Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HOT TEMP DISP STR WARMNG SET

Facility

$58.49

Hospital Charge Code	270650477
Hospital Revenue Code	272
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Commercial	$22.23
Rate for Payer: Aetna Medicare Advantage	$17.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.91
Rate for Payer: Cigna Commercial	$29.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.55
Rate for Payer: Oxford Commercial	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.77
Rate for Payer: UnitedHealthcare Commercial	$11.70
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

HOT TEMP DISP STR WARMNG SET

Facility

$58.49

Hospital Charge Code	270650477
Hospital Revenue Code	272
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.77

HOUSE APPROVED WIRE LOOP SS

Facility

$277.00

Hospital Charge Code	270330532
Hospital Revenue Code	272
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$138.50
Rate for Payer: Aetna Commercial	$105.26
Rate for Payer: Aetna Medicare Advantage	$83.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.64
Rate for Payer: Cigna Commercial	$138.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.10
Rate for Payer: Oxford Commercial	$55.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.55
Rate for Payer: UnitedHealthcare Commercial	$55.40
Rate for Payer: UnitedHealthcare Community & State	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$7.34

HOUSE APPROVED WIRE LOOP SS

Facility

$277.00

Hospital Charge Code	270330532
Hospital Revenue Code	272
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.55

HOUSE DUST GREER, IGE

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3035144
Hospital Revenue Code	305
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

HOUSE DUST GREER, IGE

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3035144
Hospital Revenue Code	305
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

HOUSING STANDARD

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705428
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

HOUSING STANDARD

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705428
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

HOVERMAT SG PT USE 34 HM345SPU

Facility

$517.28

Hospital Charge Code	270641062
Hospital Revenue Code	272
Min. Negotiated Rate	$77.59
Max. Negotiated Rate	$77.59
Rate for Payer: Qualcare PPO/HMO/WC	$77.59

HOVERMAT SG PT USE 34 HM345SPU

Facility

$517.28

Hospital Charge Code	270641062
Hospital Revenue Code	272
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$258.64
Rate for Payer: Aetna Commercial	$196.57
Rate for Payer: Aetna Medicare Advantage	$155.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.91
Rate for Payer: Cigna Commercial	$258.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.18
Rate for Payer: Oxford Commercial	$103.46
Rate for Payer: Qualcare PPO/HMO/WC	$77.59
Rate for Payer: UnitedHealthcare Commercial	$103.46
Rate for Payer: UnitedHealthcare Community & State	$12.47
Rate for Payer: Wellpoint Medicaid Managed Care	$13.71

HP 45 BLACK INK CARTRIDGE

Facility

$224.95

Hospital Charge Code	270662427
Hospital Revenue Code	270
Min. Negotiated Rate	$33.74
Max. Negotiated Rate	$33.74
Rate for Payer: Qualcare PPO/HMO/WC	$33.74

HP 45 BLACK INK CARTRIDGE

Facility

$224.95

Hospital Charge Code	270662427
Hospital Revenue Code	270
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.47
Rate for Payer: Aetna Commercial	$85.48
Rate for Payer: Aetna Medicare Advantage	$67.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.36
Rate for Payer: Cigna Commercial	$112.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.48
Rate for Payer: Oxford Commercial	$44.99
Rate for Payer: Qualcare PPO/HMO/WC	$33.74
Rate for Payer: UnitedHealthcare Commercial	$44.99
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

HP 78 TRI COLOR INK CARTRIDGE

Facility

$237.50

Hospital Charge Code	270662426
Hospital Revenue Code	270
Min. Negotiated Rate	$35.62
Max. Negotiated Rate	$35.62
Rate for Payer: Qualcare PPO/HMO/WC	$35.62

HP 78 TRI COLOR INK CARTRIDGE

Facility

$237.50

Hospital Charge Code	270662426
Hospital Revenue Code	270
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$118.75
Rate for Payer: Aetna Commercial	$90.25
Rate for Payer: Aetna Medicare Advantage	$71.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.56
Rate for Payer: Cigna Commercial	$118.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.25
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$35.62
Rate for Payer: UnitedHealthcare Commercial	$47.50
Rate for Payer: UnitedHealthcare Community & State	$5.72
Rate for Payer: Wellpoint Medicaid Managed Care	$6.29

H & P - BRIEF

Professional

Both

$80.00

Service Code	HCPCS 99221
Hospital Charge Code	2500031
Hospital Revenue Code	981
Min. Negotiated Rate	$68.04
Max. Negotiated Rate	$266.53
Rate for Payer: Aetna Commercial	$72.29
Rate for Payer: Aetna Medicare Advantage	$72.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.53
Rate for Payer: Cigna Commercial	$186.32
Rate for Payer: Cigna Medicare Advantage	$186.32
Rate for Payer: Clover Medicare Advantage	$85.05
Rate for Payer: Fidelis All Plans	$72.44
Rate for Payer: Humana Medicare Advantage	$68.04
Rate for Payer: UnitedHealthcare Commercial	$80.21
Rate for Payer: UnitedHealthcare Community & State	$80.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.21

