Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SURGIPRO MESH *********

Facility

$159.00

Hospital Charge Code	1605997
Hospital Revenue Code	272
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$60.42
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.55
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.70
Rate for Payer: Oxford Commercial	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$31.80
Rate for Payer: UnitedHealthcare Community & State	$3.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.21

SURGIPRO MESH *********

Facility

$159.00

Hospital Charge Code	1605997
Hospital Revenue Code	272
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

SURGIWRAP 100X30X0.02 2620201

Facility

$1,140.85

Hospital Charge Code	270634688
Hospital Revenue Code	272
Min. Negotiated Rate	$27.49
Max. Negotiated Rate	$570.42
Rate for Payer: Aetna Commercial	$433.52
Rate for Payer: Aetna Medicare Advantage	$342.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.92
Rate for Payer: Cigna Commercial	$570.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.25
Rate for Payer: Oxford Commercial	$228.17
Rate for Payer: Qualcare PPO/HMO/WC	$171.13
Rate for Payer: UnitedHealthcare Commercial	$228.17
Rate for Payer: UnitedHealthcare Community & State	$27.49
Rate for Payer: Wellpoint Medicaid Managed Care	$30.23

SURGIWRAP 100X30X0.02 2620201

Facility

$1,140.85

Hospital Charge Code	270634688
Hospital Revenue Code	272
Min. Negotiated Rate	$171.13
Max. Negotiated Rate	$171.13
Rate for Payer: Qualcare PPO/HMO/WC	$171.13

SURG OV EP MINIMAL VISIT 5MINS

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	75190200
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

SURG OV EP MINIMAL VISIT 5MINS

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	75190200
Hospital Revenue Code	510
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$159.82
Rate for Payer: Aetna Commercial	$121.47
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$159.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.89
Rate for Payer: Qualcare PPO/HMO/WC	$47.95
Rate for Payer: UnitedHealthcare Community & State	$7.70
Rate for Payer: Wellpoint Medicaid Managed Care	$8.47

SURG OV NP EXPANDED FOCUSED

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	75190175
Hospital Revenue Code	510
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$64.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.29

SURG OV NP EXPANDED FOCUSED

Facility

$428.58

Service Code	HCPCS 99202
Hospital Charge Code	75190175
Hospital Revenue Code	510
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$214.29
Rate for Payer: Aetna Commercial	$162.86
Rate for Payer: Aetna Medicare Advantage	$128.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.29
Rate for Payer: Cigna Commercial	$214.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.57
Rate for Payer: Qualcare PPO/HMO/WC	$64.29
Rate for Payer: UnitedHealthcare Community & State	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

SURG PATH, GROSS EXAM ONLY

Facility

$465.00

Service Code	HCPCS 88300
Hospital Charge Code	38474040
Hospital Revenue Code	310
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$69.75
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

SURG PATH, GROSS EXAM ONLY

Facility

$465.00

Service Code	HCPCS 88300
Hospital Charge Code	38474040
Hospital Revenue Code	310
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.03
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$12.32

SURG TX ECT PREG,TUB/OV REQ

Facility

$9,050.20

Service Code	HCPCS 59120
Hospital Charge Code	16000522
Hospital Revenue Code	360
Min. Negotiated Rate	$1,357.53
Max. Negotiated Rate	$1,357.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.53

SURG TX ECT PREG,TUB/OV REQ

Facility

$9,050.20

Service Code	HCPCS 59120
Hospital Charge Code	16000522
Hospital Revenue Code	360
Min. Negotiated Rate	$218.11
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$3,439.08
Rate for Payer: Aetna Medicare Advantage	$2,715.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,307.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,307.80
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	$2,307.80
Rate for Payer: Cigna Commercial	$4,525.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,715.06
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.53
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$218.11
Rate for Payer: Wellpoint Medicaid Managed Care	$239.83

