Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEAD, URINE II

Facility

$111.25

Service Code	HCPCS 83665
Hospital Charge Code	3030558B
Hospital Revenue Code	301
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$16.69
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

LEAD URINE RANDOM

Facility

$111.25

Service Code	HCPCS 83655
Hospital Charge Code	3032060A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$55.62
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$2.95

LEAD URINE RANDOM

Facility

$111.25

Service Code	HCPCS 83655
Hospital Charge Code	3032060A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$16.69
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

LEAD US MA

Facility

$5,130.00

Hospital Charge Code	270657304
Hospital Revenue Code	275
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

LEAD US MA

Facility

$5,130.00

Hospital Charge Code	270657304
Hospital Revenue Code	275
Min. Negotiated Rate	$123.63
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$123.63
Rate for Payer: Wellpoint Medicaid Managed Care	$135.94

LEAD US MA 58

Facility

$5,130.00

Hospital Charge Code	270657306
Hospital Revenue Code	278
Min. Negotiated Rate	$123.63
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$123.63
Rate for Payer: Wellpoint Medicaid Managed Care	$135.94

LEAD US MA 58

Facility

$5,130.00

Hospital Charge Code	270657306
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

LEAD US MARKET

Facility

$4,680.00

Hospital Charge Code	270663724
Hospital Revenue Code	278
Min. Negotiated Rate	$702.00
Max. Negotiated Rate	$1,132.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,132.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,029.60
Rate for Payer: Qualcare PPO/HMO/WC	$702.00

LEAD US MARKET

Facility

$4,680.00

Hospital Charge Code	270663724
Hospital Revenue Code	278
Min. Negotiated Rate	$112.79
Max. Negotiated Rate	$2,340.00
Rate for Payer: Aetna Commercial	$1,778.40
Rate for Payer: Aetna Medicare Advantage	$1,404.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,193.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,193.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,193.40
Rate for Payer: Cigna Commercial	$2,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,132.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,029.60
Rate for Payer: Qualcare PPO/HMO/WC	$702.00
Rate for Payer: UnitedHealthcare Community & State	$112.79
Rate for Payer: Wellpoint Medicaid Managed Care	$124.02

LEAD VENTRICAL DEXTRUS 4137

Facility

$3,000.00

Hospital Charge Code	270646789
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

LEAD VENTRICAL DEXTRUS 4137

Facility

$3,000.00

Hospital Charge Code	270646789
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

LEAD VENTRICLE R53 TILDA 53CM

Facility

$4,040.00

Hospital Charge Code	270663607
Hospital Revenue Code	278
Min. Negotiated Rate	$97.36
Max. Negotiated Rate	$2,020.00
Rate for Payer: Aetna Commercial	$1,535.20
Rate for Payer: Aetna Medicare Advantage	$1,212.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,030.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,030.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,030.20
Rate for Payer: Cigna Commercial	$2,020.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$977.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$888.80
Rate for Payer: Qualcare PPO/HMO/WC	$606.00
Rate for Payer: UnitedHealthcare Community & State	$97.36
Rate for Payer: Wellpoint Medicaid Managed Care	$107.06

LEAD VENTRICLE R53 TILDA 53CM

Facility

$4,040.00

Hospital Charge Code	270663607
Hospital Revenue Code	278
Min. Negotiated Rate	$606.00
Max. Negotiated Rate	$977.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$977.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$888.80
Rate for Payer: Qualcare PPO/HMO/WC	$606.00

LEAD VENTRICULAR 53CM F/PACEM

Facility

$4,965.00

Hospital Charge Code	270645704
Hospital Revenue Code	275
Min. Negotiated Rate	$744.75
Max. Negotiated Rate	$1,201.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$993.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,201.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,092.30
Rate for Payer: Qualcare PPO/HMO/WC	$744.75

