Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AEP NEURODIAGNOSTIC I&R

Facility

$1,597.40

Service Code	HCPCS 92653
Hospital Charge Code	309292653
Hospital Revenue Code	471
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$479.22
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.61
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$38.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$42.33

AEP NEURODIAGNOSTIC I&R

Facility

$1,597.40

Service Code	HCPCS 92653
Hospital Charge Code	404392653
Hospital Revenue Code	471
Min. Negotiated Rate	$239.61
Max. Negotiated Rate	$239.61
Rate for Payer: Qualcare PPO/HMO/WC	$239.61

AEP SCR AUDITORY POTENT W/STIM

Facility

$1,597.40

Service Code	HCPCS 92650
Hospital Charge Code	309292650
Hospital Revenue Code	471
Min. Negotiated Rate	$239.61
Max. Negotiated Rate	$239.61
Rate for Payer: Qualcare PPO/HMO/WC	$239.61

AEP SCR AUDITORY POTENT W/STIM

Facility

$1,597.40

Service Code	HCPCS 92650
Hospital Charge Code	309292650
Hospital Revenue Code	471
Min. Negotiated Rate	$30.05
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$607.01
Rate for Payer: Aetna Medicare Advantage	$479.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$407.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$407.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$407.34
Rate for Payer: Cigna Commercial	$798.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$479.22
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.61
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$38.50
Rate for Payer: Wellpoint Medicaid Managed Care	$42.33

AEP THRESHOLD EST MLT FREQ I&R

Facility

$1,597.40

Service Code	HCPCS 92652
Hospital Charge Code	403392652
Hospital Revenue Code	471
Min. Negotiated Rate	$239.61
Max. Negotiated Rate	$239.61
Rate for Payer: Qualcare PPO/HMO/WC	$239.61

AEP THRESHOLD EST MLT FREQ I&R

Facility

$1,597.40

Service Code	HCPCS 92652
Hospital Charge Code	309292652
Hospital Revenue Code	471
Min. Negotiated Rate	$239.61
Max. Negotiated Rate	$239.61
Rate for Payer: Qualcare PPO/HMO/WC	$239.61

AEP THRESHOLD EST MLT FREQ I&R

Facility

$1,597.40

Service Code	HCPCS 92652
Hospital Charge Code	403392652
Hospital Revenue Code	471
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$479.22
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.61
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$38.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$42.33

AEP THRESHOLD EST MLT FREQ I&R

Facility

$1,597.40

Service Code	HCPCS 92652
Hospital Charge Code	309292652
Hospital Revenue Code	471
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$479.22
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.61
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$38.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$42.33

AEQ REVERSED LOCKING SCREW

Facility

$1,012.50

Hospital Charge Code	270657898
Hospital Revenue Code	278
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$506.25
Rate for Payer: Aetna Commercial	$384.75
Rate for Payer: Aetna Medicare Advantage	$303.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.19
Rate for Payer: Cigna Commercial	$506.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$222.75
Rate for Payer: Qualcare PPO/HMO/WC	$151.88
Rate for Payer: UnitedHealthcare Community & State	$24.40
Rate for Payer: Wellpoint Medicaid Managed Care	$26.83

AEQ REVERSED LOCKING SCREW

Facility

$1,012.50

Hospital Charge Code	270657898
Hospital Revenue Code	278
Min. Negotiated Rate	$151.88
Max. Negotiated Rate	$245.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$222.75
Rate for Payer: Qualcare PPO/HMO/WC	$151.88

AEQ REVERSED LOCKING SCREW

Facility

$1,012.50

Hospital Charge Code	270657900
Hospital Revenue Code	278
Min. Negotiated Rate	$151.88
Max. Negotiated Rate	$245.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$222.75
Rate for Payer: Qualcare PPO/HMO/WC	$151.88

AEQ REVERSED LOCKING SCREW

Facility

$1,012.50

Hospital Charge Code	270657900
Hospital Revenue Code	278
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$506.25
Rate for Payer: Aetna Commercial	$384.75
Rate for Payer: Aetna Medicare Advantage	$303.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.19
Rate for Payer: Cigna Commercial	$506.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$222.75
Rate for Payer: Qualcare PPO/HMO/WC	$151.88
Rate for Payer: UnitedHealthcare Community & State	$24.40
Rate for Payer: Wellpoint Medicaid Managed Care	$26.83

