Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COGNEX/30MG/CAP

Facility

$3.00

Hospital Charge Code	60634920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

COGNEX/30MG/CAP

Facility

$3.00

Hospital Charge Code	60634920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

COGNEX/40MG/CAP

Facility

$3.00

Hospital Charge Code	60634921
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

COGNEX/40MG/CAP

Facility

$3.00

Hospital Charge Code	60634921
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

COGNITIVE RETRAINING-15 MINUTE

Facility

$117.00

Service Code	HCPCS 97532GP
Hospital Charge Code	1008310
Hospital Revenue Code	420
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.46
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
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	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

COGNITIVE RETRAINING-15 MINUTE

Facility

$117.00

Service Code	HCPCS 97532GP
Hospital Charge Code	1008310
Hospital Revenue Code	420
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

COGNITIVE RETRAINING-15 MINUTE

Facility

$141.00

Service Code	HCPCS 97129GP
Hospital Charge Code	9108070
Hospital Revenue Code	420
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$53.58
Rate for Payer: Aetna Medicare Advantage	$42.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.95
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	$35.95
Rate for Payer: Cigna Commercial	$70.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.74

COGNITIVE RETRAINING-15 MINUTE

Facility

$141.00

Service Code	HCPCS 97129GP
Hospital Charge Code	9108070
Hospital Revenue Code	420
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

COGNITIVE RETRAINING-EACH 15MI

Facility

$121.00

Service Code	HCPCS 97532GO
Hospital Charge Code	1008305
Hospital Revenue Code	430
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$45.98
Rate for Payer: Aetna Medicare Advantage	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.86
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	$30.86
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

COGNITIVE RETRAINING-EACH 15MI

Facility

$121.00

Service Code	HCPCS 97532GO
Hospital Charge Code	1008305
Hospital Revenue Code	430
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

COHERE CERFICAL 8X16X14MM 7D

Facility

$12,144.00

Service Code	HCPCS L8699
Hospital Charge Code	270693079
Hospital Revenue Code	278
Min. Negotiated Rate	$1,821.60
Max. Negotiated Rate	$2,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60

COHERE CERFICAL 8X16X14MM 7D

Facility

$12,144.00

Service Code	HCPCS L8699
Hospital Charge Code	270693079
Hospital Revenue Code	278
Min. Negotiated Rate	$292.67
Max. Negotiated Rate	$6,072.00
Rate for Payer: Aetna Commercial	$4,614.72
Rate for Payer: Aetna Medicare Advantage	$3,643.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,096.72
Rate for Payer: Cigna Commercial	$6,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60
Rate for Payer: UnitedHealthcare Community & State	$292.67
Rate for Payer: Wellpoint Medicaid Managed Care	$321.82

COHERE CERVICAL 6X14X12MM

Facility

$9,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

COHERE CERVICAL 6X14X12MM

Facility

$9,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693082
Hospital Revenue Code	278
Min. Negotiated Rate	$218.71
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$3,448.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25
Rate for Payer: UnitedHealthcare Community & State	$218.71
Rate for Payer: Wellpoint Medicaid Managed Care	$240.49

COHERE CERVICAL 7X14X12MM 7D

Facility

$9,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693070
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

COHERE CERVICAL 7X14X12MM 7D

Facility

$9,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693070
Hospital Revenue Code	278
Min. Negotiated Rate	$218.71
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$3,448.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25
Rate for Payer: UnitedHealthcare Community & State	$218.71
Rate for Payer: Wellpoint Medicaid Managed Care	$240.49

COHERE CERVICAL 8X14X12MM 7D

Facility

$9,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693084
Hospital Revenue Code	278
Min. Negotiated Rate	$218.71
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$3,448.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25
Rate for Payer: UnitedHealthcare Community & State	$218.71
Rate for Payer: Wellpoint Medicaid Managed Care	$240.49

COHERE CERVICAL 8X14X12MM 7D

Facility

$9,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693084
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

COHERE CERVICAL 9X16X14MM 7D

Facility

$9,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693078
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

COHERE CERVICAL 9X16X14MM 7D

Facility

$9,075.00

Service Code	HCPCS L8699
Hospital Charge Code	270693078
Hospital Revenue Code	278
Min. Negotiated Rate	$218.71
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$3,448.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25
Rate for Payer: UnitedHealthcare Community & State	$218.71
Rate for Payer: Wellpoint Medicaid Managed Care	$240.49

COIL 400 CPLX SFT 8MMX20CM

Facility

$11,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270695169S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$2,776.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,776.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,524.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

COIL 400 CPLX SFT 8MMX20CM

Facility

$11,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270695169S
Hospital Revenue Code	278
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) NJ Health	$2,295.00
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	$2,776.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,524.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Community & State	$276.55
Rate for Payer: Wellpoint Medicaid Managed Care	$304.09

COIL 400 CPLX XSFT 5MMX13CM

Facility

$11,160.00

Service Code	HCPCS C1889
Hospital Charge Code	270695166S
Hospital Revenue Code	278
Min. Negotiated Rate	$268.96
Max. Negotiated Rate	$5,580.00
Rate for Payer: Aetna Commercial	$4,240.80
Rate for Payer: Aetna Medicare Advantage	$3,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,845.80
Rate for Payer: Cigna Commercial	$5,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00
Rate for Payer: UnitedHealthcare Community & State	$268.96
Rate for Payer: Wellpoint Medicaid Managed Care	$295.74

COIL 400 CPLX XSFT 5MMX13CM

Facility

$11,160.00

Service Code	HCPCS C1889
Hospital Charge Code	270695166S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$2,700.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00

COIL 400 CPLX XSFT 6MMX15CM

Facility

$11,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695167S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

Know your out-of-pocket cost for care.

All Charges