Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MASTIC SOL 120ML

Facility

$179.20

Hospital Charge Code	60628532
Hospital Revenue Code	250
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$26.88
Rate for Payer: Qualcare PPO/HMO/WC	$26.88

MASTIC SOL 120ML

Facility

$133.80

Hospital Charge Code	60628643
Hospital Revenue Code	250
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$66.90
Rate for Payer: Aetna Commercial	$50.84
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.12
Rate for Payer: Cigna Commercial	$66.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.14
Rate for Payer: Oxford Commercial	$26.76
Rate for Payer: Qualcare PPO/HMO/WC	$20.07
Rate for Payer: UnitedHealthcare Commercial	$26.76
Rate for Payer: UnitedHealthcare Community & State	$3.22
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

MASTIC SOL 120ML

Facility

$179.20

Hospital Charge Code	60628532
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$89.60
Rate for Payer: Aetna Commercial	$68.10
Rate for Payer: Aetna Medicare Advantage	$53.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.70
Rate for Payer: Cigna Commercial	$89.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.76
Rate for Payer: Oxford Commercial	$35.84
Rate for Payer: Qualcare PPO/HMO/WC	$26.88
Rate for Payer: UnitedHealthcare Commercial	$35.84
Rate for Payer: UnitedHealthcare Community & State	$4.32
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

MASTIC SOL 120ML

Facility

$133.80

Hospital Charge Code	60628643
Hospital Revenue Code	250
Min. Negotiated Rate	$20.07
Max. Negotiated Rate	$20.07
Rate for Payer: Qualcare PPO/HMO/WC	$20.07

MASTISOL ADHESIVE****

Facility

$6.00

Hospital Charge Code	8003634
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

MASTISOL ADHESIVE****

Facility

$6.00

Hospital Charge Code	8003634
Hospital Revenue Code	272
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

MASTISOL ADHESIVE 3CC

Facility

$7.89

Hospital Charge Code	270650820
Hospital Revenue Code	270
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$1.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.18

MASTISOL ADHESIVE 3CC

Facility

$7.89

Hospital Charge Code	270650820
Hospital Revenue Code	270
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.94
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare Advantage	$2.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.01
Rate for Payer: Cigna Commercial	$3.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.37
Rate for Payer: Oxford Commercial	$1.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.18
Rate for Payer: UnitedHealthcare Commercial	$1.58
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

MASTISOL LIQUID UA CONTR LI

Facility

$306.45

Hospital Charge Code	270605269
Hospital Revenue Code	270
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$153.22
Rate for Payer: Aetna Commercial	$116.45
Rate for Payer: Aetna Medicare Advantage	$91.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.14
Rate for Payer: Cigna Commercial	$153.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.94
Rate for Payer: Oxford Commercial	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$45.97
Rate for Payer: UnitedHealthcare Commercial	$61.29
Rate for Payer: UnitedHealthcare Community & State	$7.39
Rate for Payer: Wellpoint Medicaid Managed Care	$8.12

MASTISOL LIQUID UA CONTR LI

Facility

$306.45

Hospital Charge Code	270605269
Hospital Revenue Code	270
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$45.97
Rate for Payer: Qualcare PPO/HMO/WC	$45.97

MAS TLIF KIT

Facility

$12,810.00

Hospital Charge Code	270691370
Hospital Revenue Code	272
Min. Negotiated Rate	$1,921.50
Max. Negotiated Rate	$1,921.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,921.50

MAS TLIF KIT

Facility

$12,810.00

Hospital Charge Code	270691370
Hospital Revenue Code	272
Min. Negotiated Rate	$308.72
Max. Negotiated Rate	$6,405.00
Rate for Payer: Aetna Commercial	$4,867.80
Rate for Payer: Aetna Medicare Advantage	$3,843.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,266.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,266.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,266.55
Rate for Payer: Cigna Commercial	$6,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,843.00
Rate for Payer: Oxford Commercial	$2,562.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,921.50
Rate for Payer: UnitedHealthcare Commercial	$2,562.00
Rate for Payer: UnitedHealthcare Community & State	$308.72
Rate for Payer: Wellpoint Medicaid Managed Care	$339.46

MAST MOD RAD

Facility

$42,601.70

Service Code	HCPCS 19307
Hospital Charge Code	16000298
Hospital Revenue Code	360
Min. Negotiated Rate	$1,026.70
Max. Negotiated Rate	$28,475.80
Rate for Payer: Aetna Commercial	$21,457.24
Rate for Payer: Aetna Medicare Advantage	$25,559.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,888.69
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	$28,475.80
Rate for Payer: Cigna Commercial	$15,812.86
Rate for Payer: Cigna Medicare Advantage	$7,888.69
Rate for Payer: Clover Medicare Advantage	$7,494.26
Rate for Payer: EmblemHealth Commercial	$23,666.07
Rate for Payer: Humana Medicare Advantage	$8,125.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,888.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,780.51
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,026.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,888.69
Rate for Payer: Wellcare Medicare Advantage	$7,888.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,128.95

