Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CLIPS HEMOLOK MEDIUM LG 544230

Facility

$20.80

Hospital Charge Code	270640217
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.12

CLIPS HEMOLOK MEDIUM LG 544230

Facility

$20.80

Hospital Charge Code	270640217
Hospital Revenue Code	272
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna Commercial	$7.90
Rate for Payer: Aetna Medicare Advantage	$6.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.30
Rate for Payer: Cigna Commercial	$10.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$4.16
Rate for Payer: Qualcare PPO/HMO/WC	$3.12
Rate for Payer: UnitedHealthcare Commercial	$4.16
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

CLIPS HEMOLOK SMALL 544220

Facility

$71.35

Hospital Charge Code	270619752
Hospital Revenue Code	272
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$35.67
Rate for Payer: Aetna Commercial	$27.11
Rate for Payer: Aetna Medicare Advantage	$21.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.19
Rate for Payer: Cigna Commercial	$35.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.41
Rate for Payer: Oxford Commercial	$14.27
Rate for Payer: Qualcare PPO/HMO/WC	$10.70
Rate for Payer: UnitedHealthcare Commercial	$14.27
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.89

CLIPS HEMOLOK SMALL 544220

Facility

$71.35

Hospital Charge Code	270619752
Hospital Revenue Code	272
Min. Negotiated Rate	$10.70
Max. Negotiated Rate	$10.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.70

CLIPS RANYE DISP.

Facility

$11.59

Hospital Charge Code	270600322
Hospital Revenue Code	272
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.79
Rate for Payer: Aetna Commercial	$4.40
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.96
Rate for Payer: Cigna Commercial	$5.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.48
Rate for Payer: Oxford Commercial	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.74
Rate for Payer: UnitedHealthcare Commercial	$2.32
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

CLIPS RANYE DISP.

Facility

$11.59

Hospital Charge Code	270600322
Hospital Revenue Code	272
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.74

CLIP STIMULATING SAFEOP STER

Facility

$2,437.50

Hospital Charge Code	270698066
Hospital Revenue Code	272
Min. Negotiated Rate	$365.62
Max. Negotiated Rate	$365.62
Rate for Payer: Qualcare PPO/HMO/WC	$365.62

CLIP STIMULATING SAFEOP STER

Facility

$2,437.50

Hospital Charge Code	270698066
Hospital Revenue Code	272
Min. Negotiated Rate	$58.74
Max. Negotiated Rate	$1,218.75
Rate for Payer: Aetna Commercial	$926.25
Rate for Payer: Aetna Medicare Advantage	$731.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$621.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$621.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$621.56
Rate for Payer: Cigna Commercial	$1,218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$731.25
Rate for Payer: Oxford Commercial	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$365.62
Rate for Payer: UnitedHealthcare Commercial	$487.50
Rate for Payer: UnitedHealthcare Community & State	$58.74
Rate for Payer: Wellpoint Medicaid Managed Care	$64.59

CLIP SURGICAL SPRING INSERT 6M

Facility

$43.98

Hospital Charge Code	270690348
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

CLIP SURGICAL SPRING INSERT 6M

Facility

$43.98

Hospital Charge Code	270690348
Hospital Revenue Code	272
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$21.99
Rate for Payer: Aetna Commercial	$16.71
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.21
Rate for Payer: Cigna Commercial	$21.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.19
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

CLIP TITANIUM LARGE

Facility

$24.88

Service Code	HCPCS C1713
Hospital Charge Code	270669638
Hospital Revenue Code	278
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.44
Rate for Payer: Aetna Commercial	$9.45
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

CLIP TITANIUM LARGE

Facility

$24.88

Service Code	HCPCS C1713
Hospital Charge Code	270669638
Hospital Revenue Code	278
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$6.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

CLIP TITANIUM MED/LARGE

Facility

$17.43

Hospital Charge Code	270669637
Hospital Revenue Code	278
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.71
Rate for Payer: Aetna Commercial	$6.62
Rate for Payer: Aetna Medicare Advantage	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.44
Rate for Payer: Cigna Commercial	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.61
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

CLIP TITANIUM MED/LARGE

Facility

$17.43

Hospital Charge Code	270669637
Hospital Revenue Code	278
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$4.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.61

CLIP TITANIUM WIDE SMALL

Facility

$40.04

Hospital Charge Code	270669636
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.02
Rate for Payer: Aetna Commercial	$15.22
Rate for Payer: Aetna Medicare Advantage	$12.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.21
Rate for Payer: Cigna Commercial	$20.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.01
Rate for Payer: Oxford Commercial	$8.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.01
Rate for Payer: UnitedHealthcare Commercial	$8.01
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CLIP TITANIUM WIDE SMALL

Facility

$40.04

Hospital Charge Code	270669636
Hospital Revenue Code	272
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$6.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.01

CLIP X-LARGE

Facility

$65.65

Hospital Charge Code	270665215
Hospital Revenue Code	272
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.70
Rate for Payer: Oxford Commercial	$13.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$13.13
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

CLIP X-LARGE

Facility

$65.65

Hospital Charge Code	270665215
Hospital Revenue Code	272
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

CLL IGVH MUTATION,CELL

Facility

$2,125.00

Service Code	HCPCS 81263
Hospital Charge Code	401081263
Hospital Revenue Code	310
Min. Negotiated Rate	$56.31
Max. Negotiated Rate	$1,063.13
Rate for Payer: Aetna Commercial	$801.09
Rate for Payer: Aetna Medicare Advantage	$954.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$294.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,063.13
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: Cigna Medicare Advantage	$294.52
Rate for Payer: Clover Medicare Advantage	$279.79
Rate for Payer: EmblemHealth Commercial	$883.56
Rate for Payer: Humana Medicare Advantage	$303.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$294.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$637.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$235.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$294.52
Rate for Payer: Wellcare Medicare Advantage	$294.52
Rate for Payer: Wellpoint Medicaid Managed Care	$56.31

CLL IGVH MUTATION,CELL

Facility

$2,125.00

Service Code	HCPCS 81263
Hospital Charge Code	401081263
Hospital Revenue Code	310
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$318.75
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

CLMP MULTI PIN LARGE

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699322
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CLMP MULTI PIN LARGE

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699322
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CLN CONSULTATION MINIMUM

Facility

$290.00

Service Code	HCPCS 99241
Hospital Charge Code	75190235
Hospital Revenue Code	510
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$110.20
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

CLN CONSULTATION MINIMUM

Facility

$290.00

Service Code	HCPCS 99241
Hospital Charge Code	75190235
Hospital Revenue Code	510
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

CLN DEBRD SKN FULL THICKNESS

Facility

$545.00

Hospital Charge Code	75190015
Hospital Revenue Code	761
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$81.75
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

Know your out-of-pocket cost for care.

All Charges