Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACID PHOSPHATASE, TOTAL

Facility

$67.25

Service Code	HCPCS 84060
Hospital Charge Code	3000106
Hospital Revenue Code	301
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$20.78
Rate for Payer: Aetna Medicare Advantage	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.58
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: Cigna Medicare Advantage	$7.64
Rate for Payer: Clover Medicare Advantage	$7.26
Rate for Payer: EmblemHealth Commercial	$22.92
Rate for Payer: Humana Medicare Advantage	$7.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.64
Rate for Payer: Wellcare Medicare Advantage	$7.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

ACID PHOSPHATASE, TOTAL

Facility

$67.25

Service Code	HCPCS 84060
Hospital Charge Code	3000106
Hospital Revenue Code	301
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

ACID PHOSPHATASE,TOTAL

Facility

$203.00

Service Code	HCPCS 84060
Hospital Charge Code	38472032
Hospital Revenue Code	301
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$20.78
Rate for Payer: Aetna Medicare Advantage	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.58
Rate for Payer: Cigna Commercial	$101.50
Rate for Payer: Cigna Medicare Advantage	$7.64
Rate for Payer: Clover Medicare Advantage	$7.26
Rate for Payer: EmblemHealth Commercial	$22.92
Rate for Payer: Humana Medicare Advantage	$7.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.64
Rate for Payer: Wellcare Medicare Advantage	$7.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.38

ACID PHOSPHATASE,TOTAL

Facility

$203.00

Service Code	HCPCS 84060
Hospital Charge Code	38472032
Hospital Revenue Code	301
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

ACIS SPACER 7MM 16X14

Facility

$9,080.00

Service Code	HCPCS C1765
Hospital Charge Code	270705056
Hospital Revenue Code	278
Min. Negotiated Rate	$218.83
Max. Negotiated Rate	$4,540.00
Rate for Payer: Aetna Commercial	$3,450.40
Rate for Payer: Aetna Medicare Advantage	$2,724.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,315.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,315.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,315.40
Rate for Payer: Cigna Commercial	$4,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,997.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.00
Rate for Payer: UnitedHealthcare Community & State	$218.83
Rate for Payer: Wellpoint Medicaid Managed Care	$240.62

ACIS SPACER 7MM 16X14

Facility

$9,080.00

Service Code	HCPCS C1765
Hospital Charge Code	270705056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.00
Max. Negotiated Rate	$2,197.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,816.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,997.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.00

ACL DISP KIT

Facility

$3,165.00

Hospital Charge Code	270678191
Hospital Revenue Code	272
Min. Negotiated Rate	$76.28
Max. Negotiated Rate	$1,582.50
Rate for Payer: Aetna Commercial	$1,202.70
Rate for Payer: Aetna Medicare Advantage	$949.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$807.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$807.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$807.08
Rate for Payer: Cigna Commercial	$1,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$949.50
Rate for Payer: Oxford Commercial	$633.00
Rate for Payer: Qualcare PPO/HMO/WC	$474.75
Rate for Payer: UnitedHealthcare Commercial	$633.00
Rate for Payer: UnitedHealthcare Community & State	$76.28
Rate for Payer: Wellpoint Medicaid Managed Care	$83.87

ACL DISP KIT

Facility

$3,165.00

Hospital Charge Code	270678191
Hospital Revenue Code	272
Min. Negotiated Rate	$474.75
Max. Negotiated Rate	$474.75
Rate for Payer: Qualcare PPO/HMO/WC	$474.75

ACL DISPOSABLE PACK

Facility

$2,470.00

Hospital Charge Code	270670502
Hospital Revenue Code	272
Min. Negotiated Rate	$370.50
Max. Negotiated Rate	$370.50
Rate for Payer: Qualcare PPO/HMO/WC	$370.50

ACL DISPOSABLE PACK

Facility

$2,470.00

Hospital Charge Code	270670502
Hospital Revenue Code	272
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$938.60
Rate for Payer: Aetna Medicare Advantage	$741.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$629.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$629.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$629.85
Rate for Payer: Cigna Commercial	$1,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$741.00
Rate for Payer: Oxford Commercial	$494.00
Rate for Payer: Qualcare PPO/HMO/WC	$370.50
Rate for Payer: UnitedHealthcare Commercial	$494.00
Rate for Payer: UnitedHealthcare Community & State	$59.53
Rate for Payer: Wellpoint Medicaid Managed Care	$65.45

