Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CROSS LINK 44-56 MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	278703983
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

CROSS LINK 44-56 MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	278703983
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

CROSS LINK 44-56MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703983
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

CROSS LINK 44-56MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703983
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

CROSSLINK #6

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270687935
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CROSSLINK #6

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270687935
Hospital Revenue Code	278
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$153.64
Rate for Payer: Wellpoint Medicaid Managed Care	$168.94

CROSSLINK 7 MM ROD ATTACH

Facility

$8,010.00

Service Code	HCPCS C1713
Hospital Charge Code	270683547
Hospital Revenue Code	278
Min. Negotiated Rate	$193.04
Max. Negotiated Rate	$4,005.00
Rate for Payer: Aetna Commercial	$3,043.80
Rate for Payer: Aetna Medicare Advantage	$2,403.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,042.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,042.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,602.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,042.55
Rate for Payer: Cigna Commercial	$4,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,938.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,762.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.50
Rate for Payer: UnitedHealthcare Community & State	$193.04
Rate for Payer: Wellpoint Medicaid Managed Care	$212.26

CROSSLINK 7 MM ROD ATTACH

Facility

$8,010.00

Service Code	HCPCS C1713
Hospital Charge Code	270683547
Hospital Revenue Code	278
Min. Negotiated Rate	$1,201.50
Max. Negotiated Rate	$1,938.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,602.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,938.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,762.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.50

CROSSLINK A6, SFX, 5.5, TI MED

Facility

$11,600.00

Hospital Charge Code	270667358
Hospital Revenue Code	278
Min. Negotiated Rate	$1,740.00
Max. Negotiated Rate	$2,807.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,807.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,740.00

CROSSLINK A6, SFX, 5.5, TI MED

Facility

$11,600.00

Hospital Charge Code	270667358
Hospital Revenue Code	278
Min. Negotiated Rate	$279.56
Max. Negotiated Rate	$5,800.00
Rate for Payer: Aetna Commercial	$4,408.00
Rate for Payer: Aetna Medicare Advantage	$3,480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,958.00
Rate for Payer: Cigna Commercial	$5,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,807.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,740.00
Rate for Payer: UnitedHealthcare Community & State	$279.56
Rate for Payer: Wellpoint Medicaid Managed Care	$307.40

CROSSLINKED POLY BEARING SZ C

Facility

$7,500.00

Hospital Charge Code	270702439
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

CROSSLINKED POLY BEARING SZ C

Facility

$7,500.00

Hospital Charge Code	270702439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

CROSSLINK SDK 1.75-2.15 811322

Facility

$3,952.00

Hospital Charge Code	270617303
Hospital Revenue Code	278
Min. Negotiated Rate	$95.24
Max. Negotiated Rate	$1,976.00
Rate for Payer: Aetna Commercial	$1,501.76
Rate for Payer: Aetna Medicare Advantage	$1,185.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,007.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,007.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,007.76
Rate for Payer: Cigna Commercial	$1,976.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$956.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$869.44
Rate for Payer: Qualcare PPO/HMO/WC	$592.80
Rate for Payer: UnitedHealthcare Community & State	$95.24
Rate for Payer: Wellpoint Medicaid Managed Care	$104.73

CROSSLINK SDK 1.75-2.15 811322

Facility

$3,952.00

Hospital Charge Code	270617303
Hospital Revenue Code	278
Min. Negotiated Rate	$592.80
Max. Negotiated Rate	$956.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$956.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$869.44
Rate for Payer: Qualcare PPO/HMO/WC	$592.80

CROSSLINK SDK LP 1/4 811-423

Facility

$3,953.65

Hospital Charge Code	270613605
Hospital Revenue Code	278
Min. Negotiated Rate	$593.05
Max. Negotiated Rate	$956.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$956.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$869.80
Rate for Payer: Qualcare PPO/HMO/WC	$593.05

CROSSLINK SDK LP 1/4 811-423

Facility

$3,953.65

Hospital Charge Code	270613605
Hospital Revenue Code	278
Min. Negotiated Rate	$95.28
Max. Negotiated Rate	$1,976.83
Rate for Payer: Aetna Commercial	$1,502.39
Rate for Payer: Aetna Medicare Advantage	$1,186.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.18
Rate for Payer: Cigna Commercial	$1,976.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$956.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$869.80
Rate for Payer: Qualcare PPO/HMO/WC	$593.05
Rate for Payer: UnitedHealthcare Community & State	$95.28
Rate for Payer: Wellpoint Medicaid Managed Care	$104.77

CROSSMATCH(ANTIGLOBULIN) EACH

Facility

$149.00

Service Code	HCPCS 86922
Hospital Charge Code	38471077
Hospital Revenue Code	309
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

CROSSMATCH(ANTIGLOBULIN) EACH

Facility

$149.00

Service Code	HCPCS 86922
Hospital Charge Code	38471077
Hospital Revenue Code	309
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

CROSSMATCH(IMMED SPIN) EACH

Facility

$126.00

Service Code	HCPCS 86920
Hospital Charge Code	38471075
Hospital Revenue Code	309
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CROSSMATCH(IMMED SPIN) EACH

Facility

$126.00

Service Code	HCPCS 86920
Hospital Charge Code	38471075
Hospital Revenue Code	309
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.34

CROSSMATCH (INCUBATION) EACH

Facility

$130.00

Service Code	HCPCS 86921
Hospital Charge Code	38471076
Hospital Revenue Code	309
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

CROSSMATCH (INCUBATION) EACH

Facility

$130.00

Service Code	HCPCS 86921
Hospital Charge Code	38471076
Hospital Revenue Code	309
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

CROSSMATCH PRE-WARM EA

Facility

$149.00

Service Code	HCPCS 86922
Hospital Charge Code	38471154
Hospital Revenue Code	309
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

CROSSMATCH PRE-WARM EA

Facility

$149.00

Service Code	HCPCS 86922
Hospital Charge Code	38471154
Hospital Revenue Code	309
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

CROSSOVER #6 1740.22.060

Facility

$5,877.65

Hospital Charge Code	270629835
Hospital Revenue Code	272
Min. Negotiated Rate	$881.65
Max. Negotiated Rate	$881.65
Rate for Payer: Qualcare PPO/HMO/WC	$881.65

Know your out-of-pocket cost for care.

All Charges