MAST MOD RAD

Facility

$42,601.70

Service Code	HCPCS 19307
Hospital Charge Code	16000298
Hospital Revenue Code	360
Min. Negotiated Rate	$6,390.26
Max. Negotiated Rate	$6,390.26
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26

MASTOIDS COMP STUDY

Facility

$5,100.00

Service Code	HCPCS 70130
Hospital Charge Code	94061003
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

MASTOIDS COMP STUDY

Facility

$5,100.00

Service Code	HCPCS 70130
Hospital Charge Code	94061003
Hospital Revenue Code	320
Min. Negotiated Rate	$47.57
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

MASTOIDS LMTD <3VWS

Facility

$204.00

Hospital Charge Code	2009370
Hospital Revenue Code	320
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

MASTOIDS LMTD <3VWS

Facility

$204.00

Hospital Charge Code	2009370
Hospital Revenue Code	320
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

MASTOPEXY

Facility

$31,541.30

Service Code	HCPCS 19316
Hospital Charge Code	16000535
Hospital Revenue Code	360
Min. Negotiated Rate	$760.15
Max. Negotiated Rate	$28,475.80
Rate for Payer: Aetna Commercial	$21,457.24
Rate for Payer: Aetna Medicare Advantage	$25,559.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,888.69
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	$28,475.80
Rate for Payer: Cigna Commercial	$15,812.86
Rate for Payer: Cigna Medicare Advantage	$7,888.69
Rate for Payer: Clover Medicare Advantage	$7,494.26
Rate for Payer: EmblemHealth Commercial	$23,666.07
Rate for Payer: Humana Medicare Advantage	$8,125.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,888.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,462.39
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.19
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$760.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,888.69
Rate for Payer: Wellcare Medicare Advantage	$7,888.69
Rate for Payer: Wellpoint Medicaid Managed Care	$835.84

MASTOPEXY

Facility

$31,541.30

Service Code	HCPCS 19316
Hospital Charge Code	16000535
Hospital Revenue Code	360
Min. Negotiated Rate	$4,731.19
Max. Negotiated Rate	$4,731.19
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.19

MASTOTOMY W EXPL DEEP

Facility

$18,641.30

Service Code	HCPCS 19020
Hospital Charge Code	16000371
Hospital Revenue Code	360
Min. Negotiated Rate	$2,796.20
Max. Negotiated Rate	$2,796.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,796.20

MASTOTOMY W EXPL DEEP

Facility

$18,641.30

Service Code	HCPCS 19020
Hospital Charge Code	16000371
Hospital Revenue Code	360
Min. Negotiated Rate	$449.26
Max. Negotiated Rate	$8,157.00
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	$1,016.00
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	$5,592.39
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,796.20
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$449.26
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	$493.99

MAST SIMPLE COMPLETE

Facility

$31,541.30

Service Code	HCPCS 19303
Hospital Charge Code	16000303
Hospital Revenue Code	360
Min. Negotiated Rate	$4,731.19
Max. Negotiated Rate	$4,731.19
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.19

MAST SIMPLE COMPLETE

Facility

$31,541.30

Service Code	HCPCS 19303
Hospital Charge Code	16000303
Hospital Revenue Code	360
Min. Negotiated Rate	$760.15
Max. Negotiated Rate	$28,475.80
Rate for Payer: Aetna Commercial	$21,457.24
Rate for Payer: Aetna Medicare Advantage	$25,559.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,888.69
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	$28,475.80
Rate for Payer: Cigna Commercial	$15,812.86
Rate for Payer: Cigna Medicare Advantage	$7,888.69
Rate for Payer: Clover Medicare Advantage	$7,494.26
Rate for Payer: EmblemHealth Commercial	$23,666.07
Rate for Payer: Humana Medicare Advantage	$8,125.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,888.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,462.39
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.19
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$760.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,888.69
Rate for Payer: Wellcare Medicare Advantage	$7,888.69
Rate for Payer: Wellpoint Medicaid Managed Care	$835.84

MAT CELL CONTAM STDY STR ANLYS

Facility

$1,327.45

Service Code	HCPCS 81265
Hospital Charge Code	401381265
Hospital Revenue Code	310
Min. Negotiated Rate	$199.12
Max. Negotiated Rate	$199.12
Rate for Payer: Qualcare PPO/HMO/WC	$199.12

Know your out-of-pocket cost for care.

All Charges