Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSA DISPOSABLE CABLE

Facility

$303.75

Hospital Charge Code	270666011
Hospital Revenue Code	272
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$45.56
Rate for Payer: Qualcare PPO/HMO/WC	$45.56

PSA DISPOSABLE CABLE

Facility

$303.75

Hospital Charge Code	270666011
Hospital Revenue Code	272
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$151.88
Rate for Payer: Aetna Commercial	$115.42
Rate for Payer: Aetna Medicare Advantage	$91.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.46
Rate for Payer: Cigna Commercial	$151.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.12
Rate for Payer: Oxford Commercial	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$45.56
Rate for Payer: UnitedHealthcare Commercial	$60.75
Rate for Payer: UnitedHealthcare Community & State	$7.32
Rate for Payer: Wellpoint Medicaid Managed Care	$8.05

PSA Disposible Cable

Facility

$303.75

Hospital Charge Code	270666011N
Hospital Revenue Code	272
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$151.88
Rate for Payer: Aetna Commercial	$115.42
Rate for Payer: Aetna Medicare Advantage	$91.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.46
Rate for Payer: Cigna Commercial	$151.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.12
Rate for Payer: Oxford Commercial	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$45.56
Rate for Payer: UnitedHealthcare Commercial	$60.75
Rate for Payer: UnitedHealthcare Community & State	$7.32
Rate for Payer: Wellpoint Medicaid Managed Care	$8.05

PSA Disposible Cable

Facility

$303.75

Hospital Charge Code	270666011S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$45.56
Rate for Payer: Qualcare PPO/HMO/WC	$45.56

PSA Disposible Cable

Facility

$303.75

Hospital Charge Code	270666011N
Hospital Revenue Code	272
Min. Negotiated Rate	$45.56
Max. Negotiated Rate	$45.56
Rate for Payer: Qualcare PPO/HMO/WC	$45.56

PSA Disposible Cable

Facility

$303.75

Hospital Charge Code	270666011S
Hospital Revenue Code	272
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$151.88
Rate for Payer: Aetna Commercial	$115.42
Rate for Payer: Aetna Medicare Advantage	$91.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.46
Rate for Payer: Cigna Commercial	$151.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.12
Rate for Payer: Oxford Commercial	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$45.56
Rate for Payer: UnitedHealthcare Commercial	$60.75
Rate for Payer: UnitedHealthcare Community & State	$7.32
Rate for Payer: Wellpoint Medicaid Managed Care	$8.05

PSA FREE

Facility

$281.00

Service Code	HCPCS 84154
Hospital Charge Code	38472582
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	$20.17
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

PSA FREE

Facility

$281.00

Service Code	HCPCS 84154
Hospital Charge Code	38472582
Hospital Revenue Code	301
Min. Negotiated Rate	$42.15
Max. Negotiated Rate	$42.15
Rate for Payer: Qualcare PPO/HMO/WC	$42.15

PSA FREE AND TOTAL I

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	39990074A
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	$47.43
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

PSA FREE AND TOTAL I

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	39990074A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PSA FREE AND TOTAL II

Facility

$390.00

Service Code	HCPCS 84154
Hospital Charge Code	39990074B
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

PSA FREE AND TOTAL II

Facility

$390.00

Service Code	HCPCS 84154
Hospital Charge Code	39990074B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PSA POST PROSTATECTOMY W HAMA

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	39708029
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PSA POST PROSTATECTOMY W HAMA

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	366884153
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PSA POST PROSTATECTOMY W HAMA

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	366884153
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	$47.43
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

PSA POST PROSTATECTOMY W HAMA

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	39708029
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	$47.43
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

PSA PSEUDO ANEURISM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	366836002
Hospital Revenue Code	361
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.90
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.95
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$25.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$27.90

PSA PSEUDO ANEURISM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	366836002
Hospital Revenue Code	361
Min. Negotiated Rate	$157.95
Max. Negotiated Rate	$157.95
Rate for Payer: Qualcare PPO/HMO/WC	$157.95

PSA,TOTAL

Facility

$126.45

Service Code	HCPCS 84153
Hospital Charge Code	39900124
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$124.00
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	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.38
Rate for Payer: Cigna Commercial	$63.23
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	$37.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.97
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	$3.35

PSA,TOTAL

Facility

$126.45

Service Code	HCPCS 84153
Hospital Charge Code	39900124
Hospital Revenue Code	301
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$18.97
Rate for Payer: Qualcare PPO/HMO/WC	$18.97

PSA ULTRA SENSITIVE

Facility

$141.40

Service Code	HCPCS 84153
Hospital Charge Code	3030560
Hospital Revenue Code	301
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$21.21
Rate for Payer: Qualcare PPO/HMO/WC	$21.21

PSA ULTRA SENSITIVE

Facility

$141.40

Service Code	HCPCS 84153
Hospital Charge Code	3030560
Hospital Revenue Code	301
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$124.00
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	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.38
Rate for Payer: Cigna Commercial	$70.70
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	$42.42
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.21
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	$3.75

PSEUDOANEURYSM INJ TRT

Facility

$2,873.16

Service Code	HCPCS 36002
Hospital Charge Code	16000732
Hospital Revenue Code	360
Min. Negotiated Rate	$69.24
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$861.95
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$430.97
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$69.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$76.14

PSEUDOANEURYSM INJ TRT

Facility

$2,873.16

Service Code	HCPCS 36002
Hospital Charge Code	16000732
Hospital Revenue Code	360
Min. Negotiated Rate	$430.97
Max. Negotiated Rate	$430.97
Rate for Payer: Qualcare PPO/HMO/WC	$430.97

PSEUDOEP HCL SYR 6MG/1 ML

Facility

$0.08

Hospital Charge Code	60635740
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

Know your out-of-pocket cost for care.

All Charges