Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TERUMOBCT/PRP

Facility

$3,050.00

Hospital Charge Code	270681065
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$1,525.00
Rate for Payer: Aetna Commercial	$1,159.00
Rate for Payer: Aetna Medicare Advantage	$915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$777.75
Rate for Payer: Cigna Commercial	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.00
Rate for Payer: Oxford Commercial	$610.00
Rate for Payer: Qualcare PPO/HMO/WC	$457.50
Rate for Payer: UnitedHealthcare Commercial	$610.00
Rate for Payer: UnitedHealthcare Community & State	$73.50
Rate for Payer: Wellpoint Medicaid Managed Care	$80.83

TERUMOBCT/PRP

Facility

$3,050.00

Hospital Charge Code	270681065
Hospital Revenue Code	272
Min. Negotiated Rate	$457.50
Max. Negotiated Rate	$457.50
Rate for Payer: Qualcare PPO/HMO/WC	$457.50

TERUMOBCT/PRP 120 ML

Facility

$11,475.00

Hospital Charge Code	270676585
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,721.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

TERUMOBCT/PRP 120 ML

Facility

$11,475.00

Hospital Charge Code	270676585
Hospital Revenue Code	272
Min. Negotiated Rate	$276.55
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$4,360.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.50
Rate for Payer: Oxford Commercial	$2,295.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Commercial	$2,295.00
Rate for Payer: UnitedHealthcare Community & State	$276.55
Rate for Payer: Wellpoint Medicaid Managed Care	$304.09

TERUMO CENTRIFUGAL HEAD

Facility

$1,115.50

Hospital Charge Code	2703110C
Hospital Revenue Code	272
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$557.75
Rate for Payer: Aetna Commercial	$423.89
Rate for Payer: Aetna Medicare Advantage	$334.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.45
Rate for Payer: Cigna Commercial	$557.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.65
Rate for Payer: Oxford Commercial	$223.10
Rate for Payer: Qualcare PPO/HMO/WC	$167.32
Rate for Payer: UnitedHealthcare Commercial	$223.10
Rate for Payer: UnitedHealthcare Community & State	$26.88
Rate for Payer: Wellpoint Medicaid Managed Care	$29.56

TERUMO CENTRIFUGAL HEAD

Facility

$1,115.50

Hospital Charge Code	2703110C
Hospital Revenue Code	272
Min. Negotiated Rate	$167.32
Max. Negotiated Rate	$167.32
Rate for Payer: Qualcare PPO/HMO/WC	$167.32

TERUMO TORQUE DEVICE

Facility

$199.50

Hospital Charge Code	270662664
Hospital Revenue Code	270
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$99.75
Rate for Payer: Aetna Commercial	$75.81
Rate for Payer: Aetna Medicare Advantage	$59.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.87
Rate for Payer: Cigna Commercial	$99.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.85
Rate for Payer: Oxford Commercial	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$29.93
Rate for Payer: UnitedHealthcare Commercial	$39.90
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.29

TERUMO TORQUE DEVICE

Facility

$199.50

Hospital Charge Code	270662664
Hospital Revenue Code	270
Min. Negotiated Rate	$29.93
Max. Negotiated Rate	$29.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.93

TESSIO MCTC 1035KD-A-1 ******

Facility

$1,058.00

Hospital Charge Code	1608207
Hospital Revenue Code	272
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$529.00
Rate for Payer: Aetna Commercial	$402.04
Rate for Payer: Aetna Medicare Advantage	$317.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.79
Rate for Payer: Cigna Commercial	$529.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$317.40
Rate for Payer: Oxford Commercial	$211.60
Rate for Payer: Qualcare PPO/HMO/WC	$158.70
Rate for Payer: UnitedHealthcare Commercial	$211.60
Rate for Payer: UnitedHealthcare Community & State	$25.50
Rate for Payer: Wellpoint Medicaid Managed Care	$28.04

TESSIO MCTC 1035KD-A-1 ******

Facility

$1,058.00

Hospital Charge Code	1608207
Hospital Revenue Code	272
Min. Negotiated Rate	$158.70
Max. Negotiated Rate	$158.70
Rate for Payer: Qualcare PPO/HMO/WC	$158.70

