Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PULMONARY FUNCTION SCREENING

Facility

$6,100.00

Service Code	HCPCS 94010
Hospital Charge Code	9500026
Hospital Revenue Code	460
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$915.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

PULMONARY FUNCTION SCREENING

Facility

$6,100.00

Service Code	HCPCS 94010
Hospital Charge Code	9500026
Hospital Revenue Code	460
Min. Negotiated Rate	$147.01
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$147.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$161.65

PULMON RF ABALATION TX

Facility

$14,506.00

Service Code	HCPCS 32998
Hospital Charge Code	2690050
Hospital Revenue Code	361
Min. Negotiated Rate	$349.59
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,351.80
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.90
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$349.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$384.41

PULMON RF ABALATION TX

Facility

$14,506.00

Service Code	HCPCS 32998
Hospital Charge Code	2690050
Hospital Revenue Code	361
Min. Negotiated Rate	$2,175.90
Max. Negotiated Rate	$2,175.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.90

PULMON RF ABALATION TX

Facility

$14,506.00

Service Code	HCPCS 32998
Hospital Charge Code	7411388
Hospital Revenue Code	361
Min. Negotiated Rate	$2,175.90
Max. Negotiated Rate	$2,175.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.90

PULMON RF ABALATION TX

Facility

$14,506.00

Service Code	HCPCS 32998
Hospital Charge Code	7411388
Hospital Revenue Code	361
Min. Negotiated Rate	$349.59
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,351.80
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.90
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$349.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$384.41

PULM STRESS TEST 6 MIN WALK

Facility

$6,100.00

Service Code	HCPCS 94618
Hospital Charge Code	95090389
Hospital Revenue Code	460
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$915.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

PULM STRESS TEST 6 MIN WALK

Facility

$6,100.00

Service Code	HCPCS 94618
Hospital Charge Code	95090389
Hospital Revenue Code	460
Min. Negotiated Rate	$30.92
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$147.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$161.65

PULM VENT IMAGING

Facility

$1,202.90

Service Code	HCPCS 78579
Hospital Charge Code	4508020
Hospital Revenue Code	341
Min. Negotiated Rate	$28.99
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.87
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.44
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$28.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$31.88

PULM VENT IMAGING

Facility

$1,202.90

Service Code	HCPCS 78579
Hospital Charge Code	4508020
Hospital Revenue Code	341
Min. Negotiated Rate	$180.44
Max. Negotiated Rate	$180.44
Rate for Payer: Qualcare PPO/HMO/WC	$180.44

PULSA VAC

Facility

$433.20

Hospital Charge Code	270656072
Hospital Revenue Code	271
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$216.60
Rate for Payer: Aetna Commercial	$164.62
Rate for Payer: Aetna Medicare Advantage	$129.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.47
Rate for Payer: Cigna Commercial	$216.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.96
Rate for Payer: Oxford Commercial	$86.64
Rate for Payer: Qualcare PPO/HMO/WC	$64.98
Rate for Payer: UnitedHealthcare Commercial	$86.64
Rate for Payer: UnitedHealthcare Community & State	$10.44
Rate for Payer: Wellpoint Medicaid Managed Care	$11.48

PULSA VAC

Facility

$433.20

Hospital Charge Code	270656072
Hospital Revenue Code	271
Min. Negotiated Rate	$64.98
Max. Negotiated Rate	$64.98
Rate for Payer: Qualcare PPO/HMO/WC	$64.98

PULSAVAC 9 S.M. TIP ********

Facility

$46.00

Hospital Charge Code	1606284
Hospital Revenue Code	279
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.80
Rate for Payer: Oxford Commercial	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.20
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

PULSAVAC 9 S.M. TIP ********

Facility

$46.00

Hospital Charge Code	1606284
Hospital Revenue Code	279
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

PULSAVAC DUAL SPIKE SET *****

Facility

$66.00

Hospital Charge Code	1606292
Hospital Revenue Code	279
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

PULSAVAC DUAL SPIKE SET *****

Facility

$66.00

Hospital Charge Code	1606292
Hospital Revenue Code	279
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

PULSAVAC HAND CONTROL 5150-020

Facility

$179.25

Hospital Charge Code	270600361
Hospital Revenue Code	272
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

PULSAVAC HAND CONTROL 5150-020

Facility

$179.25

Hospital Charge Code	270600361
Hospital Revenue Code	272
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$89.62
Rate for Payer: Aetna Commercial	$68.11
Rate for Payer: Aetna Medicare Advantage	$53.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.71
Rate for Payer: Cigna Commercial	$89.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.77
Rate for Payer: Oxford Commercial	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$35.85
Rate for Payer: UnitedHealthcare Community & State	$4.32
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

PULSAVAC PUSH HAND CONTROL****

Facility

$96.00

Hospital Charge Code	1606235
Hospital Revenue Code	272
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna Commercial	$36.48
Rate for Payer: Aetna Medicare Advantage	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.48
Rate for Payer: Cigna Commercial	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.80
Rate for Payer: Oxford Commercial	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$14.40
Rate for Payer: UnitedHealthcare Commercial	$19.20
Rate for Payer: UnitedHealthcare Community & State	$2.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.54

PULSAVAC PUSH HAND CONTROL****

Facility

$96.00

Hospital Charge Code	1606235
Hospital Revenue Code	272
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

PULSAVAC WOUND DEBRIDEMENT SYS

Facility

$90.00

Hospital Charge Code	270638990
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

PULSAVAC WOUND DEBRIDEMENT SYS

Facility

$90.00

Hospital Charge Code	270638990
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

PULSE GENERATOR KIT SC111002

Facility

$92,675.00

Hospital Charge Code	270641628
Hospital Revenue Code	278
Min. Negotiated Rate	$2,233.47
Max. Negotiated Rate	$46,337.50
Rate for Payer: Aetna Commercial	$35,216.50
Rate for Payer: Aetna Medicare Advantage	$27,802.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,632.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,632.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,632.12
Rate for Payer: Cigna Commercial	$46,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,427.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20,388.50
Rate for Payer: Qualcare PPO/HMO/WC	$13,901.25
Rate for Payer: UnitedHealthcare Community & State	$2,233.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2,455.89

PULSE GENERATOR KIT SC111002

Facility

$92,675.00

Hospital Charge Code	270641628
Hospital Revenue Code	278
Min. Negotiated Rate	$13,901.25
Max. Negotiated Rate	$22,427.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22,427.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20,388.50
Rate for Payer: Qualcare PPO/HMO/WC	$13,901.25

PULSE GENERATOR KIT SPECTRA

Facility

$102,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270696217
Hospital Revenue Code	278
Min. Negotiated Rate	$2,470.25
Max. Negotiated Rate	$51,250.00
Rate for Payer: Aetna Commercial	$38,950.00
Rate for Payer: Aetna Medicare Advantage	$30,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,137.50
Rate for Payer: Cigna Commercial	$51,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,805.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22,550.00
Rate for Payer: Qualcare PPO/HMO/WC	$15,375.00
Rate for Payer: UnitedHealthcare Community & State	$2,470.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2,716.25

Know your out-of-pocket cost for care.

All Charges