Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEREOTACTIC BREAST BIOPSY

Facility

$2,669.00

Service Code	HCPCS 19081
Hospital Charge Code	2008035
Hospital Revenue Code	361
Min. Negotiated Rate	$64.32
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$800.70
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$400.35
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$64.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$70.73

STEREOTACTIC BREAST BIOPSY

Facility

$2,669.00

Service Code	HCPCS 19081
Hospital Charge Code	2008035
Hospital Revenue Code	361
Min. Negotiated Rate	$400.35
Max. Negotiated Rate	$400.35
Rate for Payer: Qualcare PPO/HMO/WC	$400.35

STEREOTACTIC BREAST BIOPSY

Facility

$4,089.00

Service Code	HCPCS 19081
Hospital Charge Code	2300913
Hospital Revenue Code	361
Min. Negotiated Rate	$98.54
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,226.70
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$613.35
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$98.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$108.36

STEREOTACTIC BREAST BIOPSY

Facility

$4,089.00

Service Code	HCPCS 19081
Hospital Charge Code	2300913
Hospital Revenue Code	361
Min. Negotiated Rate	$613.35
Max. Negotiated Rate	$613.35
Rate for Payer: Qualcare PPO/HMO/WC	$613.35

STEREOTACTIC BREAST LOCALIZATI

Facility

$1,597.20

Service Code	HCPCS 19283
Hospital Charge Code	2700026
Hospital Revenue Code	361
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$479.16
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.58
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$38.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$42.33

STEREOTACTIC BREAST LOCALIZATI

Facility

$1,597.20

Service Code	HCPCS 19283
Hospital Charge Code	2700026
Hospital Revenue Code	361
Min. Negotiated Rate	$239.58
Max. Negotiated Rate	$239.58
Rate for Payer: Qualcare PPO/HMO/WC	$239.58

STEREOTACT RADIATION TRMT

Facility

$2,164.65

Service Code	HCPCS 77432
Hospital Charge Code	85000790
Hospital Revenue Code	333
Min. Negotiated Rate	$52.17
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$822.57
Rate for Payer: Aetna Medicare Advantage	$649.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$551.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$551.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$551.99
Rate for Payer: Cigna Commercial	$1,082.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.39
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$324.70
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$52.17
Rate for Payer: Wellpoint Medicaid Managed Care	$57.36

STEREOTACT RADIATION TRMT

Facility

$2,164.65

Service Code	HCPCS 77432
Hospital Charge Code	85000790
Hospital Revenue Code	333
Min. Negotiated Rate	$324.70
Max. Negotiated Rate	$324.70
Rate for Payer: Qualcare PPO/HMO/WC	$324.70

STERI-CUFF DISP********

Facility

$108.00

Hospital Charge Code	1605971
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$41.04
Rate for Payer: Aetna Medicare Advantage	$32.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.54
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$21.60
Rate for Payer: UnitedHealthcare Community & State	$2.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

STERI-CUFF DISP********

Facility

$108.00

Hospital Charge Code	1605971
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

STERI DRAPE 2037

Facility

$15.17

Hospital Charge Code	270610068
Hospital Revenue Code	272
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.28

STERI DRAPE 2037

Facility

$15.17

Hospital Charge Code	270610068
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.58
Rate for Payer: Aetna Commercial	$5.76
Rate for Payer: Aetna Medicare Advantage	$4.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.87
Rate for Payer: Cigna Commercial	$7.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$3.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.28
Rate for Payer: UnitedHealthcare Commercial	$3.03
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

STERILE BARIUM SULFATE 50ML

Facility

$157.00

Hospital Charge Code	270335722
Hospital Revenue Code	272
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$23.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.55

STERILE BARIUM SULFATE 50ML

Facility

$157.00

Hospital Charge Code	270335722
Hospital Revenue Code	272
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$78.50
Rate for Payer: Aetna Commercial	$59.66
Rate for Payer: Aetna Medicare Advantage	$47.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.03
Rate for Payer: Cigna Commercial	$78.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.10
Rate for Payer: Oxford Commercial	$31.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.55
Rate for Payer: UnitedHealthcare Commercial	$31.40
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

STERILE DISPOSABLE DRAIN BAG

Facility

$95.00

Hospital Charge Code	270330543
Hospital Revenue Code	272
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

STERILE DISPOSABLE DRAIN BAG

Facility

$95.00

Hospital Charge Code	270330543
Hospital Revenue Code	272
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

STERILE GOWN SIZE LARGE

Facility

$12.50

Hospital Charge Code	270653946
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.25
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Aetna Medicare Advantage	$3.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.19
Rate for Payer: Cigna Commercial	$6.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.75
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.50
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

STERILE GOWN SIZE LARGE

Facility

$12.50

Hospital Charge Code	270653946
Hospital Revenue Code	270
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

STERILE O.R. TOWELS

Facility

$280.55

Hospital Charge Code	270653367
Hospital Revenue Code	272
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$140.28
Rate for Payer: Aetna Commercial	$106.61
Rate for Payer: Aetna Medicare Advantage	$84.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.54
Rate for Payer: Cigna Commercial	$140.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.17
Rate for Payer: Oxford Commercial	$56.11
Rate for Payer: Qualcare PPO/HMO/WC	$42.08
Rate for Payer: UnitedHealthcare Commercial	$56.11
Rate for Payer: UnitedHealthcare Community & State	$6.76
Rate for Payer: Wellpoint Medicaid Managed Care	$7.43

STERILE O.R. TOWELS

Facility

$280.55

Hospital Charge Code	270653367
Hospital Revenue Code	272
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$42.08
Rate for Payer: Qualcare PPO/HMO/WC	$42.08

STERILE TALC #1680 *****

Facility

$110.00

Hospital Charge Code	1606268
Hospital Revenue Code	272
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$22.00
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

STERILE TALC #1680 *****

Facility

$110.00

Hospital Charge Code	1606268
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

STERILE TALC 4 GM AEROSOL

Facility

$112.56

Service Code	NDC 63256010030
Hospital Charge Code	6063943270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$16.88
Rate for Payer: Qualcare PPO/HMO/WC	$16.88

STERILE TALC 4 GM AEROSOL

Facility

$112.56

Service Code	NDC 63256010030
Hospital Charge Code	6063943270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$56.28
Rate for Payer: Aetna Commercial	$42.77
Rate for Payer: Aetna Medicare Advantage	$33.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.70
Rate for Payer: Cigna Commercial	$56.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.77
Rate for Payer: Oxford Commercial	$22.51
Rate for Payer: Qualcare PPO/HMO/WC	$16.88
Rate for Payer: UnitedHealthcare Commercial	$22.51
Rate for Payer: UnitedHealthcare Community & State	$2.71
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

STERILE TALC POWDER

Facility

$490.00

Hospital Charge Code	60635774
Hospital Revenue Code	250
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$73.50
Rate for Payer: Qualcare PPO/HMO/WC	$73.50

Know your out-of-pocket cost for care.

All Charges