Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUSCEPTIBILTY AGAR DILUTION

Facility

$390.00

Service Code	HCPCS 87181
Hospital Charge Code	38477037
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SUSCEPTYEASTCOMPPNL(BRONFLUID)

Facility

$623.18

Service Code	HCPCS 87186
Hospital Charge Code	401387186
Hospital Revenue Code	306
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$311.59
Rate for Payer: Aetna Commercial	$23.53
Rate for Payer: Aetna Medicare Advantage	$28.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.22
Rate for Payer: Cigna Commercial	$311.59
Rate for Payer: Cigna Medicare Advantage	$8.65
Rate for Payer: Clover Medicare Advantage	$8.22
Rate for Payer: EmblemHealth Commercial	$25.95
Rate for Payer: Humana Medicare Advantage	$8.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.48
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.65
Rate for Payer: Wellcare Medicare Advantage	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$16.51

SUSCEPTYEASTCOMPPNL(BRONFLUID)

Facility

$623.18

Service Code	HCPCS 87186
Hospital Charge Code	401387186
Hospital Revenue Code	306
Min. Negotiated Rate	$93.48
Max. Negotiated Rate	$93.48
Rate for Payer: Qualcare PPO/HMO/WC	$93.48

SUSPEND BOWEL W/PROSTHESIS

Facility

$21,202.60

Service Code	HCPCS 44700
Hospital Charge Code	1600000651
Hospital Revenue Code	360
Min. Negotiated Rate	$3,180.39
Max. Negotiated Rate	$3,180.39
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.39

SUSPEND BOWEL W/PROSTHESIS

Facility

$21,202.60

Service Code	HCPCS 44700
Hospital Charge Code	1600000651
Hospital Revenue Code	360
Min. Negotiated Rate	$510.98
Max. Negotiated Rate	$10,601.30
Rate for Payer: Aetna Commercial	$8,056.99
Rate for Payer: Aetna Medicare Advantage	$6,360.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.66
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	$5,406.66
Rate for Payer: Cigna Commercial	$10,601.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,360.78
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.39
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$510.98
Rate for Payer: Wellpoint Medicaid Managed Care	$561.87

SUSPENDERS ATTACHED W/SNAPS

Facility

$270.00

Hospital Charge Code	270667069
Hospital Revenue Code	270
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.00
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$54.00
Rate for Payer: UnitedHealthcare Community & State	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$7.16

SUSPENDERS ATTACHED W/SNAPS

Facility

$270.00

Hospital Charge Code	270667069
Hospital Revenue Code	270
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

SUSPENSORY 0-2 W/STRAP LARGE

Facility

$43.40

Hospital Charge Code	270651066
Hospital Revenue Code	270
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$6.51
Rate for Payer: Qualcare PPO/HMO/WC	$6.51

SUSPENSORY 0-2 W/STRAP LARGE

Facility

$43.40

Hospital Charge Code	270651066
Hospital Revenue Code	270
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.70
Rate for Payer: Aetna Commercial	$16.49
Rate for Payer: Aetna Medicare Advantage	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.07
Rate for Payer: Cigna Commercial	$21.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.02
Rate for Payer: Oxford Commercial	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.51
Rate for Payer: UnitedHealthcare Commercial	$8.68
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

SUSPENSORY W/STRAP MEDIUM

Facility

$38.25

Hospital Charge Code	270649813
Hospital Revenue Code	270
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.12
Rate for Payer: Aetna Commercial	$14.54
Rate for Payer: Aetna Medicare Advantage	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.75
Rate for Payer: Cigna Commercial	$19.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.47
Rate for Payer: Oxford Commercial	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.74
Rate for Payer: UnitedHealthcare Commercial	$7.65
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

SUSPENSORY W/STRAP MEDIUM

Facility

$38.25

Hospital Charge Code	270649813
Hospital Revenue Code	270
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$5.74

SUSPENSORY W/STRAP XL

Facility

$49.55

Hospital Charge Code	270650254
Hospital Revenue Code	272
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$24.77
Rate for Payer: Aetna Commercial	$18.83
Rate for Payer: Aetna Medicare Advantage	$14.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.64
Rate for Payer: Cigna Commercial	$24.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.87
Rate for Payer: Oxford Commercial	$9.91
Rate for Payer: Qualcare PPO/HMO/WC	$7.43
Rate for Payer: UnitedHealthcare Commercial	$9.91
Rate for Payer: UnitedHealthcare Community & State	$1.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

SUSPENSORY W/STRAP XL

Facility

$49.55

Hospital Charge Code	270650254
Hospital Revenue Code	272
Min. Negotiated Rate	$7.43
Max. Negotiated Rate	$7.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.43

SUSPENSORY - X-LARGE *********

Facility

$15.00

Hospital Charge Code	8001620
Hospital Revenue Code	279
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

SUSPENSORY - X-LARGE *********

Facility

$15.00

Hospital Charge Code	8001620
Hospital Revenue Code	279
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

SUT ANCHR OSSIOFIB 4.75 BB TP2

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270700793
Hospital Revenue Code	278
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$95.80
Rate for Payer: Wellpoint Medicaid Managed Care	$105.34

SUT ANCHR OSSIOFIB 4.75 BB TP2

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270700793
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

SUT ANCHR OSSIOFIB 4.75BLK TP2

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270700792
Hospital Revenue Code	278
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$95.80
Rate for Payer: Wellpoint Medicaid Managed Care	$105.34

SUT ANCHR OSSIOFIB 4.75BLK TP2

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270700792
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

SUT ANCHR OSSIOFIB 4.75 SNARE

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270700794
Hospital Revenue Code	278
Min. Negotiated Rate	$83.75
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.50
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Community & State	$83.75
Rate for Payer: Wellpoint Medicaid Managed Care	$92.09

SUT ANCHR OSSIOFIB 4.75 SNARE

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270700794
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.50
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

SUT DEXON/VICRYL/POLY4/0 V-20

Facility

$6.31

Hospital Charge Code	2709000693
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.95

SUT DEXON/VICRYL/POLY4/0 V-20

Facility

$6.31

Hospital Charge Code	2709000693
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.15
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.61
Rate for Payer: Cigna Commercial	$3.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.89
Rate for Payer: Oxford Commercial	$1.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.95
Rate for Payer: UnitedHealthcare Commercial	$1.26
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SUT FOR FIB #2 W/NDL3910090021

Facility

$110.50

Hospital Charge Code	270641992
Hospital Revenue Code	272
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$16.57
Rate for Payer: Qualcare PPO/HMO/WC	$16.57

SUT FOR FIB #2 W/NDL3910090021

Facility

$110.50

Hospital Charge Code	270641992
Hospital Revenue Code	272
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$55.25
Rate for Payer: Aetna Commercial	$41.99
Rate for Payer: Aetna Medicare Advantage	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.18
Rate for Payer: Cigna Commercial	$55.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.15
Rate for Payer: Oxford Commercial	$22.10
Rate for Payer: Qualcare PPO/HMO/WC	$16.57
Rate for Payer: UnitedHealthcare Commercial	$22.10
Rate for Payer: UnitedHealthcare Community & State	$2.66
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

Know your out-of-pocket cost for care.

All Charges