Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SDS PHASE II RECOV < 1 HOUR

Facility

$800.00

Hospital Charge Code	1000042
Hospital Revenue Code	710
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

SDS PHASE II RECOV 1 HOUR

Facility

$303.00

Hospital Charge Code	100043
Hospital Revenue Code	710
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

SDS PHASE II RECOV 1 HOUR

Facility

$303.00

Hospital Charge Code	100043
Hospital Revenue Code	710
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna Commercial	$115.14
Rate for Payer: Aetna Medicare Advantage	$90.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.27
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.90
Rate for Payer: Oxford Commercial	$60.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Commercial	$60.60
Rate for Payer: UnitedHealthcare Community & State	$7.30
Rate for Payer: Wellpoint Medicaid Managed Care	$8.03

SDS PHASE II RECOV ADD1/2 HR

Facility

$551.00

Hospital Charge Code	100044
Hospital Revenue Code	710
Min. Negotiated Rate	$82.65
Max. Negotiated Rate	$82.65
Rate for Payer: Qualcare PPO/HMO/WC	$82.65

SDS PHASE II RECOV ADD1/2 HR

Facility

$551.00

Hospital Charge Code	100044
Hospital Revenue Code	710
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$275.50
Rate for Payer: Aetna Commercial	$209.38
Rate for Payer: Aetna Medicare Advantage	$165.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.50
Rate for Payer: Cigna Commercial	$275.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.30
Rate for Payer: Oxford Commercial	$110.20
Rate for Payer: Qualcare PPO/HMO/WC	$82.65
Rate for Payer: UnitedHealthcare Commercial	$110.20
Rate for Payer: UnitedHealthcare Community & State	$13.28
Rate for Payer: Wellpoint Medicaid Managed Care	$14.60

SDS URIN PREGNANCY TEST

Facility

$20.00

Service Code	HCPCS 81025
Hospital Charge Code	1001180
Hospital Revenue Code	300
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$23.42
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.08
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: Cigna Medicare Advantage	$8.61
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Medicare Advantage	$8.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

SDS URIN PREGNANCY TEST

Facility

$20.00

Service Code	HCPCS 81025
Hospital Charge Code	1001180
Hospital Revenue Code	300
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

SDS VENIPUNCTURE

Facility

$26.25

Service Code	HCPCS 36415
Hospital Charge Code	1001183
Hospital Revenue Code	300
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.71
Rate for Payer: Cigna Commercial	$13.12
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.94
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

SDS VENIPUNCTURE

Facility

$26.25

Service Code	HCPCS 36415
Hospital Charge Code	1001183
Hospital Revenue Code	300
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$3.94
Rate for Payer: Qualcare PPO/HMO/WC	$3.94

SEALANT DURASEAL SYTEM 5ML

Facility

$3,450.00

Hospital Charge Code	270659411
Hospital Revenue Code	270
Min. Negotiated Rate	$83.14
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,311.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.00
Rate for Payer: Oxford Commercial	$690.00
Rate for Payer: Qualcare PPO/HMO/WC	$517.50
Rate for Payer: UnitedHealthcare Commercial	$690.00
Rate for Payer: UnitedHealthcare Community & State	$83.14
Rate for Payer: Wellpoint Medicaid Managed Care	$91.42

SEALANT DURASEAL SYTEM 5ML

Facility

$3,450.00

Hospital Charge Code	270659411
Hospital Revenue Code	270
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$517.50
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

SEALANT FIBRIN 1501238 10ML

Facility

$2,674.00

Hospital Charge Code	270612219
Hospital Revenue Code	272
Min. Negotiated Rate	$401.10
Max. Negotiated Rate	$401.10
Rate for Payer: Qualcare PPO/HMO/WC	$401.10

SEALANT FIBRIN 1501238 10ML

Facility

$2,674.00

Hospital Charge Code	270612219
Hospital Revenue Code	272
Min. Negotiated Rate	$64.44
Max. Negotiated Rate	$1,337.00
Rate for Payer: Aetna Commercial	$1,016.12
Rate for Payer: Aetna Medicare Advantage	$802.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$681.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$681.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$681.87
Rate for Payer: Cigna Commercial	$1,337.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$802.20
Rate for Payer: Oxford Commercial	$534.80
Rate for Payer: Qualcare PPO/HMO/WC	$401.10
Rate for Payer: UnitedHealthcare Commercial	$534.80
Rate for Payer: UnitedHealthcare Community & State	$64.44
Rate for Payer: Wellpoint Medicaid Managed Care	$70.86

