Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BREAST SIZER 750CC

Facility

$1,500.00

Hospital Charge Code	270674071
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

BREAST SIZER 750CC

Facility

$1,500.00

Hospital Charge Code	270674071
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 800CC

Facility

$1,500.00

Hospital Charge Code	270674072
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

BREAST SIZER 800CC

Facility

$1,500.00

Hospital Charge Code	270674072
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SMOOTH ROUND UH 320CC

Facility

$0.01

Hospital Charge Code	270702699
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BREAST SMOOTH ROUND UH 320CC

Facility

$0.01

Hospital Charge Code	270702699
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BREATH ALCOHOL CONFIRMATION

Facility

$80.00

Service Code	HCPCS 82075
Hospital Charge Code	3000349
Hospital Revenue Code	307
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$81.60
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.29
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: Cigna Medicare Advantage	$30.00
Rate for Payer: Clover Medicare Advantage	$28.50
Rate for Payer: EmblemHealth Commercial	$90.00
Rate for Payer: Humana Medicare Advantage	$30.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.00
Rate for Payer: Wellcare Medicare Advantage	$30.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

BREATH ALCOHOL CONFIRMATION

Facility

$80.00

Service Code	HCPCS 82075
Hospital Charge Code	3000349
Hospital Revenue Code	307
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

BREATH ALCOHOL SCREENING

Facility

$80.00

Service Code	HCPCS 82075
Hospital Charge Code	3000348
Hospital Revenue Code	307
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

BREATH ALCOHOL SCREENING

Facility

$80.00

Service Code	HCPCS 82075
Hospital Charge Code	3000348
Hospital Revenue Code	307
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$81.60
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.29
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: Cigna Medicare Advantage	$30.00
Rate for Payer: Clover Medicare Advantage	$28.50
Rate for Payer: EmblemHealth Commercial	$90.00
Rate for Payer: Humana Medicare Advantage	$30.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.00
Rate for Payer: Wellcare Medicare Advantage	$30.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

BREATH HYDROGEN TEST***

Facility

$328.00

Service Code	HCPCS 911065
Hospital Charge Code	2300887
Hospital Revenue Code	759
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$49.20
Rate for Payer: Qualcare PPO/HMO/WC	$49.20

BREATH HYDROGEN TEST***

Facility

$328.00

Service Code	HCPCS 911065
Hospital Charge Code	2300887
Hospital Revenue Code	759
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$164.00
Rate for Payer: Aetna Commercial	$124.64
Rate for Payer: Aetna Medicare Advantage	$98.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.64
Rate for Payer: Cigna Commercial	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.40
Rate for Payer: Qualcare PPO/HMO/WC	$49.20
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$8.69

BREATHING AIR E TANK 22 CU

Facility

$44.20

Hospital Charge Code	270657886
Hospital Revenue Code	270
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$22.10
Rate for Payer: Aetna Commercial	$16.80
Rate for Payer: Aetna Medicare Advantage	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.27
Rate for Payer: Cigna Commercial	$22.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.26
Rate for Payer: Oxford Commercial	$8.84
Rate for Payer: Qualcare PPO/HMO/WC	$6.63
Rate for Payer: UnitedHealthcare Commercial	$8.84
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

BREATHING AIR E TANK 22 CU

Facility

$44.20

Hospital Charge Code	270657886
Hospital Revenue Code	270
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$6.63
Rate for Payer: Qualcare PPO/HMO/WC	$6.63

BREATHING CIRCUIT MODIFIED

Facility

$59.00

Hospital Charge Code	270331542
Hospital Revenue Code	272
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Oxford Commercial	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$11.80
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

BREATHING CIRCUIT MODIFIED

Facility

$59.00

Hospital Charge Code	270331542
Hospital Revenue Code	272
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

BREO ELLIPTA 100 MCG

Facility

$37.72

Service Code	NDC 173085914
Hospital Charge Code	606390199
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.86
Rate for Payer: Aetna Commercial	$14.33
Rate for Payer: Aetna Medicare Advantage	$11.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.62
Rate for Payer: Cigna Commercial	$18.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Oxford Commercial	$7.54
Rate for Payer: Qualcare PPO/HMO/WC	$5.66
Rate for Payer: UnitedHealthcare Commercial	$7.54
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

BREO ELLIPTA 100 MCG

Facility

$37.72

Service Code	NDC 173085914
Hospital Charge Code	606390199
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$5.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.66

BREO ELLIPTA 200 MCG

Facility

$37.72

Service Code	NDC 173088214
Hospital Charge Code	606390200
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$5.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.66

BREO ELLIPTA 200 MCG

Facility

$37.72

Service Code	NDC 173088214
Hospital Charge Code	606390200
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.86
Rate for Payer: Aetna Commercial	$14.33
Rate for Payer: Aetna Medicare Advantage	$11.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.62
Rate for Payer: Cigna Commercial	$18.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Oxford Commercial	$7.54
Rate for Payer: Qualcare PPO/HMO/WC	$5.66
Rate for Payer: UnitedHealthcare Commercial	$7.54
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

BRETHAIRE/0.2MG/7.5ML

Facility

$101.00

Hospital Charge Code	60632575
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$20.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$20.20
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

BRETHAIRE/0.2MG/7.5ML

Facility

$101.00

Hospital Charge Code	60632575
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

BRETHINE 1MG

Facility

$15.40

Hospital Charge Code	6008106
Hospital Revenue Code	252
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

BRETHINE 1MG

Facility

$15.40

Hospital Charge Code	6008106
Hospital Revenue Code	252
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

BRETHINE/1MG/1ML

Facility

$12.00

Hospital Charge Code	60632577
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

Know your out-of-pocket cost for care.

All Charges