Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WET PREP***

Facility

$14.00

Hospital Charge Code	3010162
Hospital Revenue Code	306
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

WET SMEAR WHC****

Facility

$2.64

Service Code	HCPCS Q0111
Hospital Charge Code	9600032
Hospital Revenue Code	309
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.40

WET SMEAR WHC****

Facility

$2.64

Service Code	HCPCS Q0111
Hospital Charge Code	9600032
Hospital Revenue Code	309
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.43
Rate for Payer: Aetna Medicare Advantage	$60.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.92
Rate for Payer: Cigna Commercial	$1.32
Rate for Payer: Cigna Medicare Advantage	$18.54
Rate for Payer: Clover Medicare Advantage	$17.61
Rate for Payer: EmblemHealth Commercial	$55.62
Rate for Payer: Humana Medicare Advantage	$19.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.54
Rate for Payer: Wellcare Medicare Advantage	$18.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.07

WEZLANA 90MG /ML INJ

Facility

$36,376.71

Service Code	NDC 84612088901
Hospital Charge Code	6064943029
Hospital Revenue Code	250
Min. Negotiated Rate	$5,456.51
Max. Negotiated Rate	$5,456.51
Rate for Payer: Qualcare PPO/HMO/WC	$5,456.51

WEZLANA 90MG /ML INJ

Facility

$36,376.71

Service Code	NDC 84612088901
Hospital Charge Code	6064943029
Hospital Revenue Code	250
Min. Negotiated Rate	$876.68
Max. Negotiated Rate	$18,188.35
Rate for Payer: Aetna Commercial	$13,823.15
Rate for Payer: Aetna Medicare Advantage	$10,913.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,276.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,276.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,276.06
Rate for Payer: Cigna Commercial	$18,188.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,913.01
Rate for Payer: Oxford Commercial	$7,275.34
Rate for Payer: Qualcare PPO/HMO/WC	$5,456.51
Rate for Payer: UnitedHealthcare Commercial	$7,275.34
Rate for Payer: UnitedHealthcare Community & State	$876.68
Rate for Payer: Wellpoint Medicaid Managed Care	$963.98

WHC BILATERAL MAMMOGRAM DIAG

Facility

$147.00

Service Code	HCPCS 76091
Hospital Charge Code	2003028
Hospital Revenue Code	401
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$22.05
Rate for Payer: Qualcare PPO/HMO/WC	$22.05

WHC BILATERAL MAMMOGRAM DIAG

Facility

$147.00

Service Code	HCPCS 76091
Hospital Charge Code	2003028
Hospital Revenue Code	401
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$55.86
Rate for Payer: Aetna Medicare Advantage	$44.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.48
Rate for Payer: Cigna Commercial	$73.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.10
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.05
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$3.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

WHC BILATERAL SCREENING MAMMOG

Facility

$165.00

Service Code	HCPCS 76092
Hospital Charge Code	2003036
Hospital Revenue Code	403
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$62.70
Rate for Payer: Aetna Medicare Advantage	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.08
Rate for Payer: Cigna Commercial	$82.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.50
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.75
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

WHC BILATERAL SCREENING MAMMOG

Facility

$165.00

Service Code	HCPCS 76092
Hospital Charge Code	2003036
Hospital Revenue Code	403
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.75

WHC PREGNANACY TEST*****

Facility

$3.30

Service Code	HCPCS 81025WF
Hospital Charge Code	9600028
Hospital Revenue Code	309
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna Medicare Advantage	$0.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.84
Rate for Payer: Cigna Commercial	$1.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

WHC PREGNANACY TEST*****

Facility

$3.30

Service Code	HCPCS 81025WF
Hospital Charge Code	9600028
Hospital Revenue Code	309
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.50

WHC UNILATERAL MAMMOGRAM DIAG

Facility

$108.00

Service Code	HCPCS 76090
Hospital Charge Code	2003010
Hospital Revenue Code	401
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$41.04
Rate for Payer: Aetna Medicare Advantage	$32.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.54
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$2.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

WHC UNILATERAL MAMMOGRAM DIAG

Facility

$108.00

Service Code	HCPCS 76090
Hospital Charge Code	2003010
Hospital Revenue Code	401
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

WHEELCHAIR MANAGMNT PROP TRAIN

Facility

$164.50

Service Code	HCPCS 97542GP
Hospital Charge Code	9107010
Hospital Revenue Code	420
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$24.68

WHEELCHAIR MANAGMNT PROP TRAIN

Facility

$164.50

Service Code	HCPCS 97542GP
Hospital Charge Code	9107010
Hospital Revenue Code	420
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$49.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.95
Rate for Payer: Cigna Commercial	$82.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.68
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

WHEELCHAIR MANGMNT PROP TRAIN

Facility

$164.50

Service Code	HCPCS 97542GO
Hospital Charge Code	1008340
Hospital Revenue Code	430
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$49.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.95
Rate for Payer: Cigna Commercial	$82.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.68
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

WHEELCHAIR MANGMNT PROP TRAIN

Facility

$164.50

Service Code	HCPCS 97542GO
Hospital Charge Code	1008340
Hospital Revenue Code	430
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$24.68

WHEELCHAIR MANGMNT PROP TRAN

Facility

$164.50

Hospital Charge Code	1008345
Hospital Revenue Code	420
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$24.68

WHEELCHAIR MANGMNT PROP TRAN

Facility

$164.50

Hospital Charge Code	1008345
Hospital Revenue Code	420
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$49.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.95
Rate for Payer: Cigna Commercial	$82.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.68
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

WHEELCHAIR MNG EA 15 MIN CQ

Facility

$164.50

Service Code	HCPCS 97542GP
Hospital Charge Code	409197542Q
Hospital Revenue Code	420
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$49.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.95
Rate for Payer: Cigna Commercial	$82.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.35
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.68
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

WHEELCHAIR MNG EA 15 MIN CQ

Facility

$164.50

Service Code	HCPCS 97542GP
Hospital Charge Code	409197542Q
Hospital Revenue Code	420
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$24.68

WHIP SUTURE LASSO QUICK

Facility

$375.00

Hospital Charge Code	270678723
Hospital Revenue Code	272
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

WHIP SUTURE LASSO QUICK

Facility

$375.00

Hospital Charge Code	270678723
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

WHIRLPOOL CQ

Facility

$185.00

Service Code	HCPCS 97022GP
Hospital Charge Code	904197022Q
Hospital Revenue Code	420
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

WHIRLPOOL CQ

Facility

$185.00

Service Code	HCPCS 97022GP
Hospital Charge Code	904197022Q
Hospital Revenue Code	420
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

Know your out-of-pocket cost for care.

All Charges