER

Facility

$1,610.00

Hospital Charge Code	270632053
Hospital Revenue Code	272
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$805.00
Rate for Payer: Aetna Commercial	$611.80
Rate for Payer: Aetna Medicare Advantage	$483.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.55
Rate for Payer: Cigna Commercial	$805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$483.00
Rate for Payer: Oxford Commercial	$322.00
Rate for Payer: Qualcare PPO/HMO/WC	$241.50
Rate for Payer: UnitedHealthcare Commercial	$322.00
Rate for Payer: UnitedHealthcare Community & State	$38.80
Rate for Payer: Wellpoint Medicaid Managed Care	$42.66

HOLMIUM FIBER

Facility

$1,610.00

Hospital Charge Code	270684297
Hospital Revenue Code	272
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$805.00
Rate for Payer: Aetna Commercial	$611.80
Rate for Payer: Aetna Medicare Advantage	$483.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.55
Rate for Payer: Cigna Commercial	$805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$483.00
Rate for Payer: Oxford Commercial	$322.00
Rate for Payer: Qualcare PPO/HMO/WC	$241.50
Rate for Payer: UnitedHealthcare Commercial	$322.00
Rate for Payer: UnitedHealthcare Community & State	$38.80
Rate for Payer: Wellpoint Medicaid Managed Care	$42.66

HOLMIUM FIBER

Facility

$1,610.00

Hospital Charge Code	270684297
Hospital Revenue Code	272
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$241.50
Rate for Payer: Qualcare PPO/HMO/WC	$241.50

HOLMIUM FIBER 1000 MICRON

Facility

$1,500.00

Hospital Charge Code	270683939
Hospital Revenue Code	272
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

HOLMIUM FIBER 1000 MICRON

Facility

$1,500.00

Hospital Charge Code	270683939
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

HOLMIUM LASER FIBER 200 M/USE

Facility

$3,187.50

Hospital Charge Code	270658585
Hospital Revenue Code	272
Min. Negotiated Rate	$478.12
Max. Negotiated Rate	$478.12
Rate for Payer: Qualcare PPO/HMO/WC	$478.12

HOLMIUM LASER FIBER 200 M/USE

Facility

$3,187.50

Hospital Charge Code	270658585
Hospital Revenue Code	272
Min. Negotiated Rate	$76.82
Max. Negotiated Rate	$1,593.75
Rate for Payer: Aetna Commercial	$1,211.25
Rate for Payer: Aetna Medicare Advantage	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$812.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$812.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$812.81
Rate for Payer: Cigna Commercial	$1,593.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$956.25
Rate for Payer: Oxford Commercial	$637.50
Rate for Payer: Qualcare PPO/HMO/WC	$478.12
Rate for Payer: UnitedHealthcare Commercial	$637.50
Rate for Payer: UnitedHealthcare Community & State	$76.82
Rate for Payer: Wellpoint Medicaid Managed Care	$84.47

HOLTER MONITOR RECORDING

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	3654000
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR RECORDING

Facility

$1,007.00

Service Code	HCPCS 93225
Hospital Charge Code	36540008
Hospital Revenue Code	731
Min. Negotiated Rate	$24.27
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.10
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$151.05
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$24.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$26.69

HOLTER MONITOR RECORDING

Facility

$1,007.00

Service Code	HCPCS 93225
Hospital Charge Code	36540008
Hospital Revenue Code	731
Min. Negotiated Rate	$151.05
Max. Negotiated Rate	$151.05
Rate for Payer: Qualcare PPO/HMO/WC	$151.05

HOLTER MONITOR RECORDING

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	3654000
Hospital Revenue Code	731
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SCAN ANALYS RPT

Facility

$1,776.00

Service Code	HCPCS 93226
Hospital Charge Code	36540007
Hospital Revenue Code	731
Min. Negotiated Rate	$266.40
Max. Negotiated Rate	$266.40
Rate for Payer: Qualcare PPO/HMO/WC	$266.40

HOLTER MONITOR SCAN ANALYS RPT

Facility

$1,776.00

Service Code	HCPCS 93226
Hospital Charge Code	36540007
Hospital Revenue Code	731
Min. Negotiated Rate	$42.80
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.80
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.40
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$42.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$47.06

HOLTER MONITOR SCANNING & RPT

Facility

$5,400.00

Service Code	HCPCS 93226
Hospital Charge Code	74117013
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SCANNING & RPT

Facility

$5,400.00

Service Code	HCPCS 93226
Hospital Charge Code	74115013
Hospital Revenue Code	731
Min. Negotiated Rate	$66.58
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SCANNING & RPT

Facility

$5,400.00

Service Code	HCPCS 93226
Hospital Charge Code	5300042
Hospital Revenue Code	731
Min. Negotiated Rate	$66.58
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SCANNING & RPT

Facility

$5,400.00

Service Code	HCPCS 93226
Hospital Charge Code	74115013
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SCANNING & RPT

Facility

$300.85

Service Code	HCPCS 93226
Hospital Charge Code	94053055
Hospital Revenue Code	731
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.25
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.13
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$7.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$7.97

HOLTER MONITOR SCANNING & RPT

Facility

$5,400.00

Service Code	HCPCS 93226
Hospital Charge Code	74116013
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

Know your out-of-pocket cost for care.

All Charges