Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPUTUM INDUCEMENT SUBSEQUENT

Facility

$467.85

Service Code	HCPCS 94640
Hospital Charge Code	9500625
Hospital Revenue Code	410
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$939.06
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.35
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.18
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$11.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$12.40

SPUTUM INDUCEMENT SUBSEQUENT

Facility

$467.85

Service Code	HCPCS 94640
Hospital Charge Code	9500625
Hospital Revenue Code	410
Min. Negotiated Rate	$70.18
Max. Negotiated Rate	$70.18
Rate for Payer: Qualcare PPO/HMO/WC	$70.18

SPY AGENT GREEN INDOCYANNE GRE

Facility

$1,364.72

Service Code	NDC 66259014601
Hospital Charge Code	606390601
Hospital Revenue Code	250
Min. Negotiated Rate	$32.89
Max. Negotiated Rate	$682.36
Rate for Payer: Aetna Commercial	$518.59
Rate for Payer: Aetna Medicare Advantage	$409.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.00
Rate for Payer: Cigna Commercial	$682.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.42
Rate for Payer: Oxford Commercial	$272.94
Rate for Payer: Qualcare PPO/HMO/WC	$204.71
Rate for Payer: UnitedHealthcare Commercial	$272.94
Rate for Payer: UnitedHealthcare Community & State	$32.89
Rate for Payer: Wellpoint Medicaid Managed Care	$36.17

SPY AGENT GREEN INDOCYANNE GRE

Facility

$1,364.72

Service Code	NDC 66259014601
Hospital Charge Code	606390601
Hospital Revenue Code	250
Min. Negotiated Rate	$204.71
Max. Negotiated Rate	$204.71
Rate for Payer: Qualcare PPO/HMO/WC	$204.71

SPY SCOPE CATHETER DS II

Facility

$13,250.00

Hospital Charge Code	270689020
Hospital Revenue Code	272
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$1,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

SPY SCOPE CATHETER DS II

Facility

$13,250.00

Hospital Charge Code	270689020
Hospital Revenue Code	272
Min. Negotiated Rate	$319.32
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$5,035.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,975.00
Rate for Payer: Oxford Commercial	$2,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Commercial	$2,650.00
Rate for Payer: UnitedHealthcare Community & State	$319.32
Rate for Payer: Wellpoint Medicaid Managed Care	$351.12

SQ INC ACHILLES TNDN W LCL AN

Facility

$19,998.60

Service Code	HCPCS 27605
Hospital Charge Code	16000564
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$8,157.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

SQ INC ACHILLES TNDN W LCL AN

Facility

$19,998.60

Service Code	HCPCS 27605
Hospital Charge Code	16000564
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

SQUAMOUSCELL CARCINOMA ANTIGEN

Facility

$415.00

Service Code	HCPCS 86316
Hospital Charge Code	38476208
Hospital Revenue Code	302
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$62.25
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

SQUAMOUSCELL CARCINOMA ANTIGEN

Facility

$415.00

Service Code	HCPCS 86316
Hospital Charge Code	38476208
Hospital Revenue Code	302
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$207.50
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.12
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.00

SQUARE DRIVER INSERT SDI

Facility

$178.65

Hospital Charge Code	270636610
Hospital Revenue Code	272
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$26.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.80

SQUARE DRIVER INSERT SDI

Facility

$178.65

Hospital Charge Code	270636610
Hospital Revenue Code	272
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$89.33
Rate for Payer: Aetna Commercial	$67.89
Rate for Payer: Aetna Medicare Advantage	$53.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.56
Rate for Payer: Cigna Commercial	$89.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.59
Rate for Payer: Oxford Commercial	$35.73
Rate for Payer: Qualcare PPO/HMO/WC	$26.80
Rate for Payer: UnitedHealthcare Commercial	$35.73
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: Wellpoint Medicaid Managed Care	$4.73

SREP F/E/N/L/MM; 2.5CM/<

Facility

$1,142.85

Service Code	HCPCS 12011
Hospital Charge Code	1600000665
Hospital Revenue Code	360
Min. Negotiated Rate	$27.54
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.86
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.43
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$27.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$30.29

