Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AFB SENSITIVITY

Facility

$79.00

Service Code	HCPCS 87190
Hospital Charge Code	38475083
Hospital Revenue Code	309
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

AFB SENSITIVITY

Facility

$79.00

Service Code	HCPCS 87190
Hospital Charge Code	38475083
Hospital Revenue Code	309
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare Advantage	$23.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.39
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: Cigna Medicare Advantage	$7.31
Rate for Payer: Clover Medicare Advantage	$6.94
Rate for Payer: EmblemHealth Commercial	$21.93
Rate for Payer: Humana Medicare Advantage	$7.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.31
Rate for Payer: Wellcare Medicare Advantage	$7.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38475092
Hospital Revenue Code	309
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479498
Hospital Revenue Code	309
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38475092
Hospital Revenue Code	309
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479498
Hospital Revenue Code	309
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479466
Hospital Revenue Code	309
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479466
Hospital Revenue Code	309
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

AFFIX II IMPLANT -45MM

Facility

$29,840.00

Hospital Charge Code	270658008
Hospital Revenue Code	278
Min. Negotiated Rate	$4,476.00
Max. Negotiated Rate	$7,221.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,968.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,221.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,564.80
Rate for Payer: Qualcare PPO/HMO/WC	$4,476.00

AFFIX II IMPLANT -45MM

Facility

$29,840.00

Hospital Charge Code	270658008
Hospital Revenue Code	278
Min. Negotiated Rate	$719.14
Max. Negotiated Rate	$14,920.00
Rate for Payer: Aetna Commercial	$11,339.20
Rate for Payer: Aetna Medicare Advantage	$8,952.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,609.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,609.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,609.20
Rate for Payer: Cigna Commercial	$14,920.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,221.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,564.80
Rate for Payer: Qualcare PPO/HMO/WC	$4,476.00
Rate for Payer: UnitedHealthcare Community & State	$719.14
Rate for Payer: Wellpoint Medicaid Managed Care	$790.76

AFFIXUS CORTICAL BONE SCREW 4X

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704513
Hospital Revenue Code	278
Min. Negotiated Rate	$31.88
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna Commercial	$502.74
Rate for Payer: Aetna Medicare Advantage	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.37
Rate for Payer: Cigna Commercial	$661.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.06
Rate for Payer: Qualcare PPO/HMO/WC	$198.45
Rate for Payer: UnitedHealthcare Community & State	$31.88
Rate for Payer: Wellpoint Medicaid Managed Care	$35.06

AFFIXUS CORTICAL BONE SCREW 4X

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704517
Hospital Revenue Code	278
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$320.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.06
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

AFFIXUS CORTICAL BONE SCREW 4X

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704513
Hospital Revenue Code	278
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$320.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.06
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

AFFIXUS CORTICAL BONE SCREW 4X

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704517
Hospital Revenue Code	278
Min. Negotiated Rate	$31.88
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna Commercial	$502.74
Rate for Payer: Aetna Medicare Advantage	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.37
Rate for Payer: Cigna Commercial	$661.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.06
Rate for Payer: Qualcare PPO/HMO/WC	$198.45
Rate for Payer: UnitedHealthcare Community & State	$31.88
Rate for Payer: Wellpoint Medicaid Managed Care	$35.06

AFFIXUS HIP FRAC NAIL 125D 13X

Facility

$9,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270705120
Hospital Revenue Code	278
Min. Negotiated Rate	$1,476.75
Max. Negotiated Rate	$2,382.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,969.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,382.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,165.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,476.75

AFFIXUS HIP FRAC NAIL 125D 13X

Facility

$9,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270705120
Hospital Revenue Code	278
Min. Negotiated Rate	$237.26
Max. Negotiated Rate	$4,922.50
Rate for Payer: Aetna Commercial	$3,741.10
Rate for Payer: Aetna Medicare Advantage	$2,953.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,510.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,510.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,969.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,510.47
Rate for Payer: Cigna Commercial	$4,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,382.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,165.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,476.75
Rate for Payer: UnitedHealthcare Community & State	$237.26
Rate for Payer: Wellpoint Medicaid Managed Care	$260.89

