Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROSTATE SPECIFIC ANTIGEN FREE

Facility

$205.65

Hospital Charge Code	3007672
Hospital Revenue Code	309
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

PROSTATE SPECIFIC ANTIGEN FREE

Facility

$205.65

Hospital Charge Code	3007672
Hospital Revenue Code	309
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$78.15
Rate for Payer: Aetna Medicare Advantage	$61.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.44
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

PROSTATE-SPECIFIC ANTIGEN,TOTA

Facility

$281.00

Service Code	HCPCS 84153
Hospital Charge Code	38472572
Hospital Revenue Code	301
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$140.50
Rate for Payer: Aetna Commercial	$50.02
Rate for Payer: Aetna Medicare Advantage	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.38
Rate for Payer: Cigna Commercial	$140.50
Rate for Payer: Cigna Medicare Advantage	$18.39
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.39
Rate for Payer: Wellcare Medicare Advantage	$18.39
Rate for Payer: Wellpoint Medicaid Managed Care	$7.45

PROSTATE-SPECIFIC ANTIGEN,TOTA

Facility

$281.00

Service Code	HCPCS 84153
Hospital Charge Code	38472572
Hospital Revenue Code	301
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

PROSTATE SPECIFIC FREE

Facility

$390.00

Service Code	HCPCS 84154
Hospital Charge Code	3007673A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROSTATE SPECIFIC FREE

Facility

$390.00

Service Code	HCPCS 84154
Hospital Charge Code	3007673A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.02
Rate for Payer: Aetna Medicare Advantage	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.38
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.39
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.39
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	$14.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.39
Rate for Payer: Wellcare Medicare Advantage	$18.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PROSTATE SPECIFIC TOTAL

Facility

$667.59

Service Code	HCPCS 84153
Hospital Charge Code	3007673B
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PROSTATE SPECIFIC TOTAL

Facility

$667.59

Service Code	HCPCS 84153
Hospital Charge Code	3007673B
Hospital Revenue Code	301
Min. Negotiated Rate	$14.71
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$50.02
Rate for Payer: Aetna Medicare Advantage	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.38
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$18.39
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.39
Rate for Payer: Wellcare Medicare Advantage	$18.39
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

PROSTATIC-DNA***

Facility

$424.00

Service Code	HCPCS 89399
Hospital Charge Code	3032216
Hospital Revenue Code	309
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$63.60

PROSTATIC-DNA***

Facility

$424.00

Service Code	HCPCS 89399
Hospital Charge Code	3032216
Hospital Revenue Code	309
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$212.00
Rate for Payer: Aetna Commercial	$161.12
Rate for Payer: Aetna Medicare Advantage	$127.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.12
Rate for Payer: Cigna Commercial	$212.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.24

PROSTECTOMY SUBTOTAL

Facility

$39,911.00

Service Code	HCPCS 55821
Hospital Charge Code	1600000882
Hospital Revenue Code	360
Min. Negotiated Rate	$5,986.65
Max. Negotiated Rate	$5,986.65
Rate for Payer: Qualcare PPO/HMO/WC	$5,986.65

PROSTECTOMY SUBTOTAL

Facility

$39,911.00

Service Code	HCPCS 55821
Hospital Charge Code	1600000882
Hospital Revenue Code	360
Min. Negotiated Rate	$961.86
Max. Negotiated Rate	$19,955.50
Rate for Payer: Aetna Commercial	$15,166.18
Rate for Payer: Aetna Medicare Advantage	$11,973.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,177.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,177.31
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	$10,177.31
Rate for Payer: Cigna Commercial	$19,955.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,973.30
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,986.65
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$961.86
Rate for Payer: Wellpoint Medicaid Managed Care	$1,057.64

PROSTEP MICA DEPTH GAUGE 150MM

Facility

$660.00

Hospital Charge Code	270703496
Hospital Revenue Code	279
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

PROSTEP MICA DEPTH GAUGE 150MM

Facility

$660.00

Hospital Charge Code	270703496
Hospital Revenue Code	279
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.00
Rate for Payer: Oxford Commercial	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Commercial	$132.00
Rate for Payer: UnitedHealthcare Community & State	$15.91
Rate for Payer: Wellpoint Medicaid Managed Care	$17.49

PROSTEP MICA SCR 4.0X38MM STRL

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702656
Hospital Revenue Code	278
Min. Negotiated Rate	$68.57
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$68.57
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

PROSTEP MICA SCR 4.0X38MM STRL

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702656
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCR 4.0X40MM STRL

Facility

$2,845.25

Hospital Charge Code	270702755
Hospital Revenue Code	278
Min. Negotiated Rate	$68.57
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$68.57
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

PROSTEP MICA SCR 4.0X40MM STRL

Facility

$2,845.25

Hospital Charge Code	270702755
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCR 4.0X52MM STRL

Facility

$2,845.25

Hospital Charge Code	270702756
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCR 4.0X52MM STRL

Facility

$2,845.25

Hospital Charge Code	270702756
Hospital Revenue Code	278
Min. Negotiated Rate	$68.57
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$68.57
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

PROSTEP MICA SCREW

Facility

$2,845.25

Hospital Charge Code	270703026
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCREW

Facility

$2,845.25

Hospital Charge Code	270703026
Hospital Revenue Code	278
Min. Negotiated Rate	$68.57
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$68.57
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

PROSTEP MICA SCREW

Facility

$2,845.25

Hospital Charge Code	270703025
Hospital Revenue Code	278
Min. Negotiated Rate	$68.57
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$68.57
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

PROSTEP MICA SCREW

Facility

$2,845.25

Hospital Charge Code	270703025
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCREW 3.0 X 34MM

Facility

$5,762.85

Service Code	HCPCS C1713
Hospital Charge Code	270704139
Hospital Revenue Code	278
Min. Negotiated Rate	$138.88
Max. Negotiated Rate	$2,881.43
Rate for Payer: Aetna Commercial	$2,189.88
Rate for Payer: Aetna Medicare Advantage	$1,728.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,469.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,469.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,152.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,469.53
Rate for Payer: Cigna Commercial	$2,881.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,267.83
Rate for Payer: Qualcare PPO/HMO/WC	$864.43
Rate for Payer: UnitedHealthcare Community & State	$138.88
Rate for Payer: Wellpoint Medicaid Managed Care	$152.72

Know your out-of-pocket cost for care.

All Charges