AEQUALIS GLENOID & REVERSE PIN

Facility

$900.00

Hospital Charge Code	270657904
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

AEQUALIS GLENOID & REVERSE PIN

Facility

$900.00

Hospital Charge Code	270657904
Hospital Revenue Code	278
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

AEQUALIS REVERSED FRACTURE

Facility

$1,575.00

Hospital Charge Code	270657894
Hospital Revenue Code	278
Min. Negotiated Rate	$37.96
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare Advantage	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.62
Rate for Payer: Cigna Commercial	$787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25
Rate for Payer: UnitedHealthcare Community & State	$37.96
Rate for Payer: Wellpoint Medicaid Managed Care	$41.74

AEQUALIS REVERSED FRACTURE

Facility

$1,575.00

Hospital Charge Code	270657894
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

AEQUALIS REVERSED FX/ADAPTER

Facility

$11,250.00

Hospital Charge Code	270657918
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

AEQUALIS REVERSED FX/ADAPTER

Facility

$11,250.00

Hospital Charge Code	270657918
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
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
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

AEQUALIS REVERSED HEX SCREW

Facility

$1,237.50

Hospital Charge Code	270657911
Hospital Revenue Code	278
Min. Negotiated Rate	$185.62
Max. Negotiated Rate	$299.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$185.62

AEQUALIS REVERSED HEX SCREW

Facility

$1,237.50

Hospital Charge Code	270657911
Hospital Revenue Code	278
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$618.75
Rate for Payer: Aetna Commercial	$470.25
Rate for Payer: Aetna Medicare Advantage	$371.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.56
Rate for Payer: Cigna Commercial	$618.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$185.62
Rate for Payer: UnitedHealthcare Community & State	$29.82
Rate for Payer: Wellpoint Medicaid Managed Care	$32.79

AEQUALIS REVERSED II

Facility

$787.50

Hospital Charge Code	270657906
Hospital Revenue Code	278
Min. Negotiated Rate	$18.98
Max. Negotiated Rate	$393.75
Rate for Payer: Aetna Commercial	$299.25
Rate for Payer: Aetna Medicare Advantage	$236.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$393.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.25
Rate for Payer: Qualcare PPO/HMO/WC	$118.12
Rate for Payer: UnitedHealthcare Community & State	$18.98
Rate for Payer: Wellpoint Medicaid Managed Care	$20.87

AEQUALIS REVERSED II

Facility

$787.50

Hospital Charge Code	270657906
Hospital Revenue Code	278
Min. Negotiated Rate	$118.12
Max. Negotiated Rate	$190.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.25
Rate for Payer: Qualcare PPO/HMO/WC	$118.12

AEQUALIS REVERSED II CENTERED

Facility

$20,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270657916
Hospital Revenue Code	278
Min. Negotiated Rate	$488.02
Max. Negotiated Rate	$10,125.00
Rate for Payer: Aetna Commercial	$7,695.00
Rate for Payer: Aetna Medicare Advantage	$6,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,163.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,163.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,163.75
Rate for Payer: Cigna Commercial	$10,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,900.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,455.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,037.50
Rate for Payer: UnitedHealthcare Community & State	$488.02
Rate for Payer: Wellpoint Medicaid Managed Care	$536.62

AEQUALIS REVERSED II CENTERED

Facility

$20,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270657916
Hospital Revenue Code	278
Min. Negotiated Rate	$3,037.50
Max. Negotiated Rate	$4,900.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,900.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,455.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,037.50

AEQUALIS REVERSED II PILOT FOR

Facility

$787.50

Hospital Charge Code	270657909
Hospital Revenue Code	278
Min. Negotiated Rate	$118.12
Max. Negotiated Rate	$190.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.25
Rate for Payer: Qualcare PPO/HMO/WC	$118.12

Know your out-of-pocket cost for care.

All Charges