LEAD VENTRICULAR 53CM F/PACEM

Facility

$4,965.00

Hospital Charge Code	270645704
Hospital Revenue Code	275
Min. Negotiated Rate	$119.66
Max. Negotiated Rate	$2,482.50
Rate for Payer: Aetna Commercial	$1,886.70
Rate for Payer: Aetna Medicare Advantage	$1,489.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,266.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,266.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,266.08
Rate for Payer: Cigna Commercial	$2,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,201.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,092.30
Rate for Payer: Qualcare PPO/HMO/WC	$744.75
Rate for Payer: UnitedHealthcare Community & State	$119.66
Rate for Payer: Wellpoint Medicaid Managed Care	$131.57

LEAD VENTRICULAR FOR PM 508652

Facility

$4,965.00

Hospital Charge Code	270645704C
Hospital Revenue Code	275
Min. Negotiated Rate	$744.75
Max. Negotiated Rate	$1,201.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$993.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,201.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,092.30
Rate for Payer: Qualcare PPO/HMO/WC	$744.75

LEAD VENTRICULAR FOR PM 508652

Facility

$4,965.00

Hospital Charge Code	270645704C
Hospital Revenue Code	275
Min. Negotiated Rate	$119.66
Max. Negotiated Rate	$2,482.50
Rate for Payer: Aetna Commercial	$1,886.70
Rate for Payer: Aetna Medicare Advantage	$1,489.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,266.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,266.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,266.08
Rate for Payer: Cigna Commercial	$2,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,201.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,092.30
Rate for Payer: Qualcare PPO/HMO/WC	$744.75
Rate for Payer: UnitedHealthcare Community & State	$119.66
Rate for Payer: Wellpoint Medicaid Managed Care	$131.57

LEAD VENT TENDRK SDX 1488TC52

Facility

$3,720.00

Hospital Charge Code	270629428C
Hospital Revenue Code	275
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$900.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$744.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$818.40
Rate for Payer: Qualcare PPO/HMO/WC	$558.00

LEAD VENT TENDRK SDX 1488TC52

Facility

$3,720.00

Hospital Charge Code	270629428
Hospital Revenue Code	275
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$900.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$744.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$818.40
Rate for Payer: Qualcare PPO/HMO/WC	$558.00

LEAD VENT TENDRK SDX 1488TC52

Facility

$3,720.00

Hospital Charge Code	270629428
Hospital Revenue Code	275
Min. Negotiated Rate	$89.65
Max. Negotiated Rate	$1,860.00
Rate for Payer: Aetna Commercial	$1,413.60
Rate for Payer: Aetna Medicare Advantage	$1,116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$948.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$948.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$948.60
Rate for Payer: Cigna Commercial	$1,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$818.40
Rate for Payer: Qualcare PPO/HMO/WC	$558.00
Rate for Payer: UnitedHealthcare Community & State	$89.65
Rate for Payer: Wellpoint Medicaid Managed Care	$98.58

LEAD VENT TENDRK SDX 1488TC52

Facility

$3,720.00

Hospital Charge Code	270629428C
Hospital Revenue Code	275
Min. Negotiated Rate	$89.65
Max. Negotiated Rate	$1,860.00
Rate for Payer: Aetna Commercial	$1,413.60
Rate for Payer: Aetna Medicare Advantage	$1,116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$948.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$948.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$948.60
Rate for Payer: Cigna Commercial	$1,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$818.40
Rate for Payer: Qualcare PPO/HMO/WC	$558.00
Rate for Payer: UnitedHealthcare Community & State	$89.65
Rate for Payer: Wellpoint Medicaid Managed Care	$98.58

LEAD WIRE ECG 3-LEAD

Facility

$82.50

Hospital Charge Code	270609035
Hospital Revenue Code	271
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

LEAD WIRE ECG 3-LEAD

Facility

$82.50

Hospital Charge Code	270609035
Hospital Revenue Code	271
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna Commercial	$31.35
Rate for Payer: Aetna Medicare Advantage	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.04
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.75
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$16.50
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

LEAD WIRE ECG MOBILITY 5 LEAD

Facility

$135.00

Hospital Charge Code	270644944
Hospital Revenue Code	272
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$27.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

LEAD WIRE ECG MOBILITY 5 LEAD

Facility

$135.00

Hospital Charge Code	270644944
Hospital Revenue Code	272
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

Know your out-of-pocket cost for care.

All Charges