AFFIXUS In cap flush impinging

Facility

$790.00

Hospital Charge Code	270679375
Hospital Revenue Code	278
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$300.20
Rate for Payer: Aetna Medicare Advantage	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.45
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.80
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Community & State	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$20.93

AFFIXUS In cap flush impinging

Facility

$790.00

Hospital Charge Code	270679375
Hospital Revenue Code	278
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$191.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.80
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

AFFIXUS PROXIMAL HUMERUS RIGHT

Facility

$13,147.30

Service Code	HCPCS C1713
Hospital Charge Code	270704514
Hospital Revenue Code	278
Min. Negotiated Rate	$1,972.10
Max. Negotiated Rate	$3,181.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,629.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,181.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,892.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,972.10

AFFIXUS PROXIMAL HUMERUS RIGHT

Facility

$13,147.30

Service Code	HCPCS C1713
Hospital Charge Code	270704514
Hospital Revenue Code	278
Min. Negotiated Rate	$316.85
Max. Negotiated Rate	$6,573.65
Rate for Payer: Aetna Commercial	$4,995.97
Rate for Payer: Aetna Medicare Advantage	$3,944.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,352.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,352.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,629.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,352.56
Rate for Payer: Cigna Commercial	$6,573.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,181.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,892.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,972.10
Rate for Payer: UnitedHealthcare Community & State	$316.85
Rate for Payer: Wellpoint Medicaid Managed Care	$348.40

AFFIXUX BLUNT TIP SCREW 4 X 40

Facility

$965.00

Service Code	HCPCS C1713
Hospital Charge Code	270688147
Hospital Revenue Code	278
Min. Negotiated Rate	$144.75
Max. Negotiated Rate	$233.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$212.30
Rate for Payer: Qualcare PPO/HMO/WC	$144.75

AFFIXUX BLUNT TIP SCREW 4 X 40

Facility

$965.00

Service Code	HCPCS C1713
Hospital Charge Code	270688147
Hospital Revenue Code	278
Min. Negotiated Rate	$23.26
Max. Negotiated Rate	$482.50
Rate for Payer: Aetna Commercial	$366.70
Rate for Payer: Aetna Medicare Advantage	$289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.07
Rate for Payer: Cigna Commercial	$482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$212.30
Rate for Payer: Qualcare PPO/HMO/WC	$144.75
Rate for Payer: UnitedHealthcare Community & State	$23.26
Rate for Payer: Wellpoint Medicaid Managed Care	$25.57

AFFIXUX HUM CALIB DRILL 3.3MM

Facility

$2,240.00

Hospital Charge Code	270688154
Hospital Revenue Code	272
Min. Negotiated Rate	$53.98
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$851.20
Rate for Payer: Aetna Medicare Advantage	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$571.20
Rate for Payer: Cigna Commercial	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$672.00
Rate for Payer: Oxford Commercial	$448.00
Rate for Payer: Qualcare PPO/HMO/WC	$336.00
Rate for Payer: UnitedHealthcare Commercial	$448.00
Rate for Payer: UnitedHealthcare Community & State	$53.98
Rate for Payer: Wellpoint Medicaid Managed Care	$59.36

AFFIXUX HUM CALIB DRILL 3.3MM

Facility

$2,240.00

Hospital Charge Code	270688154
Hospital Revenue Code	272
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$336.00
Rate for Payer: Qualcare PPO/HMO/WC	$336.00

AFIXIS NAIL AR HUMUNIV 7.5 X 2

Facility

$8,765.00

Service Code	HCPCS C1713
Hospital Charge Code	270688146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,314.75
Max. Negotiated Rate	$2,121.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,753.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,121.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,928.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,314.75

Know your out-of-pocket cost for care.

All Charges