Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MICRO AMNI MEMB ALLOGRFT100MG

Facility

$9,170.00

Service Code	HCPCS Q4145
Hospital Charge Code	270680996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,017.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

MICRO AMNI MEMB ALLOGRFT100MG

Facility

$9,170.00

Service Code	HCPCS Q4145
Hospital Charge Code	270680996
Hospital Revenue Code	278
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,017.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Community & State	$221.00
Rate for Payer: Wellpoint Medicaid Managed Care	$243.00

MICRO ANCHOR WITH # 3 ETHOLAN

Facility

$2,395.00

Service Code	HCPCS C1713
Hospital Charge Code	270680313
Hospital Revenue Code	278
Min. Negotiated Rate	$359.25
Max. Negotiated Rate	$579.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$479.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$526.90
Rate for Payer: Qualcare PPO/HMO/WC	$359.25

MICRO ANCHOR WITH # 3 ETHOLAN

Facility

$2,395.00

Service Code	HCPCS C1713
Hospital Charge Code	270680313
Hospital Revenue Code	278
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$1,197.50
Rate for Payer: Aetna Commercial	$910.10
Rate for Payer: Aetna Medicare Advantage	$718.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$610.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$610.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$610.73
Rate for Payer: Cigna Commercial	$1,197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$526.90
Rate for Payer: Qualcare PPO/HMO/WC	$359.25
Rate for Payer: UnitedHealthcare Community & State	$57.72
Rate for Payer: Wellpoint Medicaid Managed Care	$63.47

MICRO ANIS 17 MM/3MM

Facility

$980.00

Hospital Charge Code	270703199
Hospital Revenue Code	278
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.60
Rate for Payer: Qualcare PPO/HMO/WC	$147.00

MICRO ANIS 17 MM/3MM

Facility

$980.00

Hospital Charge Code	270703199
Hospital Revenue Code	278
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$490.00
Rate for Payer: Aetna Commercial	$372.40
Rate for Payer: Aetna Medicare Advantage	$294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.90
Rate for Payer: Cigna Commercial	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.60
Rate for Payer: Qualcare PPO/HMO/WC	$147.00
Rate for Payer: UnitedHealthcare Community & State	$23.62
Rate for Payer: Wellpoint Medicaid Managed Care	$25.97

MICRO ANIS 20MMX3.0MM

Facility

$1,000.00

Hospital Charge Code	270702602
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

MICRO ANIS 20MMX3.0MM

Facility

$1,000.00

Hospital Charge Code	270702602
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

MICRO ANIS 22MMX3.0MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270702603
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

MICRO ANIS 22MMX3.0MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270702603
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

MICROBE SUSCEPTIBLE MIC PLT

Facility

$138.14

Service Code	HCPCS 87186
Hospital Charge Code	401387186B
Hospital Revenue Code	306
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.53
Rate for Payer: Aetna Medicare Advantage	$28.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.22
Rate for Payer: Cigna Commercial	$69.07
Rate for Payer: Cigna Medicare Advantage	$8.65
Rate for Payer: Clover Medicare Advantage	$8.22
Rate for Payer: EmblemHealth Commercial	$25.95
Rate for Payer: Humana Medicare Advantage	$8.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.44
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.72
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.65
Rate for Payer: Wellcare Medicare Advantage	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.66

MICROBE SUSCEPTIBLE MIC PLT

Facility

$138.14

Service Code	HCPCS 87186
Hospital Charge Code	401387186B
Hospital Revenue Code	306
Min. Negotiated Rate	$20.72
Max. Negotiated Rate	$20.72
Rate for Payer: Qualcare PPO/HMO/WC	$20.72

MICROBIAL IDENT W/AMPLIFICATIO

Facility

$431.00

Service Code	HCPCS 87798
Hospital Charge Code	38476243
Hospital Revenue Code	306
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$215.50
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	$153.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$215.50
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	$129.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.65
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	$11.42

MICROBIAL IDENT W/AMPLIFICATIO

Facility

$431.00

Service Code	HCPCS 87798
Hospital Charge Code	38476243
Hospital Revenue Code	306
Min. Negotiated Rate	$64.65
Max. Negotiated Rate	$64.65
Rate for Payer: Qualcare PPO/HMO/WC	$64.65

MICROBIOLOGY SPECIMEN BRUSH

Facility

$387.00

Hospital Charge Code	270330773
Hospital Revenue Code	272
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

MICROBIOLOGY SPECIMEN BRUSH

Facility

$387.00

Hospital Charge Code	270330773
Hospital Revenue Code	272
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$147.06
Rate for Payer: Aetna Medicare Advantage	$116.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.69
Rate for Payer: Cigna Commercial	$193.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.10
Rate for Payer: Oxford Commercial	$77.40
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$77.40
Rate for Payer: UnitedHealthcare Community & State	$9.33
Rate for Payer: Wellpoint Medicaid Managed Care	$10.26

MICROBLATOR 30 ICW 1.4MM

Facility

$2,455.00

Hospital Charge Code	270675004
Hospital Revenue Code	272
Min. Negotiated Rate	$368.25
Max. Negotiated Rate	$368.25
Rate for Payer: Qualcare PPO/HMO/WC	$368.25

MICROBLATOR 30 ICW 1.4MM

Facility

$2,455.00

Hospital Charge Code	270675004
Hospital Revenue Code	272
Min. Negotiated Rate	$59.17
Max. Negotiated Rate	$1,227.50
Rate for Payer: Aetna Commercial	$932.90
Rate for Payer: Aetna Medicare Advantage	$736.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$626.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$626.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$626.02
Rate for Payer: Cigna Commercial	$1,227.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$736.50
Rate for Payer: Oxford Commercial	$491.00
Rate for Payer: Qualcare PPO/HMO/WC	$368.25
Rate for Payer: UnitedHealthcare Commercial	$491.00
Rate for Payer: UnitedHealthcare Community & State	$59.17
Rate for Payer: Wellpoint Medicaid Managed Care	$65.06

MICROCATHETER 135 CM 45 CM

Facility

$3,250.00

Hospital Charge Code	270683212N
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

MICROCATHETER 135 CM 45 CM

Facility

$3,250.00

Hospital Charge Code	270683212
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

MICROCATHETER 135 CM 45 CM

Facility

$3,250.00

Hospital Charge Code	270683212
Hospital Revenue Code	272
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

MICROCATHETER 135 CM 45 CM

Facility

$3,250.00

Hospital Charge Code	270683212N
Hospital Revenue Code	272
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

MICROCATHETER 135CM STR LANTER

Facility

$3,250.00

Hospital Charge Code	270683211
Hospital Revenue Code	272
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

MICROCATHETER 135CM STR LANTER

Facility

$3,250.00

Hospital Charge Code	270683211N
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

MICROCATHETER 135CM STR LANTER

Facility

$3,250.00

Hospital Charge Code	270683211N
Hospital Revenue Code	272
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

Know your out-of-pocket cost for care.

All Charges