Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

L.PNEUMOPHILA AB(IGM) II

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990102B
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LP NON LOCK 2.7MM X 10MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701900
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

LP NON LOCK 2.7MM X 10MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701900
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON-LOCK 2.7MM X 13MM

Facility

$650.00

Hospital Charge Code	270663854
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

LP NON-LOCK 2.7MM X 13MM

Facility

$650.00

Hospital Charge Code	270663854
Hospital Revenue Code	278
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

LP NON LOCK 2.7MM X 16MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701901
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 16MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701901
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

LP NON-LOCK 2.7MM X 22MM

Facility

$595.00

Hospital Charge Code	270663846
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

LP NON-LOCK 2.7MM X 22MM

Facility

$595.00

Hospital Charge Code	270663846
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 24MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701902
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP NON LOCK 2.7MM X 24MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701902
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

LP NON LOCK 2.7MM X 26MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701899
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

LP NON LOCK 2.7MM X 26MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270701899
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

LP-PLA2

Facility

$286.00

Service Code	HCPCS 83698
Hospital Charge Code	38474062
Hospital Revenue Code	301
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

LP-PLA2

Facility

$240.40

Service Code	HCPCS 83698
Hospital Charge Code	38477189
Hospital Revenue Code	301
Min. Negotiated Rate	$36.06
Max. Negotiated Rate	$36.06
Rate for Payer: Qualcare PPO/HMO/WC	$36.06

LP-PLA2

Facility

$240.40

Service Code	HCPCS 83698
Hospital Charge Code	38477189
Hospital Revenue Code	301
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$167.17
Rate for Payer: Aetna Commercial	$125.96
Rate for Payer: Aetna Medicare Advantage	$150.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.17
Rate for Payer: Cigna Commercial	$120.20
Rate for Payer: Cigna Medicare Advantage	$46.31
Rate for Payer: Clover Medicare Advantage	$43.99
Rate for Payer: EmblemHealth Commercial	$138.93
Rate for Payer: Humana Medicare Advantage	$47.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$46.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.06
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$37.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.31
Rate for Payer: Wellcare Medicare Advantage	$46.31
Rate for Payer: Wellpoint Medicaid Managed Care	$6.37

LP-PLA2

Facility

$286.00

Service Code	HCPCS 83698
Hospital Charge Code	38474062
Hospital Revenue Code	301
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$167.17
Rate for Payer: Aetna Commercial	$125.96
Rate for Payer: Aetna Medicare Advantage	$150.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$46.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.17
Rate for Payer: Cigna Commercial	$143.00
Rate for Payer: Cigna Medicare Advantage	$46.31
Rate for Payer: Clover Medicare Advantage	$43.99
Rate for Payer: EmblemHealth Commercial	$138.93
Rate for Payer: Humana Medicare Advantage	$47.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$46.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$37.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.31
Rate for Payer: Wellcare Medicare Advantage	$46.31
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

LPR-VAG HYST INCL T/O =<250 GM

Facility

$43,337.60

Service Code	HCPCS 58552
Hospital Charge Code	16001007
Hospital Revenue Code	360
Min. Negotiated Rate	$1,044.44
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,001.28
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.64
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,044.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1,148.45

LPR-VAG HYST INCL T/O =<250 GM

Facility

$43,337.60

Service Code	HCPCS 58552
Hospital Charge Code	16001007
Hospital Revenue Code	360
Min. Negotiated Rate	$6,500.64
Max. Negotiated Rate	$6,500.64
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.64

LPS FLEX ARTI SURFACE POLYETHY

Facility

$5,862.10

Hospital Charge Code	270657964
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

LPS FLEX ARTI SURFACE POLYETHY

Facility

$5,862.10

Hospital Charge Code	270657964
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

LPS FLEX FIXED SUR CD 1-2 12MM

Facility

$5,862.10

Hospital Charge Code	270669608
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

LPS FLEX FIXED SUR CD 1-2 12MM

Facility

$5,862.10

Hospital Charge Code	270669608
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

LPS FLEX FIXED SUR CD 1-2 14MM

Facility

$5,862.10

Hospital Charge Code	270657092
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

LPS FLEX FIXED SUR CD 1-2 14MM

Facility

$5,862.10

Hospital Charge Code	270657092
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

Know your out-of-pocket cost for care.

All Charges