TEST******

Facility

$5.00

Hospital Charge Code	9999999999
Hospital Revenue Code	519
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TEST******

Facility

$5.00

Hospital Charge Code	9999999999
Hospital Revenue Code	519
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TEST CLO

Facility

$60.85

Hospital Charge Code	270601181
Hospital Revenue Code	270
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.43
Rate for Payer: Aetna Commercial	$23.12
Rate for Payer: Aetna Medicare Advantage	$18.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.52
Rate for Payer: Cigna Commercial	$30.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.25
Rate for Payer: Oxford Commercial	$12.17
Rate for Payer: Qualcare PPO/HMO/WC	$9.13
Rate for Payer: UnitedHealthcare Commercial	$12.17
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

TEST CLO

Facility

$60.85

Hospital Charge Code	270601181
Hospital Revenue Code	270
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$9.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.13

TESTER LEAKAGE GASTROSCOPE MU1

Facility

$1,120.00

Hospital Charge Code	270617457
Hospital Revenue Code	270
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

TESTER LEAKAGE GASTROSCOPE MU1

Facility

$1,120.00

Hospital Charge Code	270617457
Hospital Revenue Code	270
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$425.60
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.00
Rate for Payer: Oxford Commercial	$224.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Commercial	$224.00
Rate for Payer: UnitedHealthcare Community & State	$26.99
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

TESTES PROCEDURES WITH CC/MCC

Facility

$69,485.89

Service Code	MSDRG 711
Min. Negotiated Rate	$21,157.56
Max. Negotiated Rate	$69,485.89
Rate for Payer: Aetna Commercial	$48,002.07
Rate for Payer: Aetna Medicare Advantage	$69,485.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,313.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,313.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,313.32
Rate for Payer: Cigna Commercial	$38,996.23
Rate for Payer: Cigna Medicare Advantage	$22,271.12
Rate for Payer: Clover Medicare Advantage	$21,157.56
Rate for Payer: EmblemHealth Commercial	$66,813.36
Rate for Payer: Humana Medicare Advantage	$22,939.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,271.12
Rate for Payer: Oxford Commercial	$28,027.11
Rate for Payer: UnitedHealthcare Commercial	$49,146.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,271.12
Rate for Payer: Wellcare Medicare Advantage	$22,271.12

TESTES PROCEDURES WITHOUT CC/MCC

Facility

$37,678.21

Service Code	MSDRG 712
Min. Negotiated Rate	$11,472.53
Max. Negotiated Rate	$37,678.21
Rate for Payer: Aetna Commercial	$26,146.56
Rate for Payer: Aetna Medicare Advantage	$37,678.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,680.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,680.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,076.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,680.59
Rate for Payer: Cigna Commercial	$20,579.79
Rate for Payer: Cigna Medicare Advantage	$12,076.35
Rate for Payer: Clover Medicare Advantage	$11,472.53
Rate for Payer: EmblemHealth Commercial	$36,229.05
Rate for Payer: Humana Medicare Advantage	$12,438.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,076.35
Rate for Payer: Oxford Commercial	$14,790.97
Rate for Payer: UnitedHealthcare Commercial	$25,936.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,076.35
Rate for Payer: Wellcare Medicare Advantage	$12,076.35

TESTICULAR

Facility

$6,700.00

Service Code	HCPCS 76870
Hospital Charge Code	94061181
Hospital Revenue Code	402
Min. Negotiated Rate	$100.09
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

TESTICULAR

Facility

$6,700.00

Service Code	HCPCS 76870
Hospital Charge Code	2301057
Hospital Revenue Code	402
Min. Negotiated Rate	$100.09
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

TESTICULAR

Facility

$6,700.00

Service Code	HCPCS 76870
Hospital Charge Code	94061181
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

TESTICULAR

Facility

$6,700.00

Service Code	HCPCS 76870
Hospital Charge Code	2301057
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

TESTOSTERONE ESTR INJ

Facility

$53.80

Hospital Charge Code	6005185
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

TESTOSTERONE ESTR INJ

Facility

$53.80

Hospital Charge Code	6005185
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

TESTOSTERONE, FREE

Facility

$167.25

Service Code	HCPCS 84402
Hospital Charge Code	3002533
Hospital Revenue Code	301
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

Know your out-of-pocket cost for care.

All Charges