SEALANT FIBRIN TISSEAL 4ML

Facility

$1,126.90

Hospital Charge Code	270617194
Hospital Revenue Code	272
Min. Negotiated Rate	$27.16
Max. Negotiated Rate	$563.45
Rate for Payer: Aetna Commercial	$428.22
Rate for Payer: Aetna Medicare Advantage	$338.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.36
Rate for Payer: Cigna Commercial	$563.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.07
Rate for Payer: Oxford Commercial	$225.38
Rate for Payer: Qualcare PPO/HMO/WC	$169.03
Rate for Payer: UnitedHealthcare Commercial	$225.38
Rate for Payer: UnitedHealthcare Community & State	$27.16
Rate for Payer: Wellpoint Medicaid Managed Care	$29.86

SEALANT FIBRIN TISSEAL 4ML

Facility

$1,126.90

Hospital Charge Code	270617194
Hospital Revenue Code	272
Min. Negotiated Rate	$169.03
Max. Negotiated Rate	$169.03
Rate for Payer: Qualcare PPO/HMO/WC	$169.03

SEALANT PLATELET ANGL ANPLA100

Facility

$2,340.00

Hospital Charge Code	270639728
Hospital Revenue Code	278
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$566.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$468.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$566.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$514.80
Rate for Payer: Qualcare PPO/HMO/WC	$351.00

SEALANT PLATELET ANGL ANPLA100

Facility

$2,340.00

Hospital Charge Code	270639728
Hospital Revenue Code	278
Min. Negotiated Rate	$56.39
Max. Negotiated Rate	$1,170.00
Rate for Payer: Aetna Commercial	$889.20
Rate for Payer: Aetna Medicare Advantage	$702.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$596.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$596.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$596.70
Rate for Payer: Cigna Commercial	$1,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$566.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$514.80
Rate for Payer: Qualcare PPO/HMO/WC	$351.00
Rate for Payer: UnitedHealthcare Community & State	$56.39
Rate for Payer: Wellpoint Medicaid Managed Care	$62.01

SEAL CANNULA 8 MM

Facility

$75.00

Hospital Charge Code	270666216
Hospital Revenue Code	270
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

SEAL CANNULA 8 MM

Facility

$75.00

Hospital Charge Code	270666216
Hospital Revenue Code	270
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

SEAL CANNULA STAPLER

Facility

$100.00

Hospital Charge Code	270666138
Hospital Revenue Code	270
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

SEAL CANNULA STAPLER

Facility

$100.00

Hospital Charge Code	270666138
Hospital Revenue Code	270
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

SEAL CCN CYSTO BIOPSY CS-W7S

Facility

$63.25

Hospital Charge Code	270629071
Hospital Revenue Code	272
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.62
Rate for Payer: Aetna Commercial	$24.04
Rate for Payer: Aetna Medicare Advantage	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.13
Rate for Payer: Cigna Commercial	$31.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.98
Rate for Payer: Oxford Commercial	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$9.49
Rate for Payer: UnitedHealthcare Commercial	$12.65
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

SEAL CCN CYSTO BIOPSY CS-W7S

Facility

$63.25

Hospital Charge Code	270629071
Hospital Revenue Code	272
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$9.49
Rate for Payer: Qualcare PPO/HMO/WC	$9.49

SEAL EAKIN COHESIVE 2

Facility

$11.85

Hospital Charge Code	270631880
Hospital Revenue Code	270
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.92
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$3.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.02
Rate for Payer: Cigna Commercial	$5.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.56
Rate for Payer: Oxford Commercial	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$1.78
Rate for Payer: UnitedHealthcare Commercial	$2.37
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

SEAL EAKIN COHESIVE 2

Facility

$11.85

Hospital Charge Code	270631880
Hospital Revenue Code	270
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Qualcare PPO/HMO/WC	$1.78

Know your out-of-pocket cost for care.

All Charges