SURG TX INCOMPL ABORTION_

Facility

$24,422.22

Service Code	HCPCS 59812
Hospital Charge Code	16001013
Hospital Revenue Code	360
Min. Negotiated Rate	$588.58
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,326.67
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,663.33
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$588.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$647.19

SURG TX INCOMPL ABORTION_

Facility

$24,422.22

Service Code	HCPCS 59812
Hospital Charge Code	16001013
Hospital Revenue Code	360
Min. Negotiated Rate	$3,663.33
Max. Negotiated Rate	$3,663.33
Rate for Payer: Qualcare PPO/HMO/WC	$3,663.33

SURG TX MISSED ABRT,1ST TMEST

Facility

$24,422.22

Service Code	HCPCS 59820
Hospital Charge Code	16001014
Hospital Revenue Code	360
Min. Negotiated Rate	$588.58
Max. Negotiated Rate	$13,882.15
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,882.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,882.15
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,326.67
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,663.33
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$588.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$647.19

SURG TX MISSED ABRT,1ST TMEST

Facility

$24,422.22

Service Code	HCPCS 59820
Hospital Charge Code	16001014
Hospital Revenue Code	360
Min. Negotiated Rate	$3,663.33
Max. Negotiated Rate	$3,663.33
Rate for Payer: Qualcare PPO/HMO/WC	$3,663.33

SURITAL/1GM

Facility

$28.00

Hospital Charge Code	60633941
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

SURITAL/1GM

Facility

$28.00

Hospital Charge Code	60633941
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

SUSCEPTIBILITY STUDIES ENZIME

Facility

$33.00

Service Code	HCPCS 87085
Hospital Charge Code	38477038
Hospital Revenue Code	306
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

SUSCEPTIBILITY STUDIES ENZIME

Facility

$33.00

Service Code	HCPCS 87085
Hospital Charge Code	38477038
Hospital Revenue Code	306
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

SUSCEPTIBILITY STUDIES MLC

Facility

$73.00

Service Code	HCPCS 87187
Hospital Charge Code	38477071
Hospital Revenue Code	309
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$109.26
Rate for Payer: Aetna Medicare Advantage	$130.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.00
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: Cigna Medicare Advantage	$40.17
Rate for Payer: Clover Medicare Advantage	$38.16
Rate for Payer: EmblemHealth Commercial	$120.51
Rate for Payer: Humana Medicare Advantage	$41.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$40.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$32.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.17
Rate for Payer: Wellcare Medicare Advantage	$40.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

SUSCEPTIBILITY STUDIES MLC

Facility

$73.00

Service Code	HCPCS 87187
Hospital Charge Code	38477071
Hospital Revenue Code	309
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

SUSCEPTIBILITY STUD MACROBROTH

Facility

$47.00

Service Code	HCPCS 87188
Hospital Charge Code	38477049
Hospital Revenue Code	309
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.06
Rate for Payer: Aetna Medicare Advantage	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.97
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: Cigna Medicare Advantage	$6.64
Rate for Payer: Clover Medicare Advantage	$6.31
Rate for Payer: EmblemHealth Commercial	$19.92
Rate for Payer: Humana Medicare Advantage	$6.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.64
Rate for Payer: Wellcare Medicare Advantage	$6.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SUSCEPTIBILITY STUD MACROBROTH

Facility

$47.00

Service Code	HCPCS 87188
Hospital Charge Code	38477049
Hospital Revenue Code	309
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

SUSCEPTIBILTY AGAR DILUTION

Facility

$390.00

Service Code	HCPCS 87181
Hospital Charge Code	38477037
Hospital Revenue Code	309
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.75
Rate for Payer: Clover Medicare Advantage	$4.51
Rate for Payer: EmblemHealth Commercial	$14.25
Rate for Payer: Humana Medicare Advantage	$4.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.75
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	$3.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.75
Rate for Payer: Wellcare Medicare Advantage	$4.75
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges