Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SURE SWAB VIII

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39990113H
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.66
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SURE SWAB X

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113J
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB X

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113J
Hospital Revenue Code	306
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SURE SWAB XI

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113K
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB XI

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113K
Hospital Revenue Code	306
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SURFACE ARTIC LPGR 12 59964012

Facility

$4,285.50

Hospital Charge Code	270634654
Hospital Revenue Code	272
Min. Negotiated Rate	$642.83
Max. Negotiated Rate	$642.83
Rate for Payer: Qualcare PPO/HMO/WC	$642.83

SURFACE ARTIC LPGR 12 59964012

Facility

$4,285.50

Hospital Charge Code	270634654
Hospital Revenue Code	272
Min. Negotiated Rate	$103.28
Max. Negotiated Rate	$2,142.75
Rate for Payer: Aetna Commercial	$1,628.49
Rate for Payer: Aetna Medicare Advantage	$1,285.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.80
Rate for Payer: Cigna Commercial	$2,142.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,285.65
Rate for Payer: Oxford Commercial	$857.10
Rate for Payer: Qualcare PPO/HMO/WC	$642.83
Rate for Payer: UnitedHealthcare Commercial	$857.10
Rate for Payer: UnitedHealthcare Community & State	$103.28
Rate for Payer: Wellpoint Medicaid Managed Care	$113.57

SURFACE ARTIC LPS 12m 59963212

Facility

$4,456.95

Hospital Charge Code	270633241
Hospital Revenue Code	272
Min. Negotiated Rate	$107.41
Max. Negotiated Rate	$2,228.47
Rate for Payer: Aetna Commercial	$1,693.64
Rate for Payer: Aetna Medicare Advantage	$1,337.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.52
Rate for Payer: Cigna Commercial	$2,228.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,337.09
Rate for Payer: Oxford Commercial	$891.39
Rate for Payer: Qualcare PPO/HMO/WC	$668.54
Rate for Payer: UnitedHealthcare Commercial	$891.39
Rate for Payer: UnitedHealthcare Community & State	$107.41
Rate for Payer: Wellpoint Medicaid Managed Care	$118.11

SURFACE ARTIC LPS 12m 59963212

Facility

$4,456.95

Hospital Charge Code	270633241
Hospital Revenue Code	272
Min. Negotiated Rate	$668.54
Max. Negotiated Rate	$668.54
Rate for Payer: Qualcare PPO/HMO/WC	$668.54

SURFACE ARTIC LPS 5996-40-10

Facility

$5,571.07

Hospital Charge Code	623447
Hospital Revenue Code	278
Min. Negotiated Rate	$835.66
Max. Negotiated Rate	$1,348.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,114.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,348.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,225.64
Rate for Payer: Qualcare PPO/HMO/WC	$835.66

SURFACE ARTIC LPS 5996-40-10

Facility

$5,571.07

Hospital Charge Code	623447
Hospital Revenue Code	278
Min. Negotiated Rate	$134.26
Max. Negotiated Rate	$2,785.53
Rate for Payer: Aetna Commercial	$2,117.01
Rate for Payer: Aetna Medicare Advantage	$1,671.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,420.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,420.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,114.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,420.62
Rate for Payer: Cigna Commercial	$2,785.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,348.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,225.64
Rate for Payer: Qualcare PPO/HMO/WC	$835.66
Rate for Payer: UnitedHealthcare Community & State	$134.26
Rate for Payer: Wellpoint Medicaid Managed Care	$147.63

SURFACE ARTIC NEXG 17 59723017

Facility

$3,614.70

Hospital Charge Code	270633100
Hospital Revenue Code	272
Min. Negotiated Rate	$542.21
Max. Negotiated Rate	$542.21
Rate for Payer: Qualcare PPO/HMO/WC	$542.21

SURFACE ARTIC NEXG 17 59723017

Facility

$3,614.70

Hospital Charge Code	270633100
Hospital Revenue Code	272
Min. Negotiated Rate	$87.11
Max. Negotiated Rate	$1,807.35
Rate for Payer: Aetna Commercial	$1,373.59
Rate for Payer: Aetna Medicare Advantage	$1,084.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$921.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$921.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$921.75
Rate for Payer: Cigna Commercial	$1,807.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,084.41
Rate for Payer: Oxford Commercial	$722.94
Rate for Payer: Qualcare PPO/HMO/WC	$542.21
Rate for Payer: UnitedHealthcare Commercial	$722.94
Rate for Payer: UnitedHealthcare Community & State	$87.11
Rate for Payer: Wellpoint Medicaid Managed Care	$95.79

SURFACE ARTIC NEXGN 5972-40-17

Facility

$3,402.45

Hospital Charge Code	270608930
Hospital Revenue Code	278
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$1,701.22
Rate for Payer: Aetna Commercial	$1,292.93
Rate for Payer: Aetna Medicare Advantage	$1,020.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.62
Rate for Payer: Cigna Commercial	$1,701.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$823.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$748.54
Rate for Payer: Qualcare PPO/HMO/WC	$510.37
Rate for Payer: UnitedHealthcare Community & State	$82.00
Rate for Payer: Wellpoint Medicaid Managed Care	$90.16

