Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SURGI-BRA SMALL

Facility

$215.00

Hospital Charge Code	270330834
Hospital Revenue Code	270
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.50
Rate for Payer: Oxford Commercial	$43.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$43.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

SURGI-BRA SMALL

Facility

$215.00

Hospital Charge Code	270330834
Hospital Revenue Code	270
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

SURGIBRA (SML,MED,LG,X-LG)***

Facility

$214.80

Hospital Charge Code	1605989
Hospital Revenue Code	272
Min. Negotiated Rate	$32.22
Max. Negotiated Rate	$32.22
Rate for Payer: Qualcare PPO/HMO/WC	$32.22

SURGIBRA (SML,MED,LG,X-LG)***

Facility

$214.80

Hospital Charge Code	1605989
Hospital Revenue Code	272
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.40
Rate for Payer: Aetna Commercial	$81.62
Rate for Payer: Aetna Medicare Advantage	$64.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.77
Rate for Payer: Cigna Commercial	$107.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.44
Rate for Payer: Oxford Commercial	$42.96
Rate for Payer: Qualcare PPO/HMO/WC	$32.22
Rate for Payer: UnitedHealthcare Commercial	$42.96
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.69

SURGI-BRA XXL

Facility

$208.70

Hospital Charge Code	270650036
Hospital Revenue Code	270
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$104.35
Rate for Payer: Aetna Commercial	$79.31
Rate for Payer: Aetna Medicare Advantage	$62.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.22
Rate for Payer: Cigna Commercial	$104.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.61
Rate for Payer: Oxford Commercial	$41.74
Rate for Payer: Qualcare PPO/HMO/WC	$31.30
Rate for Payer: UnitedHealthcare Commercial	$41.74
Rate for Payer: UnitedHealthcare Community & State	$5.03
Rate for Payer: Wellpoint Medicaid Managed Care	$5.53

SURGI-BRA XXL

Facility

$208.70

Hospital Charge Code	270650036
Hospital Revenue Code	270
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$31.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.30

SURGI-BRA XXXL

Facility

$19.22

Hospital Charge Code	270650037
Hospital Revenue Code	272
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.88

SURGI-BRA XXXL

Facility

$19.22

Hospital Charge Code	270650037
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.61
Rate for Payer: Aetna Commercial	$7.30
Rate for Payer: Aetna Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.90
Rate for Payer: Cigna Commercial	$9.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.77
Rate for Payer: Oxford Commercial	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$2.88
Rate for Payer: UnitedHealthcare Commercial	$3.84
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

SURGICAL BLADES

Facility

$98.00

Hospital Charge Code	270330831
Hospital Revenue Code	272
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Oxford Commercial	$19.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$19.60
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

SURGICAL BLADES

Facility

$98.00

Hospital Charge Code	270330831
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

SURGICAL DX EXAM ANORECTAL

Facility

$16,148.00

Service Code	HCPCS 45990
Hospital Charge Code	1600000626
Hospital Revenue Code	360
Min. Negotiated Rate	$2,422.20
Max. Negotiated Rate	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.20

SURGICAL DX EXAM ANORECTAL

Facility

$16,148.00

Service Code	HCPCS 45990
Hospital Charge Code	1600000626
Hospital Revenue Code	360
Min. Negotiated Rate	$389.17
Max. Negotiated Rate	$11,903.20
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,903.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
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	$11,903.20
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,844.40
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.20
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$389.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56
Rate for Payer: Wellpoint Medicaid Managed Care	$427.92

SURGICAL MATRIX 7X10CM

Facility

$9,922.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,488.38
Max. Negotiated Rate	$2,401.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,984.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,401.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,182.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.38

SURGICAL MATRIX 7X10CM

Facility

$9,922.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662087
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,401.24
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,984.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,401.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,182.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.38
Rate for Payer: UnitedHealthcare Community & State	$239.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$262.95

SURGICAL MATRIX 7X10CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662087W
Hospital Revenue Code	636
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$34.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26

SURGICAL MATRIX 7X10CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662087W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$70.88
Rate for Payer: Aetna Commercial	$53.87
Rate for Payer: Aetna Medicare Advantage	$42.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.15
Rate for Payer: Cigna Commercial	$70.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

SURGICAL MATRIX 8X16CM

Facility

$18,144.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662094
Hospital Revenue Code	278
Min. Negotiated Rate	$2,721.60
Max. Negotiated Rate	$4,390.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,628.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,390.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,991.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,721.60

SURGICAL MATRIX 8X16CM

Facility

$18,144.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662094
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,390.85
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,628.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,390.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,991.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,721.60
Rate for Payer: UnitedHealthcare Community & State	$437.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$480.82

SURGICAL MATRIX 8X16CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662094W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$70.88
Rate for Payer: Aetna Commercial	$53.87
Rate for Payer: Aetna Medicare Advantage	$42.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.15
Rate for Payer: Cigna Commercial	$70.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

SURGICAL MATRIX 8X16CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662094W
Hospital Revenue Code	636
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$34.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26

SURGICAL PATHOLOGY/BIOPSY***

Facility

$68.00

Hospital Charge Code	3600020
Hospital Revenue Code	309
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

SURGICAL PATHOLOGY/BIOPSY***

Facility

$68.00

Hospital Charge Code	3600020
Hospital Revenue Code	309
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.84
Rate for Payer: Aetna Medicare Advantage	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.34
Rate for Payer: Cigna Commercial	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.80

SURGICAL PATTI 1/2 X 1

Facility

$44.00

Hospital Charge Code	270332279
Hospital Revenue Code	272
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

SURGICAL PATTI 1/2 X 1

Facility

$44.00

Hospital Charge Code	270332279
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SURGICAL PATTIES 1X1

Facility

$44.00

Hospital Charge Code	270332417
Hospital Revenue Code	272
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

Know your out-of-pocket cost for care.

All Charges