H & P - COMPREHENSIVE

Professional

Both

$179.20

Service Code	HCPCS 99223
Hospital Charge Code	2500015
Hospital Revenue Code	981
Min. Negotiated Rate	$71.33
Max. Negotiated Rate	$351.64
Rate for Payer: Aetna Commercial	$202.08
Rate for Payer: Aetna Medicare Advantage	$159.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$71.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.33
Rate for Payer: Cigna Commercial	$351.64
Rate for Payer: Cigna Medicare Advantage	$351.64
Rate for Payer: Clover Medicare Advantage	$172.71
Rate for Payer: EmblemHealth Commercial	$162.22
Rate for Payer: Fidelis All Plans	$103.68
Rate for Payer: Healthfirst NY All Plans	$71.33
Rate for Payer: Humana Medicare Advantage	$172.30
Rate for Payer: Local 1199 Commercial	$159.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Marpai Administrators LLC Commercial	$238.01
Rate for Payer: MetroPlus Health All Plans	$71.33
Rate for Payer: Molina Healthcare All Plans	$71.33
Rate for Payer: Oscar Health Commercial	$304.64
Rate for Payer: Tricare Tricare	$182.50
Rate for Payer: UnitedHealthcare Commercial	$151.74
Rate for Payer: UnitedHealthcare Community & State	$151.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$151.74
Rate for Payer: Wellpoint Medicaid Managed Care	$179.40

H & P COMPREHENSIVE LEV 4****

Facility

$81.00

Service Code	HCPCS 99204
Hospital Charge Code	9300054
Hospital Revenue Code	519
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

H & P COMPREHENSIVE LEV 4****

Facility

$81.00

Service Code	HCPCS 99204
Hospital Charge Code	9300054
Hospital Revenue Code	519
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

H & P - INTERMEDIATE

Professional

Both

$160.65

Service Code	HCPCS 99222
Hospital Charge Code	2500023
Hospital Revenue Code	981
Min. Negotiated Rate	$48.55
Max. Negotiated Rate	$295.48
Rate for Payer: Aetna Commercial	$152.95
Rate for Payer: Aetna Medicare Advantage	$107.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.55
Rate for Payer: Cigna Commercial	$284.76
Rate for Payer: Cigna Medicare Advantage	$284.76
Rate for Payer: Clover Medicare Advantage	$127.80
Rate for Payer: EmblemHealth Commercial	$105.23
Rate for Payer: Fidelis All Plans	$82.45
Rate for Payer: Healthfirst NY All Plans	$48.55
Rate for Payer: Humana Medicare Advantage	$88.58
Rate for Payer: Local 1199 Commercial	$107.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.23
Rate for Payer: Marpai Administrators LLC Commercial	$104.37
Rate for Payer: MetroPlus Health All Plans	$61.45
Rate for Payer: Molina Healthcare All Plans	$48.55
Rate for Payer: Oscar Health Commercial	$295.48
Rate for Payer: Tricare Tricare	$132.44
Rate for Payer: UnitedHealthcare Commercial	$130.16
Rate for Payer: UnitedHealthcare Community & State	$130.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$130.16
Rate for Payer: Wellpoint Medicaid Managed Care	$128.45

H-PLATE 1.5MM EXTENDED LEFT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654820
Hospital Revenue Code	278
Min. Negotiated Rate	$24.28
Max. Negotiated Rate	$503.68
Rate for Payer: Aetna Commercial	$382.79
Rate for Payer: Aetna Medicare Advantage	$302.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.87
Rate for Payer: Cigna Commercial	$503.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.62
Rate for Payer: Qualcare PPO/HMO/WC	$151.10
Rate for Payer: UnitedHealthcare Community & State	$24.28
Rate for Payer: Wellpoint Medicaid Managed Care	$26.69

H-PLATE 1.5MM EXTENDED LEFT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654820
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$243.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.62
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

H-PLATE 1.5MM EXTENDED RIGHT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654819
Hospital Revenue Code	278
Min. Negotiated Rate	$24.28
Max. Negotiated Rate	$503.68
Rate for Payer: Aetna Commercial	$382.79
Rate for Payer: Aetna Medicare Advantage	$302.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.87
Rate for Payer: Cigna Commercial	$503.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.62
Rate for Payer: Qualcare PPO/HMO/WC	$151.10
Rate for Payer: UnitedHealthcare Community & State	$24.28
Rate for Payer: Wellpoint Medicaid Managed Care	$26.69

H-PLATE 1.5MM EXTENDED RIGHT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654819
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$243.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.62
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

HPV, DNA HIGH RISK

Facility

$241.20

Service Code	HCPCS 87624
Hospital Charge Code	39900303
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

HPV, DNA HIGH RISK

Facility

$241.20

Service Code	HCPCS 87624
Hospital Charge Code	39900303
Hospital Revenue Code	306
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$126.66
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

Know your out-of-pocket cost for care.

All Charges