ACL DISP PACK BONE-TENDON-BONE

Facility

$1,482.00

Hospital Charge Code	270675672
Hospital Revenue Code	272
Min. Negotiated Rate	$222.30
Max. Negotiated Rate	$222.30
Rate for Payer: Qualcare PPO/HMO/WC	$222.30

ACL DISP PACK BONE-TENDON-BONE

Facility

$1,482.00

Hospital Charge Code	270675672
Hospital Revenue Code	272
Min. Negotiated Rate	$35.72
Max. Negotiated Rate	$741.00
Rate for Payer: Aetna Commercial	$563.16
Rate for Payer: Aetna Medicare Advantage	$444.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.91
Rate for Payer: Cigna Commercial	$741.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.60
Rate for Payer: Oxford Commercial	$296.40
Rate for Payer: Qualcare PPO/HMO/WC	$222.30
Rate for Payer: UnitedHealthcare Commercial	$296.40
Rate for Payer: UnitedHealthcare Community & State	$35.72
Rate for Payer: Wellpoint Medicaid Managed Care	$39.27

ACL GRAFTLINK

Facility

$10,865.00

Service Code	HCPCS C1713
Hospital Charge Code	270667100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,629.75
Max. Negotiated Rate	$2,629.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,173.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,629.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,390.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,629.75

ACL GRAFTLINK

Facility

$10,865.00

Service Code	HCPCS C1713
Hospital Charge Code	270667100
Hospital Revenue Code	278
Min. Negotiated Rate	$261.85
Max. Negotiated Rate	$5,432.50
Rate for Payer: Aetna Commercial	$4,128.70
Rate for Payer: Aetna Medicare Advantage	$3,259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,770.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,770.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,770.57
Rate for Payer: Cigna Commercial	$5,432.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,629.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,390.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,629.75
Rate for Payer: UnitedHealthcare Community & State	$261.85
Rate for Payer: Wellpoint Medicaid Managed Care	$287.92

ACL INSTRUMENTATION SYSTEM

Facility

$1,250.00

Hospital Charge Code	270675673
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

ACL INSTRUMENTATION SYSTEM

Facility

$1,250.00

Hospital Charge Code	270675673
Hospital Revenue Code	272
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

ACL INST SYSTEM USAGE

Facility

$2,500.00

Hospital Charge Code	270670503
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

ACL INST SYSTEM USAGE

Facility

$2,500.00

Hospital Charge Code	270670503
Hospital Revenue Code	272
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

ACL KIT

Facility

$1,240.00

Hospital Charge Code	270620357
Hospital Revenue Code	272
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.00

ACL KIT

Facility

$1,240.00

Hospital Charge Code	270620357
Hospital Revenue Code	272
Min. Negotiated Rate	$29.88
Max. Negotiated Rate	$620.00
Rate for Payer: Aetna Commercial	$471.20
Rate for Payer: Aetna Medicare Advantage	$372.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.20
Rate for Payer: Cigna Commercial	$620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.00
Rate for Payer: Oxford Commercial	$248.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.00
Rate for Payer: UnitedHealthcare Commercial	$248.00
Rate for Payer: UnitedHealthcare Community & State	$29.88
Rate for Payer: Wellpoint Medicaid Managed Care	$32.86

ACL KIT DISP

Facility

$2,730.00

Hospital Charge Code	270635264
Hospital Revenue Code	272
Min. Negotiated Rate	$409.50
Max. Negotiated Rate	$409.50
Rate for Payer: Qualcare PPO/HMO/WC	$409.50

ACL KIT DISP

Facility

$2,730.00

Hospital Charge Code	270635264
Hospital Revenue Code	272
Min. Negotiated Rate	$65.79
Max. Negotiated Rate	$1,365.00
Rate for Payer: Aetna Commercial	$1,037.40
Rate for Payer: Aetna Medicare Advantage	$819.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$696.15
Rate for Payer: Cigna Commercial	$1,365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$819.00
Rate for Payer: Oxford Commercial	$546.00
Rate for Payer: Qualcare PPO/HMO/WC	$409.50
Rate for Payer: UnitedHealthcare Commercial	$546.00
Rate for Payer: UnitedHealthcare Community & State	$65.79
Rate for Payer: Wellpoint Medicaid Managed Care	$72.34

ACLOVATE 0.05%/15GM

Facility

$56.00

Hospital Charge Code	60632391
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

ACLOVATE 0.05%/15GM

Facility

$56.00

Hospital Charge Code	60632390
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

ACLOVATE 0.05%/15GM

Facility

$56.00

Hospital Charge Code	60632391
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$11.20
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

Know your out-of-pocket cost for care.

All Charges