SURFACE ARTIC NEXGN 5972-40-17

Facility

$3,402.45

Hospital Charge Code	270608930
Hospital Revenue Code	278
Min. Negotiated Rate	$510.37
Max. Negotiated Rate	$823.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$823.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$748.54
Rate for Payer: Qualcare PPO/HMO/WC	$510.37

SURFACE ARTIC NEXGN 5982-40-10

Facility

$3,500.00

Hospital Charge Code	270615606
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

SURFACE ARTIC NEXGN 5982-40-10

Facility

$3,500.00

Hospital Charge Code	270615606
Hospital Revenue Code	272
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

SURFACE ART LP PRP 10 59962210

Facility

$4,859.40

Hospital Charge Code	270639221
Hospital Revenue Code	272
Min. Negotiated Rate	$117.11
Max. Negotiated Rate	$2,429.70
Rate for Payer: Aetna Commercial	$1,846.57
Rate for Payer: Aetna Medicare Advantage	$1,457.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,239.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,239.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,239.15
Rate for Payer: Cigna Commercial	$2,429.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,457.82
Rate for Payer: Oxford Commercial	$971.88
Rate for Payer: Qualcare PPO/HMO/WC	$728.91
Rate for Payer: UnitedHealthcare Commercial	$971.88
Rate for Payer: UnitedHealthcare Community & State	$117.11
Rate for Payer: Wellpoint Medicaid Managed Care	$128.77

SURFACE ART LP PRP 10 59962210

Facility

$4,859.40

Hospital Charge Code	270639221
Hospital Revenue Code	272
Min. Negotiated Rate	$728.91
Max. Negotiated Rate	$728.91
Rate for Payer: Qualcare PPO/HMO/WC	$728.91

SURFACE ART LPS GR 17 59964017

Facility

$4,456.95

Hospital Charge Code	270635734
Hospital Revenue Code	272
Min. Negotiated Rate	$107.41
Max. Negotiated Rate	$2,228.47
Rate for Payer: Aetna Commercial	$1,693.64
Rate for Payer: Aetna Medicare Advantage	$1,337.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.52
Rate for Payer: Cigna Commercial	$2,228.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,337.09
Rate for Payer: Oxford Commercial	$891.39
Rate for Payer: Qualcare PPO/HMO/WC	$668.54
Rate for Payer: UnitedHealthcare Commercial	$891.39
Rate for Payer: UnitedHealthcare Community & State	$107.41
Rate for Payer: Wellpoint Medicaid Managed Care	$118.11

SURFACE ART LPS GR 17 59964017

Facility

$4,456.95

Hospital Charge Code	270635734
Hospital Revenue Code	272
Min. Negotiated Rate	$668.54
Max. Negotiated Rate	$668.54
Rate for Payer: Qualcare PPO/HMO/WC	$668.54

SURFACE ART LPSYEL 14 59963014

Facility

$4,285.50

Hospital Charge Code	270633432
Hospital Revenue Code	272
Min. Negotiated Rate	$642.83
Max. Negotiated Rate	$642.83
Rate for Payer: Qualcare PPO/HMO/WC	$642.83

SURFACE ART LPSYEL 14 59963014

Facility

$4,285.50

Hospital Charge Code	270633432
Hospital Revenue Code	272
Min. Negotiated Rate	$103.28
Max. Negotiated Rate	$2,142.75
Rate for Payer: Aetna Commercial	$1,628.49
Rate for Payer: Aetna Medicare Advantage	$1,285.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.80
Rate for Payer: Cigna Commercial	$2,142.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,285.65
Rate for Payer: Oxford Commercial	$857.10
Rate for Payer: Qualcare PPO/HMO/WC	$642.83
Rate for Payer: UnitedHealthcare Commercial	$857.10
Rate for Payer: UnitedHealthcare Community & State	$103.28
Rate for Payer: Wellpoint Medicaid Managed Care	$113.57

SURFACE ZIM ART C B10 59725010

Facility

$3,899.75

Hospital Charge Code	270606473
Hospital Revenue Code	270
Min. Negotiated Rate	$93.98
Max. Negotiated Rate	$1,949.88
Rate for Payer: Aetna Commercial	$1,481.90
Rate for Payer: Aetna Medicare Advantage	$1,169.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.44
Rate for Payer: Cigna Commercial	$1,949.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,169.92
Rate for Payer: Oxford Commercial	$779.95
Rate for Payer: Qualcare PPO/HMO/WC	$584.96
Rate for Payer: UnitedHealthcare Commercial	$779.95
Rate for Payer: UnitedHealthcare Community & State	$93.98
Rate for Payer: Wellpoint Medicaid Managed Care	$103.34

SURFACE ZIM ART C B10 59725010

Facility

$3,899.75

Hospital Charge Code	270606473
Hospital Revenue Code	270
Min. Negotiated Rate	$584.96
Max. Negotiated Rate	$584.96
Rate for Payer: Qualcare PPO/HMO/WC	$584.96

Know your out-of-pocket cost for care.

All Charges