Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCOT-TUSSIN EXP S/A FREE

Facility

$3.00

Hospital Charge Code	60635273
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SCOT-TUSSIN EXP S/A FREE

Facility

$3.00

Hospital Charge Code	60635273
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SCPCOMPFTANKLKT5CCDEL11GX120MM

Facility

$23,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270696479
Hospital Revenue Code	278
Min. Negotiated Rate	$561.53
Max. Negotiated Rate	$11,650.00
Rate for Payer: Aetna Commercial	$8,854.00
Rate for Payer: Aetna Medicare Advantage	$6,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,941.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,941.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,941.50
Rate for Payer: Cigna Commercial	$11,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,638.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,126.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,495.00
Rate for Payer: UnitedHealthcare Community & State	$561.53
Rate for Payer: Wellpoint Medicaid Managed Care	$617.45

SCPCOMPFTANKLKT5CCDEL11GX120MM

Facility

$23,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270696479
Hospital Revenue Code	278
Min. Negotiated Rate	$3,495.00
Max. Negotiated Rate	$5,638.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,638.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,126.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,495.00

SCR BON CORT 150x50HAA60-15050

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270635000
Hospital Revenue Code	278
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$398.75
Rate for Payer: Aetna Commercial	$303.05
Rate for Payer: Aetna Medicare Advantage	$239.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.36
Rate for Payer: Cigna Commercial	$398.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$119.62
Rate for Payer: UnitedHealthcare Community & State	$19.22
Rate for Payer: Wellpoint Medicaid Managed Care	$21.13

SCR BON CORT 150x50HAA60-15050

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270635000
Hospital Revenue Code	278
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$119.62

SCRE CAN 3Mx14M S.S S30.14S.11

Facility

$575.00

Hospital Charge Code	270639856
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

SCRE CAN 3Mx14M S.S S30.14S.11

Facility

$575.00

Hospital Charge Code	270639856
Hospital Revenue Code	278
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	2709037
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	2709037
Hospital Revenue Code	403
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	85000903
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	85000903
Hospital Revenue Code	403
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	9406405
Hospital Revenue Code	403
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	94061497
Hospital Revenue Code	403
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	9406405
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	94061497
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING PELVIC EXAM

Facility

$405.00

Service Code	HCPCS G0101
Hospital Charge Code	87502665
Hospital Revenue Code	770
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.50
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	87502810
Hospital Revenue Code	770
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	87502810
Hospital Revenue Code	770
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SCREENING PELVIC EXAM

Facility

$405.00

Service Code	HCPCS G0101
Hospital Charge Code	87502665
Hospital Revenue Code	770
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

SCREEN MAMMO,DIRECT DIG IMAGE

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	2007020
Hospital Revenue Code	403
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$230.89
Rate for Payer: Aetna Medicare Advantage	$182.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.94
Rate for Payer: Cigna Commercial	$303.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.28
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.14
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$14.64
Rate for Payer: Wellpoint Medicaid Managed Care	$16.10

SCREEN MAMMO,DIRECT DIG IMAGE

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	2007020
Hospital Revenue Code	403
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$91.14
Rate for Payer: Qualcare PPO/HMO/WC	$91.14

SCREEN SYN TT MESH 1 100/100**

Facility

$1,638.00

Hospital Charge Code	270607186
Hospital Revenue Code	278
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$396.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$360.36
Rate for Payer: Qualcare PPO/HMO/WC	$245.70

SCREEN SYN TT MESH 1 100/100**

Facility

$1,638.00

Hospital Charge Code	270607186
Hospital Revenue Code	278
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$819.00
Rate for Payer: Aetna Commercial	$622.44
Rate for Payer: Aetna Medicare Advantage	$491.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$417.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$417.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$327.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$417.69
Rate for Payer: Cigna Commercial	$819.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$360.36
Rate for Payer: Qualcare PPO/HMO/WC	$245.70
Rate for Payer: UnitedHealthcare Community & State	$39.48
Rate for Payer: Wellpoint Medicaid Managed Care	$43.41

SCREW

Facility

$7,678.35

Service Code	HCPCS C1713
Hospital Charge Code	270685047
Hospital Revenue Code	278
Min. Negotiated Rate	$185.05
Max. Negotiated Rate	$3,839.18
Rate for Payer: Aetna Commercial	$2,917.77
Rate for Payer: Aetna Medicare Advantage	$2,303.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,957.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,957.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,957.98
Rate for Payer: Cigna Commercial	$3,839.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,689.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.75
Rate for Payer: UnitedHealthcare Community & State	$185.05
Rate for Payer: Wellpoint Medicaid Managed Care	$203.48

Know your out-of-pocket cost for care.

All Charges