SREP F/E/N/L/MM; 2.5CM/<

Facility

$1,142.85

Service Code	HCPCS 12011
Hospital Charge Code	1600000665
Hospital Revenue Code	360
Min. Negotiated Rate	$171.43
Max. Negotiated Rate	$171.43
Rate for Payer: Qualcare PPO/HMO/WC	$171.43

SREPS/N/A/G/TR/E; 2.6-7.5CM

Facility

$2,090.76

Service Code	HCPCS 12002
Hospital Charge Code	1600000678
Hospital Revenue Code	360
Min. Negotiated Rate	$313.61
Max. Negotiated Rate	$313.61
Rate for Payer: Qualcare PPO/HMO/WC	$313.61

SREPS/N/A/G/TR/E; 2.6-7.5CM

Facility

$2,090.76

Service Code	HCPCS 12002
Hospital Charge Code	1600000678
Hospital Revenue Code	360
Min. Negotiated Rate	$50.39
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$627.23
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$313.61
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$50.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$55.41

SRP AUTOANTIBODIES

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	3847978
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SRP AUTOANTIBODIES

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	3847978
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SRS LINEAR BASED

Facility

$4,966.15

Service Code	HCPCS 77372
Hospital Charge Code	85000670
Hospital Revenue Code	333
Min. Negotiated Rate	$119.68
Max. Negotiated Rate	$31,585.45
Rate for Payer: Aetna Commercial	$23,800.44
Rate for Payer: Aetna Medicare Advantage	$28,350.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,585.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,585.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,750.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,585.45
Rate for Payer: Cigna Commercial	$17,539.66
Rate for Payer: Cigna Medicare Advantage	$6,125.11
Rate for Payer: Clover Medicare Advantage	$8,312.65
Rate for Payer: EmblemHealth Commercial	$26,250.48
Rate for Payer: Humana Medicare Advantage	$9,012.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,750.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,489.85
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$744.92
Rate for Payer: UnitedHealthcare Commercial	$17,696.00
Rate for Payer: UnitedHealthcare Community & State	$119.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,750.16
Rate for Payer: Wellcare Medicare Advantage	$8,750.16
Rate for Payer: Wellpoint Medicaid Managed Care	$131.60

SRS LINEAR BASED

Facility

$4,966.15

Service Code	HCPCS 77372
Hospital Charge Code	85000670
Hospital Revenue Code	333
Min. Negotiated Rate	$744.92
Max. Negotiated Rate	$744.92
Rate for Payer: Qualcare PPO/HMO/WC	$744.92

SRS MULTISOURCE

Facility

$51,303.61

Service Code	HCPCS 77371
Hospital Charge Code	85000665
Hospital Revenue Code	333
Min. Negotiated Rate	$1,236.42
Max. Negotiated Rate	$31,585.45
Rate for Payer: Aetna Commercial	$23,800.44
Rate for Payer: Aetna Medicare Advantage	$28,350.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,585.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,585.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,750.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,585.45
Rate for Payer: Cigna Commercial	$17,539.66
Rate for Payer: Cigna Medicare Advantage	$6,125.11
Rate for Payer: Clover Medicare Advantage	$8,312.65
Rate for Payer: EmblemHealth Commercial	$26,250.48
Rate for Payer: Humana Medicare Advantage	$9,012.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,750.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,391.08
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,695.54
Rate for Payer: UnitedHealthcare Commercial	$17,696.00
Rate for Payer: UnitedHealthcare Community & State	$1,236.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,750.16
Rate for Payer: Wellcare Medicare Advantage	$8,750.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1,359.55

SRS MULTISOURCE

Facility

$51,303.61

Service Code	HCPCS 77371
Hospital Charge Code	85000665
Hospital Revenue Code	333
Min. Negotiated Rate	$7,695.54
Max. Negotiated Rate	$7,695.54
Rate for Payer: Qualcare PPO/HMO/WC	$7,695.54

SRW CORT LOPROF SLF-TPN 3.5X70

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681558
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.13
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5X70

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681558
Hospital Revenue Code	278
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.13
Rate for Payer: Qualcare PPO/HMO/WC	$23.27
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

SRW CORT LOPROF SLF-TPN 3.5x80

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681559
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.13
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

Know your out-of-pocket cost for care.

All Charges