Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SIZERS BREAST 800CC

Facility

$1,500.00

Hospital Charge Code	270665519
Hospital Revenue Code	270
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

SIZERS BREAST 800CC

Facility

$1,500.00

Hospital Charge Code	270665519
Hospital Revenue Code	270
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SIZERS BREAST HIGH PROFILE 750

Facility

$1,500.00

Hospital Charge Code	270665522
Hospital Revenue Code	270
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

SIZERS BREAST HIGH PROFILE 750

Facility

$1,500.00

Hospital Charge Code	270665522
Hospital Revenue Code	270
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SIZERS BREAST HIGH PROFILE 800

Facility

$1,500.00

Hospital Charge Code	270665520
Hospital Revenue Code	270
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SIZERS BREAST HIGH PROFILE 800

Facility

$1,500.00

Hospital Charge Code	270665520
Hospital Revenue Code	270
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

SIZERS CLR CDED FLX TOE4460001

Facility

$2,306.45

Hospital Charge Code	270611674
Hospital Revenue Code	272
Min. Negotiated Rate	$55.59
Max. Negotiated Rate	$1,153.22
Rate for Payer: Aetna Commercial	$876.45
Rate for Payer: Aetna Medicare Advantage	$691.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$588.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$588.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$588.14
Rate for Payer: Cigna Commercial	$1,153.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$691.93
Rate for Payer: Oxford Commercial	$461.29
Rate for Payer: Qualcare PPO/HMO/WC	$345.97
Rate for Payer: UnitedHealthcare Commercial	$461.29
Rate for Payer: UnitedHealthcare Community & State	$55.59
Rate for Payer: Wellpoint Medicaid Managed Care	$61.12

SIZERS CLR CDED FLX TOE4460001

Facility

$2,306.45

Hospital Charge Code	270611674
Hospital Revenue Code	272
Min. Negotiated Rate	$345.97
Max. Negotiated Rate	$345.97
Rate for Payer: Qualcare PPO/HMO/WC	$345.97

SIZER TISSUE EXPANDER 650CC

Facility

$2,000.00

Hospital Charge Code	270676082
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SIZER TISSUE EXPANDER 650CC

Facility

$2,000.00

Hospital Charge Code	270676082
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

SIZER TISSUE EXPANDER 685CC

Facility

$2,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270676081
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SIZER TISSUE EXPANDER 685CC

Facility

$2,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270676081
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

SIZER WMT FLEX TOE REG 4460105

Facility

$341.65

Hospital Charge Code	270622822
Hospital Revenue Code	272
Min. Negotiated Rate	$51.25
Max. Negotiated Rate	$51.25
Rate for Payer: Qualcare PPO/HMO/WC	$51.25

SIZER WMT FLEX TOE REG 4460105

Facility

$341.65

Hospital Charge Code	270622822
Hospital Revenue Code	272
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$170.82
Rate for Payer: Aetna Commercial	$129.83
Rate for Payer: Aetna Medicare Advantage	$102.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.12
Rate for Payer: Cigna Commercial	$170.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.50
Rate for Payer: Oxford Commercial	$68.33
Rate for Payer: Qualcare PPO/HMO/WC	$51.25
Rate for Payer: UnitedHealthcare Commercial	$68.33
Rate for Payer: UnitedHealthcare Community & State	$8.23
Rate for Payer: Wellpoint Medicaid Managed Care	$9.05

SIZING CATH PIGTAIL 5F 100CM

Facility

$3,431.25

Hospital Charge Code	270670896
Hospital Revenue Code	272
Min. Negotiated Rate	$514.69
Max. Negotiated Rate	$514.69
Rate for Payer: Qualcare PPO/HMO/WC	$514.69

SIZING CATH PIGTAIL 5F 100CM

Facility

$3,431.25

Hospital Charge Code	270670896
Hospital Revenue Code	272
Min. Negotiated Rate	$82.69
Max. Negotiated Rate	$1,715.62
Rate for Payer: Aetna Commercial	$1,303.88
Rate for Payer: Aetna Medicare Advantage	$1,029.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$874.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$874.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$874.97
Rate for Payer: Cigna Commercial	$1,715.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.38
Rate for Payer: Oxford Commercial	$686.25
Rate for Payer: Qualcare PPO/HMO/WC	$514.69
Rate for Payer: UnitedHealthcare Commercial	$686.25
Rate for Payer: UnitedHealthcare Community & State	$82.69
Rate for Payer: Wellpoint Medicaid Managed Care	$90.93

SJOGREN'S ANTIBODIES-ANTI-SS-A

Facility

$746.00

Service Code	HCPCS 86235
Hospital Charge Code	38476155
Hospital Revenue Code	302
Min. Negotiated Rate	$111.90
Max. Negotiated Rate	$111.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.90

SJOGREN'S ANTIBODIES-ANTI-SS-A

Facility

$746.00

Service Code	HCPCS 86235
Hospital Charge Code	38476155
Hospital Revenue Code	302
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$373.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$373.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$19.77

SJORGEN'S AB ANTI SSA/SSB #1

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3006897A
Hospital Revenue Code	302
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

SJORGEN'S AB ANTI SSA/SSB #1

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3006897A
Hospital Revenue Code	302
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

SJORGEN'S AB ANTI SSA/SSB #2

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3006897B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

SJORGEN'S AB ANTI SSA/SSB #2

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3006897B
Hospital Revenue Code	302
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

SKELETAL MUSCLE RELAXANT INJ

Facility

$154.25

Hospital Charge Code	6025050
Hospital Revenue Code	251
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$23.14
Rate for Payer: Qualcare PPO/HMO/WC	$23.14

SKELETAL MUSCLE RELAXANT INJ

Facility

$154.25

Hospital Charge Code	6025050
Hospital Revenue Code	251
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$77.12
Rate for Payer: Aetna Commercial	$58.62
Rate for Payer: Aetna Medicare Advantage	$46.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.33
Rate for Payer: Cigna Commercial	$77.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.27
Rate for Payer: Oxford Commercial	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.14
Rate for Payer: UnitedHealthcare Commercial	$30.85
Rate for Payer: UnitedHealthcare Community & State	$3.72
Rate for Payer: Wellpoint Medicaid Managed Care	$4.09

SKIN ARM PROTECTOR TAN

Facility

$36.15

Hospital Charge Code	270649354
Hospital Revenue Code	272
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$5.42

Know your out-of-pocket cost for care.

All Charges