Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MA BREAST NDL LOC PLC BILAT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700016
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MA BREAST NDL LOC PLC BILAT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700016
Hospital Revenue Code	361
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

MA BREAST NDL LOC PLC LEFT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700003
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MA BREAST NDL LOC PLC LEFT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700003
Hospital Revenue Code	361
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

MA BREAST NDL LOC PLC RIGHT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700004
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MA BREAST NDL LOC PLC RIGHT

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2700004
Hospital Revenue Code	361
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

MACHINE CUSA: NEURO PROCS 200

Facility

$12,096.00

Hospital Charge Code	270607649
Hospital Revenue Code	270
Min. Negotiated Rate	$1,814.40
Max. Negotiated Rate	$1,814.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,814.40

MACHINE CUSA: NEURO PROCS 200

Facility

$12,096.00

Hospital Charge Code	270607649
Hospital Revenue Code	270
Min. Negotiated Rate	$291.51
Max. Negotiated Rate	$6,048.00
Rate for Payer: Aetna Commercial	$4,596.48
Rate for Payer: Aetna Medicare Advantage	$3,628.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,084.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,084.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,084.48
Rate for Payer: Cigna Commercial	$6,048.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,628.80
Rate for Payer: Oxford Commercial	$2,419.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,814.40
Rate for Payer: UnitedHealthcare Commercial	$2,419.20
Rate for Payer: UnitedHealthcare Community & State	$291.51
Rate for Payer: Wellpoint Medicaid Managed Care	$320.54

MACHINE HUMMER ENT W/SUPPLIES

Facility

$2,298.45

Hospital Charge Code	270616578
Hospital Revenue Code	272
Min. Negotiated Rate	$344.77
Max. Negotiated Rate	$344.77
Rate for Payer: Qualcare PPO/HMO/WC	$344.77

MACHINE HUMMER ENT W/SUPPLIES

Facility

$2,298.45

Hospital Charge Code	270616578
Hospital Revenue Code	272
Min. Negotiated Rate	$55.39
Max. Negotiated Rate	$1,149.22
Rate for Payer: Aetna Commercial	$873.41
Rate for Payer: Aetna Medicare Advantage	$689.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.10
Rate for Payer: Cigna Commercial	$1,149.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$689.53
Rate for Payer: Oxford Commercial	$459.69
Rate for Payer: Qualcare PPO/HMO/WC	$344.77
Rate for Payer: UnitedHealthcare Commercial	$459.69
Rate for Payer: UnitedHealthcare Community & State	$55.39
Rate for Payer: Wellpoint Medicaid Managed Care	$60.91

MACI(AUTOLOG CULT CHONDROCYTE)

Facility

$228,480.00

Service Code	HCPCS J7330
Hospital Charge Code	270690773
Hospital Revenue Code	636
Min. Negotiated Rate	$5,506.37
Max. Negotiated Rate	$114,240.00
Rate for Payer: Aetna Commercial	$86,822.40
Rate for Payer: Aetna Medicare Advantage	$68,544.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58,262.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58,262.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58,262.40
Rate for Payer: Cigna Commercial	$114,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55,292.16
Rate for Payer: Qualcare PPO/HMO/WC	$34,272.00
Rate for Payer: UnitedHealthcare Community & State	$5,506.37
Rate for Payer: Wellpoint Medicaid Managed Care	$6,054.72

MACI(AUTOLOG CULT CHONDROCYTE)

Facility

$228,480.00

Service Code	HCPCS J7330
Hospital Charge Code	270690773
Hospital Revenue Code	636
Min. Negotiated Rate	$34,272.00
Max. Negotiated Rate	$55,292.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55,292.16
Rate for Payer: Qualcare PPO/HMO/WC	$34,272.00

MACI IMPLANT 81073

Facility

$243,030.00

Service Code	HCPCS J7330
Hospital Charge Code	270696136
Hospital Revenue Code	636
Min. Negotiated Rate	$5,857.02
Max. Negotiated Rate	$121,515.00
Rate for Payer: Aetna Commercial	$92,351.40
Rate for Payer: Aetna Medicare Advantage	$72,909.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61,972.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61,972.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61,972.65
Rate for Payer: Cigna Commercial	$121,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58,813.26
Rate for Payer: Qualcare PPO/HMO/WC	$36,454.50
Rate for Payer: UnitedHealthcare Community & State	$5,857.02
Rate for Payer: Wellpoint Medicaid Managed Care	$6,440.30

MACI IMPLANT 81073

Facility

$243,030.00

Service Code	HCPCS J7330
Hospital Charge Code	270696136
Hospital Revenue Code	636
Min. Negotiated Rate	$36,454.50
Max. Negotiated Rate	$58,813.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58,813.26
Rate for Payer: Qualcare PPO/HMO/WC	$36,454.50

MAC LAB 2 SIDES 9.4 GB DVD CAS

Facility

$65.50

Hospital Charge Code	2709002922
Hospital Revenue Code	272
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$9.82
Rate for Payer: Qualcare PPO/HMO/WC	$9.82

MAC LAB 2 SIDES 9.4 GB DVD CAS

Facility

$65.50

Hospital Charge Code	2709002922
Hospital Revenue Code	272
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.75
Rate for Payer: Aetna Commercial	$24.89
Rate for Payer: Aetna Medicare Advantage	$19.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.70
Rate for Payer: Cigna Commercial	$32.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.65
Rate for Payer: Oxford Commercial	$13.10
Rate for Payer: Qualcare PPO/HMO/WC	$9.82
Rate for Payer: UnitedHealthcare Commercial	$13.10
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

MACROBID 100MG CAPSULE

Facility

$18.00

Hospital Charge Code	60635789
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

MACROBID 100MG CAPSULE

Facility

$18.00

Hospital Charge Code	60635789
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

MACRODANTIN/100MG/CAP

Facility

$7.00

Hospital Charge Code	60633348
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MACRODANTIN/100MG/CAP

Facility

$7.00

Hospital Charge Code	60633348
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

MACRODANTIN/50MG/CAP

Facility

$7.00

Hospital Charge Code	60633349
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

MACRODANTIN/50MG/CAP

Facility

$5.00

Hospital Charge Code	60633347
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MACRODANTIN/50MG/CAP

Facility

$5.00

Hospital Charge Code	60633347
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

MACRODANTIN/50MG/CAP

Facility

$7.00

Hospital Charge Code	60633349
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MACROPLASTIQUE ENDOSCOPE NEEDL

Facility

$150.00

Hospital Charge Code	270680106
Hospital Revenue Code	272
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

Know your out-of-pocket cost for care.

All Charges